Early human development
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Early human development · Sep 2014
ReviewEvidence for CCHD screening and its practical application using pulse oximetry.
Pulse oximetry screening is a highly specific, moderately sensitive test for detecting critical congenital heart defects (CCHDs) that meets the criteria for universal screening. The possibility of using pulse oximetry as a screening test was first investigated over 10 years ago and since then data from more than 370,000 screened babies have now been published. There is significant heterogeneity in published screening protocols but almost all demonstrate that the addition of pulse oximetry screening reduces the 'diagnostic gap' - i.e. those babies with CCHD who are missed by existing screening methods and discharged from hospital before the diagnosis has been established. This review considers the available evidence and assesses the practical options for the introduction of pulse oximetry screening.
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Early human development · Mar 2014
ReviewA synopsis of 2007 ACCM clinical practice parameters for hemodynamic support of term newborn and infant septic shock.
This is a synopsis of the term newborn and infant portion of the 2007 document (Brierley et al., Crit Care Med 2009;37(2):666-88) which examined and graded new studies performed to test the utility and efficacy of the 2002 recommendations. This 2007 document examined and graded relevant new treatment and outcome studies to determine to what degree, if any, the 2002 guidelines should be modified. More than 30 clinical investigators and clinicians affiliated with the Society of Critical Care Medicine who had special interest in hemodynamic support of pediatric patients with sepsis volunteered to be members of the "update" task force. ⋯ The literature was accrued in part by searching PUBMED/MEDLINE using the following keywords: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, and ECMO. The search was narrowed to identify studies specifically relevant to term newborns, infants, and children. "Best Practice Outcomes" were identified and described clinical practice in these centers was used as a model. The new taskforce is presently working on updating new guidelines evaluating the literature of the past 6 years.
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Early human development · Mar 2014
ReviewBi-directional activation of inflammation and coagulation in septic neonates.
Neonatal sepsis is frequently accompanied by significant and sometimes life-threatening coagulopathy. More complete understanding is needed of the molecular and cellular mechanisms underlying the interaction of the inflammatory and hemostatic systems. Such information may help focus future studies toward novel ways to improve the outcome of neonates who develop septic coagulopathy.
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Early human development · Nov 2013
ReviewOptimal timing of umbilical cord clamping for term and preterm babies.
Deferring cord clamping allows blood flow between baby and placenta to continue for a few moments. This often leads to increased neonatal blood volume at birth. It also allows for longer transition to the neonatal circulation. ⋯ Therefore, a more liberal approach to deferring cord clamping appears to be warranted, provided screening and treatment for jaundice requiring phototherapy is available. For preterm births, although there are few data on the main clinical outcomes, the evidence is promising that deferred cord clamping may be beneficial. For both term and preterm infants there is little information about long term development.
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Until about forty years ago, the womb shielded the fetus from observation and therapy. The rapid changes in the diagnosis and treatment of human fetal anatomical abnormalities are due to improved fetal imaging studies as well as fetal sampling techniques (e.g. amniocentesis, chorionic villus sampling), and a better understanding of fetal pathophysiology derived from laboratory animals. ⋯ The fetal surgical treatment of the most severe form of spina bifida - myelomeningocele (MMC) - will be used as a paradigm to illustrate progress in and future prospects for fetal surgery. This review will focus on the rationale for in utero repair in the context of pathologic observations and animal models of MMC, outcomes from human fetal MMC repair including the recently completed Management of Myelomeningocele Study (MOMS trial), and future research directions.