Journal of neonatal-perinatal medicine
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J Neonatal Perinatal Med · Jan 2014
ReviewA delicate subject: The impact of cultural factors on neonatal and perinatal decision making.
The neonatal intensive care unit (NICU) is a high-stress environment for both families and health care providers that can sometimes make appropriate medical decisions challenging. We present a review article of non-medical barriers to effective decision making in the NICU, including: miscommunication, mixed messages, denial, comparative social and cultural influences, and the possible influence of perceived legal issues and family reliance on information from the Internet. ⋯ We provide background on the sources of conflict in these particular cases. We also offer suggestions for possible amelioration of similar conflicts with the twin goals of facilitating compassionate decision making in NICU settings and promoting enhanced well-being of both families and providers.
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J Neonatal Perinatal Med · Jan 2014
Review Comparative Study Observational StudyMonitoring regional tissue oxygen extraction in neonates <1250 g helps identify transfusion thresholds independent of hematocrit.
We sought to characterize the effects of "booster" packed red blood cell transfusions on multisite regional oxygen saturation in very low birth weight neonates during the first postnatal week and to examine the utility of fractional tissue oxygen extraction as an estimate of tissue oxygenation adequacy. ⋯ "Booster" transfusions improved indices of regional tissue oxygenation while no departures were observed in conventional cardiovascular assessments. We speculate that NIRS-derived oxygenation parameters can provide an objective, graded, and continuous estimate of oxygen delivery-consumption balance not evident using standard monitoring techniques.
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J Neonatal Perinatal Med · Jan 2014
Review Case ReportsUmbilical venous catheter-induced hepatic hematoma in neonates.
Umbilical vessel catheterization is common practice for infants in the neonatal intensive care unit (NICU). Umbilical venous catheters (UVC) although very useful as a means of obtaining vascular access, do not come without risks. ⋯ We believe liver hematomas may be a more common complication of malpositioned UVCs than previously believed. An appreciation of the complications of malpositioned UVCs should alert clinicians to screen for potential complications and to ensure ideal line placement.
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J Neonatal Perinatal Med · Jan 2014
ReviewPlacental transfusion strategies in extremely preterm infants: the next piece of the puzzle.
Evidence is growing on the potential value of enhancing placental-fetal transfusion at birth, with recent endorsement of the practice by the World Health Organization and American College of Gynecologists. However, these recommendations provide clinicians with little guidance on the optimal practice among infants born extremely premature (<28 weeks gestation) and those requiring immediate resuscitation. ⋯ The review provided herein suggests that delayed cord clamping or umbilical cord milking can be applied safely to infants born prior to 28 weeks gestation, but the lack of evidence on the best practice among infants born severely depressed and requiring immediate resuscitation, who comprise a greater proportion of infant deliveries at the lowest gestational ages, is recognized. Future studies using well-defined physiologic outcome measures are needed to understand the role of placental transfusion in premature infants' adaptations to extrauterine life.