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Seminars in Perinatology

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https://www.readbyqxmd.com/read/28416176/maternal-early-warning-systems-towards-reducing-preventable-maternal-mortality-and-severe-maternal-morbidity-through-improved-clinical-surveillance-and-responsiveness
#1
Lisa C Zuckerwise, Heather S Lipkind
Despite increasing awareness of obstetric safety initiatives, maternal mortality and severe maternal morbidity in the United States have continued to increase over the past 20 years. Since results from large-scale surveillance programs suggest that up to 50% of maternal deaths may be preventable, new efforts are focused on developing and testing early warning systems for the obstetric population. Early warning systems are a set of specific clinical signs or symptoms that trigger the awareness of risk and an urgent patient evaluation, with the goal of reducing severe morbidity and mortality through timely diagnosis and treatment...
April 14, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/28411947/central-line-associated-bloodstream-infections-in-the-nicu-successes-and-controversies-in-the-quest-for-zero
#2
Renée E Mobley, Matthew J Bizzarro
Central line-associated bloodstream infections (CLABSI) are among the most common healthcare-acquired infections in the neonatal intensive care unit (NICU) population and are associated with an increased risk of morbidity and mortality, as well as increased healthcare costs, and duration of hospitalization. Over the past decade, numerous local, statewide, and national quality improvement initiatives have resulted in a significant reduction in CLABSI rates. The majority of successful initiatives have utilized similar strategies to implement and sustain their efforts, including education of NICU staff in the principles of quality improvement, creation and implementation of central line insertion and maintenance bundles and methods for assessing compliance, formation of dedicated central line insertion and maintenance teams, and utilization of reliable and effective methods for collecting, analyzing, and displaying data...
April 12, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/28411946/introduction
#3
EDITORIAL
Christian M Pettker, Munish Gupta
No abstract text is available yet for this article.
April 12, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/28238454/moving-toward-a-shared-process-the-impact-of-parent-experiences-on-perinatal-palliative-care
#4
Susan L Hasegawa, Jessica T Fry
Perinatal palliative care programs seek to support parents expecting a baby diagnosed with a serious medical condition. Clinicians have increasingly recognized the importance of parental perspectives on the medical care mothers and their fetuses and live-born children receive, especially regarding factors influencing individual choices and knowledge of the medical community. We describe, using literature on trisomy 13 and trisomy 18, how information shared between parents and providers can improve perinatal counseling and family support...
February 23, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/28189331/the-role-of-palliative-care-in-critical-congenital-heart-disease
#5
Mjaye L Mazwi, Natalia Henner, Roxanne Kirsch
Patients with critical congenital heart disease are exposed to significant lifetime morbidity and mortality. Prenatal diagnosis can provide opportunities for anticipatory co-management of patients between palliative subspecialists and the cardiac care team. The benefits of palliative care include support for longitudinal decision-making and avoidance of interventions not consistent with family goals. Effectively counseling families requires an up-to-date understanding of outcomes and knowledge of provider biases...
February 8, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/28168998/neonatologist-training-in-communication-and-palliative-care
#6
Natalia Henner, Renee D Boss
Neonatologists receive highly varied and largely inadequate training to acquire and maintain communication and palliative care skills. Neonatology fellows often need to give distressing news to families and frequently face unique communication challenges. While several approaches to teaching these skills exist, practice opportunities through simulation and role play will likely provide the most effective learning.
February 4, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/28168999/palliative-care-approaches-to-neonates-with-chronic-respiratory-failure
#7
Nicolas F M Porta
Neonates with chronic respiratory failure have uncertain prognosis and can face significant treatment burden. As the trajectory of the illness becomes more concerning, consultation with a pediatric palliative service should be considered, especially as therapeutic options shift from standard to "innovative." Benefits include as follows: supporting emotionally conflicted providers and parents, maintaining transparency in determination of goals, and balancing medical progress with each individual patient's and family's best interests...
