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Seminars in Fetal & Neonatal Medicine

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https://www.readbyqxmd.com/read/30005922/monitoring-heart-rate-in-the-delivery-room
#1
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
#2
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
#3
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
#4
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/29884402/variable-role-of-patent-ductus-arteriosus
#5
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...
June 1, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29779927/patent-ductus-arteriosus-the-physiology-of-transition
#6
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...
May 5, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29730050/hemodynamic-assessment-of-the-patent-ductus-arteriosus-beyond-ultrasound
#7
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...
April 27, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29467103/designing-a-trial-for-neonatal-seizure-treatment
#8
REVIEW
Nathan J Stevenson, Sampsa Vanhatalo
Neonatal seizures are widely considered a neurological emergency with a need for prompt treatment, yet they are known to present a highly elusive target for bedside clinicians. Recent studies have suggested that the design of a neonatal seizure treatment trial will profoundly influence the sample size, which may readily increase to hundreds or even thousands as the achieved effect size diminishes to clinical irrelevance. The self-limiting and rapidly resolving nature of neonatal seizures diminishes the measurable treatment effect every hour after seizure onset and any effect may potentially be confused with spontaneous resolution, precluding the value of many observational studies...
June 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29352657/electroencephalographic-monitoring-for-seizure-identification-and-prognosis-in-term-neonates
#9
REVIEW
Shavonne L Massey, Frances E Jensen, Nicholas S Abend
Seizures represent a manifestation of neurological disease in the neonatal period. Historically, neonatal seizures were identified by direct clinical observation. However, since most seizures are electroencephalographic (EEG)-only (subclinical, non-convulsive) and clinical manifestations may be subtle, many clinicians place increasing importance on EEG data including conventional EEG or amplitude-integrated EEG to identify seizures in neonates. Beyond seizure identification, the EEG is a robust source of information about brain function that can be useful for neurobehavioral prognostication in some neonates...
June 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29705089/effective-ventilation-the-most-critical-intervention-for-successful-delivery-room-resuscitation
#10
REVIEW
Elizabeth E Foglia, Arjan B Te Pas
Lung aeration is the critical first step that triggers the transition from fetal to postnatal cardiopulmonary physiology after birth. When an infant is apneic or does not breathe sufficiently, intervention is needed to support this transition. Effective ventilation is therefore the cornerstone of neonatal resuscitation. In this article, we review the physiology of cardiopulmonary transition at birth, with particular attention to factors the caregiver should consider when providing ventilation. We then summarize the available clinical evidence for strategies to monitor and perform positive pressure ventilation in the delivery room setting...
April 17, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29523483/prenatal-screening-for-fetal-and-obstetric-complications-new-opportunities-and-challenges
#11
EDITORIAL
Neeta L Vora, Lisa Hui
No abstract text is available yet for this article.
April 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29467101/ultrasound-screening-for-complications-in-twin-pregnancy
#12
Rosemary Townsend, Asma Khalil
In the decades since the introduction of ultrasound into routine obstetric practice, the advantages of ultrasound have moved beyond the simple ability to identify multiple pregnancies antenatally to the possibility of screening them for fetal anomalies, pre-eclampsia, preterm birth, and the complications specific to monochorionic pregnancies. Screening studies have often excluded twins because physiological differences impact on the validity and sensitivity of the screening tests in routine use in singletons, and therefore, the evidence of screening performance in multiple pregnancy lags behind the evidence from singleton pregnancies...
April 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29305293/beyond-screening-for-chromosomal-abnormalities-advances-in-non-invasive-diagnosis-of-single-gene-disorders-and-fetal-exome-sequencing
#13
REVIEW
Jane Hayward, Lyn S Chitty
Emerging genomic technologies, largely based around next generation sequencing (NGS), are offering new promise for safer prenatal genetic diagnosis. These innovative approaches will improve screening for fetal aneuploidy, allow definitive non-invasive prenatal diagnosis (NIPD) of single gene disorders at an early gestational stage without the need for invasive testing, and improve our ability to detect monogenic disorders as the aetiology of fetal abnormalities. This presents clinicians and scientists with novel challenges as well as opportunities...
