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Seminars in Fetal & Neonatal Medicine

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https://www.readbyqxmd.com/read/28619624/fetal-stem-cell-and-gene-therapy
#1
REVIEW
Russell Witt, Tippi C MacKenzie, William H Peranteau
Advances in our understanding of stem cells, gene editing, prenatal imaging and fetal interventions have opened up new opportunities for the treatment of congenital diseases either through in-utero stem cell transplantation or in-utero gene therapy. Improvements in ultrasound-guided access to the fetal vasculature have also enhanced the safety and efficacy of cell delivery. The fetal environment offers accessible stem cell niches, localized cell populations with large proliferative potential, and an immune system that is able to acquire donor-specific tolerance...
June 12, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28551277/an-extrauterine-environment-for-neonatal-development-extending-fetal-physiology-beyond-the-womb
#2
REVIEW
Emily A Partridge, Marcus G Davey, Matthew A Hornick, Alan W Flake
Extreme prematurity is a major cause of neonatal mortality and morbidity, and remains an unsolved clinical challenge. The development of an artificial womb, an extrauterine system recreating the intrauterine environment, would support ongoing growth and organ maturation of the extreme preterm fetus and would have the potential to substantially improve survival and reduce morbidity. Previous efforts toward the development of such a system have demonstrated the ability to maintain the isolated fetus for short periods of support, but have failed to achieve the long-term stability required for clinical application...
May 24, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28551276/responsible-surgical-innovation-and-research-in-maternal-fetal-surgery
#3
REVIEW
Ryan M Antiel, Alan W Flake
The field of maternal-fetal intervention is rapidly evolving with new technologies and innovations. This raises complex ethical and medico-legal challenges related to what constitutes innovative treatment versus human experimentation, with or without the umbrella of "medical research." There exists a gray zone between these black and white classifications, but there are also clear guidelines that should be responsibly negotiated when making the essential transition between an innovative treatment and a validated therapy...
May 24, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28532678/selective-intrauterine-growth-restriction-in-monochorionic-diamniotic-twin-pregnancies
#4
REVIEW
Mar Bennasar, Elisenda Eixarch, Josep Maria Martinez, Eduard Gratacós
Selective intrauterine growth restriction (sIUGR) affects 10-15% of all monochorionic pregnancies. Early severe forms are associated with intrauterine demise or neurological adverse outcome for both twins. The characteristics of umbilical artery (UA) Doppler in the IUGR fetus determine three clinical types: (I) normal UA Doppler and associated with good prognosis; (II) persistently absent/reverse UA end-diastolic flow and associated with early deterioration of the IUGR twin and very preterm delivery; (III) intermittently absent/reverse end-diastolic flow in the UA, and associated with unexpected fetal demise or neurological injury in one or both twins...
May 19, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28522033/placenta-directed-gene-therapy-for-fetal-growth-restriction
#5
REVIEW
Tara Krishnan, Anna L David
Fetal growth restriction (FGR) is a serious pregnancy complication affecting ∼8% of all pregnancies. There is no treatment to increase fetal growth in the uterus. Gene therapy presents a promising treatment strategy for FGR, with the use of adenoviral vectors encoding for proteins such as vascular endothelial growth factor (VEGF) and insulin-like growth factor demonstrating improvements in fetal growth, placental function, and neonatal outcome in preclinical studies. Safety assessments suggest no adverse risk to the mother or fetus for VEGF maternal gene therapy; a clinical trial is in development...
May 15, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28456514/respiratory-distress-in-term-neonates-in-low-resource-settings
#6
REVIEW
Sindhu Sivanandan, Ramesh Agarwal, Amanpreet Sethi
Most neonatal deaths worldwide occur in low- and middle-income countries (LMICs). Respiratory distress is an important cause of neonatal morbidity and mortality. The epidemiology of respiratory distress among term neonates who constitute the vast majority of births is under reported. The scarcely available data from LMICs suggest an incidence of 1.2% to 7.2% among term live births and greater morbidity compared to that in high-income countries. Pneumonia and meconium aspiration syndrome are the predominant causes among outborn neonates, but next only to transient tachypnea among inborn neonates...
April 26, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28462858/neuromuscular-disorders-and-chronic-ventilation
#7
REVIEW
Stamatia Alexiou, Joseph Piccione
Morbidity and mortality have decreased in patients with neuromuscular disease due to implementation of therapies to augment cough and improve ventilation. Infants with progressive neuromuscular disease will eventually develop respiratory complications as a result of muscle weakness and their inability to compensate during periods of increased respiratory loads. The finding of nocturnal hypercapnia is often the trigger for initiating non-invasive ventilation and studies have shown that its use not only may improve sleep-disordered breathing, but also that it may have an effect on daytime function, symptoms related to hypercapnia, and partial pressure of CO2...
