Minerva pediatrica
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Nosocomial infections are among the leading causes of mortality and morbidity in neonatal intensive care units. Prevention of healthcare-associated infections is based on strategies that aim to limit susceptibility to infections by enhancing host defences, interrupting trasmission of organisms by healthcare workers and by promoting the judicious use of antimicrobials. Strategies for the prevention of nosocomial infections include hand hygiene practices, prevention of central venous (cvc)-related bloodstream infections, judicious use of antimicrobials for therapy, enhancement of host defences, skin care and early enteral feeding with human milk. ⋯ The lack of evidence for neonatal patients prompts urgent need for large randomised controlled trials comparing effectiveness and safety of different skin disinfectants before CVC placement in neonates and particulary in very low birth-weight infants. Nosocomial infections are still of the most serious problems for the neonatal intensive care unit. Therefore every effort must be implemented to reduce the incidence of these infections, can not be considered a toll required hospitalization, as it may not be acceptable for a place of shelter and care as the hospital may itself be a source of disease.
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Mechanical ventilation is considered a supportive, nontherapeutic technology used to perform the work of breathing for patients who are unable to do so on their own. In neonatology, mechanical ventilation is often used for premature neonates who are unable to sustain ventilation because of reduced functional residual capacity due to surfactant deficiency. Mechanical ventilation is thus an attempt to mimic the respiratory system's physiological function of gas exchange until the respiratory system reaches maturation. ⋯ There are no specific guidelines for the use of mechanical ventilation in children and the low number of infants with ARDS in PICU makes it difficult to run randomized controlled trials in this population. Thus the algorithms are based on the results of either adult or neonatal studies. The advantage of extrapolating data from the neonatal evidence relates mainly to the prevention of ventilator induced lung injury (e.g., CPAP, HFOV, NIV, permissive hypercapnia, surfattant), of which neonatologists are particularly expert.
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Chorioamnionitis (CA) is defined as an infection that can affect amniotic fluid, placenta and uterus. The chorioamnionitis is present in 10-40% of cases of maternal peripartum fever and in 50% of preterm labor. Diagnosis is based on the presence of maternal fever (>38 degrees C) at least 2 of these conditions: maternal leukocytosis (> 15,000 cells/mmc), maternal tachycardia, fetal tachycardia, stained or foul smelling amniotic fluid, uterine tenderness. ⋯ Common maternal complications include bacteremia to septic shock, cesarean section, uterine atony with hemorrhage, pelvic abscess, maternal coagulopathy, thromboembolism and wound infections. The risk of neonatal sepsis, low seizures, low Apgar score at 5 minutes increased in the newborn. Cardiotocographic fetal monitoring should be continued during labor in cases of suspected chorioamnionitis with recourse to caesarean section as soon as signs of severe fetal distress.