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https://www.readbyqxmd.com/read/27694281/interventions-to-improve-patient-safety-during-intubation-in-the-neonatal-intensive-care-unit
#1
L Dupree Hatch, Peter H Grubb, Amanda S Lea, William F Walsh, Melinda H Markham, Patrick O Maynord, Gina M Whitney, Ann R Stark, E Wesley Ely
OBJECTIVE: To improve patient safety in our NICU by decreasing the incidence of intubation-associated adverse events (AEs). METHODS: We sequentially implemented and tested 3 interventions: standardized checklist for intubation, premedication algorithm, and computerized provider order entry set for intubation. We compared baseline data collected over 10 months (period 1) with data collected over a 10-month intervention and sustainment period (period 2). Outcomes were the percentage of intubations containing any prospectively defined AE and intubations with bradycardia or hypoxemia...
October 2016: Pediatrics
https://www.readbyqxmd.com/read/26042912/inborn-errors-of-metabolism
#2
REVIEW
Ayman W El-Hattab
Inborn errors of metabolism (IEM) are individually rare but collectively common. Approximately 25% of IEMs can have manifestations in the neonatal period. Neonates with IEM are usually healthy at birth; however, in hours to days after birth they can develop nonspecific signs that are common to several other neonatal conditions. Therefore, maintaining a high index of suspicion is extremely important for early diagnosis and the institution of appropriate therapy, which are mandatory to prevent death and ameliorate complications from many IEMs...
June 2015: Clinics in Perinatology
https://www.readbyqxmd.com/read/27524449/neonatal-encephalopathy-update-on-therapeutic-hypothermia-and-other-novel-therapeutics
#3
REVIEW
Ryan M McAdams, Sandra E Juul
Neonatal encephalopathy (NE) is a major cause of neonatal mortality and morbidity. Therapeutic hypothermia (TH) is standard treatment for newborns at 36 weeks of gestation or greater with intrapartum hypoxia-related NE. Term and late preterm infants with moderate to severe encephalopathy show improved survival and neurodevelopmental outcomes at 18 months of age after TH. TH can increase survival without increasing major disability, rates of an IQ less than 70, or cerebral palsy. Neonates with severe NE remain at risk of death or severe neurodevelopmental impairment...
September 2016: Clinics in Perinatology
https://www.readbyqxmd.com/read/27456511/oxygen-targeting-in-extremely-low-birth-weight-infants
#4
James J Cummings, Richard A Polin
The use of supplemental oxygen plays a vital role in the care of the critically ill preterm infant, but the unrestricted use of oxygen can lead to unintended harms, such as chronic lung disease and retinopathy of prematurity. An overly restricted use of supplemental oxygen may have adverse effects as well. Ideally, continuous monitoring of tissue and cellular oxygen delivery would allow clinicians to better titrate the use of supplemental oxygen, but such monitoring is not currently feasible in the clinical setting...
August 2016: Pediatrics
https://www.readbyqxmd.com/read/27595621/preterm-formula-use-in-the-preterm-very-low-birth-weight-infant
#5
William W Hay, Kendra C Hendrickson
Whereas human milk is the recommended diet for all infants, preterm formulas are indicated for enteral feeding of preterm very low birth weight infants when sufficient maternal breast milk and donor human milk are not available. Feeding with preterm formulas helps to ensure consistent delivery of nutrients. The balance of risks and benefits of feeding preterm formulas versus supplemented maternal and donor breast milk for preterm infants, however, is uncertain. Numerous studies and extensive practice have shown improved growth with preterm formulas, but there is concern for increased risks of necrotizing enterocolitis, possibly from cow milk antigen in the formulas or from different gut microbiomes, increased duration of total parenteral nutrition, and increased rates of sepsis in infants receiving preterm formulas...
