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Seminars in Fetal & Neonatal Medicine最新文献

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Late preterm and early term birth: Challenges and dilemmas in clinical practice 晚期早产和早产：临床实践中的挑战和困境。
IF 2.9 3区 医学
Seminars in Fetal & Neonatal Medicine Pub Date : 2024-12-01 DOI: 10.1016/j.siny.2024.101564
Elaine M. Boyle, Frances J. Mielewczyk, Caroline Mulvaney
{"title":"Late preterm and early term birth: Challenges and dilemmas in clinical practice","authors":"Elaine M. Boyle,&nbsp;Frances J. Mielewczyk,&nbsp;Caroline Mulvaney","doi":"10.1016/j.siny.2024.101564","DOIUrl":"10.1016/j.siny.2024.101564","url":null,"abstract":"<div><div>The major focus of neonatal research for many years has been the smallest and most vulnerable infants born before 32 weeks of gestation. More recently it has become clear that a gradient of risk for adverse outcomes spans the whole spectrum of gestational age, from those born at the margins of viability, to those born close to their estimated date of delivery. Whilst effect sizes may be smaller for the more mature babies born late preterm and early term, the size of the problem is related to very large numbers with less severe difficulties, yet whose problems affect many domains of health, development and education, and may have impact across the whole life course. Our knowledge of the mechanisms and influencing factors contributing to outcomes of individuals born late preterm and early term is inadequate. The unique challenges associated with managing pregnancies, babies, children, adults and families affected by late preterm or early term birth in the face of limited evidence mandate further research to guide practice and optimise short- and long-term outcomes.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"29 6","pages":"Article 101564"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631238","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
Advocating for neonatology presence at births between 20 and 25 weeks of gestation 倡导新生儿科在妊娠 20 至 25 周的新生儿中开展工作。
IF 2.9 3区 医学
Seminars in Fetal & Neonatal Medicine Pub Date : 2024-12-01 DOI: 10.1016/j.siny.2024.101541
Amos Grünebaum , Renee McLeod-Sordjan , Michael Grosso , Frank A. Chervenak
{"title":"Advocating for neonatology presence at births between 20 and 25 weeks of gestation","authors":"Amos Grünebaum ,&nbsp;Renee McLeod-Sordjan ,&nbsp;Michael Grosso ,&nbsp;Frank A. Chervenak","doi":"10.1016/j.siny.2024.101541","DOIUrl":"10.1016/j.siny.2024.101541","url":null,"abstract":"<div><div>Extreme preterm births between 20 and 25 weeks’ gestation present significant challenges in neonatal care and ethics. This manuscript advocates for neonatology presence from 20 weeks onwards to optimize outcomes. Neonatology attendance ensures accurate gestational age assessment, immediate intervention, and informed decision-making. Survival rates for extremely preterm infants have improved significantly, ranging from 0 to 37 % at 22 weeks to 31–78 % at 24 weeks. However, outcomes vary widely based on factors such as healthcare access and socioeconomic conditions. We propose using “preterm birth between 20 and 25 weeks” instead of “periviability” for clarity in clinical protocols and parental counseling. Ethical considerations, including potential overtreatment and parental autonomy, are addressed through clear guidelines. While challenges exist in implementing this approach, particularly in smaller or rural hospitals, solutions such as strengthening regional networks and telemedicine can address these issues. Despite concerns about resource allocation, we argue that the benefits of neonatologist attendance outweigh the challenges, providing the best opportunity for survival and optimal outcomes in these ethically complex situations.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"29 6","pages":"Article 101541"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511653","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
The peripheral chemoreflex and fetal defenses against intrapartum hypoxic-ischemic brain injury at term gestation 外周化学反射和胎儿对临产缺氧缺血性脑损伤的防御能力。
IF 2.9 3区 医学
Seminars in Fetal & Neonatal Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101543
Christopher A. Lear , Simerdeep K. Dhillon , Masahiro Nakao , Benjamin A. Lear , Antoniya Georgieva , Austin Ugwumadu , Peter R. Stone , Laura Bennet , Alistair J. Gunn