February 3, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/28162789/primary-palliative-care-in-neonatal-intensive-care
#8
Krishelle L Marc-Aurele, Nancy K English
This article explores the 2014 Institute of Medicine׳s recommendation concerning primary palliative care as integral to all neonates and their families in the intensive care setting. We review trends in neonatology and barriers to implementing palliative care in intensive care settings. Neonatal primary palliative care education should address the unique needs of neonates and their families. The neonatal intensive care unit needs a mixed model of palliative care, where the neonatal team provides primary palliative care and the palliative subspecialist consults for more complex or refractory situations that exceed the primary team׳s skills or available time...
February 2, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/28139254/challenges-in-neurologic-prognostication-after-neonatal-brain-injury
#9
Niranjana Natarajan, Andrea C Pardo
Parents often ask neonatologists and neurologists to determine neurologic prognosis in the preterm and term infant after neonatal brain injury. Prognostication in these populations remains rather full of uncertainties. Knowledge of available diagnostic tests and their limitations allows the clinician to synthesize the most likely outcomes after neurologic injury. In this review, we describe the diagnostic tools available to the clinician, active areas of research, and challenges in neurologic prognostication of the neonate...
March 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/27940091/pathogenesis-of-nec-role-of-the-innate-and-adaptive-immune-response
#10
REVIEW
Timothy W Denning, Amina M Bhatia, Andrea F Kane, Ravi M Patel, Patricia W Denning
Necrotizing enterocolitis (NEC) is a devastating disease in premature infants with high case fatality and significant morbidity among survivors. Immaturity of intestinal host defenses predisposes the premature infant gut to injury. An abnormal bacterial colonization pattern with a deficiency of commensal bacteria may lead to a further breakdown of these host defense mechanisms, predisposing the infant to NEC. Here, we review the role of the innate and adaptive immune system in the pathophysiology of NEC.
February 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/27866662/should-we-believe-in-transfusion-associated-enterocolitis-applying-a-grade-to-the-literature
#11
REVIEW
Susanne Hay, John A F Zupancic, Dustin D Flannery, Haresh Kirpalani, Dmitry Dukhovny
Numerous observational studies appear to demonstrate an association between packed red blood cell (pRBC) transfusions and necrotizing enterocolitis (NEC). However, the limited numbers of randomized controlled trials (RCTs) do not support a causal relationship between pRBC transfusion and NEC. We sought to determine the quality of the evidence behind transfusion-associated necrotizing enterocolitis (TANEC), and to formulate a GRADE-based recommendation regarding transfusion practices to reduce the risk of TANEC...
February 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/27866661/a-critical-question-for-nec-researchers-can-we-create-a-consensus-definition-of-nec-that-facilitates-research-progress
#12
REVIEW
Phillip V Gordon, Jonathan R Swanson, Brianna C MacQueen, Robert D Christensen
In the last decades the reported incidence of preterm necrotizing enterocolitis (NEC) has been declining in large part due to implementing comprehensive NEC prevention initiatives, including breast milk feeding, standardized feeding protocols, transfusion guidelines, and antibiotic stewardship and improving the rigor with which non-NEC cases are excluded from NEC data. However, after more than 60 years of NEC research in animal models, the promise of a "magic bullet" to prevent NEC has yet to materialize. There are also serious issues involving clinical NEC research...
February 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/27836427/genetic-alterations-in-necrotizing-enterocolitis
#13
REVIEW
Alain Cuna, Venkatesh Sampath
An underlying genetic predisposition to necrotizing enterocolitis (NEC) is increasingly being recognized. Candidate gene or pathway approaches as well as genome-wide approaches are beginning to identify potential pathogenic variants for NEC in premature infants. However, a majority of these studies have not yielded definitive results because of limited sample size and lack of validation. Despite these challenges, understanding the contribution of genetic variation to NEC is important for providing new insights into the pathogenesis of NEC as well as allowing for targeted care of infants with inherent susceptibility...
