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Neonatal hypotension

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https://www.readbyqxmd.com/read/29785061/targeted-neonatal-echocardiography-tne-consult-service-in-a-large-tertiary-perinatal-center-in-canada
#1
Ismina Papadhima, Deepak Louis, Jyotsna Purna, Poorva Deshpande, Yenge Diambomba, Shoo Lee, Prakesh Shah, Dany Weisz, Afif El-Khuffash, Patrick J McNamara, Luc Mertens, Amish Jain
OBJECTIVE: To describe the utilization and study the factors associated with the impact on clinical management of a new TNE consultation service in a perinatal center. METHODS: This retrospective cohort study included all neonates who underwent TNE consultation at the neonatal unit of Mount Sinai Hospital in Toronto, Canada (November 2011 and July 2015). The consults that had "impact" were defined as those that led to a TNE suggested change in the clinical management within 6 h of its recommendation...
May 22, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29781504/epidural-versus-non-epidural-or-no-analgesia-for-pain-management-in-labour
#2
REVIEW
Millicent Anim-Somuah, Rebecca Md Smyth, Allan M Cyna, Anna Cuthbert
BACKGROUND: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain, and is widely used as a form of pain relief in labour. However, there are concerns about unintended adverse effects on the mother and infant. This is an update of an existing Cochrane Review (Epidural versus non-epidural or no analgesia in labour), last published in 2011. OBJECTIVES: To assess the effectiveness and safety of all types of epidural analgesia, including combined-spinal-epidural (CSE) on the mother and the baby, when compared with non-epidural or no pain relief during labour...
May 21, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29740192/safety-of-fentanyl-for-peripherally-inserted-central-catheter-in-non-intubated-infants-in-the-neonatal-intensive-care-unit
#3
Yair Kasirer, Vibhuti Shah, Eugene W Yoon, Ruben Bromiker, Carol Mcnair, Anna Taddio
OBJECTIVE: To evaluate the safety of fentanyl in non-intubated infants undergoing peripherally inserted central catheter (PICC) placement. METHODS: A retrospective chart review of PICC placements over a 3 years' period. We compared the 12h periods before and after fentanyl for clinically significant cardiorespiratory events (spells). RESULTS: Of the 998 neonates screened, 258 were eligible. The mean standard deviation gestational age was 34...
May 8, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29707527/treating-hypotension-in-preterm-neonates-with-vasoactive-medications
#4
REVIEW
Chloe Joynt, Po-Yin Cheung
Preterm neonates often have hypotension which may be due to various etiologies. While it is controversial to define hypotension in preterm neonates, various vasoactive medications are commonly used to provide the cardiovascular support to improve the blood pressure, cardiac output, or to treat shock. However, the literature on the systemic and regional hemodynamic effects of these antihypotensive medications in neonates is deficient and incomplete, and cautious translation of findings from other clinical populations and animal studies is required...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29682496/inotropes-for-preterm-infants-50-years-on-are-we-any-wiser
#5
REVIEW
Aisling A Garvey, Elisabeth M W Kooi, Eugene M Dempsey
For almost half a century, inotropes have been administered to preterm infants with the ultimate goal of increasing their blood pressure. A number of trials, the majority of which focused on dopamine administration, have demonstrated increased blood pressure following inotrope administration in preterm infants and have led to continued use of inotropes in our neonatal units. We have also seen an increase in the number of potential agents available to the clinician. However, we now know that hypotension is a much broader concept than blood pressure alone, and our aim should instead be focused on improving end organ perfusion, specifically cerebral perfusion...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29624207/large-differences-in-neonatal-drug-use-between-nicus-are-common-practice-time-for-consensus
#6
R B Flint, F van Beek, P Andriessen, L Zimmermann, K D Liem, I K M Reiss, R de Groot, D Tibboel, D M Burger, S H P Simons
INTRODUCTION: Evidence for drug use in newborn is sparse, which may cause large differences in drug prescriptions. We aimed to investigate the differences between neonatal intensive care units (NICUs) in the Netherlands in currently prescribed drugs. MATERIALS AND METHODS: This multicenter study included neonates admitted during 12 months to four different NICUs. Drugs were classified in accordance with the Anatomical Therapeutic Chemical (ATC) classification system and assessed for on/off-label status in relation to neonatal age...
