Newborn (Clarksville, Md.)最新文献

{"title":"New Therapeutic Targets in Neonatal Pulmonary Hypertension","authors":"Julie A. Dillard, Claire Murray, Amit A Mathur","doi":"10.5005/jp-journals-11002-0015","DOIUrl":"https://doi.org/10.5005/jp-journals-11002-0015","url":null,"abstract":"Persistent pulmonary hypertension of the newborn (PPHN) is a significant cause of morbidity and mortality in neonates. Despite advances in medical care, mortality remains high. In the United States, inhaled nitric oxide is the gold standard treatment in patients with PPHN. However, while it decreases the need for extracorporeal membrane oxygenation, many patients do not respond to inhaled nitric oxide, and it does not improve overall mortality in those with PPHN. Furthermore, its use is cost-prohibitive in many parts of the world. Thus, there is a critical need to research alternative therapies to improve neonatal outcomes. In this review, we present the animal and human data of some emerging therapeutic targets for pulmonary hypertension, prioritizing pediatric and neonatal data when available. Specifically, we discuss the role of soluble guanylate cyclase stimulators and activators, prostacyclin and analogues, phosphodiesterase 3, 4, and 5 inhibitors, rho-kinase inhibitors, endothelin receptor blockers, PPARγ agonists, and antioxidants in the treatment of neonates with PPHN.","PeriodicalId":74306,"journal":{"name":"Newborn (Clarksville, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43227050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Cardiac Imaging in Neonatology","authors":"Bijoy Thattaliyath, P. Porayette, R. Ashwath","doi":"10.5005/jp-journals-11002-0020","DOIUrl":"https://doi.org/10.5005/jp-journals-11002-0020","url":null,"abstract":"","PeriodicalId":74306,"journal":{"name":"Newborn (Clarksville, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46456097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extra-uterine Growth Restriction in Preterm Infants","authors":"A. Maheshwari, N. Bagga, Nalinikant Panigrahay","doi":"10.5005/jp-journals-11002-0019","DOIUrl":"https://doi.org/10.5005/jp-journals-11002-0019","url":null,"abstract":"Extra-uterine growth restriction (EUGR) is frequently seen in premature and critically ill infants. Even though advancements in neonatal intensive care have improved the survival of these high-risk infants, many new questions have emerged about the relationship between postnatal growth and neurodevelopmental outcome of these infants. EUGR has traditionally been ascribed to caloric restriction during postnatal periods of critical illness. Nutritional compromise, particularly during the first few weeks of life, may affect the overall growth and could also cause long-term neurodevelopmental impairment. The accidental and premature interruptions of pregnancy could also alter the normal mobilization and utilization of major nutrients from the ways that would have otherwise occurred during the last trimester of pregnancy, which is normally a period of maximal in utero growth. In this article, we review our current understanding of defining EUGR, various risk factors for EUGR, its pathophysiology, and possible ways with which our current healthcare protocols could prevent EUGR.","PeriodicalId":74306,"journal":{"name":"Newborn (Clarksville, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42849480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking the Paradigm: The Evolving Care of Children with Trisomy 13 and 18","authors":"Kimberly Spence, Erica K Salter","doi":"10.5005/jp-journals-11002-0007","DOIUrl":"https://doi.org/10.5005/jp-journals-11002-0007","url":null,"abstract":"A chromosomal evaluation should be used to provide better care for a child and their family, not limit it. However, in many pediatric institutions, the diagnosis of a chromosomal abnormality automatically circumscribes the medical and surgical options made available to the family. For example, alongside many other comorbidities (including severe cognitive impairment), infants diagnosed with trisomy 13 or 18 (T13/18) often have cognitive heart defects (e.g., atrial or ventricular septal defects, patent ductus arteriosus, atrioventricular septal defects) that can be successfully repaired or palliated in the general population. However, because T13/18 have historically been considered “lethal” diagnoses or “incompatible with life”, surgical correction of these defects is not frequently offered, and instead infants with these diagnoses are managed with a noninterventionist, “comfort care” approach in which the infant is simply allowed to expire after birth. In recent years, however, more data have emerged from centers that regularly pursue medical and surgical interventions in this population, demonstrating improved outcomes in both quality and quantity of life. Simultaneously, the pediatric ethics literature has argued that treatment decisions for infants with T13/18 are frequently informed by unfounded biases concerning disability and quality of life. Now that neonatology is equipped with improved medical and ethical evidence, the practice of categorically excluding infants with a T13/18 diagnosis from life-saving interventions should be challenged, and instead, parents of these infants should be offered targeted interventions, including corrective and palliative procedures, and included in the process of shared decision-making about which interventions best meet the family’s goals of care.","PeriodicalId":74306,"journal":{"name":"Newborn (Clarksville, Md.)