Journal of neonatal-perinatal medicine
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J Neonatal Perinatal Med · Jan 2014
ReviewPlacental transfusion strategies in extremely preterm infants: the next piece of the puzzle.
Evidence is growing on the potential value of enhancing placental-fetal transfusion at birth, with recent endorsement of the practice by the World Health Organization and American College of Gynecologists. However, these recommendations provide clinicians with little guidance on the optimal practice among infants born extremely premature (<28 weeks gestation) and those requiring immediate resuscitation. ⋯ The review provided herein suggests that delayed cord clamping or umbilical cord milking can be applied safely to infants born prior to 28 weeks gestation, but the lack of evidence on the best practice among infants born severely depressed and requiring immediate resuscitation, who comprise a greater proportion of infant deliveries at the lowest gestational ages, is recognized. Future studies using well-defined physiologic outcome measures are needed to understand the role of placental transfusion in premature infants' adaptations to extrauterine life.
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J Neonatal Perinatal Med · Jan 2014
ReviewA delicate subject: The impact of cultural factors on neonatal and perinatal decision making.
The neonatal intensive care unit (NICU) is a high-stress environment for both families and health care providers that can sometimes make appropriate medical decisions challenging. We present a review article of non-medical barriers to effective decision making in the NICU, including: miscommunication, mixed messages, denial, comparative social and cultural influences, and the possible influence of perceived legal issues and family reliance on information from the Internet. ⋯ We provide background on the sources of conflict in these particular cases. We also offer suggestions for possible amelioration of similar conflicts with the twin goals of facilitating compassionate decision making in NICU settings and promoting enhanced well-being of both families and providers.
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J Neonatal Perinatal Med · Jan 2014
Comparative StudyPositive distending pressure produced by heated, humidified high flow nasal cannula as compared to nasal continuous positive airway pressure in premature infants.
our objective is to assess the positive distending pressure generated by high flow nasal cannula and nasal continuous positive airway pressure by measuring the end esophageal pressure in premature infants. ⋯ HHHFNC in premature infants was well-tolerated with no adverse side effects such as pneumothorax, desaturation, apnea and bradycardia. The study also showed that HHHFNC was able to deliver distending pressure equal to nCPAP. Moreover, we have observed a significant improvement in oxygen saturation when higher levels of HHHFNC was used, most probably due to the improvement of infant comfort which is a noticeable feature of HHHFNC.
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J Neonatal Perinatal Med · Jan 2014
Observational StudyQuiescent variability of cerebral, renal, and splanchnic regional tissue oxygenation in very low birth weight neonates.
In extremely premature neonates, data concerning the normal baseline variability of near-infrared spectroscopy (NIRS)-derived regional oxygen saturation (rSO2) are lacking. We sought to determine: 1) the quiescent variability of cerebral, renal, and splanchnic rSO2 in clinically stable, undisturbed very low birth weight neonates and 2) the effects of different data averaging epochs on site-specific variability. ⋯ 1) rSO2 variability differs significantly between monitoring sites and 2) shorter data sampling epochs decrease rSO2 variability. These observations may assist clinicians in operationally defining minimally significant departures to enable medical decision making utilizing this monitoring technique.
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J Neonatal Perinatal Med · Jan 2014
In vitro measurement of flow rate variability in neonatal IV therapy with and without the use of check valves.
In multi-infusion IV therapy, the actual volume delivered to the neonate can vary over time. To reduce flow rate variability, check valves can be used. A check valve allows flow through the valve in only one direction. ⋯ The actual flows and the total delivered volume in low flow dual-infusion setups are less than expected on the pre-programmed flow-rate. These findings emphasize the need for the development of more accurate delivery systems for drugs and fluids in neonatology. Caregivers should be aware of these findings, and optimise the delivery of IV substances by making use of check valves with low opening pressures and by minimising compliance and volume of the IV-administration set. Furthermore, changes in the relative height between pumps and catheter tip should be minimized.