Seminars in pediatric surgery
-
Advances in neonatal management have resulted in dramatic increases in survival in infants with birth weights less than 1,500 g. Extensive basic science and clinical research has led to a more comprehensive understanding of the physiological differences between the VLBW infant and larger neonates. Meticulous attention must be paid to appropriate fluid, electrolyte, nutrition, and temperature maintenance to achieve homeostasis and growth. Additionally, the clinician must be aware of the diagnostic and treatment modalities for the common complications seen in the premature infant to minimize mortality and long-term morbidity.
-
Semin. Pediatr. Surg. · May 2000
ReviewNecrotizing enterocolitis in infants with very low birth weight.
Necrotizing enterocolitis (NEC) is a disease in which the primary risk factor is prematurity. Despite, and partially as a result of, the tremendous strides neonatal care has taken, it is a major cause of morbidity and mortality of the newborn. ⋯ The outcomes continue to improve, but there are significant sequelae. Prevention, which would be the best "cure," is elusive, in no small part because of the multifactorial nature of the etiology of NEC.
-
Congenital heart defects in low birth weight infants are typically managed with supportive therapy or palliative surgery, and definitive repair is delayed. However, the morbidity of such an approach has been shown to be high. Recent reports emphasize early surgical repair with good results in low birth weight and premature babies. ⋯ Complete repair of both simple and complex congenital heart lesions can be performed successfully in such patients with good early and medium-term results. Postoperative growth after repair approximates the normal growth curve for low birth weight infants without congenital heart disease. It is recommended that with few exceptions, such infants, especially when symptomatic, undergo early surgical correction rather than prolonged medical management or other forms of palliation.
-
The purpose of this report is to provide pediatric surgeons with an ethical framework and a process for ethical decision making that can be applied to the difficult issues that arise in the care of infants with very low birth weight (VLBW). Clinical ethical issues focus around choices for surgical intervention, the use of total parenteral nutrition (TPN), recommendations for bowel transplantation, and management of dying infants. The role of family in decision making and the appropriate use of common distinctions including active or passive, withholding or withdrawing, and ordinary or extraordinary in decisions about life-sustaining treatments are discussed. A clinical case discussion illustrates the application of the process for ethical decision making.