April 6, 2018: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29610159/use-of-insulin-glargine-in-the-management-of-neonatal-hyperglycemia-in-an-elbw-infant
#7
Min J Hwang, Robert Newman, Katherine Philla, Elizabeth Flanigan
Neonatal hyperglycemia is common in extremely low birth weight (ELBW) infants because of physiologic stress, exogenous glucose infusion, and postnatal corticosteroid therapy for hypotension, adrenal insufficiency, and pulmonary immaturity. The use of long-acting insulin glargine has been described in the treatment of transient neonatal diabetes in the premature infant, but in these reports is a lack of regard to its use in the treatment of iatrogenic neonatal hyperglycemia. We present the case of an ELBW infant with significant hyperglycemia that was refractory to usual treatment but demonstrated a favorable response to long-acting subcutaneous insulin glargine...
April 2018: Pediatrics
https://www.readbyqxmd.com/read/29600242/circulatory-insufficiency-and-hypotension-related-to-the-ductus-arteriosus-in-neonates
#8
REVIEW
Danielle R Rios, Soume Bhattacharya, Philip T Levy, Patrick J McNamara
The biological role of the ductus arteriosus (DA) in neonates varies from an innocent bystander role during normal postnatal transition, to a supportive role when there is compromise to either systemic or pulmonary blood flow, to a pathological state in the presence of hemodynamically significant systemic to pulmonary shunts, as occurs in low birth weight infants. Among a wide array of clinical manifestations arising due to the ductal entity, systemic circulatory insufficiency and hypotension are of significant concern as they are particularly challenging to manage...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29594003/snake-bite-in-third-trimester-of-pregnancy-with-systemic-envenomation-and-delivery-of-a-live-baby-in-a-low-resource-setting-a-case-report
#9
Adebayo A Adewole, Osadolor A Ugiagbe, Temitope G Onile, Gabriel A Joseph, Oluwamayowa D Kassim, Patricia F Medupin, Abiodun S Adeniran
Background: Snake bite in the third trimester of pregnancy with late presentation, systemic envenomation; disseminated intravascular coagulopathy and delivery of a live neonate is uncommon in a low resource setting. Case: We present a 22 year old unbooked Gravida 3 Para 1+ 1 1alive lentiviral positive woman at 32 weeks gestation with snake bite, leg swelling, vaginal bleeding and labour pains. At presentation, there were anemia, tachycardia, hypotension; a gravid uterus with a single fetus in longitudinal lie, cephalic presentation, regular fetal heart rate and cervical dilatation of 3 cm...
October 2017: Case Reports in Women's Health
https://www.readbyqxmd.com/read/29587655/impedance-cardiography-as-tool-for-continuous-hemodynamic-monitoring-during-cesarean-section-randomized-prospective-double-blind-study
#10
Alessandro D'Ambrosio, Antonella Cotoia, Renata Beck, Potito Salatto, Lada Zibar, Gilda Cinnella
BACKGROUND: Impedance Cardiography (ICG) is a non-invasive tool for continuous hemodynamic monitoring. Aims of our study were to assess the utility of ICG to evaluate the hemodynamic impact of 6 mg (GL6) vs 8 mg (GL8) levobupivacaine combined with fentanyl in healthy patients undergoing elective cesarean section; secondary, to compare the duration and quality of analgesia and anesthesia. METHODS: Sixty-two women receiving combined spinal-epidural (CSE) for elective cesarean delivery were randomly allocated to GL6 or GL8 groups...
