Neonatology
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Perinatal hypoxia-ischemia or birth asphyxia is a serious complication with a high mortality and morbidity. For decades, neuroprotective options have been explored to reduce reperfusion and reoxygenation injury to the brain, which accounts for a substantial part of birth asphyxia-related brain damage. ⋯ Since hypothermia has been proven to be beneficial for a selected group of asphyxiated neonates, we assume that a combination of this treatment option with a pharmacological means of neuroprotection will be the appropriate approach in the future. Finally, it is important to consider possible gender effects in view of the discussed pharmacological strategies.
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Review Meta Analysis
A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants.
The optimal timing of clamping the umbilical cord in preterm infants at birth is the subject of continuing debate. ⋯ The procedure of a delayed cord clamping time of at least 30 s is safe to use and does not compromise the preterm infant in the initial post-partum adaptation phase.
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Nasal continuous positive airway pressure (nCPAP) is an effective treatment of respiratory distress syndrome. Due to long-standing experience of early nCPAP as the primary respiratory support option in preterm infants, this approach is sometimes labeled 'the Scandinavian Model'. Mechanical ventilation is potentially harmful to the immature lungs and cohort studies have demonstrated that centers using more CPAP and less mechanical ventilation have reduced rates of bronchopulmonary dysplasia. ⋯ Surfactant is essential in the treatment of respiratory distress syndrome and has generally been reserved for infants on mechanical ventilation. With the development of INSURE (INtubation SURfactant Extubation), in which surfactant is administered during a brief intubation followed by immediate extubation, surfactant therapy can be given during nCPAP treatment further reducing need for mechanical ventilation. In this review the history, current knowledge and techniques of CPAP and surfactant are discussed.
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Mechanical ventilatory support is required by a large number of neonates in respiratory failure. However, its use in preterm infants is frequently associated with acute complications and long-term respiratory sequelae. Therefore, it is recommended to avoid or limit the exposure to ventilatory support. This is a review of existing practices and novel strategies to achieve weaning of ventilatory support in this population.
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Invasive ventilation via the endotracheal tube is one of the most common therapeutic interventions performed in preterm infants with respiratory failure. Respiratory distress syndrome (RDS) occurs in about 50% of preterm infants born at less than 30 weeks of gestational age. Mechanical ventilation using conventional or high-frequency ventilation and surfactant therapy have become the standard of care in management of preterm infants with RDS. ⋯ Randomized controlled trials comparing conventional mechanical ventilation and high-frequency ventilation, using 'optimal ventilatory strategies', have shown no significant difference in rates of BPD. Use of noninvasive ventilation, such as nasal continuous positive airway pressure and nasal intermittent positive pressure ventilation has shown a significant decrease in postextubation failure as well as reduced incidence of BPD. Optimal ventilatory strategy in preterm infants with RDS may begin in the delivery room with application of sustained inflation to establish functional residual capacity, followed by surfactant therapy and rapid extubation to noninvasive ventilation to decrease the incidence of BPD and improve overall outcome.