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https://www.readbyqxmd.com/read/28817167/body-mass-index-50-kg-m2-and-beyond-perioperative-care-of-pregnant-women-with-superobesity-undergoing-cesarean-delivery
#1
Marcela Carolina Smid, Sarah K Dotters-Katz, Robert M Silver, Jeffrey A Kuller
Importance: Superobesity, defined as body mass index 50 kg/m(2) or greater, is the fastest-growing obesity group in the United States. Currently, 2% of pregnant women in the United States are superobese, and 50% will deliver via cesarean delivery. Objective: To review evidence of perioperative care during cesarean delivery among superobese women. Evidence Acquisition: We performed an evidence-based review of maternal and neonatal risks of cesarean delivery and of intraoperative management and immediate postpartum care of superobese pregnant women...
August 2017: Obstetrical & Gynecological Survey
https://www.readbyqxmd.com/read/28815739/kernicterus-in-a-boy-with-ornithine-transcarbamylase-deficiency-a-case-report
#2
Eduardo López-Corella, Isabel Ibarra-González, Cynthia Fernández-Lainez, Miguel Á Rodríguez-Weber, Sara Guillén-Lopez, Leticia Belmont-Martínez, David Agüero-Linares, Marcela Vela-Amieva
Ornithine transcarbamylase deficiency (OTCD) is an X-linked urea cycle defect associated with severe and usually fatal hyperammonemia. This study describes a patient with early onset lethal OTCD due to a known pathogenic variant (c.298+1G>A), as well as the novel autopsy finding of kernicterus with relatively low blood concentration of unconjugated bilirubin (UCB) (11.55 mg/dL). The patient was a full-term male with a family history of two previous male siblings who died as newborns after acute neurologic deterioration...
August 16, 2017: Neuropathology: Official Journal of the Japanese Society of Neuropathology
https://www.readbyqxmd.com/read/28811085/the-use-of-phenobarbital-and-other-anti-seizure-drugs-in-newborns
#3
REVIEW
Mohamed El-Dib, Janet S Soul
Neonatal seizures constitute the most frequent presenting neurologic sign encountered in the neonatal intensive care unit. Despite limited efficacy and safety data, phenobarbital continues to be used near-universally as the first-line anti-seizure drug (ASD) in neonates. The choice of second-line ASDs varies by provider and institution, and is still not supported by sufficient scientific evidence. In this review, we discuss the available evidence supporting the efficacy, mechanism of action, potential adverse effects, key pharmacokinetic characteristics such as interaction with therapeutic hypothermia, logistical issues, and rationale for use of neonatal ASDs...
August 12, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28810610/microbial-investigations-in-throat-swab-and-tracheal-aspirate-specimens-are-beneficial-to-predict-the-corresponding-endotracheal-tube-biofilm-flora-among-intubated-neonates-with-ventilator-associated-pneumonia
#4
Yun Pan, Lizhong Du, Qing Ai, Sijie Song, Xiaoli Tang, Danping Zhu, Jialin Yu
Ventilator-associated pneumonia (VAP) is a common nosocomial infection in neonatal intensive care units with high morbidity and mortality. Bacterial biofilm in the endotracheal tube (ET) provides a notable and persistent source of pathogens that may cause VAP, and thus is important for VAP detection. However, during intubation microbial investigations in ET, samples are unavailable due to the infeasibility of collecting ET samples during intubation of neonates. It is therefore of great importance to find alternative sources of samples that can help identify the ET biofilm flora...
August 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28807835/the-role-of-antimicrobial-stewardship-programmes-in-children-a-systematic-review
#5
REVIEW
André Ricardo Araujo da Silva, Déborah Cardoso Albernaz de Almeida Dias, Amanda Fáris Marques, Clara Biscaia di Biase, Indah K Murni, Angela Dramowski, Mike Sharland, Johanes Huebner, Walter Zingg
The United Nations and the World Health Organization have designated antimicrobial resistance (AMR) as a major health priority and developed action plans to reduce AMR in all healthcare settings. Establishment of institutional antimicrobial stewardship programmes (ASPs) is advocated as a key intervention to reduce antibiotic consumption in hospitals and address high rates of multi-drug resistant (MDR) bacteria. We searched PUBMED and the Cochrane database of systematic reviews (1/2007-3/2017) to identify studies reporting about the effectiveness of ASPs in general paediatric wards and paediatric intensive care units (PICU), on reducing antibiotic consumption, on using broad spectrum/restricted antibiotics, and on antibiotic resistance and healthcare-associated infections (HAIs)...
August 11, 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28807643/-use-of-subcutaneous-route-for-comfort-care%C3%A2-in-neonatal-palliative-population-systematic-review-and-survey-of-practices-in-france
#6
N Pouvreau, J Tandonnet, O Tandonnet, L Renesme
INTRODUCTION: Subcutaneous hydration (hypodermoclysis) and drug administration is a widely used method of analgesic therapy in adult palliative care medicine. Very little is known about its use in neonatal medicine. Evidence-based guidelines do not exist due to a lack of data. In this study, the advantages of subcutaneous analgesic therapy in terms of comfort in neonatal palliative care situations were investigated. METHODS: This report details the results of a systematic review associated with a survey in neonatal intensive care units (NICUs) and pediatric palliative care departments (PPCTs) in France...