April 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29258838/parental-experiences-after-prenatal-diagnosis-of-fetal-abnormality
#14
Jan Hodgson, Belinda J McClaren
For many pregnant women, prenatal testing is a routine component of contemporary pregnancy care. Receiving a prenatal diagnosis is frequently associated with intense feelings of shock and grief; the extent of which may be unrelated to the pregnancy gestation or the condition diagnosed. During this time of crisis, parents are often faced with important choices about their pregnancy. Levels of understanding and experiences of professional support throughout this time likely impact decisions that are made and how they are subsequently perceived...
April 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29233624/first-and-second-trimester-screening-for-fetal-structural-anomalies
#15
REVIEW
Lindsay Edwards, Lisa Hui
Fetal structural anomalies are found in up to 3% of all pregnancies and ultrasound-based screening has been an integral part of routine prenatal care for decades. The prenatal detection of fetal anomalies allows for optimal perinatal management, providing expectant parents with opportunities for additional imaging, genetic testing, and the provision of information regarding prognosis and management options. Approximately one-half of all major structural anomalies can now be detected in the first trimester, including acrania/anencephaly, abdominal wall defects, holoprosencephaly and cystic hygromata...
April 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29233487/genetic-counselling-patient-education-and-informed-decision-making-in-the-genomic-era
#16
REVIEW
Sylvia A Metcalfe
Genomic technologies are now being applied to reproductive genetic screening. Circulating cell-free DNA testing in pregnancy for fetal chromosomal abnormalities is becoming more widely used as a screening test, and expanded carrier screening for autosomal and X-linked recessive conditions for more than a hundred conditions is available to couples for testing before and during pregnancy. These are most typically available as a commercial test. The purpose of reproductive genetic screening is to facilitate autonomous reproductive choices...
April 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29229486/screening-for-spontaneous-preterm-birth-and-resultant-therapies-to-reduce-neonatal-morbidity-and-mortality-a-review
#17
REVIEW
Angelica V Glover, Tracy A Manuck
Despite considerable effort aimed at decreasing the incidence of spontaneous preterm birth, it remains the leading cause of perinatal morbidity and mortality. Screening strategies are imperfect. Approaches used to identify women considered by historical factors to be low risk for preterm delivery (generally considered to be women with singleton pregnancies without a history of a previous preterm birth) as well as those at high risk for preterm birth (those with a previous preterm birth, short cervix, or multiple gestation) continue to evolve...
April 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29221766/screening-for-fetal-growth-restriction-and-placental-insufficiency
#18
REVIEW
Melanie C Audette, John C Kingdom
Fetal growth restriction (FGR) continues to be a leading cause of preventable stillbirth and poor neurodevelopmental outcomes in offspring, and furthermore is strongly associated with the obstetrical complications of iatrogenic preterm birth and pre-eclampsia. The terms small for gestational age (SGA) and FGR have, for too long, been considered equivalent and therefore used interchangeably. However, the delivery of improved clinical outcomes requires that clinicians effectively distinguish fetuses that are pathologically growth-restricted from those that are constitutively small...
April 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29221765/advances-in-fetal-echocardiography
#19
REVIEW
Helena M Gardiner
The development of fetal echocardiography and success in prenatal cardiac screening programs over the past 30 years has been driven by technical innovation and influenced by the different approaches of the various specialties practicing it. Screening for congenital heart defects no longer focuses on examining a limited number of pregnant women thought to be at increased risk, but instead forms an integrated part of a high-quality anatomical ultrasound performed in the second trimester using the 'five-transverse view' protocol...
April 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29128491/screening-for-fetal-chromosomal-and-subchromosomal-disorders
#20
REVIEW
Sarah Harris, Dallas Reed, Neeta L Vora
Screening for fetal chromosomal disorders has evolved greatly over the last four decades. Initially, only maternal age-related risks of aneuploidy were provided to patients. This was followed by screening with maternal serum analytes and ultrasound markers, followed by the introduction and rapid uptake of maternal plasma cell-free DNA-based screening. Studies continue to demonstrate that cfDNA screening for common aneuploidies has impressive detection rates with low false-positive rates. The technology continues to push the boundaries of prenatal screening as it is now possible to screen for less common aneuploidies and subchromosomal disorders...
April 2018: Seminars in Fetal & Neonatal Medicine
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