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Neonatal critical care

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https://www.readbyqxmd.com/read/29149877/key-bottlenecks-to-the-provision-of-safe-obstetric-anaesthesia-in-low-income-countries-a-cross-sectional-survey-of-64-hospitals-in-uganda
#1
Isabella Epiu, Agnes Wabule, Andrew Kambugu, Harriet Mayanja-Kizza, Jossy Verel Bahe Tindimwebwa, Gerald Dubowitz
BACKGROUND: Despite recent advances in surgery and anaesthesia which significantly improve safety, many health facilities in low-and middle-income countries (LMICs) remain chronically under-resourced with inability to cope effectively with serious obstetric complications (Knight et al., PLoS One 8:e63846, 2013). As a result many of these countries still have unacceptably high maternal and neonatal mortality rates. Recent data at the national referral hospitals in East Africa reported that none of the national referral hospitals met the World Federation of Societies of Anesthesiologists (WFSA) international standards required to provide safe obstetric anaesthesia (Epiu I: Challenges of Anesthesia in Low-and Middle-Income Countries...
November 17, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29149182/comparison-between-public-and-private-sectors-of-care-and-disparities-in-adverse-neonatal-outcomes-following-emergency-intrapartum-cesarean-at-term-a-retrospective-cohort-study
#2
Woonji Jang, Christopher Flatley, Ristan M Greer, Sailesh Kumar
BACKGROUND: Perinatal outcomes may be influenced by a variety of factors including maternal demographics and medical condition as well as socio-economic status. The evidence for disparities in health outcomes stratified by type of care (public or private) is lacking. The aim of this study was to investigate short term neonatal outcomes following category 1 and 2 emergency cesareans at term between publicly and privately funded women at a single major tertiary centre in Australia. Category 1-immediate threat to life (maternal or fetal); Category 2-maternal or fetal compromise that is not immediately life-threatening...
2017: PloS One
https://www.readbyqxmd.com/read/29144490/neonatal-lung-ultrasound-exam-guidelines
#3
D Kurepa, N Zaghloul, L Watkins, J Liu
Point-of-care ultrasound (POC-US) is increasingly used especially in emergency and critical-care medicine. It is focused, quick and does not expose patients to ionizing radiation. It encompasses all organ systems and has well-defined indications. Lung ultrasound (LUS) represents one of the most exciting applications in the field of POC-US. It is particularly important to emphasize the role of LUS in neonatology due to the specific pathology inherent in lung immaturity as well as in the particular sensitivity of neonates to repeated radiation exposure...
November 16, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29141590/health-nutrition-and-development-of-children-born-preterm-and-low-birth-weight-in-rural-rwanda-a-cross-sectional-study
#4
Catherine M Kirk, Jean Claude Uwamungu, Kim Wilson, Bethany L Hedt-Gauthier, Neo Tapela, Peter Niyigena, Christian Rusangwa, Merab Nyishime, Evrard Nahimana, Fulgence Nkikabahizi, Christine Mutaganzwa, Eric Ngabireyimana, Francis Mutabazi, Hema Magge
BACKGROUND: As care for preterm and low birth weight (LBW) infants improves in resource-limited settings, more infants are surviving the neonatal period. Preterm and (LBW) infants are at high-risk of nutritional and medical comorbidities, yet little is known about their developmental outcomes in low-income countries. This study evaluated the health, nutritional, and developmental status of preterm/LBW children at ages 1-3 years in Rwanda. METHODS: Cross-sectional study of preterm/LBW infants discharged between October 2011 and October 2013 from a hospital neonatal unit in rural Rwanda...
November 15, 2017: BMC Pediatrics
https://www.readbyqxmd.com/read/29141482/obstetric-practice-guidelines-labor-s-love-lost
#5
Wayne R Cohen, Emanuel A Friedman
Implementation of clinical practice guidelines may moderate health care costs, improve care, reduce medicolegal liability, and provide a uniformity in care allowing meaningful investigation of treatments and outcomes. However, new guidelines are often uncritically embraced by clinicians, risk management organizations, insurance companies, and the courts as the standard of care. Adoption of incompletely vetted recommendations can lead to patient harm. Recent recommendations made by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine for assessment and management of labor provide an example of well-intended guidelines adopted uncritically...
