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Managment of neonatal shock

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https://www.readbyqxmd.com/read/29799085/venoarterial-extracorporeal-membrane-oxygenation-support-for-neonatal-and-pediatric-refractory-septic-shock-more-than-15-years-of-learning
#1
Anna Solé, Iolanda Jordan, Sara Bobillo, Julio Moreno, Monica Balaguer, Lluisa Hernández-Platero, Susana Segura, Francisco José Cambra, Elisabeth Esteban, Javier Rodríguez-Fanjul
The objective of the study was to report our institutional experience in the management of children and newborns with refractory septic shock who required venoarterial extracorporeal membrane oxygenation (VA ECMO) treatment, and to identify patient-and infection-related factors associated with mortality. This is a retrospective case series in an intensive care unit of a tertiary pediatric center. Inclusion criteria were patients ≤ 18 years old who underwent a VA ECMO due to a refractory septic shock due to circulatory collapse...
May 24, 2018: European Journal of Pediatrics
https://www.readbyqxmd.com/read/29649938/preoperative-physiology-imaging-and-management-of-interrupted-aortic-arch
#2
Kevin Friedman
Interrupted aortic arch (IAA) is a rare form of critical neonatal heart disease in which there is lack of continuity between the ascending aorta and the descending thoracic aorta. In the absence of prenatal diagnosis, patients with IAA present in shock when the patent ductus arteriosus closes. Diagnosis can generally be made by echocardiography, and initiation of prostaglandin E1 infusion allows for adequate lower body perfusion prior to surgical repair. Full neonatal repair can be achieved with good outcomes in most cases...
April 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29404312/advances-in-diagnosis-and-management-of-hemodynamic-instability-in-neonatal-shock
#3
REVIEW
Yogen Singh, Anup C Katheria, Farha Vora
Shock in newborn infants has unique etiopathologic origins that require careful assessment to direct specific interventions. Early diagnosis is key to successful management. Unlike adults and pediatric patients, shock in newborn infants is often recognized in the uncompensated phase by the presence of hypotension, which may be too late. The routine methods of evaluation used in the adult and pediatric population are often invasive and less feasible. We aim to discuss the pathophysiology in shock in newborn infants, including the transitional changes at birth and unique features that contribute to the challenges in early identification...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29371283/clinical-features-antimicrobial-susceptibility-patterns-and-genomics-of-bacteria-causing-neonatal-sepsis-in-a-children-s-hospital-in-vietnam-protocol-for-a-prospective-observational-study
#4
Nguyen Duc Toan, Thomas C Darton, Christine J Boinett, James I Campbell, Abhilasha Karkey, Evelyne Kestelyn, Le Quoc Thinh, Nguyen Kien Mau, Pham Thi Thanh Tam, Le Nguyen Thanh Nhan, Ngo Ngoc Quang Minh, Cam Ngoc Phuong, Nguyen Thanh Hung, Ngo Minh Xuan, Tang Chi Thuong, Stephen Baker
INTRODUCTION: The clinical syndrome of neonatal sepsis, comprising signs of infection, septic shock and organ dysfunction in infants ≤4 weeks of age, is a frequent sequel to bloodstream infection and mandates urgent antimicrobial therapy. Bacterial characterisation and antimicrobial susceptibility testing is vital for ensuring appropriate therapy, as high rates of antimicrobial resistance (AMR), especially in low-income and middle-income countries, may adversely affect outcome. Ho Chi Minh City (HCMC) in Vietnam is a rapidly expanding city in Southeast Asia with a current population of almost 8 million...