{"title":"The peripheral chemoreflex and fetal defenses against intrapartum hypoxic-ischemic brain injury at term gestation","authors":"Christopher A. Lear ,&nbsp;Simerdeep K. Dhillon ,&nbsp;Masahiro Nakao ,&nbsp;Benjamin A. Lear ,&nbsp;Antoniya Georgieva ,&nbsp;Austin Ugwumadu ,&nbsp;Peter R. Stone ,&nbsp;Laura Bennet ,&nbsp;Alistair J. Gunn","doi":"10.1016/j.siny.2024.101543","DOIUrl":"10.1016/j.siny.2024.101543","url":null,"abstract":"<div><div>Fetal hypoxemia is ubiquitous during labor and, when severe, is associated with perinatal death and long-term neurodevelopmental disability. Adverse outcomes are highly associated with barriers to care, such that developing countries have a disproportionate burden of perinatal injury. The prevalence of hypoxemia and its link to injury can be obscure, simply because the healthy fetus has robust coordinated defense mechanisms, spearheaded by the peripheral chemoreflex, such that hypoxemia only becomes apparent in the minority of cases associated with stillbirth, severe metabolic acidemia or adverse neurodevelopmental outcomes. This represents only the extreme end of the spectrum, when defense mechanisms have failed due to severe/prolonged hypoxemia, or the fetal defenses are compromised by additional risk factors. Understanding the fetal defenses to hypoxemia and when the fetus begins to decompensate is crucial to understanding perinatal health and disease, by linking antenatal health, intrapartum events, the neonatal trajectory and ultimately life-long neurodevelopmental health.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"29 4","pages":"Article 101543"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511655","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
Bedside monitoring tools and advanced signal processing approaches to monitor critically-ill infants 床旁监测工具和先进的信号处理方法，用于监测重症婴儿。
IF 2.9 3区 医学
Seminars in Fetal & Neonatal Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101544
R.B. Govindan , Kenneth A. Loparo
{"title":"Bedside monitoring tools and advanced signal processing approaches to monitor critically-ill infants","authors":"R.B. Govindan ,&nbsp;Kenneth A. Loparo","doi":"10.1016/j.siny.2024.101544","DOIUrl":"10.1016/j.siny.2024.101544","url":null,"abstract":"<div><div>There is a substantial body of literature that supports neonatal monitoring and signal analysis of the collected data to provide valuable insights for improving patient clinical care and to inform new research studies. This comprehensive monitoring approach extends beyond the collection of conventional vital signs to include the acquisition of continuous waveform data from patient monitors and other bedside medical devices. This paper discusses the necessary infrastructure for waveform retrieval from bedside monitors, and explores options provided by leading healthcare companies, third-party vendors or academic research teams to implement scalable monitoring systems across entire critical care units. Additionally, we discuss the application of advanced signal processing that transcend traditional statistics, including heart rate variability in both the time- and frequency-domains, spectral analysis of EEG, and cerebral pressure autoregulation. The infrastructures and signal processing techniques outlined here are indispensable tools for intensivists, empowering them to enhance care for critically ill infants. In addition, we briefly address the emergence of advanced tools for fetal monitoring.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"29 4","pages":"Article 101544"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523472","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
Advancing our knowledge of placental function and how it relates to the developing fetal brain 进一步了解胎盘功能及其与胎儿大脑发育的关系。
IF 2.9 3区 医学
Seminars in Fetal & Neonatal Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101549
Aine Fox , Breda Hayes , Emma Doyle
{"title":"Advancing our knowledge of placental function and how it relates to the developing fetal brain","authors":"Aine Fox ,&nbsp;Breda Hayes ,&nbsp;Emma Doyle","doi":"10.1016/j.siny.2024.101549","DOIUrl":"10.1016/j.siny.2024.101549","url":null,"abstract":"<div><div>Perinatal medicine has made significant advancements in recent decades. This has improved care and outcomes for infants. As we strive to improve neurodevelopmental outcomes, we must understand the influence the maternal/placental/fetal (MPF) triad has on fetal development and postnatal health and disease.</div><div>Our understanding of the MPF triad remains incomplete, however research is continuing to develop our understanding. Through further research and incorporating what is currently known into how we deliver perinatal care, we have the opportunity to improve outcomes for infants.</div><div>This review focuses on what is currently known about the structure and function of the placenta and the influence of the MPF triad. Current modalities for assessment of the MPF triad and future avenues for research will also be discussed.</div><div>Understanding the relationship between the MPF triad, neurodevelopment and long-term health and disease has the potential to open new avenues for disease prevention and treatment through the lifespan.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"29 2","pages":"Article 101549"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644882","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
