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Hemodynamics during noninvasive ventilation in neonates. 新生儿无创通气期间的血流动力学。
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-03-10 DOI: 10.1016/j.semperi.2025.152065
Vidhi Jhaveri, Satyan Lakshminrusimha, Yogen Singh
{"title":"Hemodynamics during noninvasive ventilation in neonates.","authors":"Vidhi Jhaveri, Satyan Lakshminrusimha, Yogen Singh","doi":"10.1016/j.semperi.2025.152065","DOIUrl":"https://doi.org/10.1016/j.semperi.2025.152065","url":null,"abstract":"<p><p>Noninvasive ventilation (NIV) is increasingly used in neonatal care to reduce lung injury and improve respiratory outcomes. However, its effects on cardiovascular function and cardiopulmonary interactions, particularly in preterm neonates, remain unclear. This paper reviews the hemodynamic changes associated with NIV and provides an overview of how NIV influences cardiac preload, pulmonary vascular resistance, ventricular output, and systemic blood flow. NIV also affects these parameters in different ways in neonates with compromised cardiovascular stability, such as those with persistent pulmonary hypertension, patent ductus arteriosus and systemic hypotension. The synthesis of current evidence underscores that optimizing NIV requires careful titration of ventilatory parameters and highlights the potential role of targeted echocardiography and other clinical monitoring tools in guiding individualized management strategies. This review emphasizes the need for a nuanced approach that balances respiratory support with hemodynamic stability and calls for further research to establish best practices for the safe and effective use of NIV in neonates with hemodynamic compromise.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152065"},"PeriodicalIF":3.2,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of non-invasive ventilation on Bronchopulmonary Dysplasia. 无创通气对支气管肺发育不良的影响。
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-03-07 DOI: 10.1016/j.semperi.2025.152061
Vikramaditya Dumpa, Indirapriya Avulakunta, Vineet Bhandari
{"title":"Effect of non-invasive ventilation on Bronchopulmonary Dysplasia.","authors":"Vikramaditya Dumpa, Indirapriya Avulakunta, Vineet Bhandari","doi":"10.1016/j.semperi.2025.152061","DOIUrl":"https://doi.org/10.1016/j.semperi.2025.152061","url":null,"abstract":"<p><p>Bronchopulmonary dysplasia (BPD) is a major complication of prematurity, leading to long-term pulmonary morbidity. Invasive mechanical ventilation (IMV) is associated with ventilator-induced lung injury, oxygen toxicity, and inflammation, all contributing to BPD pathogenesis. Non-invasive ventilation (NIV) has emerged as a key strategy to reduce the incidence and severity of BPD. We examine the role of various NIV strategies in the respiratory management of premature infants. We discuss the common forms of NIV, including nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation, bilevel positive airway pressure, high-flow nasal cannula, and nasal high-frequency ventilation, with a focus on their mechanisms of action, benefits, and limitations. Several studies have demonstrated that early and appropriate NIV use can reduce the incidence of BPD, improve oxygenation, and promote lung growth. However, NIV is not without challenges, including patient selection, the timing of initiation, and potential difficulties in achieving adequate ventilation, especially in extremely low birth weight neonates. Adjunctive therapies such as early surfactant therapy, less invasive surfactant administration, and caffeine may enhance the effectiveness of NIV. In conclusion, NIV is a promising approach to decreasing BPD, yet its effectiveness relies on proper clinical application and integration with other therapies to maximize its benefits.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152061"},"PeriodicalIF":3.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Advances in management of noninvasive ventilation for preterm infants. 早产儿无创通气治疗的进展。
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-03-06 DOI: 10.1016/j.semperi.2025.152060
Manoj Biniwale, Rangasamy Ramanathan
{"title":"Advances in management of noninvasive ventilation for preterm infants.","authors":"Manoj Biniwale, Rangasamy Ramanathan","doi":"10.1016/j.semperi.2025.152060","DOIUrl":"https://doi.org/10.1016/j.semperi.2025.152060","url":null,"abstract":"<p><p>Providing most appropriate noninvasive ventilation (NIV) for preterm infants remains priority in neonatal intensive care units. Several newer modes of ventilation have evolved including continuous positive airway pressure, nasal intermittent positive pressure ventilation and noninvasive high frequency ventilation to meet patients' demands. Advanced level of monitoring is performed while patients are receiving NIV for optimization of the respiratory support. Point of care lung ultrasound and electrical impedance tomography are the newer tools that give insights towards aeration of the lungs. Pulmonary near infrared spectroscopy, electromyography of the diaphragm and advanced techniques of noninvasive pulmonary function testing provide data focusing on the performance of lungs. The hybrid modalities of ventilators used often in adults are needed in neonates to provide on demand individualized level of noninvasive respiratory support. Automated oxygen adjustment, inhaled nitric oxide and heliox can be benefcial when successfully provided through NIV. Delivery room NIV has a strong potential to improve neonatal outcomes. Further research should be focused taking into consideration physiologic needs and applying customized approach to meet patient's demands. Artificial intelligence leading to precision treatment is the way forward for providing individualized respiratory support for newborn infants.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152060"},"PeriodicalIF":3.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
