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Neonatal end of life

Austin T Mudd, Lindsey S Alexander, Stacey K Johnson, Caitlyn M Getty, Olga V Malysheva, Marie A Caudill, Ryan N Dilger
BACKGROUND: Choline is essential for synthesis of phospholipids, neurodevelopment, and DNA methylation. It is unknown whether dietary perinatal choline deficiency affects maternal milk composition. OBJECTIVE: We examined whether perinatal maternal dietary choline deficiency influences porcine-milk composition. METHODS: Yorkshire sows were fed choline-deficient (CD) or choline-sufficient (CS) gestation diets [544 or 1887 mg choline/kg dry matter (DM), respectively] from 65 d before to 48 h after parturition and then fed lactation diets (517 or 1591 mg choline/kg DM, respectively) through day 19 of lactation...
October 12, 2016: Journal of Nutrition
Fiona Brigid McDonald, Kumaran Chandrasekharan, Richard J A Wilson, Shabih U Hasan
Maternal cigarette smoke (CS) exposure exhibits a strong epidemiological association with Sudden Infant Death Syndrome but other environmental stressors, including infection, hyperthermia and hypoxia have also been postulated as important risk factors. This study examines if maternal CS exposure causes maladaptations within homeostatic control networks by influencing the response to lipopolysaccharide, heat stress and/or hypoxia in neonatal rats. Pregnant dams were exposed to CS or parallel sham treatments daily for the length of gestation...
October 12, 2016: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
Eva Hoffmannova, Šárka Bejdová, Jiri Borský, Ján Dupej, Veronika Cagáňová, Jana Velemínská
BACKGROUND: A new method of early neonatal cheiloplasty has recently been employed on patients having complete unilateral cleft lip and palate (cUCLP). We aimed to investigate (1) their detailed palatal morphology before surgery and growth during the 10 months after neonatal cheiloplasty, (2) the growth of eight dimensions of the maxilla in these patients, (3) the development of these dimensions compared with published data on noncleft controls and on cUCLP patients operated using later operation protocol (LOP; 6 months of age)...
November 2016: International Journal of Pediatric Otorhinolaryngology
Marie-Noëlle Bélanger-Lévesque, Marc Dumas, Simon Blouin, Jean-Charles Pasquier
BACKGROUND: While spirituality is well described in end-of-life care literature, research on its place in the delivery room remains largely limited to mother-oriented qualitative studies focusing on life-threatening situations (e.g., high-risk pregnancies). Our aim was to compare mothers' and fathers' spirituality during childbirth. METHODS: A mixed methods questionnaire was developed from our childbirth-related spirituality categorization and distributed to all parents of newborns, 12-24 h postpartum, over 45 consecutive days...
September 30, 2016: BMC Pregnancy and Childbirth
Joy E Lawn, Hannah Blencowe, Mary V Kinney, Fiorella Bianchi, Wendy J Graham
Despite the impressive progress gains for maternal and child health during the Millennium Development Goals era, over 5.6 million women and babies died in 2015 due to complications during pregnancy, birth and in the first month of life. In order to achieve the new mortality targets set out in the Sustainable Development Goals, there needs to be intentional efforts to maintain and accelerate action to end preventable maternal and newborn deaths and stillbirths. This paper outlines what progress is required to meet these new 2030 targets based on patterns of progress in the recent past; where the burden is the greatest; when to focus attention along the continuum of care; and what causes of death require concerted efforts...
July 28, 2016: Best Practice & Research. Clinical Obstetrics & Gynaecology
Deborah Gilmour, Mark W Davies, Anthony R Herbert
AIM: End-of-life care remains part of the scope of practice in all neonatal units. This study aimed to characterise the end-of-life care provided in an Australian tertiary neonatal centre, where paediatric palliative care was accessible via a consultative service. METHODS: This retrospective cohort study examined indicators of quality palliative care provided to 46 infants born within a 30-month period. The cohort included four infants who received palliative care consultations additional to usual neonatal care...
October 4, 2016: Journal of Paediatrics and Child Health
Melanie J Cozad, Lisa C Lindley, Sandy J Mixer
The use of agency nurses offers flexibility in filling registered nurse (RN) openings during times of shortage, yet little is known about their use in specialized palliative care. In an effort to fill this knowledge gap, this study determined whether significant relationships existed between full-time and part-time RN vacancies and the use of agency RNs within specialized hospices that deliver perinatal end-of-life care to women and their families in the event of miscarriage, ectopic pregnancy, or other neonatal complications resulting in death...
