Journal of perinatology : official journal of the California Perinatal Association
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Clinicians frequently use hydrocortisone (HC) to treat vasopressor-resistant hypotension even before establishing its cause. ⋯ Evaluation for early ductal shunting and closure of the ductus, if patent, should be attempted before HC is considered in hypotensive infants with escalating needs for vasopressors.
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Hemolysis is a significant complication of extracorporeal membrane oxygenation (ECMO), with a reported incidence of 12.2%. The aims of this study were (1) to investigate hemolysis caused by saline-washed versus unwashed RBCs, (2) to determine in vitro the effects of saline washing on erythrocyte hemolytic markers and (3) to investigate hemolysis by centrifugal versus roller pumps. ⋯ (1) Using unwashed RBCs decreased hemolysis within the first 3 days of ECMO. (2) Saline washing, while decreasing the concentration of K+ in the plasma, significantly increases RBC membrane osmotic fragility. (3) Hemolysis is linked to the use of centrifugal pumps.
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Evaluate the value of random urinary protein-creatinine (PrCr) and calcium-creatinine (CaCr) ratios to predict 24-h proteinuria in hypertensive pregnancies. ⋯ Spot urinary PrCr predicts total urinary protein excretion in hypertensive pregnancies.
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Effective and consistent management of neonatal pain remains a controversial issue. Premature infants are repeatedly subjected to painful tests and procedures or suffer painful conditions when they are most vulnerable. With different mechanisms transducing various types of pain the practice of 'one-drug fits all' becomes questionable. ⋯ Morphine infusions do not alter the neurological outcomes of preterm neonates and may not be effective against acute pain. Alternative approaches with methadone, ketamine, or local anesthetics should be considered. Clinicians must understand the contextual circumstances underlying pain in individual neonates and tailor therapy accordingly, using the most current evidence related to neonatal pain assessment and management.
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Comparative Study
Comparison of glyburide and insulin for the management of gestational diabetics with markedly elevated oral glucose challenge test and fasting hyperglycemia.
To compare the effectiveness of glyburide and insulin for the treatment of Gestational diabetes mellitus (GDM) in women who had OGCT >or=200 mg/dl and fasting hyperglycemia. ⋯ In women with GDM who had a markedly elevated OGCT and fasting hyperglycemia, glyburide achieved similar birth weights and delivery outcomes but was associated with an increased risk of macrosomia. The possible increased risk of neonatal hypoglycemia in the glyburide group warrants further investigation.