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Neonatal palliative

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https://www.readbyqxmd.com/read/28100120/hybrid-stage-i-procedure-as-initial-palliation-for-neonate-with-hypoplastic-left-heart-syndrome-and-right-congenital-diaphragmatic-hernia
#1
Draginja Cvetkovic, Joseph Giamelli, Michael Lyew, Markus Erb, Suvro Sett, Youmna DiStefano
During the past decade, a hybrid procedure has emerged and dramatically evolved as an alternative stage I palliation to the conventional Norwood procedure in neonates with hypoplastic left heart syndrome (HLHS). The hybrid approach avoids the need for cardiopulmonary bypass (CPB) utilizing stenting of the arterial duct and bilateral pulmonary artery banding. Cerebral and coronary perfusion pressure is maintained, and the pulmonary vasculature is protected from higher systemic pressure. Elimination of risks associated with CPB gains vital time to stabilize the patient and correct coexisting noncardiac anomalies and allows growth in preparation for the later stages of the Fontan pathway...
January 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28093463/bidirectional-cavopulmonary-anastomosis-with-additional-pulmonary-blood-flow-good-or-bad-pre-fontan-strategy
#2
Nataliya R Nichay, Yuriy N Gorbatykh, Igor A Kornilov, Ilya A Soynov, Sergey M Ivantsov, Artem V Gorbatykh, Dmitriy N Ponomarev, Alexander V Bogachev-Prokophiev, Alexander M Karaskov
OBJECTIVES: This study aimed to evaluate the influence of preserved additional pulmonary blood flow (APBF) on survival after bidirectional cavopulmonary shunt (BCPS) and completion of Fontan circulation. METHODS: From March 2003 and April 2015, 156 patients with a single ventricle underwent BCPS. After performing propensity score analysis (1:1) for the entire sample, 50 patients with APBF (APBF group) were matched with 50 patients without APBF (no-APBF group). RESULTS: Age (P = 0...
January 15, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28092282/neonatal-palliative-care
#3
Elvira Parravicini
PURPOSE OF REVIEW: A significant number of newborns are affected by life-limiting or life-threatening conditions. When prolongation of survival is no longer a goal, or prognosis is uncertain, a plan of care focused on the infant's comfort is essential. The aim of this article is to review the most recent and relevant literature regarding neonatal palliative care (NPC). RECENT FINDINGS: A variety of perinatal and NPC programs are described, but most programs focus exclusively on end-of-life care...
January 13, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28077181/at-what-age-should-tetralogy-of-fallot-be-corrected
#4
Julien I E Hoffman
Tetralogy of Fallot can be corrected with very low mortality at any age, even in neonates, but this does not necessarily mean that it should be corrected in the neonatal period. Although there are many advantages to early correction, a high proportion of these neonates have residual stenosis or pulmonary regurgitation that impairs ventricular function and may require further surgery or implantation of a pulmonary valve. Before we had the ability to correct this anomaly with low mortality in small children, a variety of palliative procedures had to be performed...
January 12, 2017: Cardiology in the Young
https://www.readbyqxmd.com/read/28041869/-palliative-care-after-neonatal-intensive-care-contributions-of-leonetti-law-and-remaining-challenges
#5
P Kuhn, L Dillenseger, N Cojean, B Escande, C Zores, D Astruc
The 2005 enactment of the "Patients' rights and end-of-life care" act, known as the Leonetti law, has been accompanied by practical changes in the processes of withdrawal and withholding of active life-sustaining treatments. This law has also promoted the implementation of palliative care in perinatal medicine to avoid unreasonable therapeutic interventions and to preserve the dying patient's quality of life and human dignity. Recently, a new law has been voted by the French National Assembly and new reflections on the ethical aspects of the end of life in neonatal medicine should resume again within the French Society of Neonatology in the working group on ethical issues in neonatology...