April 24, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28438477/apnea-in-the-term-infant
#8
REVIEW
Mary Elaine Patrinos, Richard J Martin
Whereas apnea of prematurity has been well defined and its pathophysiology extensively studied, apnea in the term infant remains a greater challenge. Unfortunately, clear diagnostic criteria are lacking and pathogenesis and management vary widely. In this review we have arbitrarily organized the discussion chronologically into earlier and later postnatal periods. In the first days of life, presumed apnea may reflect physiologic events such as positional or feeding etiologies, or may be a manifestation of serious pathophysiology, such as a seizure disorder...
April 21, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28411000/meconium-aspiration-or-respiratory-distress-associated-with%C3%A2-meconium-stained-amniotic-fluid
#9
REVIEW
Nestor E Vain, Daniel G Batton
The designation meconium aspiration syndrome (MAS) reflects a spectrum of disorders in infants born with meconium-stained amniotic fluid, ranging from mild tachypnea to severe respiratory distress and significant mortality. The frequency of MAS is highest among infants with post-term gestation, thick meconium, and birth asphyxia. Pulmonary hypertension is an important component in severe cases. Prenatal hypopharyngeal suctioning and postnatal endotracheal intubation and suctioning of vigorous infants are not effective...
April 11, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28389088/pulmonary-diagnostics
#10
REVIEW
Steven M Donn, Sunil K Sinha
Term infants with respiratory distress may have extremely varied etiologies of their illnesses. These range from anatomical malformations to infectious or inflammatory conditions to genetic, metabolic, or neurological abnormalities. This article reviews the present array of diagnostic studies available to the clinician, including the physical examination, imaging (radiography, computed tomography, magnetic resonance imaging, ultrasound, and nuclear scanning techniques), lung mechanics and function testing, evaluation of gas exchange (blood gases, pulse oximetry, transcutaneous monitoring, and end-tidal carbon monoxide measurements), and anatomical studies (bronchoscopy and lung biopsy)...
April 4, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28363760/interstitial-lung-disease-in-newborns
#11
REVIEW
Lawrence M Nogee
The term 'interstitial lung disease' (ILD) refers to a group of disorders involving both the airspaces and tissue compartments of the lung, and these disorders are more accurately termed diffuse lung diseases. Although rare, they are associated with significant morbidity and mortality, with the prognosis depending upon the specific diagnosis. The major categories of ILD in children that present in the neonatal period include developmental disorders, growth disorders, surfactant dysfunction disorders, and specific conditions of unknown etiology unique to infancy...
March 28, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28457816/interventions-to-prevent-stillbirth
#12
REVIEW
Jessica M Page, Robert M Silver
Stillbirth is one of the most distressing complications of pregnancy and still occurs far too frequently. The rate of stillbirth has been decreasing worldwide but room for improvement remains even in high-income countries. Risk factors for stillbirth have been identified in an effort to detect those women at increased risk. However, risk factors are non-specific and do not identify most stillbirths. Strategies employed to screen the general population such as assessment of fetal activity, fetal growth screening and biomarkers have also been used to identify increased risk for stillbirth...
June 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28325580/perinatal-death-investigations-what-is-current-practice
#13
REVIEW
J W Nijkamp, N J Sebire, K Bouman, F J Korteweg, J J H M Erwich, S J Gordijn
Perinatal death (PD) is a devastating obstetric complication. Determination of cause of death helps in understanding why and how it occurs, and it is an indispensable aid to parents wanting to understand why their baby died and to determine the recurrence risk and management in subsequent pregnancy. Consequently, a perinatal death requires adequate diagnostic investigation. An important first step in the analysis of PD is to identify the case circumstances, including relevant details regarding maternal history, obstetric history and current pregnancy (complications are evaluated and recorded)...
