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Neonatal clinical guides

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https://www.readbyqxmd.com/read/29217722/successfully-implementing-and-embedding-guidelines-to-improve-the-nutrition-and-growth-of-preterm-infants-in-neonatal-intensive-care-a-prospective-interventional-study
#1
Mark J Johnson, Alison A Leaf, Freya Pearson, Howard W Clark, Borislav D Dimitrov, Catherine Pope, Carl R May
OBJECTIVES: We aimed to improve the nutritional care of preterm infants by developing a complex (multifaceted) intervention intended to translate current evidence into practice. We used the sociological framework of Normalization Process Theory (NPT), to guide implementation in order to embed the new practices into routine care. DESIGN: A prospective interventional study with a before and after methodology. PARTICIPANTS: Infants <30 weeks gestation or <1500 g at birth...
December 6, 2017: BMJ Open
https://www.readbyqxmd.com/read/29212522/a-systematic-review-of-neonatal-treatment-intensity-scores-and-their-potential-application-in-low-resource-setting-hospitals-for-predicting-mortality-morbidity-and-estimating-resource-use
#2
Jalemba Aluvaala, Gary S Collins, Michuki Maina, James A Berkley, Mike English
BACKGROUND: Treatment intensity scores can predict mortality and estimate resource use. They may therefore be of interest for essential neonatal care in low resource settings where neonatal mortality remains high. We sought to systematically review neonatal treatment intensity scores to (1) assess the level of evidence on predictive performance in predicting clinical outcomes and estimating resource utilisation and (2) assess the applicability of the identified models to decision making for neonatal care in low resource settings...
December 7, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/29205995/volume-and-health-outcomes-evidence-from-systematic-reviews-and-from-evaluation-of-italian-hospital-data
#3
Laura Amato, Danilo Fusco, Anna Acampora, Katia Bontempi, Alessandro Cesare Rosa, Paola Colais, Fabio Cruciani, Mariangela D'Ovidio, Francesca Mataloni, Silvia Minozzi, Zuzana Mitrova, Luigi Pinnarelli, Rosella Saulle, Salvatore Soldati, Chiara Sorge, Simona Vecchi, Martina Ventura, Marina Davoli
BACKGROUND Improving quality and effectiveness of healthcare is one of the priorities of health policies. Hospital or physician volume represents a measurable variable with an impact on effectiveness of healthcare. An Italian law calls for the definition of «qualitative, structural, technological, and quantitative standards of hospital care». There is a need for an evaluation of the available scientific evidence in order to identify qualitative, structural, technological, and quantitative standards of hospital care, including the volume of care above or below which the public and private hospitals may be accredited (or not) to provide specific healthcare interventions...
September 2017: Epidemiologia e Prevenzione
https://www.readbyqxmd.com/read/29187358/vitamin-d-supplementation-during-pregnancy-state-of-the-evidence-from-a-systematic-review-of-randomised-trials
#4
Daniel E Roth, Michael Leung, Elnathan Mesfin, Huma Qamar, Jessica Watterworth, Eszter Papp
Objectives To estimate the effects of vitamin D supplementation during pregnancy on 11 maternal and 27 neonatal/infant outcomes; to determine frequencies at which trial outcome data were missing, unreported, or inconsistently reported; and to project the potential contributions of registered ongoing or planned trials.Design Systematic review and meta-analysis of randomised controlled trials; systematic review of registered but unpublished trials.Data sources Medline, Embase, PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from inception to September 2017; manual searches of reference lists of systematic reviews identified in the electronic search; and online trial registries for unpublished, ongoing, or planned trials...
November 29, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/29173777/surgical-excision-is-the-treatment-of-choice-for-cervical-lymphatic-malformations-with-mediastinal-expansion
#5
Nader Ghaffarpour, Carmen Mesas Burgos, Tomas Wester
BACKGROUND: Lymphatic malformations (LMs) in the mediastinum are uncommon. However, cervical LMs may expand into the mediastinum. The aim of this study was to review our experience with the management of patients with LMs involving the mediastinum and to propose a treatment algorithm to guide the management of these rare malformations. MATERIAL AND METHODS: This was a descriptive retrospective chart review of all patients with LMs involving the mediastinum treated at our Institution between 2009 and 2015...
October 16, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29170288/midwife-or-doctor-local-opinion-leader-to-implement-a-national-guideline-in-babies-on-postnatal-wards-design-protocol-of-a-cluster-randomised-blinded-controlled-trial
#6
Jane Marie Alsweiler, Caroline A Crowther, Jane E Harding
INTRODUCTION: Neonatal hypoglycaemia is a common condition that can cause developmental delay. Treatment of neonatal hypoglycaemia with oral dextrose gel has been shown to reverse hypoglycaemia and reduce admissions to neonatal intensive care for hypoglycaemia. An evidence-based clinical practice guideline was written to guide the use of dextrose gel to treat neonatal hypoglycaemia in New Zealand. However, it is unclear what clinical discipline might most effectively lead the implementation of the guideline recommendations...