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41707423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-time Echocardiography-guided Weaning of Veno-arterial Extracorporeal Membrane Oxygenation in Neonates","authors":"Sharada H. Gowda, Alice King, A. Vogel, R. Coleman, C. Chartan, J. Garcia-Prats, C. Fernandes","doi":"10.5005/jp-journals-11002-0006","DOIUrl":"https://doi.org/10.5005/jp-journals-11002-0006","url":null,"abstract":"Objective: The objective of the study is to evaluate the utility of real-time echocardiography (RTE) to provide objective hemodynamic guidance during decannulation of neonates from extracorporeal membrane oxygenation (ECMO). Design: Retrospective case series. Patients: Neonates with respiratory and circulatory failure who underwent venoarterial ECMO (VA-ECMO). Interventions: Use of RTE to assess cardiac function, pulmonary hypertension (PH), and readiness for decannulation from ECMO. Outcome measures: Data abstracted included clinical parameters, RTE data, and management decisions during weaning from VA-ECMO. Results: We used RTE during weaning in 12 of 33 patients between 2016 and 2019. Findings prompted inotrope titration in 10 (83%) patients and volume resuscitation in 10 patients. PH was present in 12 (100%) patients and prompted initiation of prostaglandin infusion (in 3 (25%) patients. Ten of 12 patients were successfully weaned off; in 2, RTE was instrumental in halting decannulation. Conclusions: RTE may serve as a valuable tool in clinical decision-making while weaning neonates from VA-ECMO and providing data to choose appropriate support for successful decannulation. (2022):","PeriodicalId":74306,"journal":{"name":"Newborn (Clarksville, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43539559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approach to Neonatal Hypocalcemia","authors":"S. Pillai, C. Foster, A. Ashraf","doi":"10.5005/jp-journals-11002-0017","DOIUrl":"https://doi.org/10.5005/jp-journals-11002-0017","url":null,"abstract":"","PeriodicalId":74306,"journal":{"name":"Newborn (Clarksville, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49187078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Potential Role of Maternal Periodontitis on Preterm Birth and Adverse Neonatal Neurologic Outcomes","authors":"G. Valentine, S. Juul","doi":"10.5005/jp-journals-11002-0008","DOIUrl":"https://doi.org/10.5005/jp-journals-11002-0008","url":null,"abstract":"Periodontitis is an often overlooked but important risk factor for both preterm birth and adverse neonatal outcomes. With preterm birth being the leading cause of mortality for all children under the age of 5, any potentially modifiable risk factor associated with preterm birth must be fully evaluated. Periodontal disease is due to bacterial infection of the gingivae with resulting localized and systemic inflammation that can have profound effects in both nonpregnant and pregnant individuals. In pregnancy, several studies have demonstrated an association between periodontitis and preterm birth. Furthermore, extensive evidence demonstrates that fetal exposure to systemic inflammation during gestation predisposes to brain injury and neurodevelopmental delay. Thus, periodontitis and the resulting inflammatory cascade not only affect the pregnant individual but also have significant lifelong consequences on the development and well-being of future offspring. In this review, we will first discuss the epidemiology, prevalence, and pathophysiology of periodontitis. We will then explore the medical literature evaluating the association between periodontitis and preterm birth prior to delving into the potential for neurodevelopmental delay and brain injury among offspring. Finally, we will conclude by discussing future directions and unanswered questions related to periodontitis and its relationship with preterm birth and adverse neonatal outcomes. demonstrated prevention of preterm birth, LBW, or fetal growth restriction with dental scaling and root planing of the mother in the second trimester. 77,78 Other findings have similarly not found improvements in birth outcomes related to periodontal treatment during gestation. 