June 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28285990/classification-of-causes-and-associated-conditions-for-stillbirths-and-neonatal-deaths
#14
REVIEW
Vicki Flenady, Aleena M Wojcieszek, David Ellwood, Susannah Hopkins Leisher, Jan Jaap H M Erwich, Elizabeth S Draper, Elizabeth M McClure, Hanna E Reinebrant, Jeremy Oats, Lesley McCowan, Alison L Kent, Glenn Gardener, Adrienne Gordon, David Tudehope, Dimitrios Siassakos, Claire Storey, Jane Zuccollo, Jane E Dahlstrom, Katherine J Gold, Sanne Gordijn, Karin Pettersson, Vicki Masson, Robert Pattinson, Jason Gardosi, T Yee Khong, J Frederik Frøen, Robert M Silver
Accurate and consistent classification of causes and associated conditions for perinatal deaths is essential to inform strategies to reduce the five million which occur globally each year. With the majority of deaths occurring in low- and middle-income countries (LMICs), their needs must be prioritised. The aim of this paper is to review the classification of perinatal death, the contemporary classification systems including the World Health Organization's International Classification of Diseases - Perinatal Mortality (ICD-PM), and next steps...
June 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28279640/care-following-stillbirth-in-high-resource-settings-latest-evidence-guidelines-and-best-practice-points
#15
REVIEW
Danya Bakhbakhi, Christy Burden, Claire Storey, Dimitrios Siassakos
Third-trimester stillbirth affects approximately 2.6 million women worldwide each year. Although most stillbirths (98%) occur in low- and middle-income countries, most of the research on the impact of stillbirth and bereavement care has come from high-income countries. The impact of stillbirth ranges from stigma to disenfranchised grief, broken relationships, clinical depression, chronic pain, substance use, increased use of health services, employment difficulties, and debt. Appropriate bereavement care following a stillbirth is essential to minimise the negative socio-economic impact on parents and their families...
June 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28262391/pregnancy-subsequent-to-stillbirth-medical-and-psychosocial-aspects-of-care
#16
REVIEW
Megan E Fockler, Noor Niyar N Ladhani, Jo Watson, Jon F R Barrett
Pregnancy after stillbirth presents unique challenges for families and healthcare providers. Medical surveillance and interventions must be optimized to improve outcomes and provide individualized support for families. A key component of acceptable care is psychosocial support that is delivered in a timely and sensitive manner by care providers with knowledge about the pervasive impact of stillbirth. With the lack of existing evidence to guide care, there is an urgent need for global leadership and research to address knowledge gaps...
June 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28259738/reducing-the-impact-of-perinatal-death-the-case-for-increased-understanding-of-underlying-causes-to-inform-change-to-save-babies-lives
#17
EDITORIAL
Zarko Alfirevic, Alexander Heazell
No abstract text is available yet for this article.
June 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28238633/early-neonatal-death-a-challenge-worldwide
#18
REVIEW
Liisa Lehtonen, Ana Gimeno, Anna Parra-Llorca, Máximo Vento
Early neonatal death (ENND), defined as the death of a newborn between zero and seven days after birth, represents 73% of all postnatal deaths worldwide. Despite a 50% reduction in childhood mortality, reduction of ENND has significantly lagged behind other Millennium Developmental Goal achievements and is a growing contributor to overall mortality in children aged <5 years. The etiology of ENND is closely related to the level of a country's industrialization. Hence, prematurity and congenital anomalies are the leading causes in high-income countries...
June 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28215929/each-baby-counts-national-quality-improvement-programme-to-reduce-intrapartum-related-deaths-and-brain-injuries-in-term-babies
#19
REVIEW
Louise Robertson, Hannah Knight, Edward Prosser Snelling, Emily Petch, Marian Knight, Alan Cameron, Zarko Alfirevic
Although the most recent MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) perinatal mortality report has shown a downward trend in perinatal mortality, the UK still lags behind the best-performing countries in Europe. The burden of perinatal morbidity and mortality is wide-reaching and devastating for the families and care-providers involved. The aim of the Each Baby Counts (EBC) project is to reduce intrapartum term stillbirths, early neonatal deaths, and severe brain injuries by 50% by 2020...
June 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28214157/causes-and-temporal-changes-in-nationally-collected-stillbirth-audit-data-in-high-resource-settings
#20
REVIEW
Tom Norris, Bradley N Manktelow, Lucy K Smith, Elizabeth S Draper
Few high-income countries have an active national programme of stillbirth audit. From the three national programmes identified (UK, New Zealand, and the Netherlands) steady declines in annual stillbirth rates have been observed over the audit period between 1993 and 2014. Unexplained stillbirth remains the largest group in the classification of stillbirths, with a decline in intrapartum-related stillbirths, which could represent improvements in intrapartum care. All three national audits of stillbirths suggest that up to half of all reviewed stillbirths have elements of care that failed to follow standards and guidance...
June 2017: Seminars in Fetal & Neonatal Medicine
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