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Seminars in Perinatology

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https://www.readbyqxmd.com/read/29338874/extracorporeal-membrane-oxygenation-in-infants-with-congenital-diaphragmatic-hernia
#1
REVIEW
Theresa R Grover, Natalie E Rintoul, Holly L Hedrick
Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly which impairs normal pulmonary development leading to acute and chronic respiratory failure, pulmonary hypoplasia, pulmonary hypertension, and mortality. CDH is the most common non-cardiac indication for neonatal ECMO. Prenatal and postnatal predictors of CDH severity aid in patient selection. Centers vary in preferred mode of ECMO and timing of CDH repair. Survivors of severe CDH with ECMO are at risk for long-term sequelae including neurodevelopmental delays...
January 12, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29336834/an-overview-of-medical-ecmo-for-neonates
#2
REVIEW
Kathryn Fletcher, Rachel Chapman, Sarah Keene
Extracorporeal membrane oxygenation (ECMO), a life-saving therapy for respiratory and cardiac failure, was first used in neonates in the 1970s. The indications and criteria for ECMO have changed over the years, but it continues to be an important option for those who have failed other medical therapies. Since the Extracorporeal Life Support Organization (ELSO) Registry was established in 1989, more than 29,900 neonates have been placed on ECMO for respiratory failure, with 84% surviving their ECMO course, and 73% surviving to discharge or transfer...
January 11, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29336833/education-for-ecmo-providers-using-education-science-to-bridge-the-gap-between-clinical-and-educational-expertise
#3
REVIEW
Lindsay Johnston, Susan B Williams, Anne Ades
A well-organized educational curriculum for the training of both novice and experienced ECMO providers is critical for the continued function of an institutional ECMO program. ELSO provides guidance for the education for ECMO specialists, physicians and staff, which incorporates "traditional" instructor-centered educational methods, such as didactic lectures and technical skill training. Novel research suggests utilization of strategies that align with principles of adult learning to promote active learner involvement and reflection on how the material can be applied to understand existing and new constructs may be more effective...
January 11, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29336832/anticoagulation-in-neonatal-ecmo
#4
REVIEW
Aditi Kamdar, Natalie Rintoul, Leslie Raffini
Despite advances made in technology and neonatal intensive care, the rate of hemorrhagic and thrombotic complications remains unacceptably high in patients undergoing extracorporeal membrane oxygenation (ECMO) and these complications negatively impact morbidity and mortality. Management of anticoagulation in neonates who have a developing hemostatic system is vastly different from adults and poses unique challenges. Variation in practice among ECMO centers regarding anticoagulation monitoring and titration reflects the lack of high-quality evidence...
January 11, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29331209/ethical-and-end-of-life-considerations-for-neonates-requiring-ecmo-support
#5
REVIEW
Roxanne Kirsch, David Munson
ECMO has proven to be a life-saving intervention for a variety of disease entities with a high rate of survival in the neonatal population. However, ECMO requires clinical teams to engage in many ethical considerations. Even with ongoing improvements in technology and expertise, some patients will not survive a course of ECMO. An unsuccessful course of ECMO can be difficult to accept and cause a great deal of angst. These questions can result in real conflict both within the care team, and between the care team and the family...
January 10, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29310986/multidisciplinary-obstetric-critical-care-delivery-the-concept-of-the-virtual-intensive-care-unit
#6
REVIEW
Michael P Leovic, Hailey N Robbins, Roman S Starikov, Michael R Foley
With an increasing prevalence of chronic medical conditions and the associated potential for decompensation to critical illness among modern day parturients, we present here the concept of the "virtual" intensive care unit. We challenge the traditional association of the word "unit" to extend beyond a fixed physical setting to portray an individualized, predetermined patient care team capable of managing these complex patients in a variety of settings. In this model, obstetric critical care is provided through a multidisciplinary patient care team, with emphasis on early identification of complicated pregnancies, detailed antepartum planning, anticipation of complications, and retrospective review of clinical outcomes aimed at continued quality improvement...