August 30, 2016: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/26055811/osteogenesis-imperfecta-pathophysiology-and-treatment
#6
REVIEW
Heike Hoyer-Kuhn, Christian Netzer, Oliver Semler
Osteogenesis imperfecta is a rare hereditary disease mostly caused by mutations impairing collagen synthesis and modification. Recently recessive forms have been described influencing differentiation and activity of osteoblasts and osteoclasts. Most prominent signs are fractures due to low traumata and deformities of long bones and vertebrae. Additional patients can be affected by dwarfism, scoliosis Dentinogenesis imperfecta, deafness and a blueish discoloration of the sclera. During childhood state of the art medical treatment are i...
July 2015: Wiener Medizinische Wochenschrift
https://www.readbyqxmd.com/read/26929865/lactobacillus-sepsis-and-probiotic-therapy-in-newborns-two-new-cases-and-literature-review
#7
Carlo Dani, Caterina Coviello C, Iuri Corsini I, Fabio Arena, Alberto Antonelli, Gian Maria Rossolini
Many term and preterm infants are commonly supplemented with probiotics to prevent adverse effects of antibiotic administration and necrotizing enterocolitis and they are believed to be safe. However, the supplementation with Lactobacillus rhamnosus GG has been associated with the development of sepsis with a cause-effect relationship in six newborns and children. In this study, we report two further cases and discuss the emerging issue of probiotic supplementation safety in neonates. We conclude that physicians must be aware that supplementation with L...
March 2016: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/25155722/acute-kidney-injury-in-the-neonate
#8
REVIEW
Jennifer G Jetton, David J Askenazi
Critically ill neonates are at risk for acute kidney injury (AKI). AKI has been associated with increased risk of morbidity and mortality in adult and pediatric patients, and increasing evidence suggests a similar association in the neonatal population. This article describes the current AKI definitions (including their limitations), work on novel biomarkers to define AKI, diagnosis and management strategies, long-term outcomes after AKI, and future directions for much-needed research in this important area...
September 2014: Clinics in Perinatology
https://www.readbyqxmd.com/read/26169430/neonatal-acute-kidney-injury
#9
REVIEW
David T Selewski, Jennifer R Charlton, Jennifer G Jetton, Ronnie Guillet, Maroun J Mhanna, David J Askenazi, Alison L Kent
In recent years, there have been significant advancements in our understanding of acute kidney injury (AKI) and its impact on outcomes across medicine. Research based on single-center cohorts suggests that neonatal AKI is very common and associated with poor outcomes. In this state-of-the-art review on neonatal AKI, we highlight the unique aspects of neonatal renal physiology, definition, risk factors, epidemiology, outcomes, evaluation, and management of AKI in neonates. The changes in renal function with gestational and chronologic age are described...
August 2015: Pediatrics
https://www.readbyqxmd.com/read/26474706/a-patent-ductus-arteriosus-severity-score-predicts-chronic-lung-disease-or-death-before-discharge
#10
MULTICENTER STUDY
Afif El-Khuffash, Adam T James, John David Corcoran, Patrick Dicker, Orla Franklin, Yasser N Elsayed, Joseph Y Ting, Arvind Sehgal, Andra Malikiwi, Andrei Harabor, Amuchou S Soraisham, Patrick J McNamara
OBJECTIVES: To test the hypothesis that a patent ductus arteriosus (PDA) severity score (PDAsc) incorporating markers of pulmonary overcirculation and left ventricular (LV) diastolic function can predict chronic lung disease or death before discharge (CLD/death). STUDY DESIGN: A multicenter prospective observational study was conducted for infants <29 weeks gestation. An echocardiogram was carried out on day 2 to measure PDA diameter and maximum flow velocity, LV output, diastolic flow in the descending aorta and celiac trunk, and variables of LV function using tissue Doppler imaging...
December 2015: Journal of Pediatrics
https://www.readbyqxmd.com/read/24709456/healthcare-associated-infections-in-the-hospitalized-neonate-a-review
#11
REVIEW
Thomas A Hooven, Richard A Polin
Healthcare-associated infections in the neonatal intensive care unit add considerably to hospital stays and costs, and contribute to numerous adverse outcomes, including death. The relatively high prevalence of healthcare-associated infections among neonates is secondary to the newborn's underdeveloped immune system, the need for frequent invasive procedures, and generally prolonged hospitalization. Central line associated bloodstream infections (CLABSI) are the most common form of healthcare-associated infection, with coagulase-negative Staphylococcus species (CONS) being the most commonly cultured microorganism...