Brain care bundles applied over each and successive generations 在每一代和连续几代人身上应用大脑护理捆绑包。
IF 2.9 3区 医学
Seminars in Fetal & Neonatal Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101558
Mark S. Scher , Susan Ludington , Valerie Smith , Stina Klemming , Betsy Pilon
{"title":"Brain care bundles applied over each and successive generations","authors":"Mark S. Scher ,&nbsp;Susan Ludington ,&nbsp;Valerie Smith ,&nbsp;Stina Klemming ,&nbsp;Betsy Pilon","doi":"10.1016/j.siny.2024.101558","DOIUrl":"10.1016/j.siny.2024.101558","url":null,"abstract":"<div><div>Worldwide polycrises continue to challenge the World Health Organization's proposed 2030 sustainable development goals. Continuity of brain care bundles helps attain these goals by sustaining brain health over successive generations. Factors representing social drivers of health must incorporate transdisciplinary care into equitable intervention choices. Drivers are more effectively addressed by combining maternal and pediatric assessments to address morbidity and mortality across each lifespan. Care bundles comprise at least three evidenced-based interventions collectively implemented during a clinical experience to achieve a desired outcome. Synergy among stakeholders prioritize communication, responsibility, compliance and trust when choosing bundles in response to changing clinical conditions. A prenatal transdisciplinary model continues after birth with infant and family-centered developmental care practices through discharge to supplement essential skin-to-skin contact. Fetal-neonatal neurology training encourages participation in this model of brain health care to more effectively choose neurodiagnostic and neuroprotective options. Shared clinical decisions evaluate interventions from conception through the first 1000 days. At least eighty percent of brain connectivity will have been completed during this first critical/sensitive period of neuroplasticity. The developmental origins of health and disease concept offers neurology subspecialists a life-course perspective when choosing brain health strategies. Toxic stressor interplay from reproductive and pregnancy diseases and adversities potentially impairs embryonic, fetal and neonatal brain development. Continued exposures throughout maturation and aging worsen outcome risks, particularly during adolescence and reproductive senescence. Intragenerational and transgenerational use of care bundles will guide neuromonitoring and neuroprotection choices that strengthen preventive neurology strategies.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"29 4","pages":"Article 101558"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631211","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
A review of neurogenetics in fetal and neonatal clinical medicine 胎儿和新生儿临床医学中的神经遗传学回顾。
IF 2.9 3区 医学
Seminars in Fetal & Neonatal Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101550
Amitha L. Ananth , Michael A. Lopez
{"title":"A review of neurogenetics in fetal and neonatal clinical medicine","authors":"Amitha L. Ananth ,&nbsp;Michael A. Lopez","doi":"10.1016/j.siny.2024.101550","DOIUrl":"10.1016/j.siny.2024.101550","url":null,"abstract":"<div><div>This review of neurogenetics serves as a primer for clinicians practicing in fetal-neonatal medicine. The review provides an update on neurogenetics, understanding the language of genetics, genetic testing approaches, and interpretation of genetic test results. Common examples of neurogenetic disease in fetal-neonatal medicine are used to enhance basic concepts. The results of genetic testing and their implications for patients and families are outlined. Genetics is becoming foundational to clinical practice across specialties. The advances are improving the speed of diagnosis, facilitating early treatments, and improving outcomes in neurogenetic disorders. A basic understanding of genetics is foundational to appropriate clinical-decision making and interpretation of those results to describe common fetal-neonatal neurological phenotypes.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"29 2","pages":"Article 101550"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649494","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
Advances in prenatal surgical management of congenital aqueductal stenosis: A bench to bedside approach 先天性导水管狭窄产前手术治疗的进展：从工作台到床边的方法。
IF 2.9 3区 医学
Seminars in Fetal & Neonatal Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101540
Emrah Aydın, Soner Duru, Marc Oria, Jose L. Peiro