September 27, 2016: Policy, Politics & Nursing Practice
Chloe Shaw, Elizabeth Stokoe, Katie Gallagher, Narendra Aladangady, Neil Marlow
The article analyses the decision-making process between doctors and parents of babies in neonatal intensive care. In particular, it focuses on cases in which the decision concerns the redirection of care from full intensive care to palliative care at the end of life. Thirty one families were recruited from a neonatal intensive care unit in England and their formal interactions with the doctor recorded. The conversations were transcribed and analysed using conversation analysis. Analysis focused on sequences in which decisions about the redirection of care were initiated and progressed...
September 25, 2016: Sociology of Health & Illness
Anouk Bokslag, Mirjam van Weissenbruch, Ben Willem Mol, Christianne J M de Groot
Preeclampsia is a common pregnancy specific disease, that presents with hypertension and a variety of organ failures, including malfunction of kidneys, liver and lungs. At present, the only definitive treatment of preeclampsia is end the pregnancy and deliver the neonate and placenta. For women with mild preeclampsia in the preterm phase of pregnancy, expectant management is generally indicated to improve fetal maturity, often requiring maternal medical treatment. Last decades, more evidence is available that the underlying mechanism of preeclampsia, endothelial disease, is not limited to pregnancy but increases cardiovascular risk in later life...
September 19, 2016: Early Human Development
Flaminia Cesare Marincola, Sara Corbu, Milena Lussu, Antonio Noto, Angelica Dessì, Stefania Longo, Elisa Civardi, Francesca Garofoli, Beatrice Grenci, Elisa Mongini, Andrea Budelli, Alessia Grinzato, Francesca Fasano, Vassilios Fanos, Mauro Stronati
NMR-based metabolomics was used to compare the metabolic urinary profiles of exclusively breast-fed term infants (n = 11) with those of a double-blinded controlled trial with 49 formula-fed term newborns randomized to receive either an infant formula enriched by functional ingredients (n = 24) or a standard formula (n = 25). Anthropometric measurements and urine samples were taken at enrollment (within the first month of life), at around 60 days of life, and at the end of study period (average age of 130 days)...
October 7, 2016: Journal of Proteome Research
Carmen Mesas Burgos, Agnes Modée, Elin Öst, Björn Frenckner
INTRODUCTION: Despite improvements of neonatal intensive care, mortality among patients born with congenital diaphragmatic hernia (CDH), remains high, and there is a significant late mortality in this cohort. OBJECTIVE: The aim of this study was to evaluate the causes of death among 251 consecutive CDH patients treated at our institution during the last 26years period. METHODS: Retrospective review of all causes of death between 1990 and 2015 of the CDH cohort prospectively collected in a database...
September 5, 2016: Journal of Pediatric Surgery
Narges Sadeghi, Marzieh Hasanpour, Mohamad Heidarzadeh
BACKGROUND: Hospitalization of a neonate in the neonatal intensive care unit (NICU) can be a stressful event for parents. They need specific information and communication to alleviate their stress, but these parental needs are not met by NICU staff. Exploration of these needs can help health professionals to provide better healthcare services. OBJECTIVES: The purpose of this study was to explore the information and communication needs of families in neonatal end-of-life and bereavement in the NICU...
June 2016: Iranian Red Crescent Medical Journal
Wojciech Roczniak, Joanna M Oswiecimska, Barbara Brodziak-Dopierala, Elzbieta Cipora, Przemyslaw G Nowak, Magdalena Babuska-Roczniak
OBJECTIVES: Stimulation of some noradrenergic system receptors demonstrates a synergistic anti-nociceptive effect with the opioid system at the level of peripheral tissues, spinal cord, and supraspinal structures. Furthermore, opioids stimulate the noradrenergic descending pathways originating from the substantia nigra by presynaptic inhibition of the GABA neuron ends. It is thus important to determine whether a disruption to the adrenergic transmission obtained via DPS-4 administration to neonatal rats impacts the perception of noxious stimuli mediated by 5-HT3-serotonin receptors at the level of spinal cords or higher tiers of the central nervous system...
July 16, 2016: Neuro Endocrinology Letters
J Downing, R Kiman, S Boucher, B Nkosi, B Steel, C Marston, E Lascar, J Marston
The International Children's Palliative Care Network held its second international conference on children's palliative care in Buenos Aires, Argentina, from the 18th-21st May 2016. The theme of the conference was 'Children's Palliative Care…. Now!' emphasising the need for palliative care for children now, as the future will be too late for many of them. Six pre-conference workshops were held, addressing issues connected to pain assessment and management, adolescent palliative care, ethics and decision-making, developing programmes, the basics of children's palliative care, and hidden aspects of children's palliative care...