November 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/29163364/telomere-length-in-preterm-infants-a-promising-biomarker-of-early-adversity-and-care-in-the-neonatal-intensive-care-unit
#7
Livio Provenzi, Giunia Scotto di Minico, Roberto Giorda, Rosario Montirosso
Preterm infants present an immature neurobehavioral profile at birth, even in absence of severe brain injuries and perinatal complications. As such, they require a long-lasting hospitalization in the Neonatal Intensive Care Unit (NICU), which is thought to grant at-risk newborns' survival, but still entails a number of physical, painful, and socio-emotional stressors. Hence, preterm birth and NICU stay represent an early adverse experience, which has been linked to detrimental consequences for neurological, neuro-endocrinal, behavioral, and socio-emotional development, as well as to disease later in life...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/29132336/study-protocol-the-labor-progression-study-laps-does-the-use-of-a-dynamic-progression-guideline-in-labor-reduce-the-rate-of-intrapartum-cesarean-sections-in-nulliparous-women-a-multicenter-cluster-randomized-trial-in-norway
#8
Stine Bernitz, Rebecka Dalbye, Pål Øian, Jun Zhang, Torbjørn Moe Eggebø, Ellen Blix
BACKGROUND: The increasing rate of intrapartum cesarean sections is subject of attention and concern as it is associated with adverse outcomes. Labor dystocia is one of the most frequent indications for cesarean sections even though there is no consensus on criteria for labor dystocia. Traditionally the progression of labor follows guidelines based on Friedman's curve from the mid 1950s. In 2010 Zhang presented a new labor curve and a dynamic guideline for labor progression based on contemporary research...
November 13, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29100554/intersociety-policy-statement-on-the-use-of-whole-exome-sequencing-in-the-critically-ill-newborn-infant
#9
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/29084032/dosopt-a-tool-for-personalized-bayesian-dose-adjustment-of-vancomycin-in-neonates
#10
Tõnis Tasa, Tuuli Metsvaht, Riste Kalamees, Jaak Vilo, Irja Lutsar
BACKGROUND: Our main aim has been to design a framework to improve vancomycin dosing in neonates. This required the development and verification of a computerized dose adjustment application, DosOpt, to guide the selection. METHODS: Model fitting in DosOpt uses Bayesian methods for deriving individual pharmacokinetic (PK) estimates from population priors and patient therapeutic drug monitoring measurements. These are used to simulate concentration-time curves and target-constrained dose optimization...
December 2017: Therapeutic Drug Monitoring
https://www.readbyqxmd.com/read/29072785/predicting-cyp3a-mediated-midazolam-metabolism-in-critically-ill-neonates-infants-children-and-adults-with-inflammation-and-organ-failure
#11
J M Brussee, N J Vet, E H J Krekels, A J Valkenburg, E Jacqz-Aigrain, J M A van Gerven, E L Swart, J N van den Anker, D Tibboel, M de Hoog, S N de Wildt, C A J Knibbe
AIMS: Inflammation and organ failure have been reported to impact cytochrome P450 (CYP) 3A-mediated clearance of midazolam in critically ill children. Our aim was to evaluate a previously developed population pharmacokinetic model in both critically ill children and other populations in order to allow the model to be used to guide dosing in clinical practice. METHODS: The model was externally evaluated in 136 individuals, including (pre)term neonates, infants, children, and adults (body weight 0...
October 26, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29068853/neonatal-rhizomelic-chondrodysplasia-punctata-type-1-weaving-evidence-into-clinical-practice
#12
Jessica Landino, Amy J Jnah, Desi M Newberry, Sabine C Iben
Rhizomelic chondrodysplasia punctata (RCDP) is a rare genetic peroxisome biogenesis disorder with a reported incidence of 1 in 100 000 live births. The 3 genetic subtypes of RCDP are acquired by an autosomal recessive inheritance pattern. RCDP type 1 accounts for greater than 90% of all aggregate cases. Differentiating between the 3 subtypes of RCDP, as well as disorders characterized by similar punctate cartilaginous changes, is essential to guide an appropriate postnatal plan of care. Management strategies are focused toward associated clinical manifestations and require an interdisciplinary approach including ophthalmology, cardiovascular, endocrine, physical and occupational therapy, and neurology...
October 2017: Journal of Perinatal & Neonatal Nursing
https://www.readbyqxmd.com/read/29058556/feasibility-of-a-miniature-esophageal-heat-exchange-device-for-rapid-therapeutic-cooling-in-newborns-preliminary-investigations-in-a-piglet-model
#13
John Dingley, Satomi Okano, Silvia Planas, Elavazhagan Chakkarapani
Therapeutic hypothermia (TH) after neonatal encephalopathy, commonly provided by 72 hours of whole-body cooling using a wrap, limits parents' physical contact with their infants affecting bonding and may not be suitable for encephalopathic preterm infants with fragile skin. Alternative cooling methods are unavailable for this population. We investigated in a neonatal pig model the feasibility of achieving a 3.5°C reduction in rectal temperature (Trectal) similar to clinical TH protocols from 38.5°C (normothermia for pigs) to a target of 35°C ± 0...