January 5, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29307472/special-equipment-considerations-for-neonatal-ecmo
#7
REVIEW
James Connelly, Thane Blinman
Extracorporeal membrane oxygenation (ECMO) for neonates is applied routinely at major children's hospitals around the world. While the practice seems routine, the peculiar physiology of the small human imposes particular constraints on selection of equipment, performance of the circuit, and risks to the child. The physiology of small patients and physics of circuit elements leave many areas opaque and far from optimal, but still allow assembly of a set of useful heuristics for good practice. Here, we examine individual mechanical components of the ECMO circuit with attention to selection, pitfalls, and peculiarities of each when applied to the neonate...
January 4, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29305227/current-trends-in-neonatal-ecmo
#8
REVIEW
Burhan Mahmood, Debra Newton, Eugenia K Pallotto
Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for patients with respiratory and cardiac failure refractory to maximal medical management. The extracorporeal life support organization registry is the largest available resource for describing the population and outcomes of patients treated with this therapy. The use of ECMO for neonatal patients is decreasing in proportion to the total annual ECMO runs most likely due to advancements in medical management. Although the overall survival for neonatal ECMO has decreased, this is likely a reflection of the increasingly complex neonatal patients treated with this therapy...
January 2, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29305226/extracorporeal-membrane-oxygenation-in-congenital-heart-disease
#9
REVIEW
Kiona Y Allen, Catherine K Allan, Lillian Su, Mary E McBride
This review article will discuss the indications for and outcomes of neonates with congenital heart disease who receive extracorporeal membrane oxygenation (ECMO) support. Most commonly, ECMO is used as a perioperative bridge to recovery or temporary support for those after cardiac arrest or near arrest in patients with congenital or acquired heart disease. What had historically been considered a contraindication to ECMO, is evolving and more of the sickest and most complicated babies are cared for on ECMO...
January 2, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29291939/introduction-update-on-neonatal-extracorporeal-membrane-oxygenation
#10
EDITORIAL
Lindsay C Johnston, Natalie Rintoul, Anne M Ades
No abstract text is available yet for this article.
December 29, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/29254600/introduction
#11
EDITORIAL
Roman S Starikov, Michael R Foley
No abstract text is available yet for this article.
December 15, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/29246735/cardiac-arrest-in-pregnancy
#12
REVIEW
Jacqueline Kikuchi, Shad Deering
Cardiac arrest in pregnancy is a rare and frightening event. Although not every obstetrician will encounter cardiac arrest in pregnancy during their career, it is imperative to be prepared to manage this acute emergency. The management is particularly complex due to maternal physiologic changes from pregnancy and the simultaneous management of two patients, the mother and fetus. In 2010, the American Heart Association released their first scientific statement on guidelines for management of cardiac arrest in pregnancy that has since been updated in 2015...
December 12, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/29195695/the-diagnosis-and-management-of-morbidly-adherent-placenta
#13
REVIEW
Michael A Belfort, Alireza A Shamsirsaz, Karin A Fox
The incidence of morbidly adherent placenta (MAP) has risen 13-fold since the early 1900s and is directly correlated with the rising rate of cesarean delivery. It is important for clinicians to screen all pregnancies for MAP at the time of routine second-trimester ultrasonography. In addition, patients with risk factors (e.g., multiple prior cesarean deliveries) should undergo targeted screening for MAP. Optimal maternal and fetal outcomes for these high-risk pregnancies result from accurate prenatal diagnosis and comprehensive multidisciplinary preparation and delivery between 34 and 36 weeks of gestation...
