Neonatal network : NN
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The five-part "Pointers in Practical Pharmacology" immunomodulation series has presented some of the agents researchers are investigating in hopes of finding the means to effectively prevent and treat infectious processes in neonates. The phosphodiesterase inhibitor pentoxifylline appears promising, but large, randomized, clinical trials are still lacking. So far, there is no clear evidence to support the use of G-CSF for either the prevention or the treatment of sepsis. ⋯ The "conditionally essential" amino acid glutamine administered either enterally or parenterally does not make a difference in the rate of systemic infection or NEC in very low birth weight infants. Finally, probiotics appear promising as documented by at least two of the three randomized, clinical trials described here. As the search continues for agents to enhance the neonate's immune system and prevent and treat infectious diseases, remember that our best prevention tool is excellent and consistent hand hygiene.
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Glutamine, a nonessential amino acid that appears to be conditionally essential during periods of physiologic stress, plays important physiologic roles in the immune system. However, neither enteral nor parenteral glutamine supplementation makes a difference in the rate of systemic infection or of NEC in very low birth weight infants. Thus, the search for agents to enhance the neonate's immune system and to serve as safe and effective adjuvants to antibiotics continues. Part V, the final article in this immunomodulation series, will explore the use of probiotics to support the neonatal immune system.
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Neonatal network : NN · Jul 2006
ReviewEvidence-based review of oral sucrose administration to decrease the pain response in newborn infants.
Pain assessment and management are important issues for the neonatal nurse today. Clinicians have gradually come to acknowledge that newborn infants (term and preterm) are capable of responding to painful stimuli. This article reviews the evidence regarding the safety and efficacy of oral sucrose administration, to help answer the clinical question of how to manage an infant's pain response to minor invasive procedures that are everyday occurrences in the NICU. ⋯ The evidence presented in the 16 studies reviewed here shows the safety and efficacy of sucrose in decreasing term infants' pain response to a single procedure. In regard to preterm infants, there is insufficient evidence to recommend the use of sucrose as a routine comfort measure. More research is needed to determine the safety and efficacy of repeated doses of oral sucrose given for multiple procedures in preterm infants.
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PTXF appears to be a promising adjunct to antibiotic therapy in neonatal sepsis. No adverse effects were noted in either study reported in the literature. However, there is a need for large randomized clinical trials to confirm or refute the role of PTXF in the treatment of sepsis in neonates. ⋯ Comparison of PTXF with immunomodulatory agents such as colony-stimulating factors and intravenous immunoglobulins is suggested. Part II of this five-part series on immunomodulation will explore the use of colony-stimulating factors in neonates. Other topics will include the amino acid glutamine, intravenous immunoglobulins, and probiotics.
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Neonatal network : NN · May 2005
ReviewParents and professionals in the NICU: communication within the context of ethical decision making--an integrative review.
Communication between parents and professionals in the NICU is a necessary part of collaborative decision making in the provision of family-centered care. Decisions with ethical components, those regarding treatment plans or neonatal research enrollment, need to be made conjointly with parents and health care professionals. This article reviews the present state of knowledge of how parents' input can be facilitated in regard to decisions made about their children. Research studies involving decisions made with ethical components in the NICU since the advent of the Baby Doe regulations reveal parents' frustration with communication practices, their need for control of information, and the trust in their children's health care providers that is required to best facilitate their input into ethical decisions made about their children.