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Seminars in Fetal & Neonatal Medicine Oct 2020The current standard approach to manage circulatory insufficiency is inappropriately simple and clear: respond to low blood pressure to achieve higher values. However,... (Review)
Review
The current standard approach to manage circulatory insufficiency is inappropriately simple and clear: respond to low blood pressure to achieve higher values. However, the evidence for this is limited affecting all steps within the process: assessment, decision making, therapeutic options, and treatment effects. We have to overcome the 'one size fits all' approach and respect the dynamic physiologic transition from fetal to neonatal life in the context of complex underlying conditions. Caregivers need to individualize their approaches to individual circumstances. This paper will review various clinical scenarios, including managing transitional low blood pressure, to circulatory impairment involving different pathologies such as hypoxia-ischemia and sepsis. We will highlight the current evidence and set potential goals for future development in these areas. We hope to encourage caregivers to question the current standards and to support urgently needed research in this overlooked but crucial field of neonatal intensive care.
Topics: Hemodynamics; Humans; Hypotension; Infant, Newborn; Intensive Care, Neonatal; Neonatology; Shock, Septic
PubMed: 32473881
DOI: 10.1016/j.siny.2020.101121 -
Deutsches Arzteblatt International Mar 2019Invasive mechanical ventilation (IMV) has been replaced by early continuous positive airway pressure (CPAP) in the treatment of respiratory distress syndrome (RDS) in... (Review)
Review
BACKGROUND
Invasive mechanical ventilation (IMV) has been replaced by early continuous positive airway pressure (CPAP) in the treatment of respiratory distress syndrome (RDS) in preterm infants aiming to reduce the rate of bronchopulmonary dysplasia (BPD). Subsequently, modern non-invasive ventilation strategies (NIV) were introduced into clinical practice with limited evidence of effects on pulmonary and neurodevelopmental outcomes.
METHODS
We performed a selective literature search in PubMed including randomized controlled trials (RCT) (n ≥ 200) and meta-analyses published in the field of NIV in neonatology and follow-up studies focusing on long term pulmonary and neurodevelopmental outcomes.
RESULTS
Individual studies do not show a significant risk reduction for the combined endpoint death or BPD in preterm infants caused by early CPAP in RDS when compared to primary intubation. One meta-analysis comparing four studies found CPAP significantly reduces the risk of BPD or death (relative risk: 0.91; 95% confidence interval [0.84;0.99]). Nasal intermittent positive pressure ventilation (NIPPV) as a primary ventilation strategy reduces the rate of intubations in infants with RDS (RR: 0.78 [0.64;0.94]) when compared to CPAP but does not affect the rate of BPD (RR: 0.78 [0.58;1.06]).
CONCLUSION
Early CPAP reduces the need for IMV and the risk of BPD or death in preterm infants with RDS. NIPPV may offer advantages over CPAP regarding intubation rates. Networking-based follow-up programs are required to assess the effect of NIV on long term pulmonary and neurodevelopmental outcomes.
Topics: Continuous Positive Airway Pressure; Humans; Infant, Newborn; Infant, Premature; Intermittent Positive-Pressure Ventilation; Meta-Analysis as Topic; Neonatology; Noninvasive Ventilation; Randomized Controlled Trials as Topic; Respiratory Distress Syndrome, Newborn; Treatment Outcome
PubMed: 31014448
DOI: 10.3238/arztebl.2019.0177 -
Archivos Argentinos de Pediatria Oct 2019The recognition of the existence of pain in infants hospitalized in the Neonatal Intensive Care Units makes it necessary to reach consensus on prevention, assessment and...
The recognition of the existence of pain in infants hospitalized in the Neonatal Intensive Care Units makes it necessary to reach consensus on prevention, assessment and treatment strategies. Acute pain produces adverse changes in the short term and chronic pain alters the response systems to stress and impacts on neurodevelopment. The objective of this pain management agreement is to unify criteria of attention of these patients in different situations that generate pain and stress that they face during their hospitalization. There are validated scales to assess pain and guide appropriate strategies for its approach that include measures of comprehensive or nonpharmacological care and pharmacological care that we will review.
Topics: Acute Pain; Chronic Pain; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Neonatology; Pain Management; Pain Measurement; Pain Perception
PubMed: 31833337
DOI: 10.5546/aap.2019.S180 -
Pediatric Research Mar 2020White matter injury (WMI) is the most frequent form of preterm brain injury. Cranial ultrasound (CUS) remains the preferred modality for initial and sequential... (Review)
Review
White matter injury (WMI) is the most frequent form of preterm brain injury. Cranial ultrasound (CUS) remains the preferred modality for initial and sequential neuroimaging in preterm infants, and is reliable for the diagnosis of cystic periventricular leukomalacia. Although magnetic resonance imaging is superior to CUS in detecting the diffuse and more subtle forms of WMI that prevail in very premature infants surviving nowadays, recent improvement in the quality of neonatal CUS imaging has broadened the spectrum of preterm white matter abnormalities that can be detected with this technique. We propose a structured CUS assessment of WMI of prematurity that seeks to account for both cystic and non-cystic changes, as well as signs of white matter loss and impaired brain growth and maturation, at or near term equivalent age. This novel assessment system aims to improve disease description in both routine clinical practice and clinical research. Whether this systematic assessment will improve prediction of outcome in preterm infants with WMI still needs to be evaluated in prospective studies.