November 28, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/29179957/catastrophic-antiphospholipid-syndrome-and-pregnancy
#14
REVIEW
Robert M Silver
Catastrophic antiphospholipid syndrome (CAPS) is a rare but life-threatening condition that may be precipitated by pregnancy. The condition can be hard to diagnose since it mimics other thrombotic microangiopathies that are associated with pregnancy. Accurate and timely diagnosis is critical for effective treatment. In this review, we highlight pertinent clinical features of CAPS so that obstetricians will be able to recognize and treat the condition.
November 24, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/29179956/extracorporeal-membrane-oxygenation-ecmo-during-pregnancy-and-postpartum
#15
REVIEW
Luis D Pacheco, George R Saade, Gary D V Hankins
Extracorporeal membrane oxygenation (ECMO) can provide respiratory support (VV-ECMO) or both respiratory and circulatory support (VA-ECMO). The use of ECMO has increased dramatically as a result of simpler technology. No level I evidence is yet available reflecting improved outcomes with ECMO. The use of this technology during pregnancy may be indicated in very select cases and should be delivered in centers with dedicated ECMO specialized units.
November 24, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/29179955/the-utility-of-bedside-simulation-for-training-in-critical-care-obstetrics
#16
REVIEW
Jean-Ju Sheen, Colleen Lee, Dena Goffman
Over the last 2 decades, the maternal mortality ratio in the United States has doubled from 7.4/100,000 live births in 1986 to 14.5/100,000 today. Despite great advances in health care, increasing rates of maternal morbidity and mortality in the United States have prompted calls to action to reverse this disturbing trend. Assisted reproductive technology has allowed women to delay childbearing to more advanced ages, resulting in a greater number of pregnancies complicated by one or more of the diseases associated with aging, such as cardiovascular disease, cancer, type 2 diabetes, and hypertension...
November 24, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/29191292/long-term-childhood-outcomes-after-interventions-for-prevention-and-management-of-preterm-birth
#17
REVIEW
Sarah R Murray, Sarah J Stock, Jane E Norman
Globally, preterm birth rates are rising and have a significant impact on neonatal morbidity and mortality. Preterm birth remains difficult to prevent and a number of strategies for preterm birth prevention (progesterone, cervical pessaries, cervical cerclage, tocolytics, and antibiotics) have been identified. While some of these show more promise, there is a paucity of evidence regarding the long-term effects of these strategies on childhood outcomes. Strategies used to improve the health of babies if born preterm, such as antenatal magnesium sulfate for fetal neuroprotection and antenatal corticosteroids for fetal lung maturation, show evidence of short-term benefit but lack large-scale follow-up data of long-term childhood outcomes...
December 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/29191291/tocolysis-present-and-future-treatment-options
#18
REVIEW
Joshua D Younger, Elena Reitman, George Gallos
In the United States, the generally accepted indication for tocolytic therapy centers on suppression of preterm labor. This may be in the form of preventative therapy with progesterone in women with prior spontaneous preterm birth or as an acute intervention to suppress established uterine contractions associated with cervical change occurring at less than 37 weeks gestation. This article seeks to apply this perspective to tocolytic therapy. Here, we provide a review of current tocolytic options and what the last decade of discovery has revealed about the regulation of myometrial excitability and quiescence...
December 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/29191290/new-techniques-in-evaluation-of-the-cervix
#19
REVIEW
Helen Feltovich, Lindsey Carlson
The process of parturition is poorly understood, but the cervix clearly plays a key role. Because of this, recent research efforts have been directed at objective quantification of cervical remodeling. Investigation has focused on two basic areas: (1) quantification of tissue deformability and (2) presence, orientation, and/or concentration of microstructural components (e.g. collagen). Methods to quantify tissue deformability include strain elastography and shear wave elasticity imaging (SWEI). Methods to describe tissue microstructure include attenuation and backscatter...
December 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/29191289/introduction-current-preterm-birth-prevention-strategies-part-2
#20
EDITORIAL
Joy Vink, Cynthia Gyamfi-Bannerman
No abstract text is available yet for this article.
December 2017: Seminars in Perinatology
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