February 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/27836425/necrotizing-a-historical-perspective
#14
REVIEW
Michael S Caplan, Avroy Fanaroff
Necrotizing enterocolitis is a devastating disease afflicting premature infants, though after 50 years of investigation, the pathophysiology remains elusive. This report describes the possible etiologic factors from a historical perspective, and outlines the importance of human milk, intestinal blood flow, and intestinal blood flow changes from a developmental perspective over the last 40-50 years.
February 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/27836423/impact-of-probiotics-on-necrotizing-enterocolitis
#15
REVIEW
Mark A Underwood
A large number of randomized placebo-controlled clinical trials and cohort studies have demonstrated a decrease in the incidence of necrotizing enterocolitis with administration of probiotic microbes. These studies have prompted many neonatologists to adopt routine prophylactic administration of probiotics while others await more definitive studies and/or probiotic products with demonstrated purity and stable numbers of live organisms. Cross-contamination and inadequate sample size limit the value of further traditional placebo-controlled randomized controlled trials...
February 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/27836421/human-milk-is-the-feeding-strategy-to-prevent-necrotizing-enterocolitis
#16
REVIEW
Diana Maffei, Richard J Schanler
Human milk is the preferred diet for preterm infants as it protects against a multitude of NICU challenges, specifically necrotizing enterocolitis. Infants who receive greater than 50% of mother's own milk (MOM) in the 2 weeks after birth have a significantly decreased risk of NEC. An additional factor in the recent declining rates of NEC is the increased utilization of donor human milk (DHM). This creates a bridge until MOM is readily available, thus decreasing the exposure to cow milk protein. Preterm infants are susceptible to NEC due to the immaturity of their gastrointestinal and immune systems...
February 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/27832931/cytokines-and-growth-factors-in-the-developing-intestine-and-during-necrotizing-enterocolitis
#17
REVIEW
Krishnan MohanKumar, Kopperuncholan Namachivayam, Thao T B Ho, Benjamin A Torres, Robin K Ohls, Akhil Maheshwari
Cytokines and growth factors play diverse roles in the uninflamed fetal/neonatal intestinal mucosa and in the development of inflammatory bowel injury during necrotizing enterocolitis (NEC). During gestational development and the early neonatal period, the fetal/premature intestine is exposed to high levels of many "inflammatory" cytokines and growth factors, first via swallowed amniotic fluid in utero and then, after birth, in colostrum and mother's milk. This article reviews the dual, seemingly counter-intuitive roles of cytokines, where these agents play a "trophic" role and promote maturation of the uninflamed mucosa, but can also cause inflammation and promote intestinal injury during NEC...
February 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/28131321/neonatal-pain-management
#18
Brian S Carter, Jessica Brunkhorst
Pain management in the neonatal ICU remains challenging for many clinicians and in many complex care circumstances. The authors review general pain management principles and address the use of pain scales, non-pharmacologic management, and various agents that may be useful in general neonatal practice, procedurally, or at the end of life. Chronic pain and neonatal abstinence are also noted.
January 25, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/28109538/introduction
#19
EDITORIAL
Joel Frader, Natalia Henner, Jessica Fry
No abstract text is available yet for this article.
January 18, 2017: Seminars in Perinatology
https://www.readbyqxmd.com/read/28108023/the-intersection-of-fetal-palliative-care-and-fetal-surgery-addressing-mortality-and-quality-of-life
#20
David Munson
Over the last few decades, the fields of fetal surgery and maternal-fetal medicine have developed interventions aimed at modifying severe diseases in utero. Innovations in fetal approaches to congenital diaphragmatic hernia and myelomeningocele have shown considerable promise in modifying the clinical course with fetal intervention. Patients who present to fetal centers to be evaluated for these interventions face challenging decisions that directly relate to questions of mortality and quality of life. This article explores how clinicians might apply the tools and principles of fetal palliative care to supporting a woman and her family who are considering fetal surgery...
January 17, 2017: Seminars in Perinatology
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