79 These results suggest that traditional methodologies for treating maternal periodontal disease during the second trimester of pregnancy do not likely have significant effects in the prevention of adverse offspring outcomes.","PeriodicalId":74306,"journal":{"name":"Newborn (Clarksville, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42861400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Group B Streptococcal Infections in Neonates","authors":"Kirtikumar Upadhyay, A. Talati","doi":"10.5005/jp-journals-11002-0022","DOIUrl":"https://doi.org/10.5005/jp-journals-11002-0022","url":null,"abstract":"","PeriodicalId":74306,"journal":{"name":"Newborn (Clarksville, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46856615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Necrotizing Enterocolitis Associated with Congenital Heart Disease-A Review Article.","authors":"Sriya Roychaudhuri,&nbsp;Gurpreet Grewal,&nbsp;Sakethram Saravu Vijayashankar,&nbsp;Pascal Lavoie,&nbsp;Akhil Maheshwari","doi":"10.5005/jp-journals-11002-0016","DOIUrl":"10.5005/jp-journals-11002-0016","url":null,"abstract":"<p><p>Necrotizing enterocolitis (NEC) is a relatively rare but devastating entity associated classically with the preterm cohort in the neonatal intensive care unit. Preterm and term babies with congenital heart disease are at risk of a number of comorbidities because of the hemodynamic derangements due to a structurally abnormal heart and the corrective procedures adopted. Necrotizing enterocolitis is one of the dreaded complications associated with this cohort and impacts the course of these babies in the hospital in a major way. A large majority of term babies with NEC are in the backdrop of a significant congenital cardiac lesion. This review article summarizes the literature and elaborates this entity including its specific features, risk factors associated with its causality, histopathology and related aspects of hemodynamics, and feeding in this vulnerable population. It also provides insight into modifiable risk factors and early markers of detection of gut necrosis to facilitate prevention and early detection. It highlights the subtle but definite difference in outcome variables to help physicians enable the parents of babies with heart disease to develop a better understanding of the entity and its expected course while counseling.</p>","PeriodicalId":74306,"journal":{"name":"Newborn (Clarksville, Md.)","volume":"1 1","pages":"170-176"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bf/5d/nihms-1870279.PMC9976612.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10832205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intestinal Resection is More Likely to be Effective in Necrotizing Enterocolitis Extending to Colon than in Disease Limited to the Small Intestine.","authors":"Parvesh M Garg,&nbsp;Jaslyn L Paschal,&nbsp;Katherine Lett,&nbsp;Charles Middleton,&nbsp;Neha Varshney,&nbsp;Akhil Maheshwari","doi":"10.5005/jp-journals-11002-0024","DOIUrl":"https://doi.org/10.5005/jp-journals-11002-0024","url":null,"abstract":"<p><strong>Background: </strong>The prognosis in surgical necrotizing enterocolitis (NEC) has focused on the total length of the resected bowel; the relative impact of small intestinal vs colonic resection is not well studied.</p><p><strong>Objective: </strong>We hypothesized that intestinal resections may reduce mortality and length of hospital stay (LOS) more likely in infants who have NEC extending into the colon than in those with disease limited to the small intestine. We also investigated the relationship between gestational maturation and NEC-related mortality.</p><p><strong>Methods: </strong>A retrospective study of 153 patients compared demographic, clinical, and histopathological information in infants who had NEC limited to the small intestine vs disease with colonic involvement.</p><p><strong>Results: </strong>Our 153 infants had a mean (±standard deviation) gestational age of 27.4 ± 3.4 weeks and a birth weight of 987 ± 505 g. NEC was limited to the small intestine in 103 (67.3%) infants and extended into the colon in 50 (32.7%). Infants with small intestinal NEC needed shorter bowel resections of 28 ± 31.9 cm than 42.2 ± 40.7 cm in those with colonic involvement (<i>p</i> = 0.02). The LOS was longer in NEC limited to the small intestine than in disease with colonic lesions (96 ± 88.1 vs 69.7 ± 19.1 days; <i>p</i> <0.05). In small intestinal NEC, mortality decreased to <50% beyond a gestational age (GA) >37 weeks. In contrast, infants with NEC that involved the colon had mortality <50% mortality beyond 27.3 weeks' GA (<i>p</i> = 0.008).</p><p><strong>Conclusions: </strong>Bowel resections may be more likely associated with shorter LOS in surgical NEC that involves both the small bowel and colon, even when longer segments of the gastrointestinal tract are removed, than in disease limited to the small intestine.</p>","PeriodicalId":74306,"journal":{"name":"Newborn (Clarksville, Md.)","volume":" ","pages":"14-26"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/47/69/nihms-1815778.PMC9282977.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40513941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}