Current opinion in pediatrics
-
Curr. Opin. Pediatr. · Apr 2013
ReviewPredictive monitoring for early detection of sepsis in neonatal ICU patients.
Predictive monitoring is an exciting new field involving analysis of physiologic data to detect abnormal patterns associated with critical illness. The first example of predictive monitoring being taken from inception (proof of concept) to reality (demonstration of improved outcomes) is the use of heart rate characteristics (HRC) monitoring to detect sepsis in infants in the neonatal ICU. The commercially available 'HeRO' monitor analyzes electrocardiogram data from existing bedside monitors for decreased HR variability and transient decelerations associated with sepsis, and converts these changes into a score (the HRC index or HeRO score). This score is the fold increase in probability that a patient will have a clinical deterioration from sepsis within 24 h. This review focuses on HRC monitoring and discusses future directions in predictive monitoring of ICU patients. ⋯ Predictive monitoring has recently been shown to save lives. Harnessing and analyzing the vast amounts of physiologic data constantly displayed in ICU patients will lead to improved algorithms for early detection, prognosis, and therapy of critical illnesses.
-
Curr. Opin. Pediatr. · Apr 2013
ReviewDuration of empirical antibiotic therapy for infants suspected of early-onset sepsis.
Clinicians' adherence to the Centers for Disease Control guidelines to prevent group B Streptococcus (GBS) early-onset sepsis (EOS) has reduced GBS EOS. Although evidence-based testing and empirical antibiotic initiation are likely saving lives, clinicians have less compelling data to guide duration of empirically initiated antibiotics when cultures remain sterile and clinical signs resolve quickly. Our purpose is to review current opinions and evidence influencing clinicians' choices for duration of empirically initiated antibiotics in newborns with sterile cultures. ⋯ Every day clinicians caring for thousands of neonates in the United States stop antibiotics which were started empirically to treat EOS on the first postnatal day. Evidence is lacking to support a universal approach to decisions on duration of empirical antibiotics when cultures remain sterile. Reviewing predictive value relative to timing of laboratory testing can help clinicians develop locally appropriate antimicrobial duration decision-making guidelines.
-
Curr. Opin. Pediatr. · Apr 2013
ReviewOptimal oxygen saturations in preterm infants: a moving target.
New evidence is emerging to address the continued uncertainty regarding the optimal range to target oxygen saturation levels in preterm infants. ⋯ Defining and maintaining optimal oxygen saturations in preterm infants remains a challenge for clinicians caring for preterm infants. However, ongoing investigative collaborations may soon provide guidance.
-
Curr. Opin. Pediatr. · Apr 2013
ReviewTiming of umbilical cord clamping after birth for optimizing placental transfusion.
A brief delay in clamping the umbilical cord after birth offers health benefits to the newborn, with no adverse effects to the mother or her infant. Yet, in most obstetric practice, the cord is clamped soon after birth. A summary of the current evidence on delayed cord clamping and some reasons for the disconnect between the evidence and practice are discussed here, along with the recommendations from professional organizations and societies about this practice. ⋯ Many professional organizations, societies, and experts recommend at least a 30-s delay before clamping the umbilical cord, especially after preterm births. The value of this practice for term births in resource-rich settings has not been evaluated.