October 23, 2017: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/29051889/supraclavicular-approach-to-ultrasound-guided-brachiocephalic-vein-cannulation-in-children-and-neonates
#14
REVIEW
Zied Merchaoui, Ulrik Lausten-Thomsen, Florence Pierre, Maher Ben Laiba, Nolwenn Le Saché, Pierre Tissieres
The correct choice of intra vascular access in critically ill neonates should be individualized depending on the type and duration of therapy, gestational and chronological age, weight and/or size, diagnosis, clinical status, and venous system patency. Accordingly, there is an ongoing demand for optimization of catheterization. Recently, the use of ultrasound (US)-guided cannulation of the subclavian vein (SCV) has been described in children and neonates. This article gives an overview of the current use of US for achieving central venous catheter placement in the SCV or the brachiocephalic vein (BCV) in neonates...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29045256/a-quality-improvement-initiative-to-increase-scoring-consistency-and-accuracy-of-the-finnegan-tool-challenges-in-obtaining-reliable-assessments-of-drug-withdrawal-in-neonatal-abstinence-syndrome
#15
Wendy Timpson, Cheryl Killoran, Louise Maranda, Alan Picarillo, Elisabeth Bloch-Salisbury
BACKGROUND: Current practice for diagnosing neonatal abstinence syndrome and guiding pharmacological management of neonatal drug withdrawal is dependent on nursing assessments and repeated evaluation of clinical signs. PURPOSE: This single-center quality improvement initiative was designed to improve accuracy and consistency of Finnegan scores among neonatal nurses. METHODS: One-hundred seventy neonatal nurses participated in a single-session withdrawal-assessment program that incorporated education, scoring guidelines, and a restructured Finnegan scale...
October 17, 2017: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/29045045/mesenchymal-stromal-cell-therapy-in-bronchopulmonary-dysplasia-systematic-review-and-meta-analysis-of-preclinical-studies
#16
Sajit Augustine, Marc T Avey, Brittany Harrison, Tiffany Locke, Mona Ghannad, David Moher, Bernard Thébaud
Extreme prematurity is the leading cause of death among children under 5 years of age. Currently, there is no treatment for bronchopulmonary dysplasia (BPD), the most common complication of extreme prematurity. Experimental studies in animal models of BPD suggest that mesenchymal stromal cells (MSCs) are lung protective. To date, no systematic review and meta-analysis has evaluated the preclinical evidence of this promising therapy. Our protocol was registered with Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies prior to searching MEDLINE (1946 to June 1, 2015), Embase (1947 to 2015 Week 22), Pubmed, Web of Science, and conference proceedings (1990 to present) for controlled comparative studies of neonatal animal models that received MSCs or cell free MSC-derived conditioned media (MSC-CM)...
October 17, 2017: Stem Cells Translational Medicine
https://www.readbyqxmd.com/read/29044830/optimal-management-of-apparatus-dead-space-in-the-anesthetized-infant
#17
REVIEW
Michael R King, Jeffrey M Feldman
Mechanical ventilation of the anesthetized infant requires careful attention to equipment and ventilator settings to assure optimal gas exchange and minimize the potential for lung injury. Apparatus dead space, defined as dead space resulting from devices placed between the endotracheal tube and the Y-piece of the breathing circuit, is the primary source of dead space controlled by the clinician. Due to the small tidal volumes required by infants and neonates, it is easy to create excessive apparatus dead space resulting in unintended hypercarbia or increased minute ventilation in an effort to achieve a desirable PCO2 ...
October 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29041964/olfactive-stimulation-interventions-for-managing-procedural-pain-in-preterm-and-full-term-neonates-a-systematic-review-protocol
#18
Gwenaëlle De Clifford-Faugère, Andréane Lavallée, Marilyn Aita
BACKGROUND: While hospitalized in the NICU, preterm neonates undergo many painful procedures. This may be the same for full-term neonates when longer hospitalization is required. Untreated and repeated pain has short-term as well as long-term consequences for these neonates. Pharmacological pain management methods have many limitations in their applications for both preterm and full-term neonates. A combination of different non-pharmacological methods is recommended for pain management...
October 17, 2017: Systematic Reviews
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/29019748/doppler-us-in-the-evaluation-of-fetal-growth-and-perinatal-health
#20
Kristen R Uquillas, Brendan H Grubbs, Ashley E Prosper, Ramen H Chmait, Edward G Grant, Daphne K Walker
Fetal growth restriction is commonly defined as an estimated fetal weight (EFW) that is below the 10th percentile for gestational age. It is associated with an increased risk of intrauterine demise, neonatal morbidity, and neonatal death; therefore, antenatal detection and surveillance with the optimization of delivery timing are necessary to improve pregnancy outcomes. If the estimated due date has been verified and the EFW is below the 10th percentile for gestational age, the underlying cause should be investigated, since the clinical management, outcome, and counseling options are largely dependent on the cause of the growth restriction...
October 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
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