December 29, 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28029339/long-term-outcomes-of-single-ventricle-palliation-for-unbalanced-atrioventricular-septal-defects-fontan-survivors-do-better-than-previously-thought
#6
Edward Buratto, Xin Tao Ye, Gregory King, William Y Shi, Robert G Weintraub, Yves d'Udekem, Christian P Brizard, Igor E Konstantinov
BACKGROUND: Single-ventricle palliation (SVP) for children with unbalanced atrioventricular septal defect (uAVSD) is thought to carry a poor prognosis, but limited data have been reported. METHODS: We performed a retrospective review of children with uAVSD who underwent SVP at a single institution. Data were obtained from medical records and correspondence with general practitioners and cardiologists. RESULTS: Between 1976 and 2016, a total of 139 patients underwent SVP for uAVSD...
September 24, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28025631/amniotic-band-syndrome-perinatal-hospice-and-palliative-care-versus-active-management
#7
Shadi Rezai, Justin Faye, Annika Chadee, Sri Gottimukkala, Ruchi Upadhyay, Carla Lara, Benamanahalli H Rajegowda, Andrew D Corwin, Rasila V Lala, Jessica Vernon, Dilfuza Nuritdinova, Stephen Chasen, Cassandra E Henderson
Introduction. Amniotic band syndrome and sequence are a relatively rare condition in which congenital anomalies occur as a result of the adherence and entrapment of fetal parts with coarse fibrous bands of the amniotic membrane. A large percentage of reported cases have an atypical gestational history. The frequency of this obstetric complication is not affected by fetal gender, genetic abnormality, or prenatal infection. Case. A 21-year-old, G1P0 female parturient at 18 weeks and 5 days with a single intrauterine gestation during a routine ultrasound evaluation was noted to have amniotic band sequence...
2016: Case Reports in Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28007511/-neonatal-palliative-care-at-home-contribution-of-the-regional-pediatric-palliative-care-team
#8
N Cojean, C Strub, P Kuhn, L Calvel
The "patients' rights and end-of-life care" act, known as the Leonetti law, has allowed implementation of palliative care in neonatology as an alternative to unreasonable therapeutic interventions. A palliative care project can be offered to newborns suffering from intractable diseases. It must be focused on the newborn's quality of life and comfort and on family support. Palliative care for newborns can be provided in the delivery room, in the neonatal unit, and also at home. Going home is possible but requires medical support...
December 19, 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/27964765/arginine-vasopressin-therapy-in-hypotensive-neonates-and-infants-after-cardiac-surgery-response-is-unrelated-to-baseline-ventricular-function
#9
Ilias Iliopoulos, Saul Flores, J N Pratap, David S Cooper, Amy Cassedy, David P Nelson
We hypothesised that infants with ventricular dysfunction after cardiac surgery have impaired haemodynamic response to arginine-vasopressin therapy. We retrospectively reviewed the medical records of neonates and infants treated with arginine-vasopressin within 48 hours of corrective or palliative cardiac surgery who underwent echocardiographic assessment of ventricular function before initiation of therapy. Patients were classified as "responders" if their systolic blood pressure increased by ⩾10% without increase in catecholamine score or if it was maintained with decreased catecholamine score...
December 14, 2016: Cardiology in the Young
https://www.readbyqxmd.com/read/27941515/parents-and-families-experiences-of-palliative-and-end-of-life-neonatal-care-in-neonatal-settings-a-systematic-review-protocol
#10
Jann Foster, Victoria Kain, Tiffany Patterson
The overall objective of this systematic review is to identify, critically appraise and synthesize the parents' and families' experiences of palliative and end-of-life neonatal care at facilities/services globally. The specific review question is: what are parents' and families' experiences of palliative and end-of-life neonatal care?
November 2016: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/27938905/the-effects-of-postoperative-hematocrit-on-shunt-occlusion-for-neonates-undergoing-single-ventricle-palliation
#11
Brett R Anderson, Victoria L Blancha, Jennifer M Duchon, Paul J Chai, David Kalfa, Emile A Bacha, Ganga Krishnamurthy, Veniamin Ratner
OBJECTIVES: Our primary objective was to test the effects of first postoperative hematocrit on early shunt occlusion for children undergoing systemic to pulmonary artery shunt placement. Because any intervention to reduce shunt occlusion is only beneficial if it reduces mortality or is, at least, mortality neutral, we also tested the effects of first postoperative hematocrit on in-hospital mortality. METHODS: We conducted a retrospective study on all neonates who underwent primary systemic to pulmonary artery shunt placement, with or without a Norwood/Damus-Kaye-Stansel procedure, at Columbia University Medical Center between January 2010 and July 2015...
