Neonatology
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Low-birth-weight (LBW) infants have a significantly greater mortality than other babies, not only within the neonatal period but also in infancy and early childhood. Babies are LBW either because they are preterm or they have experienced intrauterine growth retardation. Reducing the prevalence of LBW babies is important in reducing child and infant mortality. ⋯ Key features of the Cuban healthcare system are that it is both free and universal, and additionally there is a strong emphasis on primary healthcare. It is likely that a similar approach in both developing countries and disadvantaged communities in developed countries would reduce the prevalence of LBW babies. This would have a major impact in relation to reducing infant mortality rates.
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Review Meta Analysis Comparative Study
Resuscitation of newborn infants with 21% or 100% oxygen: an updated systematic review and meta-analysis.
The issue of whether 21% O(2) is more effective than 100% O(2) for resuscitation of newborn infants remains controversial. ⋯ There is a significant reduction in the risk of neonatal mortality and a trend towards a reduction in the risk of severe hypoxic ischemic encephalopathy in newborns resuscitated with 21% O(2).
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Newborn babies, even if extremely preterm, show responses to pain. The major stress responses seen with surgical pain are associated with serious adverse medical outcomes. There is an ethical imperative to consider pain relief in babies, despite the fact that they cannot verbalise their experience. ⋯ Topical anaesthetic creams reduce the pain response when used in anticipation of phlebotomy or vascular cannulation. Intra-oral sucrose is effective cover for procedures associated with mild to moderate distress, but its role in preterm infants is uncertain. Nursing interventions to reduce environmental stress, although commonly used, have not consistently been shown to be of benefit.
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We review information about how the preterm lung can be injured with the initiation of mechanical ventilation at birth. Although multiple variables such as pressure, tidal volume, positive end expiratory pressure, and the gas used for ventilation may contribute to the injury, the relative contribution of each is not known. ⋯ A model for gas inflation of the fluid-filled lung may explain why even low tidal volumes may injure the preterm lung, and why the injury may initially occur to the small airways. Ventilation strategies that minimize injury need to be developed.
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Review
Monitoring neonatal regional cerebral oxygen saturation in clinical practice: value and pitfalls.
This review focuses on the clinical use of near infrared spectroscopy (NIRS) to assess brain oxygenation by the tissue oxygenation index (TOI), and monitoring regional cerebral oxygen saturation (rScO(2)), cerebral fractional tissue oxygen extraction (cFTOE), which is derived from rScO(2), and systemic oxygen saturation. Its precision and pitfalls are discussed. At this stage, it is clear that NIRS-monitored oxygenation of the brain by rScO(2) or TOI lacks the precision required to be used as a robust quantitative variable to monitor cerebral oxygenation. ⋯ Since neonatal intensive care is for a substantial part 'brain orientated' this approach seems conceivable. This gives rise to the conclusion that NIRS-monitored TOI, rScO(2) and cFTOE increasingly will have a role in clinical practice as semiquantitative indicators of changes in cerebral oxygenation and oxygen extraction. Combination with other (cerebral) parameters such as amplitude-integrated EEG and blood pressure seems promising for further optimization of monitoring the immature brain.