January 24, 2018: BMJ Open
https://www.readbyqxmd.com/read/29344051/experiences-of-fathers-with-inpatient-premature-neonates-phenomenological-interpretative-analysis
#5
Tahmineh Dadkhahtehrani, Narges Eskandari, Zohre Khalajinia, Hoda Ahmari-Tehran
Background: Birth and hospitalization of premature neonates create enormous challenges for the family with serious impacts on parents' mental and emotional health. The present study was designed to explore the experiences of fathers with premature neonates hospitalized in a neonatal intensive care unit (NICU). Materials and Methods: In this interpretative phenomenological study, data were collected using in-depth interviews guided with a semi-structured questionnaire and analyzed by interpretative phenomenological analysis...
January 2018: Iranian Journal of Nursing and Midwifery Research
https://www.readbyqxmd.com/read/29198533/usefulness-of-routine-transtelephonic-monitoring-for-supraventricular-tachycardia-in-infants
#6
Jonathan Yaari, Dorota Gruber, Andrew D Blaufox
OBJECTIVE: We hypothesize that routine daily transtelephonic monitoring (TTM) transmissions can accurately detect supraventricular tachycardia (SVT) in asymptomatic infants and/or assuage parental concerns rather than being used solely to diagnose arrhythmias. STUDY DESIGN: Single center, retrospective chart review of 60 patients with fetal or infant SVT prescribed TTM for at least 30 days, January 2010-September 2016. Patients were excluded if initial SVT was not documented, was perioperative, was atrial flutter/fibrillation, or chaotic atrial tachycardia...
February 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29176025/a-newborn-with-combined-pituitary-hormone-deficiency-developing-shock-and-sludge
#7
Yasuhiro Ueda, Hayato Aoyagi, Toshihiro Tajima
A male neonate was born at 41 weeks of gestation with a birth weight of 3320 g. Artificial respiratory management was required due to respiratory disturbance 1 h after birth, and subsequently catecholamine-refractory low cardiac output-induced shock occurred. Severe combined pituitary hormone deficiency (CPHD) was considered based on the presence of his respiratory disturbance, hypoglycemia and micropenis. After hydrocortisone (HDC) administration, circulatory dynamics rapidly improved. Brain magnetic resonance imaging (MRI) showed aplasia of the anterior pituitary gland and ectopic posterior gland...
November 27, 2017: Journal of Pediatric Endocrinology & Metabolism: JPEM
https://www.readbyqxmd.com/read/28966921/echocardiographic-evaluation-of-hemodynamics-in-neonates-and-children
#8
REVIEW
Yogen Singh
Hemodynamic instability and inadequate cardiac performance are common in critically ill children. The clinical assessment of hemodynamic status is reliant upon physical examination supported by the clinical signs such as heart rate, blood pressure, capillary refill time, and measurement of the urine output and serum lactate. Unfortunately, all of these parameters are surrogate markers of cardiovascular well-being and they provide limited direct information regarding the adequacy of blood flow and tissue perfusion...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28775080/nephrolithisis-in-a-newborn-a-rare-case-and-review-of-literature
#9
REVIEW
Kawaljit Singh, Ashok Kumar Sokhal, Satyanarayan Sankhwar, Bimalesh Purkait
Nephrolithiasis, although a common entity in adults, is less common in children and rare in newborns. The evaluation and management strategies of renal stones in neonates are unclear. We report a rare scenario of renal calculus in a newborn aged 3 days presenting with decreased urine output, fever and crying during micturition. Patient was thoroughly investigated and managed conservatively. Further follow-up showed increase in stone size with recurrent urinary tract infections, hence shock wave lithotripsy was performed to successfully break and clear the stone fragments...
August 3, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28549987/spontaneous-heterotopic-triplets%C3%A2-%C3%A2-a-review-of-literature
#10
REVIEW
P Bataille, A Reynard, G Ducarme
OBJECTIVE: Spontaneous heterotopic triplets, a tubal ectopic pregnancy and a twin pregnancy, are rare disorders. The study aimed to examine all available evidence regarding signs and symptoms, imaging findings, management and newborn outcome of spontaneous heterotopic triplets. DESIGN: A literature search in Medline and EMBASE databases from 2000 to 2016 was conducted. The following key words were employed: 'spontaneous heterotopic pregnancy', OR 'heterotopic triplets'...
