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Seminars in Fetal & Neonatal Medicine

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https://www.readbyqxmd.com/read/30213591/intestinal-microcirculation-and-necrotizing-enterocolitis-the-vascular-endothelial-growth-factor-system
#1
REVIEW
Rakhee M Bowker, Xiaocai Yan, Isabelle G De Plaen
Necrotizing enterocolitis (NEC), a leading cause of morbidity and mortality in preterm neonates, is a devastating disease characterized by intestinal tissue inflammation and necrosis. NEC pathogenesis is multifactorial but remains unclear. Translocation of bacteria and/or bacterial products across a weak intestinal barrier in the setting of impaired mucosal immunity leads to an exaggerated inflammatory response and secondary mucosal epithelial injury. In addition to prematurity, other risk factors for NEC include congenital heart disease, maternal pre-eclampsia with placental vascular insufficiency, severe anemia and blood transfusion - all conditions that predispose the intestine to ischemia...
September 6, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/30196017/surgical-considerations-for-neonates-with-necrotizing-enterocolitis
#2
REVIEW
Charles R Hong, Sam M Han, Tom Jaksic
Necrotizing enterocolitis (NEC) is a potentially devastating condition that preferentially affects premature and low birth weight infants, with approximately half requiring acute surgical intervention. Surgical consult should be considered early on, and deterioration despite maximal medical therapy or the finding of pneumoperitoneum are the strongest indications for emergent surgical intervention. There is no clear consensus on the optimal surgical approach between peritoneal drainage and laparotomy; the best course of action likely depends on the infant's comorbidities, hemodynamic status, size, disease involvement, and available resources...
August 20, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/30172660/necrotizing-enterocolitis-the-intestinal-microbiome-metabolome-and-inflammatory-mediators
#3
REVIEW
Josef Neu, Mohan Pammi
Necrotizing enterocolitis (NEC) is a disease of preterm infants and associated with significant mortality and morbidity. Although the pathogenesis of NEC is not clear, microbial dysbiosis, with a bloom of the phylum Proteobacteria, has been reported. Antibiotics and the use of H2 blockers, which affect the gut microbiome, are associated with increased incidence of NEC. In association with dysbiosis, inflammatory processes are upregulated with increased Toll-like receptor signaling, leading to translocation of nuclear factor kappa-β, a transcription factor that induces transcription of various pro-inflammatory cytokines and chemokines...
August 17, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/30146477/innate-and-adaptive-immunity-in-necrotizing-enterocolitis
#4
REVIEW
Madison A Mara, Misty Good, Joern-Hendrik Weitkamp
Necrotizing enterocolitis (NEC) is the most frequent and devastating gastrointestinal disease of premature infants. Although the precise mechanisms are not fully understood, NEC is thought to develop following a combination of prematurity, formula feeding, and adverse microbial colonization. Within the last decade, studies increasingly support an important role of a heightened mucosal immune response initiating a pro-inflammatory signaling cascade, which can lead to the disruption of the intestinal epithelium and translocation of pathogenic species...
August 17, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/30145060/neurodevelopmental-outcomes-following-necrotizing-enterocolitis
#5
REVIEW
Marie Hickey, Michael Georgieff, Sara Ramel
Necrotizing enterocolitis (NEC), a gastrointestinal emergency predominantly affecting premature infants, is associated with increased risk for poor neurodevelopmental outcomes. NEC often strikes during a period of rapid and dynamic neurologic development when the brain is particularly vulnerable to insults and nutrient deficits. The pathogenesis of neurodevelopmental impairment following NEC is likely multifactorial, with both nutritional and non-nutritional factors at play. Follow-up testing that ensures early detection and intervention for impairments is crucial to optimize neurodevelopmental outcomes following NEC...
August 17, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/30145059/the-cost-of-necrotizing-enterocolitis-in-premature-infants
#6
REVIEW
Meredith E Mowitz, Dmitry Dukhovny, John A F Zupancic
Necrotizing enterocolitis (NEC), a common morbidity of prematurity, affects 5-10% of premature infants with a birthweight <1500 g. The added cost remains unclear. Multiple studies report the cost of care for an infant with NEC as higher than that of well premature infants, but these studies are fraught with limitations. Surgical intervention and type of surgery appear to impact overall costs. Health care resource utilization extends beyond the birth hospitalization, particularly in those infants requiring surgery, and persists to at least three years of age...
