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Seminars in Fetal & Neonatal Medicine

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https://read.qxmd.com/read/30777708/epidemiology-of-perinatal-substance-use-exploring-trends-in-maternal-substance-use
#1
REVIEW
Jennifer J Rodriguez, Vincent C Smith
Over the last two decades, the prevalence of substance use among women of childbearing age has risen dramatically in the United States making substance use during pregnancy a significant public health concern. This article offers a general overview of the epidemiology of perinatal substance use focusing primarily on the United States but when available international trends will be presented as well.
February 6, 2019: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30770326/screening-for-substance-use-in-pregnancy-and-the-newborn
#2
REVIEW
Kathryn Polak, Sydney Kelpin, Mishka Terplan
Substance use during pregnancy is common, costly and associated with maternal and newborn health consequences. Assessment of substance use should be integrated into prenatal care. Substance use identification methods include patient interview, screening instruments, and biological testing. In this review, we critically evaluate screening and testing for substance use during pregnancy, highlighting the benefits and barriers of integrated assessment into prenatal care. We also discuss the limitations and negative consequences that should be considered when implementing screening and/or testing procedures...
February 5, 2019: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30745219/pharmacological-and-non-pharmacological-treatments-for-the-neonatal-abstinence-syndrome-nas
#3
REVIEW
A K Mangat, G M Schmölzer, W K Kraft
Neonatal abstinence syndrome is defined by signs and symptoms of withdrawal that infants develop after intrauterine maternal drug exposure. All infants with documented in utero opioid exposure, or a high pre-test probability of exposure should have monitoring with a standard assessment instrument such as a Finnegan Score. A Finnegan score of >8 is suggestive of opioid exposure, even in the absence of declared use during pregnancy. At least half of infants in most locales can be treated without the use of pharmacologic means...
February 5, 2019: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30744981/assessment-of-the-newborn-prenatally-exposed-to-drugs-the-history
#4
REVIEW
Karol Kaltenbach
This paper reviews the history of the development of scoring tools used to assess the occurrence and severity of the Neonatal Abstinence Syndrome. Beginning with the first tools published in 1975, this review describes tools published through 2010; identifies each tool's strengths and weaknesses; and discusses their representation in the literature.
February 4, 2019: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30744980/effects-of-unconventional-recreational-drug-use-in-pregnancy
#5
REVIEW
Summon Chomchai, Jariya Phuditshinnapatra, Pattaraporn Mekavuthikul, Chulathida Chomchai
Recreational drug toxicity is a rapidly evolving aspect in clinical practice. The prevalence of recreational drug abuse in the past decade has achieved an epidemic scale due to invention of new agents and ease of accessibility to the abused drugs. "Unconventional recreational drugs" is the term that includes new psychoactive drugs and medications diverted for recreational goals. Misuse of unconventional recreational drugs during pregnancy can affect both the pregnant woman and the fetus. However, the problems are usually unrecognized and overlooked by healthcare professionals...
February 4, 2019: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30738754/beyond-the-finnegan-scoring-system-novel-assessment-and-diagnostic-techniques-for-the-opioid-exposed-infant
#6
REVIEW
Davida M Schiff, Matthew R Grossman
Infants with in-utero opioid exposure are most commonly assessed using the Finnegan Neonatal Abstinence Scoring System (FNASS) or a modified version of that tool. Traditionally, the purpose of these tools has been to characterize the extent of withdrawal signs to guide the pharmacologic treatment for infants with neonatal opioid withdrawal syndrome (NOWS). In the past decade however, in response to some of the limitations of the FNASS tool, there has been an increasing emphasis on developing novel assessment tools not based on the FNASS in addition to the promotion of non-pharmacologic treatment options as the first line treatment for infants with opioid exposure...
January 28, 2019: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30709700/the-genetics-and-epigenetics-of-neonatal-abstinence-syndrome
#7
REVIEW
Elisha M Wachman, Lindsay A Farrer
Neonatal abstinence syndrome (NAS) due to in-utero opioid exposure is a growing epidemic with significant variability in clinical presentation and severity. Currently, NAS severity cannot be predicted based on clinical factors alone. To date, small studies have identified genetic variants in opioid receptor and stress response genes that are associated with differences in NAS pharmacologic treatment rates and length of hospitalization. In addition, epigenetic variation in the mu opioid receptor (OPRM1) gene has been associated with differences in NAS hospitalization outcomes...
January 25, 2019: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30274904/health-economic-aspects-of-late-preterm-and-early-term-birth
#8
Stavros Petrou
Despite an increasing body of knowledge on the adverse clinical sequelae associated with late preterm birth and early term birth, little is known about their economic consequences or the cost-effectiveness of interventions aimed at their prevention or alleviation of their effects. This review assesses the health economic evidence surrounding late preterm and early term birth. Evidence is gathered on hospital resource use associated with late preterm and early term birth, economic costs associated with late preterm and early term birth, and economic evaluations of prevention and treatment strategies...