October 2017: Journal of Gynecology Obstetrics and Human Reproduction
https://www.readbyqxmd.com/read/28511469/clinical-profile-and-outcome-of-newborns-with-acute-kidney-injury-in-a-level-3-neonatal-unit-in-western-india
#11
Satvik Chaitanya Bansal, Archana Somashekhar Nimbalkar, Amit R Kungwani, Dipen Vasudev Patel, Ankur Rajinder Sethi, Somashekhar Marutirao Nimbalkar
INTRODUCTION: Acute Kidney Injury (AKI) is a serious condition in neonatal care. It complicates the management necessitating the restrictive use of medications. AIM: To evaluate clinical profile, identify associated and prog-nostic factors in newborns with AKI. MATERIALS AND METHODS: This was a case control study done between January 2008 to January 2010. Total 1745 newborns were admitted, of which 74 babies had AKI. It was defined as serum creatinine >1...
March 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28416468/cardiac-transplantation-in-children-and-adolescents-with-long-qt-syndrome
#12
Angela M Kelle, J Martijn Bos, Susan P Etheridge, Bryan C Cannon, Randall M Bryant, Jonathan N Johnson, Michael J Ackerman
BACKGROUND: Long QT syndrome (LQTS) is a potentially lethal, yet highly treatable, cardiac channelopathy. Cardiac transplantation has been reported anecdotally for patients with severe LQTS refractory to standard therapies. OBJECTIVE: The purpose of this study was to evaluate the incidence of and risk factors for cardiac transplantation in children evaluated and treated in an LQTS specialty center. METHODS: This was a retrospective review of 349 children with LQTS (mean age at diagnosis, 8...
August 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28395022/optogenetic-manipulation-of-anatomical-re-entry-by-light-guided-generation-of-a-reversible-local-conduction-block
#13
Masaya Watanabe, Iolanda Feola, Rupamanjari Majumder, Wanchana Jangsangthong, Alexander S Teplenin, Dirk L Ypey, Martin J Schalij, Katja Zeppenfeld, Antoine A F de Vries, Daniël A Pijnappels
Aims: Anatomical re-entry is an important mechanism of ventricular tachycardia, characterized by circular electrical propagation in a fixed pathway. It's current investigative and therapeutic approaches are non-biological, rather unspecific (drugs), traumatizing (electrical shocks), or irreversible (ablation). Optogenetics is a new biological technique that allows reversible modulation of electrical function with unmatched spatiotemporal precision using light-gated ion channels. We therefore investigated optogenetic manipulation of anatomical re-entry in ventricular cardiac tissue...
March 1, 2017: Cardiovascular Research
https://www.readbyqxmd.com/read/28211488/differences-in-the-clinical-characteristics-of-early-and-late-onset-necrotizing-enterocolitis-in-full-term-infants-a-retrospective-case-control-study
#14
Qiu-Yu Li, Yao An, Li Liu, Xue-Qiu Wang, Shi Chen, Zheng-Li Wang, Lu-Quan Li
Information regarding the influence of age at onset on prognosis in full-term infants with necrotizing enterocolitis (NEC) is limited, and identifying differences between the clinical characteristics of early-onset NEC (EO-NEC) and late-onset NEC (LO-NEC) may be helpful in the determination of effective management strategies. In the present study, the medical records of 253 full-term infants with NEC were reviewed, and the clinical characteristics of the EO-NEC group (n = 150) and the LO-NEC group (n = 103) were compared...
February 17, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28148323/primary-care-management-of-patients-with-coarctation-of-the-aorta
#15
REVIEW
Jeffrey R Boris
Coarctation of the aorta is a congenital cardiac defect that results in a variable degree of obstruction to the left side of the heart. It can present with either acute shock in the neonatal period as a critical lesion or it can appear more insidiously with hypertension or other findings later in life. This article summarises aspects of outpatient care of patients with this lesion, including clinical history and physical examination, ancillary testing, and issues associated with long-term follow-up and management...