March 27, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29554082/postnatal-developmental-changes-in-the-sensitivity-of-l-type-ca-2-channel-to-inhibition-by-verapamil-in-a-mouse-heart-model
#11
Hironori Sagawa, Shinsuke Hoshino, Kengo Yoshioka, Wei-Guang Ding, Mariko Omatsu-Kanbe, Masao Nakagawa, Yoshihiro Maruo, Hiroshi Matsuura
BackgroundIn the clinical setting, verapamil is contraindicated in neonates and infants, because of the perceived risk of hypotension or bradyarrhythmia. However, it remains unclear whether there is an age-dependent difference in the sensitivity of cardiac L-type Ca2+ channel current (ICa,L ) to inhibition by verapamil.MethodsVentricular myocytes were enzymatically dissociated from the hearts of six different age groups (0, 7, 14, 21, 28 days, and 10-15 weeks) of mice, using a similar Langendorff-perfusion method...
April 18, 2018: Pediatric Research
https://www.readbyqxmd.com/read/29520867/randomised-double-blind-comparison-of-bolus-phenylephrine-or-ephedrine-for-treatment-of-hypotension-in-women-with-pre-eclampsia-undergoing-caesarean-section
#12
M Mohta, S Duggal, G T Chilkoti
Treatment of post-spinal hypotension during caesarean section assumes special concern in pre-eclamptic patients due to a compromised fetoplacental circulation and increased risk of placental hypoperfusion. Phenylephrine and ephedrine are the most commonly used vasopressors, although the best choice is still not clear. We studied 80 pre-eclamptic women with a singleton pregnancy who underwent caesarean section with spinal anaesthesia, and who developed hypotension defined as a decrease in systolic arterial pressure ≥ 20% from baseline or absolute value < 100 mmHg...
March 9, 2018: Anaesthesia
https://www.readbyqxmd.com/read/29516705/comparison-of-the-effects-of-low-doses-of-dexmedetomidine-and-remifentanil-on-the-maternal-haemodynamic-changes-during-caesarean-delivery-in-patients-with-severe-preeclampsia-a-randomised-trial
#13
Mohamed R El-Tahan, Samah El Kenany, Ehsan M Abdelaty, Eiad A Ramzy
BACKGROUND: Preoperative remifentanil administration blunts haemodynamic responses to tracheal intubation in parturients with severe preeclampsia. We hypothesised that the preoperative administration of low doses of remifentanil or dexmedetomidine would lead to comparable maternal neurohormonal responses and neonatal outcomes in patients with severe preeclampsia. METHODS: Parturients diagnosed with severe preeclampsia undergoing caesarean delivery were randomly allocated to receive remifentanil (0...
March 7, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29515305/rare-cause-of-hyperkalemia-in-the-newborn-period-report-of-two-cases-of-pseudohypoaldosteronism-type-1
#14
R Manipriya, B Umamaheswari, A Prakash, N Binu
Pseudohypoaldosteronism (PHA) Type 1 is characterized by mineralocorticoid resistance, manifesting as neonatal salt wasting, hypotension, hyperkalemia, hyponatremia, and metabolic acidosis in spite of elevated aldosterone levels and plasma renin activity. It is important to differentiate children with systemic PHA from renal PHA, as these children are likely to decompensate even with mild symptoms. Here, we report two neonates with PHA that presented to us with multiorgan involvement.
January 2018: Indian Journal of Nephrology
https://www.readbyqxmd.com/read/29499081/beta-blockers-for-prevention-and-treatment-of-retinopathy-of-prematurity-in-preterm-infants
#15
REVIEW
Siree Kaempfen, Roland P Neumann, Kerstin Jost, Sven M Schulzke
BACKGROUND: Retinopathy of prematurity (ROP) is a vision-threatening disease of preterm neonates. The use of beta-adrenergic blocking agents (beta-blockers), which modulate the vasoproliferative retinal process, may reduce the progression of ROP or even reverse established ROP. OBJECTIVES: To determine the effect of beta-blockers on short-term structural outcomes, long-term functional outcomes, and the need for additional treatment, when used either as prophylaxis in preterm infants without ROP, stage 1 ROP (zone I), or stage 2 ROP (zone II) without plus disease or as treatment in preterm infants with at least prethreshold ROP...
