Pediatric clinics of North America
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Pediatr. Clin. North Am. · Jun 2009
Review Historical ArticleUse of therapeutic hypothermia for term infants with hypoxic-ischemic encephalopathy.
Newborn encephalopathy represents a clinical syndrome with diverse causes, many of which may result in brain injury. Hypoxic-ischemic encephalopathy represents a subset of newborns with encephalopathy and, in contrast to other causes, may have a modifiable outcome. Laboratory research has demonstrated robust neuroprotection associated with reductions of brain temperature following hypoxia-ischemia in animals. ⋯ Clinical trials have translated laboratory observations into successful interventions. Hypoxicischemic encephalopathy is often unanticipated, unavoidable, and may occur in any obstetric setting. Pediatricians and other providers based in community hospitals play a critical role in the initial assessment, recognition, and stabilization of infants who may be candidates for therapeutic hypothermia.
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Pediatr. Clin. North Am. · Jun 2009
Historical ArticleRegionalization and mortality in neonatal intensive care.
This article examines the outcome data for very low birth weight infants in low-volume, mid-volume, and high-volume neonatal ICUs (NICUs) and argues for regionalization of NICU services on the basis of both medical outcomes and economic rationality. It recognizes some of the obstacles to regionalization of these services and presents ways to surmount them.
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Pediatr. Clin. North Am. · Jun 2009
Review Historical ArticleNeurodevelopmental outcome of the premature infant.
Advances in antenatal medicine and neonatal intensive care have successfully resulted in improved survival rates of preterm infants. These improvements have been most dramatic in infants born extremely low birth weight (ELBW,
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Child neglect, the most prevalent form of maltreatment, poses challenges for pediatricians. There often is uncertainty regarding what constitutes neglect and how best to address it. ⋯ This article first discusses why neglect is so important a concern and then provides definitional considerations and a description of forms of neglect. Next presented are principles for assessing and addressing neglect and suggestions for prevention and advocacy.
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Pediatr. Clin. North Am. · Apr 2009
ReviewHome visiting for the prevention of child maltreatment: lessons learned during the past 20 years.
For nearly two decades, home visitation has been promoted as a promising strategy to prevent child maltreatment, but reviews of the literature on home visiting programs have been mixed. This article examines how home visitation for the prevention of child maltreatment has evolved during the past 20 years. ⋯ It discusses how advocacy and public policy for prevention of child maltreatment have shifted from a general call to promote universal home visitation programs to a more refined emphasis on promoting programs that are evidence-based, targeted to those most at risk for maltreatment, and with infrastructure in place to ensure implementation with fidelity to the model tested in trials. Finally, it discusses how primary care providers may advocate to ensure that their patients have access to evidence-based home visiting programs that meet their needs.