Topics: Brain; Brain Injuries; Echoencephalography; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Leukomalacia, Periventricular; Magnetic Resonance Imaging; Neonatology; Predictive Value of Tests; White Matter
PubMed: 32218534
DOI: 10.1038/s41390-020-0781-1 -
Pediatric Research Mar 2020Germinal matrix-intraventricular haemorrhage (GMH-IVH), periventricular haemorrhagic infarction (PHI) and its complication, post-haemorrhagic ventricular dilatation... (Review)
Review
Germinal matrix-intraventricular haemorrhage (GMH-IVH), periventricular haemorrhagic infarction (PHI) and its complication, post-haemorrhagic ventricular dilatation (PHVD), are still common neonatal morbidities in preterm infants that are highly associated with adverse neurodevelopmental outcome. Typical cranial ultrasound (CUS) findings of GMH-IVH, PHI and PHVD, their anatomical substrates and underlying mechanisms are discussed in this paper. Furthermore, we propose a detailed descriptive classification of GMH-IVH and PHI that may improve quality of CUS reporting and prediction of outcome in infants suffering from GMH-IVH/PHI.
Topics: Brain; Cerebral Hemorrhage; Cerebral Ventricles; Dilatation; Echoencephalography; Humans; Incidence; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Magnetic Resonance Imaging; Neonatology; Treatment Outcome; Ultrasonography, Doppler
PubMed: 32218535
DOI: 10.1038/s41390-020-0780-2 -
Revista Da Associacao Medica Brasileira... 2022
Topics: Algorithms; Artificial Intelligence; Child; Delivery of Health Care; Humans; Machine Learning; Neonatology
PubMed: 35766685
DOI: 10.1590/1806-9282.20220177 -
Archives de Pediatrie : Organe Officiel... May 2022Nutritional vitamin D supplements are often used in general pediatrics. Here, the aim is to address vitamin D supplementation and calcium nutritional intakes in...
OBJECTIVES
Nutritional vitamin D supplements are often used in general pediatrics. Here, the aim is to address vitamin D supplementation and calcium nutritional intakes in newborns, infants, children, and adolescents to prevent vitamin D deficiency and rickets in general populations.
STUDY DESIGN
We formulated clinical questions relating to the following categories: the Patient (or Population) to whom the recommendation will apply; the Intervention being considered; the Comparison (which may be "no action," placebo, or an alternative intervention); and the Outcomes affected by the intervention (PICO). These PICO elements were arranged into the questions to be addressed in the literature searches. Each PICO question then formed the basis for a statement. The population covered consisted of children aged between 0 and 18 years and premature babies hospitalized in neonatology. Two groups were assembled: a core working group and a voting panel from different scientific pediatric committees from the French Society of Pediatrics and national scientific societies.
RESULTS
We present here 35 clinical practice points (CPPs) for the use of native vitamin D therapy (ergocalciferol, vitamin D and cholecalciferol, vitamin D) and calcium nutritional intakes in general pediatric populations.
CONCLUSION
This consensus document was developed to provide guidance to health care professionals on the use of nutritional vitamin D and dietary modalities to achieve the recommended calcium intakes in general pediatric populations. These CPPs will be revised periodically. Research recommendations to study key vitamin D outcome measures in children are also suggested.
Topics: Adolescent; Calcium; Calcium, Dietary; Child; Child, Preschool; Cholecalciferol; Consensus; Dietary Supplements; Humans; Infant; Infant, Newborn; Neonatology; Vitamin D; Vitamin D Deficiency; Vitamins
PubMed: 35305879
DOI: 10.1016/j.arcped.2022.02.008 -
World Journal of Surgery Aug 2020Enhanced Recovery After Surgery (ERAS) Society guidelines integrate evidence-based practices into multimodal care pathways that have improved outcomes in multiple adult...
BACKGROUND
Enhanced Recovery After Surgery (ERAS) Society guidelines integrate evidence-based practices into multimodal care pathways that have improved outcomes in multiple adult surgical specialties. There are currently no pediatric ERAS Society guidelines. We created an ERAS guideline designed to enhance quality of care in neonatal intestinal resection surgery.
METHODS
A multidisciplinary guideline generation group defined the scope, population, and guideline topics. Systematic reviews were supplemented by targeted searching and expert identification to identify 3514 publications that were screened to develop and support recommendations. Final recommendations were determined through consensus and were assessed for evidence quality and recommendation strength. Parental input was attained throughout the process.
RESULTS
Final recommendations ranged from communication strategies to antibiotic use. Topics with poor-quality and conflicting evidence were eliminated. Several recommendations were combined. The quality of supporting evidence was variable. Seventeen final recommendations are included in the proposed guideline.
DISCUSSION
We have developed a comprehensive, evidence-based ERAS guideline for neonates undergoing intestinal resection surgery. This guideline, and its creation process, provides a foundation for future ERAS guideline development and can ultimately lead to improved perioperative care across a variety of pediatric surgical specialties.
Topics: Anti-Infective Agents; Antibiotic Prophylaxis; Consensus; Digestive System Surgical Procedures; Enhanced Recovery After Surgery; Evidence-Based Medicine; Gastroenterology; Humans; Infant, Newborn; Interdisciplinary Communication; Neonatology; Perioperative Care; Postoperative Care; Practice Guidelines as Topic; Societies, Medical
PubMed: 32385680
DOI: 10.1007/s00268-020-05530-1 -
Circulation Oct 2020
Topics: Advanced Cardiac Life Support; Age Factors; American Heart Association; Cardiology; Cardiology Service, Hospital; Cardiopulmonary Resuscitation; Consensus; Emergencies; Emergency Service, Hospital; Evidence-Based Medicine; Heart Arrest; Humans; Infant, Newborn; Neonatology; Risk Factors; Treatment Outcome; United States
PubMed: 33081528
DOI: 10.1161/CIR.0000000000000902 -
Pediatric Research Mar 2020
Topics: Algorithms; Brain; Echoencephalography; Humans; Infant, Newborn; Neonatologists; Neonatology; Perfusion; Ultrasonography
PubMed: 32218540
DOI: 10.1038/s41390-020-0779-8