March 2014: Early Human Development
https://www.readbyqxmd.com/read/23177803/health-care-associated-infections-in-the-neonatal-intensive-care-unit-barriers-to-continued-success
#12
REVIEW
Matthew J Bizzarro
Health care-associated infections often result in significant morbidity and mortality to affected patients and substantial financial cost to an overburdened health care system. Local, statewide, and national efforts have been conducted to eradicate central line-associated infections, ventilator-associated pneumonia, and urinary tract infections from inpatient and outpatient facilities. In the neonatal intensive care unit population, significant improvements have been made in many areas, but have been hindered in others by a lack of population-specific definitions, data, and guidelines for prevention and management...
December 2012: Seminars in Perinatology
https://www.readbyqxmd.com/read/25519202/urinary-tract-infections-in-a-neonatal-intensive-care-unit
#13
Mark F Weems, Daniel Wei, Rangasamy Ramanathan, Lorayne Barton, Linda Vachon, Smeeta Sardesai
OBJECTIVE: Our aim was to describe laboratory findings and imaging results for neonatal patients diagnosed with urinary tract infection (UTI). STUDY DESIGN: Medical records were reviewed for infants diagnosed with UTI in a single neonatal intensive care unit (NICU) over a 13-year period. RESULTS: Of the 8,241 patients admitted to the NICU during the study period, 137 infants were diagnosed with UTI. Imaging was reviewed for 101 patients. Renal pelvis dilation was found in 34% of patients and vesicoureteral reflux was found in 21%...
June 2015: American Journal of Perinatology
https://www.readbyqxmd.com/read/23276435/fluid-and-electrolyte-management-of-very-low-birth-weight-infants
#14
REVIEW
William Oh
Recent advances in medical knowledge and technology have markedly improved the survival rates of very low birth weight infants. Optimizing the neuro-developmental outcomes of these survivors has become an important priority in neonatal care, which includes appropriate management for achieving fluid and electrolyte balance. This review focuses on the principles of providing maintenance fluid to these infants, including careful assessment to avoid excessive fluid administration that may increase the risk of such neonatal morbidities as necrotizing enterocolitis, patent ductus arteriosus, and bronchopulmonary dysplasia (BPD)...
December 2012: Pediatrics and Neonatology
https://www.readbyqxmd.com/read/27238078/repeated-courses-of-oral-ibuprofen-in-premature-infants-with-patent-ductus-arteriosus-efficacy-and-safety
#15
Haşim Olgun, Naci Ceviz, İbrahim Kartal, İbrahim Caner, Mehmet Karacan, Ayhan Taştekin, Necip Becit
BACKGROUND: There are limited data about the results of repeated oral ibuprofen (OIBU) treatment. This study aimed to describe patent ductus arteriosus (PDA) closure rates and adverse events after repeated courses of OIBU in premature infants with PDA. METHODS: Preterm infants with hemodynamically significant (hs)PDA were enrolled in the study. If the first course of OIBU treatment failed, a second and, if required, third course was administered. RESULTS: A total of 100 patients received OIBU...
April 29, 2016: Pediatrics and Neonatology
https://www.readbyqxmd.com/read/27057767/continuous-positive-airway-pressure-versus-mechanical-ventilation-on-the-first-day-of-life-in-very-low-birth-weight-infants
#16
Dustin D Flannery, Elizabeth O'Donnell, Mike Kornhauser, Kevin Dysart, Jay Greenspan, Zubair H Aghai
Objective The objective of this study was to determine differences in the incidence of bronchopulmonary dysplasia (BPD) or death in very low-birth-weight (VLBW) infants managed successfully on continuous positive airway pressure (CPAP) versus mechanical ventilation on the first day of life (DOL). Study Design This is a retrospective analysis of the Alere neonatal database for infants born between January 2009 and December 2014, weighing ≤ 1,500 g. Baseline demographics, clinical characteristics, and outcomes were compared between the two groups...