December 2016: Cardiology in the Young
https://www.readbyqxmd.com/read/28137353/management-of-neonatal-hypotension
#16
Brian T Kalish
Hypotension is a common problem in neonates with complex underlying pathophysiology. Although treatment of low blood pressure is common, clinicians must use all available information to target neonates with compromised perfusion. Pharmacotherapy should be tailored to the specific physiologic perturbations of the individual neonate. Dopamine is the most commonly utilized agent and may be the most appropriate agent for septic shock with low diastolic blood pressure. However, alternative therapies should be considered for other etiologies of hypotension, including milrinone and vasopressin for persistent pulmonary hypertension of the newborn and dobutamine for patent ductus arteriosus...
January 1, 2017: Neonatal Network: NN
https://www.readbyqxmd.com/read/28009331/a-study-of-acute-kidney-injury-in-hospitalized-preterm-neonates-in-nicu
#17
N Nagaraj, P K Berwal, A Srinivas, A Berwal
OBJECTIVES: This study was carried out to determine the incidence, clinical features, etiology and outcome of functional and intrinsic acute kidney injury (AKI) in preterm neonates. METHODS: This is a prospective observational study on premature infants admitted to the neonatal intensive care unit (NICU) over an eight month period. All biochemical parameters of renal function tests were monitored and statically analyzed. RESULTS: The study included 450 infants; of them 300 were inborn and 150 infants were outborn and transported to the NICU...
2016: Journal of Neonatal-perinatal Medicine
https://www.readbyqxmd.com/read/28005910/melioidosis-in-malaysia-a-review-of-case-reports
#18
REVIEW
Paul Vijay Kingsley, Mark Leader, Nandika Suranjith Nagodawithana, Meghan Tipre, Nalini Sathiakumar
BACKGROUND: Melioidosis is a tropical infectious disease associated with significant mortality due to early onset of sepsis. OBJECTIVE: We sought to review case reports of melioidosis from Malaysia. METHODS: We conducted a computerized search of literature resources including PubMed, OVID, Scopus, MEDLINE and the COCHRANE database to identify published case reports from 1975 to 2015. We abstracted information on clinical characteristics, exposure history, comorbid conditions, management and outcome...
December 2016: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/27986330/making-the-quick-diagnosis-a-case-of-neonatal-shock
#19
Mike Gardiner, Timothy K Ruttan, Andrew J Kienstra, Matthew Wilkinson
BACKGROUND: The work-up and initial management of a critically ill neonate is challenging and anxiety provoking for the Emergency Physician. While sepsis and critical congenital heart disease represent a large proportion of neonates presenting to the Emergency Department (ED) in shock, there are several additional etiologies to consider. Underlying metabolic, endocrinologic, gastrointestinal, neurologic, and traumatic disorders must be considered in a critically ill infant. Several potential etiologies will present with nonspecific and overlapping signs and symptoms, and the diagnosis often is not evident at the time of ED assessment...
April 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27777295/single-ventricle-outcomes-after-neonatal-palliation-of-severe-ebstein-anomaly-with-modified-starnes-procedure
#20
S Ram Kumar, Grace Kung, Nathan Noh, Novel Castillo, Brian Fagan, Winfield J Wells, Vaughn A Starnes
BACKGROUND: We have previously shown that neonates in profound cardiogenic shock caused by a severe Ebstein anomaly can be successfully salvaged with fenestrated right ventricular exclusion and systemic to pulmonary shunt (modified Starnes procedure). The long-term outcome of single-ventricle management in these patients is not known. METHODS: We retrospectively reviewed the records of patients who underwent neonatal Starnes procedure between 1989 and 2015. Patient demographics, clinical variables, and outcome data were collected...
October 25, 2016: Circulation
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