Early human development
-
Early human development · Jun 2013
ReviewStrategies to accelerate weaning from respiratory support.
Because mechanical ventilation is associated with severe complications in premature infants, it is important to limit its duration as much as possible. This can be accomplished by using strategies that preserve spontaneous respiration such as patient triggered and volume target ventilation. The use of respiratory stimulants and nasal CPAP or nasal IPPV after extubation are also effective and improve extubation success. A short course of systemic steroids can also expedite weaning and extubation.
-
Early human development · May 2012
Review"Getting to Zero": preventing invasive Candida infections and eliminating infection-related mortality and morbidity in extremely preterm infants.
Prevention of invasive Candida infections (ICI) is an achievable goal for every NICU and supported by A-1 evidence. Due to the incidence of ICI, high infection-associated mortality and neurodevelopmental impairment, antifungal prophylaxis should be targeted to infants <1000 g or ≤ 27 weeks gestation. There is A-1 evidence for both fluconazole and nystatin prophylaxis for the prevention of ICI. ⋯ For infants 1000-1500 g if there is concern for ICI in the NICU, either drug could be chosen for prophylaxis. Fluconazole prophylaxis administered at 3 mg/kg twice a week, while intravenous access is required, appears to be the safest and most effective schedule in preventing ICI while attenuating the emergence of fungal resistance. Invasive Candida infections are one group of infections we can prevent.
-
Early human development · Feb 2012
ReviewWithholding or withdrawal of life sustaining treatment for newborn infants.
In the last two decades the survival of extreme preterm infants and sick newborn infants has improved significantly due to the advances in perinatal medicine. Despite this advance, for some babies, withholding or withdrawal of life sustaining treatment may be the best option in the interest of the baby. ⋯ The decision making process and factors influencing parents decision, how to resolve disagreement, what treatment can be withheld or withdrawn are explained. High quality palliative care must be provided after withholding or withdrawal of life sustaining treatment.
-
Palliative care for the newborn is a developing area. There are more than 2000 estimated neonatal deaths each year in the UK from causes likely to benefit from palliative care. ⋯ K. association for children's palliative care). We attempt to answer the question: 'What does the provision of good neonatal palliative care look like?' by examining the factors important in the provision of such care.
-
Early human development · Feb 2012
ReviewParents perceptions of withdrawal of life support treatment to newborn infants.
The decision to withdraw life support challenges health care professionals and parents. Parents need to fulfil their role as parents, part of which involves difficult decision making. They desire to fully understand the care of their infant in order to help in this process. ⋯ Available approaches to care need to address ethical decisions regarding treatment, pain and suffering, quality of life and decisions to move from active to palliative care. Communication requires an investment of time, repeated discussions and a compassionate approach by health care professionals to educate parents in order for them to make an informed decision. Follow-on care to help parents come to terms with the decisions they have made is a requirement of good practice.