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Clinics in Perinatology

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https://www.readbyqxmd.com/read/28477673/confronting-the-limits-of-viability
#1
EDITORIAL
Lucky Jain
No abstract text is available yet for this article.
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28477672/delivery-in-the-periviable-period
#2
EDITORIAL
Brian M Mercer, Keith J Barrington
No abstract text is available yet for this article.
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28477671/caring-for-families-at-the-limits-of-viability-the-education-of-dr-green
#3
REVIEW
Theophil A Stokes, Stephanie K Kukora, Renee D Boss
Resuscitation decisions for infants born at the edges of viability are complicated moral dilemmas, and the process of making these decisions is emotionally exhausting and morally distressful for families and physicians alike. An ethical approach to making these decisions requires input from physicians and parents; individuals tasked with facilitating such decisions must possess the communication and counseling skills needed to assist families with these painful and life-altering decisions. It is incumbent on all of us to continue our investigation into how we can better assist families in this process while providing care that is in their best interest...
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28477670/personalized-decision-making-practical-recommendations-for-antenatal-counseling-for-fragile-neonates
#4
REVIEW
Marlyse F Haward, Nathalie Gaucher, Antoine Payot, Kate Robson, Annie Janvier
Emphasis has been placed on engaging parents in processes of shared decision making for delivery room management decisions of critically ill neonates whose outcomes are uncertain and unpredictable. The goal of antenatal consultation should rather be to adapt to parental needs and empower them through a personalized decision-making process. This can be done by acknowledging individuality and diversity while respecting the best interests of neonates. The goal is for parents to feel like they have agency and ability and are good parents, before birth, at birth, and after, either in the NICU or until the death of their child...
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28477669/the-microbiota-of-the-extremely-preterm-infant
#5
REVIEW
Mark A Underwood, Kristin Sohn
Colonization of the extremely preterm infant's gastrointestinal tract and skin begins in utero and is influenced by a variety of factors, the most important including gestational age and environmental exposures. The composition of the intestinal and skin microbiota influences the developing innate and adaptive immune responses with short-term and long-term consequences including altered risks for developing necrotizing enterocolitis, sepsis, and a wide variety of microbe-related diseases of children and adults...
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28477668/nutrition-for-the-extremely-preterm-infant
#6
REVIEW
Kera McNelis, Ting Ting Fu, Brenda Poindexter
With advancements in the care of preterm infants, the goals in nutritional care have expanded from survival and mimicking fetal growth to optimizing neurodevelopmental outcomes. Inadequate nutritional support may be a risk factor for major complications of prematurity; conversely, higher disease burden is a risk for growth restriction. Early complete parenteral nutrition support, including intravenous lipid emulsion, should be adopted, and the next challenge that should be addressed is parenteral nutrition customized to fit the specific needs and metabolism of the extremely preterm infant...
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28477667/hemodynamic-assessment-and-monitoring-of-premature-infants
#7
REVIEW
Afif El-Khuffash, Patrick J McNamara
The management of the hemodynamic status of critically ill preterm infants, particularly around the periviable period, remains a significant challenge in the neonatal intensive care unit for a multitude of reasons. The causes of hemodynamic compromise in this population are heterogeneous and usually superimposed on the complex physiologic processes that occur during transition from fetal to neonatal life. This review outlines the unique nature of low blood flow states in this population and present an overview of the current methods for identification and assessment of hemodynamic compromise...
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28477666/management-of-extremely-low-birth-weight-infants-in-delivery-room
#8
REVIEW
Asma Nosherwan, Po-Yin Cheung, Georg M Schmölzer
Extremely low birth weight (ELBW) infants are particularly vulnerable at birth, and stabilization in the delivery room (DR) remains challenging. After birth, ELBW infants are at high risk for the development of thermal dysregulation, respiratory insufficiency, and hemodynamic instability due to their immature physiology and anatomy. Although successful stabilization facilitates the transition and reduces acute morbidity, suboptimal care in the DR could cause long-term sequelae. This review addresses the challenges in stabilization in the DR and current neonatal resuscitation guidelines and recommendations...
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28477665/medical-and-surgical-interventions-available-before-a-periviable-birth
#9
REVIEW
Edward K Chien, Kelly S Gibson
Periviable birth contributes disproportionately to perinatal morbidity and mortality. By analyzing the most relevant outcomes after a preterm birth some information can be provided on the potential benefit of interventions. This article discusses surgical and medical interventions that may offer neonatal benefit including cerclage, amniocentesis, progesterone, antenatal corticosteroids, magnesium sulfate for neuroprotection, and tocolysis. Cervical cerclage has the greatest promise at reducing morbidity and mortality related to periviable birth even though it may not reduce the overall preterm birth rate...
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28477664/epidemiology-of-periviable-births-the-impact-and-neonatal-outcomes-of-twin-pregnancy
#10
REVIEW
Cande V Ananth, Suneet P Chauhan
This article discusses a study that estimated the prevalence of twin live births in the United States that were delivered in the periviable (20-25 weeks) gestational age, and compared changes in twin neonatal mortality and morbidity rates between 2005 and 2013 overall, and at periviable gestations. Although the decline in twin neonatal mortality rates at 23 and 24 weeks is encouraging, and suggests advancement in the neonatal care of these extremely small twins, the concomitant increase in neonatal morbidity at 23 weeks is concerning...
