Journal of perinatology : official journal of the California Perinatal Association
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To create a protocol delineating the needs of patients, families, and staff necessary to provide a pain-free, dignified, family-, and staff-supported death for newborns who cannot benefit from intensive, life-extending, technological support. ⋯ Specific consensus-based recommendations are presented with a description of palliative care; categories of candidates; planning and education needed to begin palliative care services; relationships between community and tertiary centers; components of optimally supported neonatal death; family care, including cultural, spiritual, and practical needs; ventilator withdrawal, including pain and symptom management; recommendations when death does not occur after cessation of life-extending interventions; family follow-up care; and necessary ongoing staff support.
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Comparative Study
Uterine contraction pattern as a predictor of the mode of delivery.
To determine whether analysis of the frequency or regularity of uterine contractions can distinguish between women delivering vaginally and women requiring Cesarean section for dystocia. ⋯ As normal labor progresses, there is a shortening of the intercontraction interval and an increase in contraction regularity. A successful response to oxytocin augmentation may be predicted by the change in contraction pattern following treatment.
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In the breastfed infant, prolongation of unconjugated hyperbilirubinemia into the third and later weeks of life in the healthy newborn is a normal and regularly occurring extension of physiologic jaundice. This is known as breastmilk jaundice. A factor in human milk increases the enterohepatic circulation of bilirubin. ⋯ It is known as breastfeeding jaundice or "breast-nonfeeding jaundice." This increase in severity of physiologic jaundice of the newborn also results from increased enterohepatic circulation of bilirubin, but not because of a factor in human milk. In extreme cases, it may place the infant at risk for development of bilirubin encephalopathy. Optimal breastfeeding practices, which result in minimal initial weight loss and early onset of weight gain, are associated with both reduced breastfeeding jaundice and minimization of the intensity of breastmilk jaundice.
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Case Reports
Decompression of multiple pneumatoceles in a premature infant by percutaneous catheter placement.
Pneumatoceles due to acquired localized overinflation as a form of pulmonary interstitial emphysema are complications of advanced bronchopulmonary dysplasia. Different ventilation modes, selective bronchial intubation, balloon obstruction of the affected bronchus and steroids have been reported with success. ⋯ We present a premature infant with multiple large pneumatoceles causing respiratory compromise. In our case percutaneous decompression under fluoroscopy guidance resulted in a permanent cure.