American journal of perinatology
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Review
Approach to Infants Born Through Meconium Stained Amniotic Fluid: Evolution Based on Evidence?
Meconium-stained amniotic fluid (MSAF) during delivery is a marker of fetal stress. Neonates born through MSAF often need resuscitation and are at risk of meconium aspiration syndrome (MAS), air leaks, hypoxic-ischemic encephalopathy, extracorporeal membrane oxygenation (ECMO), and death. The neonatal resuscitation approach to MSAF has evolved over the last three decades. ⋯ Changes in resuscitation practices may have contributed to reduced incidence and severity of MAS. Larger randomized controlled studies are needed among nonvigorous infants with MSAF. However, ethical dilemmas and loss of equipoise pose a challenge to conduct such studies.
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Despite being a bedside technique under rapid development and diffusion, lung ultrasound has not been often used in the management of viral low respiratory tract infections, although these infections represent a significant burden of care in neonatology and pediatrics. The aim of this article is to review the lung ultrasound findings and the evidence-based data available on this topic. Guidance on bedside imaging interpretation and future research direction are also discussed in this article.
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Review Historical Article
The Historical Development of Obstetric Anesthesia and Its Contributions to Perinatology.
Scottish obstetrician James Young Simpson first introduced the use of ether and chloroform anesthesia for labor in 1847, just 1 year after William Morton's first successful public demonstration of ether anesthesia at the Massachusetts General Hospital. The contemporaneous development of surgical anesthesia and obstetrics enabled obstetric anesthesia to address the pain of childbirth. Shortly after its introduction, obstetricians raised concerns regarding placental transport, or the idea that drugs not only crossed the placenta, but exerted detrimental effects on the neonate. The development of regional anesthesia and clinical work in obstetric anesthesia and perinatology addressed issues of the safety of the neonate, enabling obstetric anesthesia to safely and dramatically reduce the pain of childbirth.
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Heated, humidified high-flow delivered by nasal cannulae (HHHFNC) is increasingly used for noninvasive respiratory support in preterm infants and critically ill children due to its perceived effectiveness and ease of use. Evidence from randomized controlled trials suggests that HHHFNC and continuous positive airway pressure (CPAP) are equally effective as postextubation support in preterm infants. HHHFNC is also used for weaning preterm infants from CPAP. ⋯ Most published studies were conducted on infants and young children with bronchiolitis. The results of a few observational studies and two randomized trials suggest that HHHFNC therapy is effective in the treatment of bronchiolitis. This review discusses the proposed mechanisms of action behind HHHFNC, the results of observational studies, and the evidence emerging from clinical trials on the use of HHHFNC in preterm infants and children critically ill with bronchiolitis.
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The latest Zika virus (ZIKV) outbreak has reached epidemic proportions as it spreads throughout South and Central America. In November 2015, the Brazilian Ministry of Health reported a 20-fold increase in the number of cases of neonatal microcephaly, which corresponds geographically and temporally to the ZIKV outbreak. ⋯ Our objective is to review and synthesize the current literature regarding ZIKV as it pertains to pregnancy and provide some assistance to clinicians who may have to manage a pregnant patient with potential exposure to ZIKV. We will also explore certain aspects of related viruses in pregnancy in hopes to shed light on this little-known topic.