August 17, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/30143341/enteral-feeding-composition-and-necrotizing-enterocolitis
#7
REVIEW
Diomel de la Cruz, Catalina Bazacliu
Enteral feeding and composition play a chief role in the prevention and treatment of necrotizing enterocolitis (NEC). In the face of decades of research on this fatal disease, the exact mechanism of disease is still poorly understood. There is established evidence that providing mother's own breast milk and standardization of feeding regimens leads to a decreased risk for NEC. More recent studies have focused on the provision of donor human milk or an exclusive human milk diet in the endeavor to prevent NEC while still maintaining adequate nutrition to the premature infant...
August 17, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/30115546/a-critical-analysis-of-risk-factors-for-necrotizing-enterocolitis
#8
REVIEW
Allison Thomas Rose, Ravi Mangal Patel
Necrotizing enterocolitis (NEC) is the most common serious gastrointestinal morbidity in preterm infants. A number of risk factors for NEC have been reported in the literature. With the exception of decreasing gestational age, decreasing birth weight and formula feeding, there is disagreement on the importance of reported risk factors with uncertain causality. Causal risk factors may be observed at any time before the onset of NEC, including prior to an infant's birth. The purpose of this review is to examine the existing literature and summarize risk factors for NEC...
August 1, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/30082194/an-update-on-biomarkers-of-necrotizing-enterocolitis
#9
REVIEW
Pak Cheung Ng
Necrotizing enterocolitis (NEC) remains a devastating surgical emergency with high morbidity and mortality in preterm infants. Slow but steady progress has been made in past years searching for novel biomarkers of NEC, for both surveillance and diagnostic purposes. This review primarily focuses on recent discoveries: clinical applications of different categories of biomarkers for surveillance, early diagnosis, and predicting severity and prognosis; and understanding of pathophysiological mechanisms as a basis to rationalize the search for 'gut-associated specific biomarkers' of NEC...
August 1, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/30100524/necrotizing-enterocolitis-comes-in-different-forms-historical-perspectives-and-defining-the-disease
#10
REVIEW
J Neu, N Modi, M Caplan
The specific cause of what is commonly referred to as necrotizing enterocolitis (NEC) disease has been elusive largely because it is becoming clear that this entity represents more than one disease with multifactorial pathogenic mechanisms. Furthermore, finding clear and consistent diagnostic biomarkers will be difficult until the different subsets of what we are calling this disease are better delineated. In this introductory chapter, we discuss different disease entities that are frequently termed "NEC" in the newborn infant...
July 31, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/30076109/a-new-wrinkle-umbilical-cord-management-how-when-who
#11
REVIEW
Anup Katheria, Shigeharu Hosono, Walid El-Naggar
In the past five years, umbilical cord management in both term and preterm infants has come full circle, going from the vast majority of infants receiving immediate cord clamping to virtually all governing organizations promoting placental transfusion, mainly in the form of delayed cord clamping (DCC). Placental transfusion refers to the transfer of more blood components to the infant during the first few minutes after birth. The different strategies for ensuring placental transfusion to the baby include delayed (deferred) cord clamping, milking of the attached cord before clamping, and milking of the cut cord...
July 20, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/30005922/monitoring-heart-rate-in-the-delivery-room
#12
REVIEW
J A Dawson, G M Schmölzer, J Wyllie
Resuscitation algorithms and guidelines highlight the importance of heart rate (HR) in determining interventions and assessing their effect. However, the actual HR values used are historical based upon normal physiology, and HR at birth may be affected by mode of delivery and timing of cord clamping as well as respiratory status and condition at delivery. Furthermore, the most accurate and effective ways to assess and monitor HR in the newborn infant are only now becoming established. This article examines the importance of HR values and the most widely used methods of estimation as well as some newer modalities which are being developed...
July 6, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/30001819/animal-models-in-neonatal-resuscitation-research-what-can-they-teach-us
#13
REVIEW
Stuart B Hooper, Arjan B Te Pas, Graeme R Polglase, Myra Wyckoff
Animal models have made and continue to make important contributions to neonatal medicine. For example, studies in fetal sheep have taught us much about the physiology of the fetal-to-neonatal transition. However, whereas animal models allow multiple factors to be investigated in a logical and systematic manner, no animal model is perfect for humans and so we need to understand the fundamental differences in physiology between the species in question and humans. Although most physiological systems are well conserved between species, some small differences exist and so wherever possible the knowledge generated from preclinical studies in animals should be tested in clinical trials...