November 15, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29132597/retrospective-review-of-pediatric-transport-where-do-our-patients-go-after-transport
#6
REVIEW
Emily Krennerich, Curtis G Sitler, Manish Shah, Fong Lam, Jeanine Graf
OBJECTIVE: This review describes disposition of transported children and identifies contributing factors affecting optimal patient placement. The study describes timing and patient placement indicators in transport patients to identify areas of improvement, re-education, and training. METHODS: A retrospective chart review for transports via our pediatric specialty transport team from January 1, 2012, to December 31, 2014, was performed. Patients were identified by the transport quality assurance performance improvement database, hospital electronic medical records, and transport medical records...
November 2017: Air Medical Journal
https://www.readbyqxmd.com/read/29130288/optimising-early-neonatal-nutrition-using-translational-research-methodology
#7
Denise Page, Melissa Gilroy, Elizabeth Hurrion, Lisa Clark, Shelley Wilkinson
AIM: Preterm birth has been described as a 'nutritional emergency', with these infants often born with minimal nutrition reserves. Failure to provide adequate early nutrition jeopardises growth and neurodevelopment. Consensual nutrition guidelines exist for infants who weigh <1500 g; however, audits have identified shortfalls in their adherence, consequently highlighting an evidence-practice gap. This work aimed to identify the barriers to the delivery of early optimal nutrition in a tertiary-level Neonatal Critical Care Unit to inform an implementation project to ensure best practice care...
November 2017: Nutrition & Dietetics: the Journal of the Dietitians Association of Australia
https://www.readbyqxmd.com/read/29119806/ethical-dilemmas-associated-with-clinicians-decisions-about-treatment-in-critically-ill-infants-born-in-c%C3%A3-rdoba-argentina
#8
Agustín Alfredo Silberberg, Juan Eduardo Gallo
The objective of this article is to examine end of life decisions made by neonatologists of Córdoba, Argentina. An anonymous questionnaire was designed to investigate neonatologists' decisions on when to initiate or withdraw treatment in critical neonates. All neonatologists who take care of critically ill neonates in Córdoba participated in the survey. More than 75% of them would initiate treatment in preterm infants with uncertain prognosis based on the viability of the newborn. Because it is common to find that critically ill neonates lack sufficient diagnostic information at birth, this attitude seems to manifest a certain therapeutic activism...
March 2017: Journal of Child Health Care: for Professionals Working with Children in the Hospital and Community
https://www.readbyqxmd.com/read/29115861/postnatal-overnutrition-affects-metabolic-and-vascular-function-reflected-by-physiological-and-histological-changes-in-the-aorta-of-adult-wistar-rats
#9
Gerardo Sánchez-García, Laura Del Bosque-Plata, Enrique Hong
Rigorous nutritional care during early life leads to healthy adulthood. Cardiovascular and metabolic disorders, the most prevalent clinical challenges worldwide, are epidemiologically linked to poor nutritional habits throughout life. We aimed to understand whether postnatal overnutrition (PO) initiated during lactation affects metabolic markers and vascular function later in life. To test this hypothetical effect, we studied a PO Wistar rat model based on adjusting litter size at the third day of age to three pups and eight for the control group (C)...
November 8, 2017: Clinical and Experimental Hypertension: CHE
https://www.readbyqxmd.com/read/29104765/postnatal-gestational-age-estimation-using-newborn-screening-blood-spots-a-proposed-validation-protocol
#10
Malia S Q Murphy, Steven Hawken, Katherine M Atkinson, Jennifer Milburn, Jesmin Pervin, Courtney Gravett, Jeffrey S A Stringer, Anisur Rahman, Eve Lackritz, Pranesh Chakraborty, Kumanan Wilson
Background: Knowledge of gestational age (GA) is critical for guiding neonatal care and quantifying regional burdens of preterm birth. In settings where access to ultrasound dating is limited, postnatal estimates are frequently used despite the issues of accuracy associated with postnatal approaches. Newborn metabolic profiles are known to vary by severity of preterm birth. Recent work by our group and others has highlighted the accuracy of postnatal GA estimation algorithms derived from routinely collected newborn screening profiles...