November 14, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27913766/myocardial-cytochrome-oxidase-activity-increases-with-age-and-hypoxemia-in-patients-with-congenital-heart-disease
#12
Michael Onwugbufor, Richard J Levy, David Zurakowski, Richard A Jonas, Pranava Sinha
BACKGROUND: Myocardial tolerance to ischemia is influenced by age and preoperative cyanosis through unknown mechanisms and significantly affects postoperative outcomes. Cytochrome c oxidase (CcOx), the terminal enzyme of the mitochondrial electron transport chain, may play a role in the susceptibility to ischemic-reperfusion (IR) injury. Our study aimed at investigating changes in human myocardial CcOx activity based on age and preoperative oxygen saturation to understand its role in transition from neonatal to mature myocardium and hypoxic conditions...
December 1, 2016: Perfusion
https://www.readbyqxmd.com/read/27907936/early-treatment-for-neonatal-abstinence-syndrome-a-palliative-approach
#13
Jennifer Hudson, Rachel Mayo, Lori Dickes, Liwei Chen, Windsor Westbrook Sherrill, Julie Summey, Bradley Dalton, Kindal Dankovich
Objective To describe medical, safety, and health care utilization outcomes associated with an early treatment model for neonatal opioid withdrawal. Study Design This is a retrospective review of 117 opioid-exposed infants born in a large regional hospital and treated in the level I nursery with methadone initiated within 48 hours of birth. Results For this cohort, mean length of stay was 8.3 days. Hospital safety events were infrequent; there were no medication errors or deaths. Within 30 days of discharge, 14% of infants visited the emergency department; 7% were readmitted...
December 1, 2016: American Journal of Perinatology
https://www.readbyqxmd.com/read/27879470/incidence-and-management-of-thrombotic-and-thromboembolic-complications-following-the-norwood-procedure-a-systematic-review
#14
Arnav Agarwal, Mohammed Firdouse, Nishaan Brar, Andy Yang, Panos Lambiris, Anthony K Chan, Tapas K Mondal
BACKGROUND: The stage 1 Norwood procedure and its variants represent the first step of palliation for hypoplastic left heart syndrome. Although appropriate postoperative thromboprophylaxis is integral, significant variance remains across institutional practices. The purpose of this systematic review is to estimate the incidence of thrombosis and thromboembolism following the Norwood or modified Blalock-Taussig shunt procedure and examine current thromboprophylaxis regimens. METHODS: Ovid MEDLINE and Embase were searched from January 2000 to June 2016 for primary studies explicitly reporting incidence of thrombosis, thromboembolism (strokes and pulmonary embolisms), or shunt occlusion in neonates, infants, and children undergoing the Norwood procedure or any variant...
November 21, 2016: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/27858281/herpesvirus-an-underestimated-virus
#15
REVIEW
Daniele Zendrini Rechenchoski, Ligia Carla Faccin-Galhardi, Rosa Elisa Carvalho Linhares, Carlos Nozawa
Herpes simplex virus (HSV) infections are common and widespread; nevertheless, their outcome can be of unpredictable prognosis in neonates and in immunosuppressed patients. Anti-HSV therapy is effective, but the emergence of drug-resistant strains or the drug toxicity that hamper the treatment is of great concern. Vaccine has not yet shown relevant benefit; therefore, palliative prophylactic measures have been adopted to prevent diseases. This short review proposes to present concisely the history of HSV, its taxonomy, physical structure, and replication and to explore the pathogenesis of the infection, clinical manifestations, laboratory diagnosis, treatment, prophylaxis and epidemiology of the diseases...