July 6, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/30001818/beyond-basic-resuscitation-what-are-the-next-steps-to-improve-the-outcomes-of-resuscitation-at-birth-when-resources-are-limited
#14
REVIEW
Susan Niermeyer, Nicola J Robertson, Hege L Ersdal
Implementation of basic neonatal resuscitation in low- and middle-income settings consistently saves lives on the day of birth. What can be done to extend these gains and further improve the outcomes of infants who require resuscitation at birth when resources are limited? This review considers how resuscitation and post-resuscitation care can advance to help meet the survival goals of the Every Newborn Action Plan for 2030. A brief summary of the evidence for benefit from basic neonatal resuscitation training in low- and middle-income countries highlights key aspects of training, low-dose high-frequency practice, and implementation with single providers or teams...
June 30, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29983332/the-goldilocks-principle-oxygen-in-the-delivery-room-when-is-it-too-little-too-much-and-just-right
#15
REVIEW
Vishal Kapadia, Yacov Rabi, Ju Lee Oei
Oxygen has been used to stabilize newborn infants for more than a century. Over the last two decades, a paradigm shift towards using less oxygen has occurred but without firm evidence of benefit. Using lower levels of oxygen has also added new conundrums to clinical care. Can oxygen delivery to sick newborn babies meet the Goldilocks principle, of being "just right"? This review discusses the history of oxygen use in the delivery room and the impetus to change from the long-established practice of using pure oxygen to using lower oxygen concentrations...
June 30, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/30093170/contemporary-approach-to-the-patent-ductus-arteriosus-and-future-considerations
#16
EDITORIAL
Samir Gupta, Patrick McNamara
No abstract text is available yet for this article.
August 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29884402/variable-role-of-patent-ductus-arteriosus
#17
REVIEW
Jennifer Shepherd, Kai-Hsiang Hsu, Shahab Noori
Although patent ductus arteriosus is essential in fetal life, interventions to close or minimize the adverse hemodynamic effects associated with the left-to-right shunt are often needed after birth, especially in extremely premature infants. However, there are clinical conditions where maintaining patency of the ductus is essential for survival. In this article we discuss use of prostaglandin E1 in the management of congenital heart defects, pulmonary hypertension and left ventricular failure in early neonatal period...
August 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29779927/patent-ductus-arteriosus-the-physiology-of-transition
#18
REVIEW
Poorva Deshpande, Michelle Baczynski, Patrick J McNamara, Amish Jain
The transition from intrauterine to extrauterine life represents a critical phase of physiological adaptation which impacts many organ systems, most notably the heart and the lungs. The majority of term neonates complete this transition without complications; however, dysregulation of normal postnatal adaptation may lead to acute cardiopulmonary instability, necessitating advanced intensive care support. Although not as well appreciated as changes in vascular resistances, the shunt across the DA plays a crucial physiologic role in the adaptive processes related to normal transitional circulation...
August 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29730050/hemodynamic-assessment-of-the-patent-ductus-arteriosus-beyond-ultrasound
#19
REVIEW
M Kluckow, P Lemmers
Assessment and management of a patent ductus arteriosus (PDA) in premature infants remains problematic. The more immature the infant, the more likely a PDA is to be present, due to lower spontaneous PDA closure rates. Clinicians now recognize that not all PDAs require treatment and that selection of the group of infants with a more hemodynamically relevant PDA, often manifesting as an increasing systemic-to-pulmonary shunt, is increasingly important. Ultrasound is the mainstay of diagnosis and physiological assessment of the PDA; however, there are other methodologies used to assess hemodynamic importance of the PDA...
August 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29636280/surgical-management-of-a-patent-ductus-arteriosus-is-this-still-an-option
#20
REVIEW
Dany E Weisz, Regan E Giesinger
The evolution of neonatal intensive care over the past decade has seen the role of surgical patent ductus arteriosus (PDA) ligation in preterm infants both decrease in scope and become laden with uncertainty. Associations of ligation with adverse neonatal and neurodevelopmental outcomes have rendered the ligation decision more challenging for clinicians and have been associated with a decline in surgical treatment, but these findings may be due to bias from confounding by indication in observational studies rather than a causal detrimental effect of ligation...
August 2018: Seminars in Fetal & Neonatal Medicine
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