Archives of disease in childhood. Fetal and neonatal edition
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Arch. Dis. Child. Fetal Neonatal Ed. · Mar 2015
ReviewImproving infant outcome with a 10 min Apgar of 0.
Asystole at birth and extending through 10 min is rare, with current international recommendations stating it may be appropriate to consider discontinuation of resuscitation in this clinical scenario. These recommendations are based on small case series of both term and preterm infants, where death or abnormal outcome was nearly universal. Study objective was to determine recent outcome of infants with an Apgar score of 0 at 10 min despite cardiopulmonary resuscitation, treated with therapeutic hypothermia or standard treatment, in randomised cooling studies. ⋯ Although poor, the outcome for infants with an Apgar of 0 at 10 min of life has improved substantially in recent years. This may be related to treatment with hypothermia, enhanced resuscitation techniques and/or other supportive management. Current recommendations to consider discontinuation of resuscitation without a detectable heart rate at 10 min should consider these findings.
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Arch. Dis. Child. Fetal Neonatal Ed. · Mar 2015
Observational StudyUmbilical blood flow patterns directly after birth before delayed cord clamping.
Delayed umbilical cord clamping (DCC) affects the cardiopulmonary transition and blood volume in neonates immediately after birth. However, little is known of blood flow in the umbilical vessels immediately after birth during DCC. The objective is to describe the duration and patterns of blood flow through the umbilical vessels during DCC. ⋯ During delayed umbilical cord clamping, venous and arterial umbilical flow occurs for longer than previously described. Net placental transfusion is probably the result of several factors of which breathing could play a major role. Umbilical flow is unrelated to cessation of pulsations.
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Arch. Dis. Child. Fetal Neonatal Ed. · Mar 2015
Randomized Controlled Trial Multicenter StudyPaCO2 in surfactant, positive pressure, and oxygenation randomised trial (SUPPORT).
To determine the association of arterial partial pressure of carbon dioxide PaCO2 with severe intraventricular haemorrhage (sIVH), bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (NDI) at 18-22 months in premature infants. ⋯ Higher PaCO2 was an independent predictor of sIVH/death, BPD/death and NDI/death. Further trials are needed to evaluate optimal PaCO2 targets for high-risk infants.
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Arch. Dis. Child. Fetal Neonatal Ed. · Mar 2015
Multicenter StudyThe outcome of treatment limitation discussions in newborns with brain injury.
Most deaths in severely brain-injured newborns in neonatal intensive care units (NICUs) follow discussions and explicit decisions to limit life-sustaining treatment. There is little published information on such discussions. ⋯ Some critically ill newborn infants with brain injury survive following TLDs between their parents and physicians. Outcome in this group of infants provides valuable information about the integrity of prognostication in NICU, and should be incorporated into counselling.