Journal of perinatology : official journal of the California Perinatal Association
-
Review
Navigating care after a baby dies: a systematic review of parent experiences with health providers.
Health care providers are on the front lines of care when a baby dies, but there is no consensus about which behaviors are most helpful or harmful for families. ⋯ Interactions with health providers has profound effects on parents with perinatal losses. Grieving parents perceive many behaviors to be thoughtless or insensitive. Physicians and nurses may benefit from increased training in bereavement support.
-
Respiratory support of neonates during and following laser surgery for retinopathy of prematurity (ROP) is commonly accomplished using endotracheal intubation and mechanical ventilation. However, most patients undergoing ROP surgery have been weaned off mechanical ventilation days or weeks before the surgery. When they are electively re-intubated for ROP surgery, it can be difficult to extubate them postoperatively. One of the three level III neonatal intensive care units (NICUs) in the Intermountain Healthcare system initiated a program of using nasopharyngeal prongs, rather than endotracheal intubation, for respiratory support during ROP surgery. ⋯ Neonates undergoing laser surgery for ROP can often be supported intraoperatively and postoperatively using nasopharyngeal prongs, thus avoiding the need for endotracheal intubation.
-
Comparative Study
Indomethacin prophylaxis or expectant treatment of patent ductus arteriosus in extremely low birth weight infants?
Indomethacin prophylaxis or expectant treatment are common strategies for the prevention or management of symptomatic patent ductus arteriosus (sPDA). ⋯ In our experience, indomethacin prophylaxis does not show any advantages over expectant early treatment on the management of sPDA in ELBW infants. Although no deleterious effects were observed, prophylaxis exposed a significant number of infants who may have never developed sPDA, to potential indomethacin-related complications.
-
We report a baby born with flaccid quadraparesis that was considered possibly attributable to birth injury. Postmortem examination identified an injury that occurred well before delivery caused by hemorrhage from an arteriovenous malformation of the brainstem and spinal cord. We discuss imaging modalities to diagnose neonatal cord injuries, possible treatments, prognosis and end of life decision making for these unfortunate patients. We also emphasize the importance of the autopsy in cases of suspected birth injury.
-
Thoracostomy tubes are commonly required to treat pnuemothoraces in premature infants. Evidence of impalement of the lungs by tube thoracostomy has been seen in autopsy studies. In neonates, there has been described a surprisingly high incidence of lung perforation. ⋯ The modified Fuhrman catheter, or polyurethane pigtail catheter, has been developed for the drainage of pneumothorax in premature infants. In a study of complications of the placement of pigtail catheters, no instance of penetration of the lungs was reported. We report the case of a premature infant with pigtail catheter placement that, at autopsy, was found to have impaled the lung and discuss the incidence of lung injury associated with invasive management of pnuemothoraces.