Clinics in perinatology
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Clinics in perinatology · Mar 2016
ReviewDevelopmental Care Rounds: An Interdisciplinary Approach to Support Developmentally Appropriate Care of Infants Born with Complex Congenital Heart Disease.
Newborn infants with complex congenital heart disease are at risk for developmental delay. Developmental care practices benefit prematurely born infants in neonatal intensive care units. ⋯ Interdisciplinary developmental care rounds in our center have helped in the promotion of developmentally supportive care for infants before and after cardiac surgery. This article discusses basic principles of developmental care, the role of each member of the interdisciplinary team on rounds, common developmental care practices integrated into care from rounds, and impacts to patients, families, and staff.
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Clinics in perinatology · Dec 2015
ReviewOxygen Saturation Targeting and Bronchopulmonary Dysplasia.
Oxygen saturation targeting is widely used in neonatal intensive care, but the optimal target range in very preterm infants has been uncertain and is the subject of recent debate and research. This review briefly discusses the technology of oxygen monitoring and the role of oxygen toxicity in preterm infants. The background to the recent trials of oxygen saturation targeting in acute and continuing care of very preterm infants is reviewed, and the findings and implications of the recent trials, particularly with respect to bronchopulmonary dysplasia, are discussed.
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Mechanical ventilation is an important potentially modifiable risk factor for the development of bronchopulmonary dysplasia. Effective use of noninvasive respiratory support reduces the risk of lung injury. Lung volume recruitment and avoidance of excessive tidal volume are key elements of lung-protective ventilation strategies. Avoidance of oxidative stress, less invasive methods of surfactant administration, and high-frequency ventilation are also important factors in lung injury prevention.
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Clinics in perinatology · Sep 2015
ReviewPlatelet Transfusions in the Neonatal Intensive Care Unit.
There is significant world-wide variability in platelet transfusion thresholds used to transfuse thrombocytopenic neonates. A large multicenter randomized controlled trial comparing 2 different platelet transfusion thresholds in neonates is currently ongoing, and should provide data to guide transfusion practice. However, several studies have found that factors other than the degree of thrombocytopenia determine the bleeding risk. Thus, it will be important to develop better tests to assess primary hemostasis and bleeding risk in neonates.
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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.