NIPPV vs CPAP: Lessons from meta-analyses. NIPPV与CPAP：来自荟萃分析的教训。
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-03-06 DOI: 10.1016/j.semperi.2025.152062
Marc-Olivier Deguise, Brigitte Lemyre
{"title":"NIPPV vs CPAP: Lessons from meta-analyses.","authors":"Marc-Olivier Deguise, Brigitte Lemyre","doi":"10.1016/j.semperi.2025.152062","DOIUrl":"https://doi.org/10.1016/j.semperi.2025.152062","url":null,"abstract":"<p><p>Care of the extremely premature infant has been in constant state of re-evaluation as the population, technologies and knowledge continue to evolve. A growing population of extremely low gestational age neonates (ELGAN - <28 weeks) and \"nanopremies\" (<24 weeks) are undergoing successful resuscitation, stabilization, and intensive care leading to improved survival. Respiratory care is the cornerstone of ELGAN management, as their lungs are at a critical stage of development. The lifesaving intensive care they require can lead to various injurious stimuli making them prone to bronchopulmonary dysplasia (BPD). Non-invasive ventilation (NIV), including continuous positive airway pressure ventilation (CPAP) and nasal intermittent positive pressure ventilation (NIPPV) has evolved and can appropriately support premature infants' breathing, while limiting the invasiveness and associated complications of mechanical ventilation. This review focuses on our current understanding, knowledge and evidence gathered via meta-analysis on these two modes of NIV in preterm infants, when used either as primary intent respiratory support post-birth or following extubation. We will summarize the current data of recent meta-analyses, their pitfalls, and the remaining questions to be addressed by future research to optimize the use of these modes of respiratory support in preterm infants most at risk for BPD.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152062"},"PeriodicalIF":3.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Melanoma in pregnancy 妊娠期黑色素瘤
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-03-01 DOI: 10.1016/j.semperi.2025.152040
Christina S. Oh , Elizabeth F. Sher , Amy K. Bieber
{"title":"Melanoma in pregnancy","authors":"Christina S. Oh ,&nbsp;Elizabeth F. Sher ,&nbsp;Amy K. Bieber","doi":"10.1016/j.semperi.2025.152040","DOIUrl":"10.1016/j.semperi.2025.152040","url":null,"abstract":"<div><div>Cutaneous melanoma is a malignant neoplasm of melanocytes that most frequently affects the skin. It is the most common malignancy in women of childbearing age, and accounts for almost one-third of all malignancies diagnosed during gestation. The pathophysiology of melanoma, particularly during pregnancy, is not well understood, but there are several ways in which the physiologic state pregnancy may impact melanoma. Based on the available literature, pregnancy does not seem to worsen maternal outcomes with melanoma, and outside of placental and fetal metastases, melanoma does not seem to cause serious obstetric or fetal complications. Treatment of localized melanoma during pregnancy follows guidelines for the general population, but advanced melanoma in pregnancy poses unique challenges given the lack of unifying research and management recommendations. Herein, we review the current literature, highlighting diagnostic clinical pearls and key multidisciplinary management considerations with regard to melanoma in the child-bearing population.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 2","pages":"Article 152040"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cervical cancer in pregnancy 妊娠期子宫颈癌
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-03-01 DOI: 10.1016/j.semperi.2025.152038
Charlotte LeJeune , Nathalia Mora-Soto , Lone Storgaard , René Pareja , Frédéric Amant
{"title":"Cervical cancer in pregnancy","authors":"Charlotte LeJeune ,&nbsp;Nathalia Mora-Soto ,&nbsp;Lone Storgaard ,&nbsp;René Pareja ,&nbsp;Frédéric Amant","doi":"10.1016/j.semperi.2025.152038","DOIUrl":"10.1016/j.semperi.2025.152038","url":null,"abstract":"<div><div>Cervical cancer is one of the most common and challenging malignancies diagnosed during pregnancy, requiring a complex balance between effective oncological management and pregnancy preservation. This narrative review synthesizes current evidence and clinical experience regarding the management of cervical cancer in pregnant patients. While treatment should generally follow standard protocols for nonpregnant patients, emerging data suggest that pregnancy can often be safely maintained without compromising oncological outcomes. Nevertheless, robust prognostic data from larger patient cohorts are still needed. Individualized treatment approaches that incorporate the patient's preferences and values are crucial. Given the complexities involved, referral to specialized tertiary centers with expertise in the oncological and obstetric care of pregnant cancer patients is strongly recommended to ensure optimal outcomes for both mother and child.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 2","pages":"Article 152038"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Obstetric and perinatal management in the setting of cancer 癌症背景下的产科和围产期管理
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-03-01 DOI: 10.1016/j.semperi.2025.152044
Eve Overton , Gabriela Tessler
