Journal of perinatology : official journal of the California Perinatal Association
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This is an executive summary of a workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7 through 25 6/7 weeks of gestation), and the treatment options for the newborn. Upon review of the available literature, the workshop panel noted that the rates of neonatal survival and neurodevelopmental disabilities among the survivors vary greatly across the periviable gestations and are significantly influenced by the obstetric and neonatal management practices (for example, antenatal steroid, tocolytic agents and antibiotic administration; cesarean birth; and local protocols for perinatal care, neonatal resuscitation and intensive care support). These are, in turn, influenced by the variations in local and regional definitions of limits of viability. ⋯ Since clinical circumstances can change rapidly with increasing gestational age, counseling should include discussion of the benefits and risks of various maternal and neonatal interventions at the time of counseling. There should be a plan for follow-up counseling as clinical circumstances evolve. The panel proposed a research agenda and recommended developing educational curricula on the care and counseling of families facing the birth of a periviable infant.
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To evaluate the effect of placenta previa location (anterior vs posterior) on cesarean morbidity. ⋯ An anterior placenta previa increases the risk of hysterectomy for both primary and repeat cesareans due to abnormal placentation. In the absence of accreta, blood transfusion remained a significant cause of maternal morbidity in both anterior and posterior placenta previas. This information may be useful for operative planning.
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To investigate whether creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) can be used to predict neurodevelopmental outcome at 18 months in infants with perinatal asphyxia (PA). The diagnostic value of cTnI to assess myocardial dysfunction was considered as well. ⋯ In asphyxiated neonates, cTnI concentrations within 12 h of birth correlate with medium-term outcome. Early cTnI concentration correlates with severity of HIE, myocardial dysfunction and with Bayley II scores at 18 months.
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Comparative Study
Transcribed oxygen saturation vs oximeter recordings in very low birth weight infants.
The objective of this study was to compare hand-transcribed oxygen saturation (SpO2) with electronic oximeter data in very low birth weight infants (VLBWI, <1500 g). ⋯ Transcribed SpO2 values overdocumented target range and underdocumented hyperoxemic and hypoxemic ranges compared with electronic oximeter data. These results support incorporating electronic oximeter data into medical records.
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To define the core data elements of a neonatal intensive care unit (NICU) handoff compare NICU residents' written and verbal handoff data with real-time, auto-populated data and identify the epidemiology of handoff errors. ⋯ NICU infants are subjected to many handoff errors. Sicker infants are at higher risk for error. Auto-population can reduce written handoff errors and allow residents more time for training and educational opportunities.