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Seminars in Perinatology

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https://www.readbyqxmd.com/read/27986328/pathogenesis-of-nec-impact-of-an-altered-intestinal-microbiome
#1
REVIEW
Josef Neu, Mohan Pammi
Necrotizing enterocolitis (NEC), a disease most commonly seen in preterm infants, often presents without warning and is associated with very high mortality and morbidity. Progress in the prevention and treatment of NEC has been slow. In this article, we will discuss some of the reasons as to why this progress has been slow. We will describe some of the factors that appear to be highly associated and important components in the pathophysiology of NEC. We will discuss the intestinal microbial environment of the fetus as well as the preterm infant and how interaction of dysbiosis with an immature gastrointestinal tract combined with dietary factors play a role in the pathogenesis of NEC...
December 13, 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27940091/pathogenesis-of-nec-role-of-the-innate-and-adaptive-immune-response
#2
REVIEW
Timothy L Denning, Amina M Bhatia, Andrea F Kane, Ravi M Patel, Patricia L 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.
December 8, 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27866662/should-we-believe-in-transfusion-associated-enterocolitis-applying-a-grade-to-the-literature
#3
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...
November 17, 2016: 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
#4
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...
November 17, 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27836427/genetic-alterations-in-necrotizing-enterocolitis
#5
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...
November 8, 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27836426/introduction
#6
EDITORIAL
Michael S Caplan
No abstract text is available yet for this article.
November 8, 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27836425/necrotizing-a-historical-perspective
#7
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.
November 8, 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27836423/impact-of-probiotics-on-necrotizing-enterocolitis
#8
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...
November 8, 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27836422/surgical-necrotizing-enterocolitis
#9
REVIEW
Jamie R Robinson, Eric J Rellinger, L Dupree Hatch, Joern-Hendrik Weitkamp, K Elizabeth Speck, Melissa Danko, Martin L Blakely
Although currently available data are variable, it appears that the incidence of surgical necrotizing enterocolitis (NEC) has not decreased significantly over the past decade. Pneumoperitoneum and clinical deterioration despite maximal medical therapy remain the most common indications for operative treatment. Robust studies linking outcomes with specific indications for operation are lacking. Promising biomarkers for severe NEC include fecal calprotectin and S100A12; serum fatty acid-binding protein; and urine biomarkers...
November 8, 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27836421/human-milk-is-the-feeding-strategy-to-prevent-necrotizing-enterocolitis
#10
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...
November 8, 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27832931/cytokines-and-growth-factors-in-the-developing-intestine-and-during-necrotizing-enterocolitis
#11
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...
November 7, 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/28029389/neonatology-faculty-development-using-simulation
#12
REVIEW
Heather M French, Roberta L Hales
The goal of faculty development activities is to supply the public with knowledgeable, skilled, and competent physicians who are prepared for high performance in the dynamic and complex healthcare environment. Current faculty development programs lack evidence-based support and are not sufficient to meet the professional needs of practicing physicians. Simulation activities for faculty development offer an alternative to traditional, teacher-centric educational offerings. Grounded in adult learning theory, simulation is a learner-centric, interactive, efficient, and effective method to train busy professionals...
October 28, 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27989374/functional-quality-of-life-and-neurodevelopmental-outcomes-after-congenital-cardiac-surgery
#13
REVIEW
Megan L Ringle, Gil Wernovsky
Throughout the past few decades, advances in cardiology, neonatal intensive care, and surgical techniques have resulted in a growing cohort of thriving school-aged children with previously lethal complex congenital heart diseases. While survival has increased, there remains significant morbidity following repair including neurodevelopmental sequelae. Compared to children with a structurally normal heart, these infants and children have a higher frequency of abnormalities in tone, feeding, and delayed developmental milestones, as well as challenges with speech and learning disabilities, while a higher proportion of adolescents suffer from problems with processing speed, executive function, and a unique set of medical hardships related to exercise intolerance and obesity, medication burden, and mental health comorbidities...
December 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27865437/early-neurodevelopmental-outcomes-of-extremely-preterm-infants
#14
REVIEW
Elizabeth E Rogers, Susan R Hintz
Infants born at extreme preterm gestation are at risk for both death and disability. Although rates of survival have improved for this population, and some evidence suggests a trend toward decreased neuromotor impairment over the past decades, a significant improvement in overall early neurodevelopmental outcome has not yet been realized. This review will examine the rates and types of neurodevelopmental impairment seen after extremely preterm birth, including neurosensory, motor, cognitive, and behavioral outcomes...
December 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27863707/outcomes-in-childhood-following-therapeutic-hypothermia-for-neonatal-hypoxic-ischemic-encephalopathy-hie
#15
REVIEW
Girija Natarajan, Athina Pappas, Seetha Shankaran
In this article, we review the childhood outcomes of neonates with birth depression and/or hypoxic-ischemic encephalopathy. The outcomes of these children prior to the era of hypothermia for neuroprotection will first be summarized, followed by discussion of results from randomized controlled trials of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy. The predictors of outcome in childhood following neonatal HIE using clinical and imaging biomarkers following hypothermia therapy will be described...
December 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27863706/advanced-neuroimaging-and-its-role-in-predicting-neurodevelopmental-outcomes-in-very-preterm-infants
#16
REVIEW
Nehal A Parikh
Up to 35% of very preterm infants survive with neurodevelopmental impairments (NDI) such as cognitive deficits, cerebral palsy, and attention deficit disorder. Advanced MRI quantitative tools such as brain morphometry, diffusion MRI, magnetic resonance spectroscopy, and functional MRI at term-equivalent age are ideally suited to improve current efforts to predict later development of disabilities. This would facilitate application of targeted early intervention therapies during the first few years of life when neuroplasticity is optimal...
December 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27856003/in-their-own-words-life-at-adulthood-after-very-premature-birth
#17
REVIEW
Saroj Saigal
Very premature infants born in the last century following the early days of post-neonatal intensive care have demonstrated an array of physical, emotional, and mental health problems as they approach their third and fourth decades. These outcomes have been well documented by several international investigators. However, there is a paucity of information on the personal perspectives of these individuals with regard to their own quality of life, their hopes and their fears. This article will focus on the objective information from the published literature and how it differs from the personal perspectives of former very premature infants...
December 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27842712/defining-outcomes-for-high-risk-infants-problems-and-possibilities
#18
EDITORIAL
Susan R Hintz
No abstract text is available yet for this article.
December 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27836424/executive-function-in-children-born-preterm-risk-factors-and-implications-for-outcome
#19
REVIEW
H Gerry Taylor, Caron A C Clark
Executive function (EF) refers to the set of cognitive processes involved in the self-regulation of emotion and goal-directed behavior. These skills and the brain systems that support them develop throughout childhood and are frequently compromised in preterm children, even in those with broadly average global cognitive ability. Risks for deficits in EF in preterm children and attendant problems in learning and psychosocial functioning are higher in those with more extreme prematurity, neonatal complications, and related brain abnormalities...
December 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27817913/the-role-of-early-developmental-intervention-to-influence-neurobehavioral-outcomes-of-children-born-preterm
#20
REVIEW
Alicia Spittle, Karli Treyvaud
Children who are born preterm are at risk of adverse long-term neurobehavioral outcomes, including cognitive, motor, and behavioral impairments. Early developmental interventions that commence within the first year after preterm birth have a preventative focus, with the aim to positively influence the developmental trajectory. While there is a great deal of heterogeneity in the research trials to date, there is evidence that early developmental interventions have a moderate effect on cognitive and behavioral outcomes up to preschool age, with some evidence for improved motor outcomes...
December 2016: Seminars in Perinatology
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