2016: Ecancermedicalscience
Katharina Hellbach, Andre Yaroshenko, Konstantin Willer, Tina Pritzke, Alena Baumann, Nina Hesse, Sigrid Auweter, Maximilian F Reiser, Oliver Eickelberg, Franz Pfeiffer, Anne Hilgendorff, Felix G Meinel
OBJECTIVE: The aim of this study was to evaluate the diagnostic value of x-ray dark-field imaging in projection radiography-based depiction of pneumothoraces in the neonatal murine lung, a potentially life-threatening medical condition that requires a timely and correct diagnosis. MATERIALS AND METHODS: By the use of a unique preclinical model, 7-day-old C57Bl/6N mice received mechanical ventilation for 2 or 8 hours with oxygen-rich gas (FIO2 = 0.4; n = 24). Unventilated mice either spontaneously breathed oxygen-rich gas (FIO2 = 0...
October 2016: Investigative Radiology
Marion Mitchell, Maureen Coombs, Krista Wetzig
BACKGROUND: Caring for the bereaved is an intrinsic part of intensive care practice with family bereavement support an important aspect of the nursing role at end of life. However, reporting on provision of intensive care family bereavement support at a national level has not been well reported since an Australian paper published ten years ago. OBJECTIVES: The objective was to investigate provision of family bereavement support in intensive care units (ICU) across New Zealand (NZ) and Australia...
August 25, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Sabine Huenecke, Esther Fryns, Boris Wittekindt, Horst Buxmann, Christoph Königs, Andrea Quaiser, Doris Fischer, Melanie Bremm, Thomas Klingebiel, Ulrike Koehl, Rolf Schloesser, Konrad Bochennek
Preterm newborns show an increased susceptibility to infections, conceivably related to their immature immune system. To gain further knowledge about the immune development in early preterm infants, we aimed to establish references for lymphocyte subsets and compare the maturation process during hospitalization to healthy term-born children and adolescents. For this purpose peripheral blood samples (n=153) were collected from 40 preterm infants; gestational age (GA) 26 to 30 week between 2(nd) and 6(th) day of life and were monitored in intervals of every 2 or rather 4 weeks until the end of hospitalization...
August 22, 2016: Scandinavian Journal of Immunology
Stephen C Brown, Benedicte Eyskens, Derize Boshoff, Bjorn Cools, Ruth Heying, Filip Rega, Bart Meyns, Marc Gewillig
OBJECTIVES: To determine the outcome of a bailout procedure using the right ventricle to re-assist the left ventricle in neonates after technically adequate coarctectomy but a failing borderline left heart. METHODS: The surgical procedure was performed on bypass. A 'reversed' 6-mm surgical shunt was inserted between the pulmonary trunk and the descending aorta together with bilateral branch pulmonary artery banding. RESULTS: Over a 10-year period, 89 neonates presented with coarctation and small left hearts...
August 19, 2016: Interactive Cardiovascular and Thoracic Surgery
Malki Miller, Keyur Donda, Alok Bhutada, Deepa Rastogi, Shantanu Rastogi
BACKGROUND: Growth in preterm infants is compromised during the transition phase of nutrition, when parenteral nutrition (PN) volumes are weaned with advancing enteral nutrition (EN) feeds, likely due to suboptimal nutrient intakes during this time. We implemented new PN guidelines designed to maintain optimal nutrient intakes during the transition phase and compared growth outcomes of this cohort with a control group. MATERIALS AND METHODS: A chart review was conducted on infants born <32 weeks' gestation, before (control group) and after (study group) a new transition PN protocol was implemented in the neonatal intensive care unit...
August 18, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
Bo Yang, Bo Xu Ren, Feng Ru Tang
Embryo/fetus is much more radiosensitive than neonatal and adult human being. The main potential effects of pre-natal radiation exposure on the human brain include growth retardation, small head/brain size, mental retardation, neocortical ectopias, callosal agenesis and brain tumor which may result in a lifetime poor quality of life. The patterns of prenatal radiation-induced effects are dependent not only on the stages of fetal development, the sensitivity of tissues and organs, but also on radiation sources, doses, dose rates...
August 12, 2016: Brain & Development
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