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28477663/adult-consequences-of-extremely-preterm-birth-cardiovascular-and-metabolic-diseases-risk-factors-mechanisms-and-prevention-avenues
#11
REVIEW
Anne Monique Nuyt, Jean-Claude Lavoie, Ibrahim Mohamed, Katryn Paquette, Thuy Mai Luu
Extremely preterm babies are exposed to various sources of injury during critical stages of development. The extremely preterm infant faces premature transition to ex utero physiology and undergoes adaptive mechanisms that may be deleterious in the long term because of permanent alterations in organ structure and function. Perinatal events can also directly cause structural injury. These disturbances induce morphologic and functional changes in their organ systems that might heighten their risks for later adult chronic diseases...
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28477662/long-term-impact-of-preterm-birth-neurodevelopmental-and-physical-health-outcomes
#12
REVIEW
Thuy Mai Luu, Muhammad Oneeb Rehman Mian, Anne Monique Nuyt
Preterm birth severely disrupts the normal developmental maturation of organ systems, resulting in lasting adverse effects. High blood pressure, cardiac dysfunction, obstructive lung disease, elevated blood glucose, and mental health problems occur earlier and at higher rates in the preterm-born than in the term populations. Disadvantageous health conditions may have a significant impact on the well-being of preterm-born individuals from childhood through adulthood. This review summarizes the impact of preterm birth on neurodevelopment and on cardiovascular, renal, metabolic, and pulmonary health...
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28477661/survival-of-infants-born-at-periviable-gestational-ages
#13
REVIEW
Ravi Mangal Patel, Matthew A Rysavy, Edward F Bell, Jon E Tyson
Periviable births are those occurring from 20 0/7 through 25 6/7 weeks of gestation. Among and within developed nations, significant variation exists in the approach to obstetric and neonatal care for periviable birth. Understanding gestational age-specific survival, including factors that may influence survival estimates and how these estimates have changed over time, may guide approaches to the care of periviable births and inform conversations with families and caregivers. This review provides a historical perspective on survival following periviable birth, summarizes recent and new data on gestational age-specific survival rates, and addresses factors that have a significant impact on survival...
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28477660/periviable-birth-and-the-shifting-limit-of-viability
#14
REVIEW
Brian M Mercer
Periviable birth carries a high risk of fetal and newborn death, and the potential for life-long complications in survivors. The family at risk for periviable birth should receive objective, accurate, and up to date information regarding fetal, newborn, and maternal risks and outcomes with delivery or with continued pregnancy. This article describes the various descriptive terms for delivery near the limit of viability, considers the evolving limit of viability over time, and highlights the importance of adjusted counseling with brief pregnancy prolongation and/or changing clinical circumstances within the periviable period...
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28477659/care-of-extremely-small-premature-infants-in-the-neonatal-intensive-care-unit-a-parent-s-perspective
#15
REVIEW
Kelley Benham French
Parents and doctors look at a baby from fundamentally different perspectives. Every prognosis expands or contracts a universe for a doctor or a parent. When the clinician and the parent come together to make a life-and-death decision, language matters.
June 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28159214/dairy-cows-famines-and-what-neonatologists-can-learn-from-them
#16
EDITORIAL
Lucky Jain
No abstract text is available yet for this article.
March 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28159213/human-milk-for-preterm-infants
#17
EDITORIAL
Francis B Mimouni, Berthold Koletzko
No abstract text is available yet for this article.
March 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28159212/human-milk-treatment-and-quality-of-banked-human-milk
#18
REVIEW
Jean-Charles Picaud, Rachel Buffin
The aim of human milk banks is to deliver safe and high quality donor human milk. Treatment of human milk has to destroy most microorganisms while preserving immunological and nutrient components, which is obtained when using low time low temperature pasteurization. However it destroys bile-simulated lipase, reduces lactoferrin, lysozyme, immunoglobulins, and bactericidal capacity of human milk. New methods are under investigation such as high temperature short time pasteurization, high pressure processing, or ultraviolet irradiation...
March 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28159211/should-women-providing-milk-to-their-preterm-infants-take-docosahexaenoic-acid-supplements
#19
REVIEW
Berthold Koletzko
Based on the available data, a high milk docosahexaenoic acid supply to very low-birth-weight infants and to extremely low-birth-weight infants at levels that support tissue accretion rates similar to the high rates of intrauterine deposition has the potential to enhance the early visual and cognitive development, and to reduce the occurrence of adverse events, such as severe developmental delay, bronchopulmonary dysplasia, necrotizing enterocolitis, and allergic manifestations in infancy and early childhood...
March 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28159210/neurodevelopmental-outcomes-of-preterm-infants-fed-human-milk-a-systematic-review
#20
REVIEW
Beatrice E Lechner, Betty R Vohr
The neurodevelopmental benefits of breast milk feedings for preterm infants have been controversial. However, the effect on preterm infant neurodevelopment is sustained into childhood. The effects of breast milk feeding during the neonatal period and the duration of breastfeeding display effects on cognition into adolescence. The volume of breast milk received is a key factor in these effects. Additionally, emerging studies support the effects of human milk on structural brain development, such as increased white matter development and increased cortical thickness...
March 2017: Clinics in Perinatology
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