Journal of perinatology : official journal of the California Perinatal Association
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Sick neonates often require periodic small volume transfusions (10 mL/kg) to replace blood drawn for laboratory monitoring during their hospital stay. We use red blood cells (RBCs), stored as CPDA-1 whole blood, up to their expiration date, and are unaware of any clinical problems with this practice. We proceeded to confirm our clinical impression by reviewing the hospital records of 22 transfused neonates who received a median of 2.5 RBC transfusions (range 1 to 11) with a volume of 16 mL (range 5 to 38) each, and total volume of 60 mL (range 16 to 152). ⋯ Paradoxically, RBCs over 10 days of age resulted in a fall in potassium (-0.9 +/- 0.8 mEq/L, P less than .01), but not below 3.4 mEq/L. We could find no evidence by clinical observation or laboratory indexes that small volume transfusion of RBCs more than 5 days old was deleterious to the newborns studied. By using RBCs up to their expiration date, the number of donor exposures and the potential risk of transfusion-transmitted diseases can be decreased.
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The precordial stethoscope allows direct monitoring of infants in the delivery room during neonatal resuscitation. The use of this monitor is already mandated as a standard of care practice in pediatric and adult anesthesia. ⋯ The routine use of the precordial stethoscope during infant resuscitation in the delivery room may improve quality of care, especially pertaining to airway management, in an area otherwise devoid of monitors. It may be useful in other pediatric resuscitation settings and when transporting ill or sedated pediatric patients.
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Awareness of the role of anaerobic bacteria in neonatal bacteremia has increased in recent years. The incidence of recovery of anaerobes in neonatal bacteremia varies, according to different studies, between 1.8% and 12.5%. Of the 178 cases reported in the literature, 73 were due to Bacteroides species (69 were the Bacteroides fragilis group), 57 Clostridium species (mostly Clostridium perfringens), 35 Peptostreptococci, 5 Propionibacterium acnes, 3 Veillonella species, 3 Fusobacterium species, and 2 Eubacterium species. ⋯ Correction of underlying pathology, surgical drainage, and the use of proper antimicrobials are critical to successful resolution of the infection. Penicillin G is the drug of choice for anaerobic infection other than beta-lactamase-producing Bacteroides. Antimicrobials useful for therapy of beta-lactamase-producing Bacteroides include clindamycin, metronidazole, chloramphenicol, imipenem-cilastatin, and the combination of a penicillin plus a beta-lactamase inhibitor.
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Recent national guidelines for neonatal resuscitation state that personnel trained in resuscitation skills should be immediately available for every delivery. Meeting this standard is a challenge for small community hospitals with limited staff and few 24-hour in-house physicians. We have developed a strategy for organizing neonatal resuscitation teams in community hospitals and describe our experience with establishing such teams in our region. ⋯ Recommendations are made for training and scheduling of neonatal resuscitation team members and for the contents of the resuscitation protocol. Barriers to successful implementation are discussed, including liability concerns or lack of confidence among team members, nonacceptance of expanded roles by other professionals, and difficulties with scheduling, equipment maintenance, and risk assignment. Nevertheless, successful establishment of a neonatal resuscitation team can effectively reduce the risk of neonatal asphyxia in small community hospitals.
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Fifteen patients were identified in a retrospective analysis of one institution's experience with the use of tocolysis in selected patients with an admission diagnosis of placenta previa or abruptio placentae. There were no fetal deaths after admission, and the two neonatal deaths were related to prematurity. Eight of the 15 patients receiving tocolysis had their pregnancies prolonged by 2 weeks or more, and there were no fetal or neonatal deaths in this group. ⋯ These data suggest the safety of tocolysis in preterm patients with the diagnosis of placenta previa or abruption who are bleeding. A prospective, randomized trial is required to evaluate whether tocolysis is superior to expectant management or to immediate delivery. The clinical difficulty in differentiating between these two diagnoses, despite liberal use of ultrasonography, is discussed.