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Seminars in Perinatology

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https://www.readbyqxmd.com/read/30150080/conjoined-twins-pre-birth-management-changes-to-nrp-and-transport
#1
REVIEW
Elizabeth C Sager, Alana Thomas, Nathan C Sundgren
The management of conjoined twins is complex and requires careful preparation. Pre-birth management includes prenatal counseling, which is important due to the overall poor prognosis. In instances of trial of life, the delivery must be tailored to address the anticipated anatomy based on prenatal imaging and anticipated physiology. A multidisciplinary team is essential to anticipate and address the ergonomic challenges and medical issues related to organ fusion, cross-circulation and associated anomalies. There are several suggested modifications to the current Neonatal Resuscitation Program algorithm including modifications to initial assessment, airway management, administration of chest compressions, obtaining emergency access, and medication dosing...
July 30, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30185382/nursing-considerations-and-interdisciplinary-coordination-in-the-care-of-conjoined-twins
#2
REVIEW
Alexandra Luton, Nidia Estrada, Kalynn Barrientez, Jennifer McGinnis, Jennifer Pitlik, Alexandra Carter, Lisa Davenport, Jonathan Davies
Traditional nursing care strategies may require modification to meet the unique needs of conjoined twins. Here we discuss the strategies found to be useful in planning for and responding to distinctive circumstances encountered throughout hospitalization, as well as lessons learned. Areas of focus include ensuring privacy, designing adequate unit accommodations to meet space and equipment needs, staffing considerations and adaptations to typical neonatal intensive care nursing interventions. The utility of a team-based approach to interdisciplinary care coordination is also discussed...
July 27, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30217664/an-ethically-justifiable-practical-approach-to-decision-making-surrounding-conjoined-twin-separation
#3
REVIEW
Alana Thomas, Karen Johnson, Frank X Placencia
Conjoined twins present unique ethical and palliative care challenges. We present an ethically-justifiable, practical approach to decision-making with regards to surgical separation. These decisions must account for the short- and long-term prognoses for each infant prior to, and after, separation. Other considerations include the benefits and burdens of separation and the family's values and goals. Caregivers should recognize that decisions surrounding separation may be unduly influenced by social biases. The palliative care team aids in developing goals of care to guide decision-making by promoting communication between the medical team and family...
July 26, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30209012/optimizing-use-of-existing-prenatal-genetic-tests-screening-and-diagnostic-testing-for-aneuploidy
#4
REVIEW
Katie Stoll, Mary E Norton
Screening and diagnostic testing for detection of fetal aneuploidy has been an integral part of prenatal care for over three decades. The recent introduction of new technologies, such as cell free DNA (cfDNA) screening and preimplantation genetic screening, has created increased complexity for obstetrical care providers. Inconsistencies among the professional society recommendations have caused confusion and disparities in practice. As we work to responsibly incorporate new technologies, clear guidelines with consensus among relevant professional societies are needed...
July 26, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30206017/laboratory-considerations-for-prenatal-genetic-testing
#5
REVIEW
Karen Wou, Wendy K Chung, Ronald J Wapner
New genetic tests have rapidly entered clinical care with little consistency in laboratory testing and reporting. Non-invasive prenatal screening using cell free DNA (cfDNA) may either screen for common aneuploidies alone or include chromosomal microdeletions. All cfDNA screening tests have false positives and false negatives, and accordingly laboratories should report positive and negative predictive values. In addition, since fetal fraction plays a significant role in the reliability of results, this should also be reported with all test results...
July 26, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30201416/family-support-and-media-considerations-with-conjoined-twins
#6
REVIEW
Colleen Hanratty, Hester De Jong, Veronika Javor, Lindsey Fox, Jenn Jacome, Caley Johns, Kirstin Springmeyer, Jonathan Davies
Conjoined twins offer unique challenges for the family and medical care team including psychosocial stressors, religious dilemmas and public relation considerations. The involvement of social workers, child life specialists, chaplains and public relation experts is an important component in the care of conjoined twins. In this paper, we discuss the issues that could be encountered when supporting families with conjoined twins and strategies to address them.
July 26, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30197028/nutritional-considerations-in-the-care-of-conjoined-twins
#7
REVIEW
Erynn M Bergner, Laura Gollins, L Adriana Massieu, Nancy Hurst, Amy B Hair
Conjoined twins represent an interesting nutritional challenge as nutrient delivery and absorption is greatly affected by anatomy and, therefore, unique to each twin pair. Nutritional support is essential to optimize growth and development in the neonatal period; however, very little data exists on the topic in this population. Conjoined twins require individualized nutritional assessment that focuses on the interaction between the metabolic rate, nutrient uptake, and nutrient delivery of each twin in the dyad...
