Journal of perinatology : official journal of the California Perinatal Association
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This article summarizes the historical background for the use of oxygen during newborn resuscitation and describes some of the research and the process of changing the previous practice from a high- to a low-oxygen approach. Findings of a recent Cochrane review suggest that more than 100,000 newborn lives might be saved globally each year by changing from 100 to 21% oxygen for newborn resuscitation. This estimate represents one of the largest yields for a simple therapeutic approach to decrease neonatal mortality in the history of pediatric research. ⋯ As more data are needed for the very preterm population, creation of strict guidelines for these infants would be premature at present. However, it can be stated that term and late preterm infants in need of resuscitation should, in general, be started on 21% oxygen, and if resuscitation is not started with 21% oxygen, a blender should be available, enabling the administration of the lowest FiO(2) possible to keep heart rate and SaO(2) within the target range. For extremely low birth weight infants, initial FiO(2) could be between 0.21 and 0.30 and adjusted according to the response in SaO(2) and heart rate.
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The implementation of amplitude-integrated electroencephalography (aEEG) has enhanced the neurological monitoring of critically ill infants. Limited channel leads are applied to the patient and data are displayed in a semilogarithmic, time-compressed scale. Several classifications are currently in use to describe patient tracings, incorporating voltage criteria, pattern recognition, cyclicity, and the presence or absence of seizures. ⋯ The sensitivity and specificity of aEEG are enhanced by the display of a simultaneous raw EEG, which aids interpretation. Caution must be taken when using and interpreting this tool in conjunction with certain medications and in the setting of less experienced staff. Continuing efforts at developing software that can aid seizure detection and background classification will enhance the bedside utility of this tool.
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To describe the various anesthetic techniques used for surgical closure of PDA in premature infants at the Montreal Children's Hospital and assess their impact on postoperative outcome. ⋯ We conclude that the use of at least 10.5 mcg kg(-1) of fentanyl equivalent as a component of the anesthetic regimen for surgical closure of a PDA in premature infants, avoids an unstable postoperative respiratory course.
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Editorial Comment
Regional anesthesia for external cephalic version: its time has come.
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Various modes of nasal continuous positive airway pressure have been well established as a means of providing non-invasive respiratory support in the neonate. Recent reports suggest that nasal intermittent positive pressure ventilation may offer a better alternative, as a mode of non-invasive ventilation. This article will critically review the literature and provide some practical guidelines of the use of this technique in neonates.