2017: BMJ Global Health
https://www.readbyqxmd.com/read/29100554/intersociety-policy-statement-on-the-use-of-whole-exome-sequencing-in-the-critically-ill-newborn-infant
#11
REVIEW
Alessandro Borghesi, Maria Antonietta Mencarelli, Luigi Memo, Giovanni Battista Ferrero, Andrea Bartuli, Maurizio Genuardi, Mauro Stronati, Alberto Villani, Alessandra Renieri, Giovanni Corsello
The rapid advancement of next-generation sequencing (NGS) technology and the decrease in costs for whole-exome sequencing (WES) and whole-genome sequening (WGS), has prompted its clinical application in several fields of medicine. Currently, there are no specific guidelines for the use of NGS in the field of neonatal medicine and in the diagnosis of genetic diseases in critically ill newborn infants. As a consequence, NGS may be underused with reduced diagnostic success rate, or overused, with increased costs for the healthcare system...
November 3, 2017: Italian Journal of Pediatrics
https://www.readbyqxmd.com/read/29091782/ante-peri-and-postnatal-factors-associated-with-intraventricular-hemorrhage-in-very-premature-infants
#12
Martin Poryo, Judith Caroline Boeckh, Ludwig Gortner, Michael Zemlin, Perrine Duppré, Daniel Ebrahimi-Fakhari, Stefan Wagenpfeil, Matthias Heckmann, Eva Mildenberger, Anne Hilgendorff, Andreas W Flemmer, Georg Frey, Sascha Meyer
BACKGROUND: Intraventricular hemorrhage (IVH) is one of the most serious complications in preterm infants and is associated with neurological sequelae and mortality. Over the past few decades, the rate of IVH has decreased due to improved neonatal intensive care. However, up to 15-25% of very and extremely premature infants (<32 and <28weeks of pregnancy (WOP) respectively) still suffer from IVH. STUDY PURPOSE: The aim of this study was to perform an updated, multicenter analysis to identify ante-, peri, and postnatal factors other than gestational age/birth weight associated with IVH of any grade in a large cohort of very and extremely premature infants...
October 26, 2017: Early Human Development
https://www.readbyqxmd.com/read/29080023/bidirectional-effects-of-mother-young-contact-on-the-maternal-and-neonatal-brains
#13
Gabriela González-Mariscal, Angel I Melo
Adaptive plasticity occurs intensely during the early postnatal period through processes like proliferation, migration, differentiation, synaptogenesis, myelination and apoptosis. Exposure to particular stimuli during this critical period has long-lasting effects on cognition, stress reactivity and behavior. Maternal care is the main source of social, sensory and chemical stimulation to the young and is, therefore, critical to "fine-tune" the offspring's neural development. Mothers providing a low quantity or quality of stimulation produce offspring that will exhibit reduced cognitive performance, impaired social affiliation and increased agonistic behaviors...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29060355/reducing-false-asystole-alarms-in-intensive-care
#14
Remi Dekimpe, Thomas Heldt
High rates of false monitoring alarms in intensive care can desensitize staff and therefore pose a significant risk to patient safety. Like other critical arrhythmia alarms, asystole alarms require immediate attention by the care providers as a true asystole event can be acutely life threatening. Here, it is illustrated that most false asystole alarms can be attributed to poor signal quality, and we propose and evaluate an algorithm to identify data windows of poor signal quality and thereby help suppress false asystole alarms...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29057694/early-unexpected-diagnosis-of-fetal-life-limiting-malformation-antenatal-palliative-care-and-parental-decision
#15
Federico Mariona, Marianne Burnett, Melody Zoma, Janice Blake, Hanna Khouri
INTRODUCTION: Conjoined twins are an infrequent occurrence in obstetric practice. Live-conjoined twins on a late preterm triplet pregnancy is an even rarer event. OBJECTIVE: The objective of this study is to emphasize the critical importance of perinatal palliative care and non-directive parental counseling, informed decision making and respect for autonomy following full disclosure of findings, fetal life-limiting diagnosis, treatment alternatives, maternal-fetal potential complications, and most likely perinatal outcomes...