{"title":"Obstetric and perinatal management in the setting of cancer","authors":"Eve Overton ,&nbsp;Gabriela Tessler","doi":"10.1016/j.semperi.2025.152044","DOIUrl":"10.1016/j.semperi.2025.152044","url":null,"abstract":"<div><div>Obstetric care for patients with cancer diagnoses during pregnancy is medically and ethically complex, and limited prospective data and national guidelines are available to guide care. Guiding principles for treatment are to optimize maternal outcomes while minimizing neonatal morbidity. Oncologic work- up and management are dependent on the trimester of diagnosis, and are specific to the type, stage, and grade of the oncologic diagnosis. Obstetric care should occur within a multidisciplinary setting, with involvement of maternal fetal medicine, oncologic specialists, and mental health support.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 2","pages":"Article 152044"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Thyroid cancer 甲状腺癌
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-03-01 DOI: 10.1016/j.semperi.2025.152042
Liyang Tang , Trevor E Angell
{"title":"Thyroid cancer","authors":"Liyang Tang ,&nbsp;Trevor E Angell","doi":"10.1016/j.semperi.2025.152042","DOIUrl":"10.1016/j.semperi.2025.152042","url":null,"abstract":"<div><div>Thyroid cancer encountered during pregnancy requires a systematic approach balancing risks and benefits to both maternal and fetal health specific to this unique phase of life. Thyroid nodules are common and are predominantly evaluated to detect thyroid cancer. Clinical examination, serum thyroid stimulating hormone (TSH) measurement, ultrasonographic risk stratification, and fine needle aspiration biopsy when indicated are used to assess for malignancy. When thyroid cancer is diagnosed, further evaluation determines whether surgery during gestation is necessary or if delaying surgery until after delivery to minimize fetal and maternal risks is preferred. For patients who have undergone thyroidectomy for thyroid cancer, whether during pregnancy or before it, active management of levothyroxine therapy during pregnancy is recommended to ensure a sufficient thyroid hormone supply for both thyroid cancer treatment and optimal reproductive outcomes. This clinically oriented review summarizes key data, recommendations, and current trends regarding thyroid cancer care in pregnancy.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 2","pages":"Article 152042"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lymphoma and leukemia occurring during pregnancy 怀孕期间发生的淋巴瘤和白血病
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-03-01 DOI: 10.1016/j.semperi.2025.152041
Adam S. Zayac, Ogechukwu Egini, Neil D. Palmisiano, Andrew M. Evens
{"title":"Lymphoma and leukemia occurring during pregnancy","authors":"Adam S. Zayac,&nbsp;Ogechukwu Egini,&nbsp;Neil D. Palmisiano,&nbsp;Andrew M. Evens","doi":"10.1016/j.semperi.2025.152041","DOIUrl":"10.1016/j.semperi.2025.152041","url":null,"abstract":"<div><div>Malignancies arising during pregnancy are an infrequent occurrence, leading to a paucity of data on the optimal management of cancers during pregnancy. Unlike most solid tumors, the primary, and often curative, management of hematologic malignancies relies heavily on multiagent cytotoxic chemotherapies over surgery and other localized therapies, making their management during pregnancy even more complex and hazardous to both mother and fetus. Close multidisciplinary care and coordination between obstetrician, maternal fetal medicine, and oncologists are essential given the dangers to both in the management, from diagnosis and throughout treatment, even through delivery and survivorship. Due to the importance of this topic and the number of lives that could be impacted, guidelines have been published by interdisciplinary expert panels based on available data and clinical experience. This review addresses the management of both Hodgkin and non-Hodgkin lymphomas as well as acute and chronic leukemias. The optimal diagnostic approaches, and therapeutic schemes, including the use of cellular therapies, immunotherapies, targeted and cytotoxic agents, as well as guidance on decision making regarding management of the pregnancy weighing both the maternal and fetal risks and benefits of each approach are discussed herein.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 2","pages":"Article 152041"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Trends and outcomes associated with cancer diagnoses during delivery hospitalizations 分娩住院期间与癌症诊断相关的趋势和结果
IF 3.2 3区 医学
Seminars in perinatology Pub Date : 2025-03-01 DOI: 10.1016/j.semperi.2025.152046
Timothy Wen , Madeleine G. Fish , Alexander M. Friedman
{"title":"Trends and outcomes associated with cancer diagnoses during delivery hospitalizations","authors":"Timothy Wen ,&nbsp;Madeleine G. Fish ,&nbsp;Alexander M. Friedman","doi":"10.1016/j.semperi.2025.152046","DOIUrl":"10.1016/j.semperi.2025.152046","url":null,"abstract":"<div><div>Pregnancy associated cancer is fortunately rare. However, cancer risk is age related, and the proportion of births to older women in the United States appears to be increasing. As a result of delayed childbearing and better detection, cancer may be increasing in the obstetric population. A review of data from the United States Inpatient Sample found that from 2000 to 2019 the proportion of deliveries with an active cancer diagnosis doubled and deliveries with a diagnosis of a history of cancer more than tripled. These trends and associations are similar to findings from other registries and population-based studies which show that pregnancy associated cancer is increasing and associated with a range of adverse obstetric outcomes including severe maternal morbidity and preterm birth. Given these trends and findings it is likely pregnancy associated cancer will continue to be of public health and clinical importance and represent an ongoing challenge given the maternal and neonatal risks and specialized, coordinated care required to optimize outcomes.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"49 2","pages":"Article 152046"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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