March 2, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29470360/oral-supplementation-with-bovine-colostrum-prevents-septic-shock-and-brain-barrier-disruption-during-bloodstream-infection-in-preterm-newborn-pigs
#16
Anders Brunse, Päivi Worsøe, Susanne Elisabeth Pors, Kerstin Skovgaard, Per Torp Sangild
Preterm infants have increased risk of neonatal sepsis, potentially inducing brain injury, and they may benefit from early initiation of enteral milk feeding. Using preterm pigs as models, we hypothesized that early provision of bovine colostrum to parentally nourished newborns protects against sepsis and neuroinflammation during bloodstream infection. Preterm newborn pigs were administered 10 CFU/kg of intra-arterial Staphylococcus epidermidis (SE, an opportunistic pathogen often causing sepsis in preterm infants), followed by administration of total parenteral nutrition (TPN, SE + TPN, n = 15) or oral provision of bovine colostrum with supplementary parenteral nutrition (SE + COL, n = 14), and compared with uninfected, TPN-nourished controls (CON + TPN, n = 11)...
February 21, 2018: Shock
https://www.readbyqxmd.com/read/29465274/intubation-success-in-critical-care-transport-a-multicenter-study
#17
Ryan J Reichert, Megan Gothard, M David Gothard, Hamilton P Schwartz, Michael T Bigham
INTRODUCTION: Tracheal intubation (TI) is a lifesaving critical care skill. Failed TI attempts, however, can harm patients. Critical care transport (CCT) teams function as the first point of critical care contact for patients being transported to tertiary medical centers for specialized surgical, medical, and trauma care. The Ground and Air Medical qUality in Transport (GAMUT) Quality Improvement Collaborative uses a quality metric database to track CCT quality metric performance, including TI...
February 21, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29461392/combined-colloid-preload-and-crystalloid-coload-versus-crystalloid-coload-during-spinal-anesthesia-for-cesarean-delivery-a-randomized-controlled-trial
#18
Mohamed Mohamed Tawfik, Amany Ismail Tarbay, Ahmed Mohamed Elaidy, Karim Ali Awad, Hanaa Mohamed Ezz, Mohamed Ahmed Tolba
BACKGROUND: The optimal strategy of fluid administration during spinal anesthesia for cesarean delivery is still unclear. Ultrasonography of the inferior vena cava (IVC) has been recently used to assess the volume status and predict fluid responsiveness. In this double-blind, randomized controlled study, we compared maternal hemodynamics using a combination of 500-mL colloid preload and 500-mL crystalloid coload versus 1000-mL crystalloid coload. We assessed the IVC at baseline and at subsequent time points after spinal anesthesia...
February 14, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29450194/avoiding-arterial-hypotension-in-preterm-neonates-ahip-a-single-center-randomised-controlled-study-investigating-simultaneous-near-infrared-spectroscopy-measurements-of-cerebral-and-peripheral-regional-tissue-oxygenation-and-dedicated-interventions
#19
Gerhard Pichler, Nina Höller, Nariae Baik-Schneditz, Bernhard Schwaberger, Lukas Mileder, Jasmin Stadler, Alexander Avian, Jasmin Pansy, Berndt Urlesberger
Introduction: Up to 50% of preterm infants admitted to intensive care units require cardiocirculatory support. The aim of the present study was to assess whether simultaneous monitoring of cerebral tissue oxygenation index (cTOI) and peripheral tissue oxygenation index (pTOI) using near-infrared spectroscopy (NIRS) in combination with dedicated intervention guidelines may help avoiding arterial hypotension and catecholamine administration in preterm neonates. Study design: Preterm neonates <37 weeks of gestation were included in a single center randomized controlled study...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29439919/solutions-to-technical-challenges-during-therapeutic-plasma-exchange-using-the-spectra-optia-on-a-4-kilogram-neonate
#20
Gagan Mathur, Laura Collins, Cody R Tigges, Annette J Schlueter
Therapeutic plasma exchange (TPE) on severely ill neonates poses many technical challenges, including obtaining adequate vascular access. In addition, clinical challenges such as risk of hypotension and cardiovascular instability are more pronounced in these patients. We report an approach to successfully managing these challenges while performing TPE on a 4 kilogram neonate using the Spectra Optia and 22 G venous access.
February 2, 2018: Transfusion and Apheresis Science
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