La Pediatria medica e chirurgica : Medical and surgical pediatrics
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Review Comparative Study
[Intensive care at extremely low gestational age: ethical issues and treatment choices].
With the continuing progress of obstetrical and neonatal care, the limit of human viability has continued to shift towards younger gestational ages. The survival rate as well as the survival without disability increases with each additional week of gestation but, for infants born from 22 to 25 w GA, it is still really low, and the threshold of human viability appears to be limited to the physiological development of the lungs, which take place around the 23rd-24th w GA. ⋯ What is the true infant's best interest is far to be understood and concern about the ethical basis of providing such intensive care is arising in the scientific community. In this paper the authors provide a review of the ethical basis of decisions related to the care of such infants: to treat, not to treat, intensive or compassionate care, withhold or withdraw treatment.
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We describe a full term male infant born by cesarean section, who presented a deep round depression of the left parietal bone at birth. MRI scan showed no signal alteration on cortical and sub-cortical level in correspondence of the depressed skull fracture. At four months of age, a skull X-ray was normal. At 18 months of age growth and neurologic follow-up is normal.
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Practice Guideline
[Italian guidelines and recommendations for prevention and treatment of pain in the newborn].
Despite accumulating evidence that procedural pain experienced by preterm infants may have acute detrimental and even long-term effects on an infant's subsequent behavior and neurological outcome, neonates admitted to Neonatal Intensive Care Units still frequently experience acute and prolonged uncontrolled pain. Many invasive and surgical procedures are routinely performed at the bedside in the NICU without adequate pain management. ⋯ Adequate pain prevention and management should be an essential part of standard health care at the NICU, and recognizing and assessing sources of pain should be routine in the day-to-day practice of physicians and nurses taking care of the newborn. We hope these guidelines will contribute towards increasing the NICU caregiver's awareness and understanding of the importance of adequate pain control and prevention.
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Pressure Support Ventilation (PSV) is one of the most frequently applied modes of partial ventilatory assistance, in which inspiratory time, respiratory rate, tidal volume and minute ventilation are under patient's control. Due to this peculiarity, i.e. during PSV the patient keeps the control of breathing pattern, this mode of ventilatory support is now widely used in neonatal intensive care units. By definition, PSV is a pressure-targeted and flow-cycled method of ventilation, in which each breath is patient-triggered and supported by means of a positive pressure synchronized with the inspiratory effort of the newborn. ⋯ Nevertheless, also the newborn under PSV may encounter patient-ventilator asynchrony, with consequent discomfort, increased oxygen consumption and possible ineffective efforts. Moreover, since no controlled breaths are present, alveolar hypoventilation may occur in some categories of newborns. In conclusion, PSV represents a modality of ventilation that ca be used in stable newborns, while its use is contraindicates in critically newborns with abnormal central respiratory drive.