August 2016: American Journal of Perinatology
https://www.readbyqxmd.com/read/26916176/effect-of-early-low-dose-hydrocortisone-on-survival-without-bronchopulmonary-dysplasia-in-extremely-preterm-infants-premiloc-a-double-blind-placebo-controlled-multicentre-randomised-trial
#17
RANDOMIZED CONTROLLED TRIAL
Olivier Baud, Laure Maury, Florence Lebail, Duksha Ramful, Fatima El Moussawi, Claire Nicaise, Véronique Zupan-Simunek, Anne Coursol, Alain Beuchée, Pascal Bolot, Pierre Andrini, Damir Mohamed, Corinne Alberti
BACKGROUND: Bronchopulmonary dysplasia, a major complication of extreme prematurity, has few treatment options. Postnatal steroid use is controversial, but low-dose hydrocortisone might prevent the harmful effects of inflammation on the developing lung. In this study, we aimed to assess whether low-dose hydrocortisone improved survival without bronchopulmonary dysplasia in extremely preterm infants. METHODS: In this double-blind, placebo-controlled, randomised trial done at 21 French tertiary-care neonatal intensive care units (NICUs), we randomly assigned (1:1), via a secure study website, extremely preterm infants inborn (born in a maternity ward at the same site as the NICU) at less than 28 weeks of gestation to receive either intravenous low-dose hydrocortisone or placebo during the first 10 postnatal days...
April 30, 2016: Lancet
https://www.readbyqxmd.com/read/27236858/prevalence-of-maternal-colonisation-with-group-b-streptococcus-a-systematic-review-and-meta-analysis
#18
Gaurav Kwatra, Marianne C Cunnington, Elizabeth Merrall, Peter V Adrian, Margaret Ip, Keith P Klugman, Wing Hung Tam, Shabir A Madhi
BACKGROUND: The most important risk factor for early-onset (babies younger than 7 days) invasive group B streptococcal disease is rectovaginal colonisation of the mother at delivery. We aimed to assess whether differences in colonisation drive regional differences in the incidence of early-onset invasive disease. METHODS: We did a systematic review of maternal group B streptococcus colonisation studies by searching MEDLINE, Embase, Pascal Biomed, WHOLIS, and African Index Medicus databases for studies published between January, 1997, and March 31, 2015, that reported the prevalence of group B streptococcus colonisation in pregnant women...
September 2016: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/27117179/what-we-learned-about-the-role-of-antenatal-magnesium-sulfate-for-the-prevention-of-cerebral-palsy
#19
REVIEW
Dwight J Rouse, Deborah Hirtz
Based on the convincing case control study of Nelson and Grether which suggested that the administration of magnesium sulfate to mothers prior to early preterm birth might protect their offspring from cerebral palsy, and a pilot study by John Hauth et al. at the University of Alabama at Birmingham, the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, with co-funding from the National Institute of Neurologic Disorders and Stroke embarked on the Beneficial Effects of Antenatal Magnesium (BEAM) Trial in 1997...
August 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27287615/novel-echocardiography-methods-in-the-functional-assessment-of-the-newborn-heart
#20
Colm R Breatnach, Philip T Levy, Adam T James, Orla Franklin, Afif El-Khuffash
Echocardiography in the neonatal intensive care unit has led to improvements in our ability to assess the neonatal heart in health and disease. Advances in neonatal cardiac imaging have provided the capability to obtain quantitative information that often supersedes the qualitative information provided by conventional methods. Novel quantitative measures of function include the assessment of the velocity of muscle tissue movement during systole and diastole using tissue Doppler velocity imaging, and evaluation of deformation and rotational characteristics of the myocardium utilizing speckle tracking echocardiography or tissue Doppler-derived strain imaging...
2016: Neonatology
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