August 11, 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28806579/access-to-emergency-care-services-a-transversal-ecological-study-about-brazilian-emergency-health-care-network
#7
T A H Rocha, N C da Silva, P V Amaral, A C Q Barbosa, J V M Rocha, V Alvares, D G de Almeida, E Thumé, E B A F Thomaz, R C de Sousa Queiroz, M R de Souza, A Lein, N Toomey, C A Staton, J R N Vissoci, L A Facchini
OBJECTIVES: Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). STUDY DESIGN: Cross-sectional ecological study. METHODS: Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs)...
August 11, 2017: Public Health
https://www.readbyqxmd.com/read/28806281/ventilator-associated-pneumonia-in-neonatal-intensive-care-unit-due-to-chryseobacterium-indologenes
#8
Vicente S Antonello, Priscila Daht, Janaína Polli, Milton Gross, Maurício Colvero
Ventilator-associated pneumonia (VAP) represents one of the most common nosocomial infections in neonatal intensive care units, increasing morbidity and mortality, and associated costs. The authors report the case of a neonatal patient with VAP secondary to Chryseobacterium indologenes and a review of the literature. . The most effective empiric treatment for C. indologenes infection remains unclear due to limited data in the literature, and therefore, therapy should be adjusted in accordance with the result of the susceptibility profile...
August 10, 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/28805942/maternal-and-neonatal-outcomes-following-abnormally-invasive-placenta-a-population-based-record-linkage-study
#9
Heather J Baldwin, Jillian A Patterson, Tanya A Nippita, Siranda Torvaldsen, Ibinabo Ibiebele, Judy M Simpson, Jane B Ford
INTRODUCTION: Abnormally invasive placenta (AIP) involves abnormal adherence of the placenta to the myometrium, and is associated with severe pregnancy complications such as blood transfusion and hysterectomy. Knowledge of outcomes has been limited by small sample sizes and a focus on maternal rather than neonatal outcomes. This study uses population-level data collected over ten years to investigate maternal and neonatal outcomes and trends in incidence of AIP (also known as placenta accreta, increta and percreta)...
August 14, 2017: Acta Obstetricia et Gynecologica Scandinavica
https://www.readbyqxmd.com/read/28805619/intrauterine-fetal-death-caused-by-seatbelt-injury
#10
Shizuka Yamada, Koji Nishijima, Jin Takahashi, Nozomu Takahashi, Chiyo Tamamura, Yoshio Yoshida
OBJECTIVE: Severe motor vehicle accidents involving pregnant women can result in fetal and neonatal death. We describe a case in which fetal death occurred due to relatively mild seatbelt injuries and present the characteristic magnetic resonance imaging (MRI) findings of the placenta. CASE REPORT: A 26-year-old primigravid woman at 20 weeks gestation was involved in an automobile accident. Although she suffered only a seatbelt injury, fetal death subsequently occurred...
August 2017: Taiwanese Journal of Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28804867/sources-of-distress-for-physicians-and-nurses-working-in-swiss-neonatal-intensive-care-units
#11
Sabine D Klein, Hans Ulrich Bucher, Manya J Hendriks, Ruth Baumann-Hölzle, Jürg C Streuli, Thomas M Berger, Jean-Claude Fauchère, On Behalf Of The Swiss Neonatal End-Of-Life Study Group
BACKGROUND: Medical personnel working in intensive care often face difficult ethical dilemmas. These may represent important sources of distress and may lead to a diminished self-perceived quality of care and eventually to burnout. AIMS OF THE STUDY: The aim of this study was to identify work-related sources of distress and to assess symptoms of burnout among physicians and nurses working in Swiss neonatal intensive care units (NICUs). METHODS: In summer 2015, we conducted an anonymous online survey comprising 140 questions about difficult ethical decisions concerning extremely preterm infants...
August 14, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28803228/utility-of-routine-urine-cmv-pcr-and-total-serum-igm-testing-of-small-for-gestational-age-infants-a-single-center-review
#12
Michael M Espiritu, Sean Bailey, Elena V Wachtel, Pradeep V Mally
BACKGROUND: Due to the extremely low incidence of TORCH (toxoplasmosis, rubella, CMV, herpes simplex virus) infections, diagnostic testing of all small for gestational age (SGA) infants aimed at TORCH etiologies may incur unnecessary tests and cost. OBJECTIVE: To determine the frequency of urine CMV PCR and total IgM testing among infants with birth weight <10% and the rate of test positivity. To evaluate the frequency of alternative etiologies of SGA in tested infants...
