Minerva pediatrica
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Chorioamnionitis (CA) is defined as an infection that can affect amniotic fluid, placenta and uterus. The chorioamnionitis is present in 10-40% of cases of maternal peripartum fever and in 50% of preterm labor. Diagnosis is based on the presence of maternal fever (>38 degrees C) at least 2 of these conditions: maternal leukocytosis (> 15,000 cells/mmc), maternal tachycardia, fetal tachycardia, stained or foul smelling amniotic fluid, uterine tenderness. ⋯ Common maternal complications include bacteremia to septic shock, cesarean section, uterine atony with hemorrhage, pelvic abscess, maternal coagulopathy, thromboembolism and wound infections. The risk of neonatal sepsis, low seizures, low Apgar score at 5 minutes increased in the newborn. Cardiotocographic fetal monitoring should be continued during labor in cases of suspected chorioamnionitis with recourse to caesarean section as soon as signs of severe fetal distress.
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In the neonatal population, pleural effusion and particularly tension pneumothorax can be a deadly situation. Pneumothorax occurs more often in the neonatal period that any other time of life. Tension pneumothorax can result in very high pressures within the pleural space, collapsing the lung on the involved side and resulting in immediate hypoxia, hypercapnia and subsequent circulatory collapse. ⋯ If a tension pneumothorax is suspected, emergency needle decompression in the second intercostal space in the midclavicular line is required. In this article, we describe the management of tube thoracostomy using trocar tubes or pigtail catheters. Besides, we pay attention to the use of pain control for neonates undergoing painful procedures such as chest tube insertion.
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Endotracheal intubation is frequently performed in neonatal intensive care. This procedure is extremely distressing and painful, and it has the potential for causing laryngospasm, hemodynamic changes, a rise in intracranial pressure and a risk of hemorrhage and airway injury. These adverse changes can be attenuated by using premedication with analgesic, sedative and muscle-relaxant drugs. ⋯ In Italy, a recent survey (in press) showed that the majority of NICU (Neonatal Intensive Care Units) use the sa me association of drugs for analgesia and sedation before tracheal intubation, but "not always" in more than half of these units. There is clearly a persistent concern about using such drugs in preterm and newborn infants, despite recent evidence showing that premedication for elective neonatal intubation is safer and more effective than when the infant is awake. Here we review the effects of using analgesic and sedative drugs on intubation conditions (good jaw relaxation, open and immobile vocal cord, suppression of pharyngeal and laryngeal reflex), on the time it takes to complete the procedure successfully, on pain control and the potentially adverse effects of using combinations of drugs for sedation.