July 26, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30195989/what-are-the-goals-of-prenatal-genetic-testing
#8
REVIEW
Stephanie Dukhovny, Mary E Norton
The landscape of genetic testing and screening has changed tremendously since the initial description of the molecular structure of DNA. Given this, it is critical that providers reflect on the goals of prenatal screening and diagnostic testing, and how these tests impact perinatal outcomes. The participants of this workshop were in agreement that the goal of prenatal genetic testing should be focused on improving outcomes for women and families. While prenatal testing has historically focused on the option for pregnancy termination, increasing numbers of prenatal and perinatal treatments are available...
July 26, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30173949/how-should-costs-and-cost-effectiveness-be-considered-in-prenatal-genetic-testing
#9
REVIEW
Teresa N Sparks, Aaron B Caughey
In January 2017, a group of experts in prenatal genetics attended a workshop at the Society of Maternal-Fetal Medicine meeting to review the evidence behind the costs and cost-effectiveness of prenatal genetic testing. Over the past decade, prenatal genetic testing options have dramatically expanded to include additional options with cell-free DNA (cfDNA) screening, as well as increased diagnostic abilities through chromosomal microarray analysis (CMA), gene panels, whole exome sequencing, and other tests. With these expanding technologies, it is important to consider the options available as well as the cost effectiveness of their use...
July 26, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30170825/prenatal-and-postnatal-radiologic-evaluation-of-conjoined-twins
#10
REVIEW
Amy R Mehollin-Ray
Imaging of conjoined twins requires the use of multiple modalities, in both the prenatal and postnatal setting. Prenatal imaging, including both ultrasound and magnetic resonance imaging, benefits from an organized, worksheet-based approach, careful labelling of all images, and adoption of supplemental techniques. Postnatal imaging should be informed by the prenatal imaging findings and should be thoughtfully planned prior to performance. Complete evaluation prior to planned surgical separation will require the use of complementary modalities and multidisciplinary review and discussion...
July 26, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30166054/therapy-services-and-specialized-devices-for-conjoined-twins-unique-challenges-with-conjoined-twins-and-the-importance-of-physical-and-occupational-therapy
#11
REVIEW
Katherine Cugini, Frank B McCormick, Cheryl Mitchell, Erin Psencik, Stephanie Sarduy, Isabela Masuoka, Rose Toruno, Jonathan Davies
Conjoined twins are a rare occurrence that offer unique challenges and circumstances to therapists. The overall goal of physical and occupational therapy treatment is to provide care that promotes developmental progression to two conjoined individuals with distinct personalities and potentially different physical and medical needs. The unique presentation of conjoined twins must be considered in determining therapeutic goals, interventions and plans of care. Providing therapeutic interventions throughout the NICU stay is a dynamic, evolving process, which challenges the therapy team to work together to find solutions...
July 26, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30144953/role-of-simulation-in-preparation-for-the-care-of-conjoined-twins-prenatal-preparation-to-separation
#12
REVIEW
Shweta Parmekar, Leisa McMullen, Courtney Washington, Jennifer L Arnold
The rarity and complexity of conjoined twins creates a challenge for prenatal planning, delivery resuscitation, and postnatal management. The modality of simulation offers a safe practice environment for a multidisciplinary group consisting of neonatal providers, nurses, respiratory therapists, and surgeons in which to identify and address clinical decision making, procedural, and behavioral plans related to routine and emergency care of these patients. Simulation-based clinical rehearsals (SbCR) provide a unique opportunity to prepare for rare, complex, and patient specific clinical procedures and scenarios...
July 26, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30122608/pharmaceutical-considerations-with-conjoined-twins
#13
REVIEW
Emily Rodman, Jennifer L Placencia
Sharing of the vascular system in conjoined twins creates pharmaceutical dilemmas that require individualization of protocols. One of the major goals for the medical team is to determine how medications should be administered, dosed, and monitored in each set of conjoined twins. In order to achieve these goals, the team must determine the extent of shared circulation, volume of distribution, effectiveness of enteral absorption, renal clearance, and develop processes to ensure medication safety. In this article, we discuss unique challenges in medication practices in conjoined twins and present general principles that can be applied to determine optimal pharmaceutical strategies...