August 14, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28802348/alarm-safety-and-alarm-fatigue
#13
REVIEW
Kendall R Johnson, James I Hagadorn, David W Sink
Clinical alarm systems have received significant attention in recent years following warnings from hospital accrediting and health care technology organizations regarding patient harm caused by unsafe practices. Alarm desensitization or fatigue from frequent, false, or unnecessary alarms, has led to serious events and even patient deaths. Other concerns include settings inappropriate to patient population or condition, inadequate staff training, and improper use or disabling. Research on human factors in alarm response and of functionality of medical devices will help clinicians develop appropriate policies, practices, and device settings for clinical alarms in neonatal intensive care units...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28802347/using-quality-improvement-tools-to-reduce-chronic-lung-disease
#14
REVIEW
Alan Peter Picarillo, Waldemar Carlo
Rates of chronic lung disease (CLD) in very low birthweight infants have not decreased at the same pace as other neonatal morbidities over the past 20 years. Multifactorial causes of CLD make this common morbidity difficult to reduce, although there have been several successful quality improvement (QI) projects in individual neonatal intensive care units. QI projects have become a mainstay of neonatal care over the past decade, with an increasing number of publications devoted to this topic. A specific QI project for CLD must be based on best available evidence in the medical literature, expert recommendations, or based on work by previous QI initiatives...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28802344/creating-a-highly-reliable-neonatal-intensive-care-unit-through-safer-systems-of-care
#15
REVIEW
Patoula G Panagos, Stephen A Pearlman
Neonates requiring intensive care are at high risk for medical errors due to their unique characteristics and high acuity. Designing a safer work environment begins with safe processes. Creating a culture of safety demands the involvement of all organizational levels and an interdisciplinary approach. Adverse events can result from suboptimal communication and lack of a shared mental model. This chapter describes tools to promote better patient safety in the NICU through monitoring adverse events, improving communication and using information technology...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28802342/improving-value-in-neonatal-intensive-care
#16
REVIEW
Timmy Ho, John A F Zupancic, DeWayne M Pursley, Dmitry Dukhovny
Work within the US health care system has sought to improve outcomes, decrease costs, and improve the patient experience. Combining those three elements leads to value-added care. Quality improvement within neonatology has focused primarily on the improvement of clinical outcomes without explicit consideration of cost. Future improvement efforts in neonatology should consider opportunities to decrease or eliminate waste, and improve outcomes. Consideration of how a change affects all stakeholders reveals potential cost-saving opportunities, and developing aims with value in mind facilitates understanding and goal-setting with senior administrative leaders...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28802339/family-involvement-in-quality-improvement-from-bedside-advocate-to-system-advisor
#17
REVIEW
Joanna F Celenza, Denise Zayack, Madge E Buus-Frank, Jeffrey D Horbar
Family involvement in newborn intensive care quality improvement dates back to the 1980s. In recent years, there has been an evolution of support for family partnerships at the bedside, transforming parents from being passively present to being active and engaged caregivers and team members. Through those same efforts, a transformational understanding of the power of the family perspective in system design and improvement has occurred. Even with the progression and deepening of this involvement, opportunities exist to learn from families and to improve the quality of neonatal care as a result of the unique family perspective...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28802334/has-quality-improvement-really-improved-outcomes-for-babies-in-the-neonatal-intensive-care-unit
#18
REVIEW
Alan R Spitzer
During the past decade, the emergence of outcome measurement and quality improvement in the neonatal intensive care unit, far more than the introduction of new research approaches or novel therapies, has had a profound effect on improving outcomes for premature neonates. Collection of outcome data, review of those data, and strategies to identify and resolve problems using continuous quality improvement methods can dramatically improve patient outcomes. It is likely that further initiatives in quality improvement will continue to have additional beneficial effects for the neonate...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28801177/uses-and-misuses-of-sodium-bicarbonate-in-the-neonatal-intensive-care-unit
#19
Amélie Collins, Rakesh Sahni
Over the past several decades, bicarbonate therapy continues to be used routinely in the treatment of acute metabolic acidosis in critically ill neonates despite the lack of evidence for its effectiveness in the treatment of acid-base imbalance, and evidence indicating that it may be detrimental. Clinicians often feel compelled to use bicarbonate since acidosis implies a need for such therapy and thus the justification for its use is based on hearsay rather than science. This review summarizes the evidence and refutes the clinical practice of administering sodium bicarbonate to treat metabolic acidosis associated with several specific clinical syndromes in neonates...
August 8, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28801176/caffeine-use-in-the-neonatal-intensive-care-unit
#20
REVIEW
Jalal M Abu-Shaweesh, Richard J Martin
Caffeine is the most frequently used medication in the neonatal intensive care unit. It is used for the prevention and treatment of apnea, although this has been associated with lower incidence of bronchopulmonary dysplasia (BPD) and patent ductus arteriosus as well as intact survival at 18-21 months of life. Although neurodevelopmental advantage was no longer statistically significant at age 5 years, caffeine was associated with sustained improvement in co-ordination and less gross motor impairment than placebo...
August 8, 2017: Seminars in Fetal & Neonatal Medicine
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