Neonatology
-
Cardiovascular drugs play a major role in the pre- and postoperative care in neonates with congenital heart disease. Management strategies aim to optimise contractility, improve diastolic function, maintain adequate preload, and reduce afterload. Levosimendan, a novel inodilator agent, enhances myocardial contractility and causes peripheral and coronary vasodilation. ⋯ Levosimendan improves cerebral and systemic perfusion and oxygenation in critically ill infants suffering from LCOS.
-
Most pediatric cardiologists believe that pulse oximetry helps to diagnose critical congenital heart disease in neonates who might otherwise be discharged from the newborn nursery undiagnosed. Some of these patients develop catastrophic cardiac and multi-system failure after the ductus closes and die or suffer severe morbidity. Nevertheless, pulse oximetry is not universally used in the newborn nursery. ⋯ Recent studies, however, show that even cardiologists miss critical congenital heart defects, modern oximeters are stable and reliable, and that the false positive rate is very low, lower than the false positive rate based on physical examination. The benefits probably exceed the cost, and evidence is provided to confirm this. There is no reason not to use pulse oximetry routinely in the newborn nursery.
-
Review Meta Analysis
In search of the optimal oxygen saturation for extremely low birth weight infants: a systematic review and meta-analysis.
The optimal arterial oxygen saturation in the first weeks of life is unknown for immature newborn infants. ⋯ A low oxygen saturation approach reduces severe retinopathy of prematurity by 50%, i.e., from 20.9 to 9.5%, and bronchopulmonary dysplasia/lung problems by 25%, i.e., from 40.8 to 29.7%. Further randomized trials are needed to provide definite conclusions and to assess whether reducing oxygen saturation has an impact on mortality among very and extremely low birth weight infants.
-
Helium-oxygen mixture (heliox) ventilation has been known as an alternative treatment in patients with airway obstruction. Because of the physical properties of heliox, mechanical ventilation with this gas mixture may offer advantages in the management of respiratory failure associated with meconium aspiration syndrome (MAS). ⋯ Ventilation with a helium and oxygen mixture had a positive effect on the selected parameters of oxygenation, while its effects on other respiratory parameters were relatively small.
-
Opinions and practice regarding end-of-life decisions in neonatal medicine show considerable variations between countries. A recent change of the legal framework, together with an ongoing debate among French neonatologists, led the French Society of Neonatology to reconsider and update its previous recommendations. ⋯ This statement provides the principles identified by French neonatologists on which to base their decisions concerning the ending of life. Arguments are set forth, discussed and compared with international statements and previously published considerations.