November 2, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29054835/a-strategy-to-reduce-critical-cardiorespiratory-alarms-due-to-intermittent-enteral-feeding-of-preterm-neonates-in-intensive-care
#16
Rohan Joshi, Carola van Pul, Anouk Sanders, Hans Weda, Jan Willem Bikker, Loe Feijs, Peter Andriessen
BACKGROUND: Many preterm infants require enteral feeding as they cannot coordinate sucking, swallowing, and breathing. In enteral feeding, milk feeds are delivered through a small feeding tube passed via the nose or mouth into the stomach. Intermittent milk feeds may either be administered using a syringe to gently push milk into the infant's stomach (push feed) or milk can be poured into a syringe attached to the tube and allowed to drip in by gravity (gravity feed). This practice of enteral feeding is common in neonatal intensive care units...
October 20, 2017: Interactive Journal of Medical Research
https://www.readbyqxmd.com/read/29048405/cooling-in-neonatal-hypoxic-ischemic-encephalopathy-practices-and-opinions-on-minimum-standards-in-the-state-of-california
#17
C J Wusthoff, C L Clark, H C Glass, T K Shimotake, J Schulman, S L Bonifacio
OBJECTIVE: Although hospitals increasingly offer therapeutic hypothermia (TH), there is variable implementation of related services. We assessed current practices and opinions regarding what services should be required of centers providing TH in California. STUDY DESIGN: We surveyed neonatal intensive care unit physicians statewide regarding practices and opinions about services related to TH. RESULTS: Of the 50 participating centers (47% response rate), 66% offer TH...
October 19, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29044002/irrational-antibiotic-prescribing-practice-among-children-in-critical-care-of-tertiary-hospitals
#18
Mirza Tasawer Baig, Ali Akbar Sial, Ambreen Huma, Maryam Ahmed, Uzma Shahid, Nayel Syed
This study assessed the prescribing pattern of irrational use of antibiotic among children under age of 12 years in public and private sector hospitals in Pakistan. The prospective clinical evaluation of drug utilization pattern of antimicrobials from Patient Bedside File (PBF) of in-patients and Culture Sensitivity Test (CST) reports were evaluated to determine the antibiotic resistance. Two indicators recorded to assess antibiotic prescribing were; dose of prescribed antibiotic (low-dose, rational and high -dose) and Indication (valid or invalid)...
July 2017: Pakistan Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/29038971/the-implementation-of-targeted-temperature-management-an-evidence-based-guideline-from-the-neurocritical-care-society
#19
Lori Kennedy Madden, Michelle Hill, Teresa L May, Theresa Human, Mary McKenna Guanci, Judith Jacobi, Melissa V Moreda, Neeraj Badjatia
BACKGROUND: Targeted temperature management (TTM) is often used in neurocritical care to minimize secondary neurologic injury and improve outcomes. TTM encompasses therapeutic hypothermia, controlled normothermia, and treatment of fever. TTM is best supported by evidence from neonatal hypoxic-ischemic encephalopathy and out-of-hospital cardiac arrest, although it has also been explored in ischemic stroke, traumatic brain injury, and intracranial hemorrhage patients. Critical care clinicians using TTM must select appropriate cooling techniques, provide a reasonable rate of cooling, manage shivering, and ensure adequate patient monitoring among other challenges...
October 16, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29037485/temporary-removal-a-tale-of-two-pregnancies-a-critical-interpretive-synthesis-of-women-s-perceptions-about-delayed-initiation-of-antenatal-care
#20
Rosalind Haddrill
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
October 14, 2017: Women and Birth: Journal of the Australian College of Midwives
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