{"title":"Advances in prenatal surgical management of congenital aqueductal stenosis: A bench to bedside approach","authors":"Emrah Aydın,&nbsp;Soner Duru,&nbsp;Marc Oria,&nbsp;Jose L. Peiro","doi":"10.1016/j.siny.2024.101540","DOIUrl":"10.1016/j.siny.2024.101540","url":null,"abstract":"<div><div>Congenital aqueduct stenosis AS is a significant cause of fetal obstructive hydrocephalus, characterized by the obliteration of the cerebral aqueduct, leading to cerebrospinal fluid (CSF) accumulation in the ventricular system and secondary brain damage and cerebral maldevelopment. This review explores the progression from basic science to clinical applications of antenatal surgical interventions for AS, emphasizing historical efforts, current research, and translational studies. Despite advances in prenatal imaging and genetic screening, challenges remain in achieving appropriate fetal candidates, consistent ventricular decompression, and standardized surgical protocols. This review highlights the need for further research and innovation to improve prenatal treatment and outcomes for AS-affected fetuses.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"29 2","pages":"Article 101540"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511652","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
Cerebral palsy as a childhood-onset neurological disorder caused by both genetic and environmental factors 脑瘫是一种由遗传和环境因素引起的儿童期神经系统疾病。
IF 2.9 3区 医学
Seminars in Fetal & Neonatal Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101551
Nandini G. Sandran , Nadia Badawi , Jozef Gecz , Clare L. van Eyk
{"title":"Cerebral palsy as a childhood-onset neurological disorder caused by both genetic and environmental factors","authors":"Nandini G. Sandran ,&nbsp;Nadia Badawi ,&nbsp;Jozef Gecz ,&nbsp;Clare L. van Eyk","doi":"10.1016/j.siny.2024.101551","DOIUrl":"10.1016/j.siny.2024.101551","url":null,"abstract":"<div><div>Cerebral palsy (CP) is a clinical term used to describe a spectrum of movement and posture disorders resulting from non-progressive disturbances in the developing fetal brain. The clinical diagnosis of CP does not include pathological or aetiological defining features, therefore both genetic and environmental causal pathways are encompassed under the CP diagnostic umbrella. In this review, we explore several genetic causal pathways, including both monogenic and polygenic risks, and present evidence supporting the multifactorial contributions to CP. Historically, CP has been associated with various risk factors such as pre-term birth, multiple gestation, intrauterine growth restriction (IUGR), maternal infection, and perinatal asphyxia. Thus, we also examine genetic predispositions that may contribute to these risk factors. Understanding the specific aetiology of CP enables more tailored treatments, especially with the increasing potential for early genetic testing.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"29 2","pages":"Article 101551"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631215","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
Preventive, rescue and reparative neuroprotective strategies for the fetus and neonate 胎儿和新生儿神经保护的预防、挽救和修复策略。
IF 2.9 3区 医学
Seminars in Fetal & Neonatal Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101542
Benjamin A. Lear, Kelly Q. Zhou, Simerdeep K. Dhillon, Christopher A. Lear, Laura Bennet, Alistair J. Gunn
{"title":"Preventive, rescue and reparative neuroprotective strategies for the fetus and neonate","authors":"Benjamin A. Lear,&nbsp;Kelly Q. Zhou,&nbsp;Simerdeep K. Dhillon,&nbsp;Christopher A. Lear,&nbsp;Laura Bennet,&nbsp;Alistair J. Gunn","doi":"10.1016/j.siny.2024.101542","DOIUrl":"10.1016/j.siny.2024.101542","url":null,"abstract":"<div><div>Neonatal encephalopathy remains a major contributor to death and disability around the world. Acute hypoxia-ischaemia before, during or after birth creates a series of events that can lead to neonatal brain injury. Understanding the evolution of injury underpinned the development of therapeutic hypothermia. This review discusses the determinants of injury, including maturity, the pattern of exposure to HI, impaired placental function, often associated with fetal growth restriction and in the long-term, socio-economic deprivation. Chorioamnionitis has been associated with the presence of NE, but it is important to note that experimentally, inflammation can either sensitize to greater neural injury after HI or alleviate injury, depending on its precise timing. As fetal surveillance tools improve it is likely that improved detection of specific pathways will offer future opportunities for preventive and reparative interventions in utero and after birth.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"29 4","pages":"Article 101542"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548566","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
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