July 26, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30115457/introducing-new-and-emerging-genetic-tests-into-prenatal-care
#14
REVIEW
Neeta L Vora, Ronald J Wapner
Given the rapid advances in genomics, translating new genomic tests effectively into prenatal clinical practice remains challenging. We discuss emerging genetic tests, considerations for their use, how tests should ideally be validated prior to use in clinical practice, and the role of the Federal Drug Administration, Clinical Laboratory Improvement Amendments (CLIA) laboratories, commercial laboratories, insurers, and professional societies such as the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine (SMFM) in the introduction of new prenatal genetic tests...
July 26, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30107889/what-are-the-required-components-of-pre-and-post-test-counseling
#15
REVIEW
Britton D Rink, Jeffrey A Kuller
Prenatal care providers are faced with a myriad of decisions about how to offer genetic screening and testing in ways that are appropriate to their patient population and their workflow. Among the critical issues brought to the forefront of rapidly advancing genetic and genomic technologies is the importance of pre- and post-test counseling. This document is a synthesis of proceedings of a workshop sponsored by the American College of Obstetricians and Gynecologists, the American College of Medical Genetics and Genomics, and the Society for Maternal-Fetal Medicine, on January 24-25, 2017, during which invited experts discussed required components of pre- and post-test counseling and associated concerns in the provision of prenatal care...
July 26, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30104009/what-education-background-and-credentials-are-required-to-provide-genetic-counseling
#16
REVIEW
Barbara M O'Brien, Lorraine Dugoff
Technological advances in genetics have resulted in an increase in the number and complexity of screening and diagnostic tests in the prenatal clinical arena. It is critical that patients are provided with appropriate counseling to enable them to make educated decisions. During this workshop session participants discussed the education, background and credentials required to provide counseling regarding prenatal genetic testing options. The participants agreed that prenatal care providers may have limited time and training to adequately address prenatal genetic testing...
July 26, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/30195988/preface
#17
REVIEW
Mary E Norton, Ronald J Wapner
No abstract text is available yet for this article.
July 25, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29958703/patent-ductus-arteriosus-its-treatments-and-the-risks-of-pulmonary-morbidity
#18
REVIEW
Ronald I Clyman
A persistent left-to-right shunt through a patent ductus arteriosus (PDA) increases the rate of hydrostatic fluid filtration into the lung's interstitium, impairs pulmonary mechanics, and prolongs the need for mechanical ventilation. In preclinical trials, pharmacologic PDA closure leads to improved alveolarization and minimizes the impaired postnatal alveolar development that is the pathologic hallmark of bronchopulmonary dysplasia (BPD). Although routine prophylactic treatment of a PDA on the day of birth does not appear to offer any more protection against BPD than delaying treatment for 2-3 days, recent evidence from quality improvement trials suggests that early pharmacologic treatment decreases the incidence of BPD compared with a treatment approach that exposes infants to a moderate-to-large PDA shunt for the first 7-10 days after birth...
June 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29958702/evidence-based-use-of-acetaminophen-for-hemodynamically-significant-ductus-arteriosus-in-preterm-infants
#19
REVIEW
B Jasani, D E Weisz, P J McNamara
While cyclooxygenase inhibitors have been the most common medications used to facilitate earlier closure of patent ductus arteriosus in preterm infants, adverse effects and variable efficacy have highlighted a need for alternative options. Acetaminophen facilitates ductal closure via an alternate pathway of prostaglandin inhibition. Despite treatment with high doses, toxicity is uncommon in preterm infants, possibly due to immature hepatic metabolism. Pooled data from randomized clinical trials of early treatment demonstrate that acetaminophen has similar efficacy as cyclooxygenase inhibitors for PDA closure with a favorable side effect profile and without any apparent increase in adverse neonatal outcomes...
June 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29954594/changing-patterns-of-patent-ductus-arteriosus-surgical-ligation-in-the-united-states
#20
REVIEW
Jeff Reese, Theresa A Scott, Stephen W Patrick
Optimal management of patent ductus arteriosus (PDA) is unclear. One treatment, surgical ligation, is associated with adverse outcomes. We reviewed data from the Kids' Inpatient Database (2000-2012) to determine if PDA ligation rates: (1) changed over time, (2) varied geographically, or (3) influenced surgical complication rates. In 2012, 47,900 infants <1500g birth weight were born in the United States, including 2,800 undergoing PDA ligation (5.9%). Ligation was more likely in infants <1000g (85.9% vs...
June 2018: Seminars in Perinatology
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