November 17, 2016: Folia Microbiologica
https://www.readbyqxmd.com/read/27849163/fifteen-minute-consultation-perinatal-palliative-care
#16
Peter Sidgwick, Emily Harrop, Brenda Kelly, Ana Todorovic, Dominic Wilkinson
Perinatal palliative medicine is an emerging subspecialty within paediatric palliative medicine, neonatal medicine, fetal medicine and obstetrics. It comprises patient-focused, non-judgemental shared decision making and aims to provide holistic multidisciplinary support for families. In this paper we define and describe one model for providing perinatal palliative care, drawing on the personal and professional experience of the authors.
November 14, 2016: Archives of Disease in Childhood. Education and Practice Edition
https://www.readbyqxmd.com/read/27826706/clinical-associations-of-early-dysnatremias-in-critically-ill-neonates-and-infants-undergoing-cardiac-surgery
#17
Jon Kaufman, Daniel Phadke, Suhong Tong, Jennifer Eshelman, Sarah Newman, Christopher Ruzas, Eduardo M da Cruz, Suzanne Osorio
: Dysnatremias (DN) are common electrolyte disturbances in cardiac critical illness and are known risk factors for adverse outcomes in certain populations. Little information exists on DN in children with cardiac disease admitted to the cardiac intensive care unit (CICU) after undergoing cardiac surgery, either corrective or palliative. The aim was to determine the incidence and adverse outcomes associated with DN in neonates and infants undergoing cardiac surgery. Retrospective cohort and single center study performed at Children's Hospital Colorado from May 2013 to May 2014, in children under 1 year old admitted to the CICU after undergoing surgery for congenital or acquired cardiac disease...
November 8, 2016: Pediatric Cardiology
https://www.readbyqxmd.com/read/27824769/palliative-care-in-obstetrics-and-gynecology
#18
Carolyn Lefkowits, Caroline Solomon
Palliative care is specialized care for people with life-limiting illness; it focuses on symptom management and quality of life and ensures that a patient's care is concordant with her goals and values. Unlike end-of-life care, palliative care can be offered concurrently with disease-directed therapies, including when the goal is cure. Obstetrics and gynecology patients for whom palliative care is most appropriate include women with gynecologic cancer and women with a fetus or neonate with a potentially life-limiting illness...
December 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27817953/mechanically-assisted-bidirectional-cavopulmonary-shunt-in-neonates-and-infants-an-acute-human-pilot-study
#19
Osami Honjo, Sandra L Merklinger, John B Poe, Anne-Marie Guerguerian, Hargen Zhang, Katherine L Taylor, Glen S Van Arsdell
OBJECTIVE: Poor survival following surgical palliation for hypoplastic left heart syndrome (HLHS) raises the question of the need for a paradigm shift. This is the first human study to investigate the possibility of primary "in-series" palliation in neonates and infants with HLHS in an acute setting with the aid of 2 types of mechanical assist: superior vena cava (SVC)-to-pulmonary artery (PA) pump assist and SVC-to-right atrium (RA) oxygenation assist. METHODS: By rearranging the cannula sites and flow rates for modified ultrafiltration, 2 types of mechanically assisted bidirectional cavopulmonary shunt (BCPS) circulation were simulated for 20 minutes...
September 28, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27806964/phosphodiesterase-inhibitor-based-vasodilation-improves-oxygen-delivery-and-clinical-outcomes-following-stage-1-palliation
#20
Kimberly I Mills, Aditya K Kaza, Brian K Walsh, Hilary C Bond, Mackenzie Ford, David Wypij, Ravi R Thiagarajan, Melvin C Almodovar, Luis G Quinonez, Christopher W Baird, Sitaram E Emani, Frank A Pigula, James A DiNardo, John N Kheir
BACKGROUND: Systemic vasodilation using α-receptor blockade has been shown to decrease the incidence of postoperative cardiac arrest following stage 1 palliation (S1P), primarily when utilizing the modified Blalock-Taussig shunt. We studied the effects of a protocol in which milrinone was primarily used to lower systemic vascular resistance (SVR) following S1P using the right ventricular to pulmonary artery shunt, measuring its effects on oxygen delivery (DO2) profiles and clinical outcomes...
November 2, 2016: Journal of the American Heart Association
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