February 2019: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30292709/genetic-predisposition-to-necrotizing-enterocolitis-in-premature-infants-current-knowledge-challenges-and-future-directions
#9
REVIEW
Alain Cuna, Lovya George, Venkatesh Sampath
The role of genetics in the pathogenesis of necrotizing enterocolitis (NEC) was initially informed by epidemiological data indicating differences in prevalence among different ethnic groups as well as concordance in twins. These early observations, together with major advances in genomic research, paved the way for studies that begin to reveal the contribution of genetics to NEC. Using the candidate gene or pathway approach, several potential pathogenic variants for NEC in premature infants have already been identified...
December 2018: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30279063/necrotizing-enterocolitis
#10
EDITORIAL
Josef Neu
No abstract text is available yet for this article.
December 2018: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30213591/intestinal-microcirculation-and-necrotizing-enterocolitis-the-vascular-endothelial-growth-factor-system
#11
REVIEW
Rakhee M Bowker, Xiaocai Yan, Isabelle G De Plaen
Necrotizing enterocolitis (NEC), a leading cause of morbidity and mortality in preterm neonates, is a devastating disease characterized by intestinal tissue inflammation and necrosis. NEC pathogenesis is multifactorial but remains unclear. Translocation of bacteria and/or bacterial products across a weak intestinal barrier in the setting of impaired mucosal immunity leads to an exaggerated inflammatory response and secondary mucosal epithelial injury. In addition to prematurity, other risk factors for NEC include congenital heart disease, maternal pre-eclampsia with placental vascular insufficiency, severe anemia and blood transfusion - all conditions that predispose the intestine to ischemia...
December 2018: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30196017/surgical-considerations-for-neonates-with-necrotizing-enterocolitis
#12
REVIEW
Charles R Hong, Sam M Han, Tom Jaksic
Necrotizing enterocolitis (NEC) is a potentially devastating condition that preferentially affects premature and low birth weight infants, with approximately half requiring acute surgical intervention. Surgical consult should be considered early on, and deterioration despite maximal medical therapy or the finding of pneumoperitoneum are the strongest indications for emergent surgical intervention. There is no clear consensus on the optimal surgical approach between peritoneal drainage and laparotomy; the best course of action likely depends on the infant's comorbidities, hemodynamic status, size, disease involvement, and available resources...
December 2018: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30172660/necrotizing-enterocolitis-the-intestinal-microbiome-metabolome-and-inflammatory-mediators
#13
REVIEW
Josef Neu, Mohan Pammi
Necrotizing enterocolitis (NEC) is a disease of preterm infants and associated with significant mortality and morbidity. Although the pathogenesis of NEC is not clear, microbial dysbiosis, with a bloom of the phylum Proteobacteria, has been reported. Antibiotics and the use of H2 blockers, which affect the gut microbiome, are associated with increased incidence of NEC. In association with dysbiosis, inflammatory processes are upregulated with increased Toll-like receptor signaling, leading to translocation of nuclear factor kappa-β, a transcription factor that induces transcription of various pro-inflammatory cytokines and chemokines...
December 2018: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30146477/innate-and-adaptive-immunity-in-necrotizing-enterocolitis
#14
REVIEW
Madison A Mara, Misty Good, Joern-Hendrik Weitkamp
Necrotizing enterocolitis (NEC) is the most frequent and devastating gastrointestinal disease of premature infants. Although the precise mechanisms are not fully understood, NEC is thought to develop following a combination of prematurity, formula feeding, and adverse microbial colonization. Within the last decade, studies increasingly support an important role of a heightened mucosal immune response initiating a pro-inflammatory signaling cascade, which can lead to the disruption of the intestinal epithelium and translocation of pathogenic species...
December 2018: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30145060/neurodevelopmental-outcomes-following-necrotizing-enterocolitis
#15
REVIEW
Marie Hickey, Michael Georgieff, Sara Ramel
Necrotizing enterocolitis (NEC), a gastrointestinal emergency predominantly affecting premature infants, is associated with increased risk for poor neurodevelopmental outcomes. NEC often strikes during a period of rapid and dynamic neurologic development when the brain is particularly vulnerable to insults and nutrient deficits. The pathogenesis of neurodevelopmental impairment following NEC is likely multifactorial, with both nutritional and non-nutritional factors at play. Follow-up testing that ensures early detection and intervention for impairments is crucial to optimize neurodevelopmental outcomes following NEC...
December 2018: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30145059/the-cost-of-necrotizing-enterocolitis-in-premature-infants
#16
REVIEW
Meredith E Mowitz, Dmitry Dukhovny, John A F Zupancic
Necrotizing enterocolitis (NEC), a common morbidity of prematurity, affects 5-10% of premature infants with a birthweight <1500 g. The added cost remains unclear. Multiple studies report the cost of care for an infant with NEC as higher than that of well premature infants, but these studies are fraught with limitations. Surgical intervention and type of surgery appear to impact overall costs. Health care resource utilization extends beyond the birth hospitalization, particularly in those infants requiring surgery, and persists to at least three years of age...
December 2018: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30143341/enteral-feeding-composition-and-necrotizing-enterocolitis
#17
REVIEW
Diomel de la Cruz, Catalina Bazacliu
Enteral feeding and composition play a chief role in the prevention and treatment of necrotizing enterocolitis (NEC). In the face of decades of research on this fatal disease, the exact mechanism of disease is still poorly understood. There is established evidence that providing mother's own breast milk and standardization of feeding regimens leads to a decreased risk for NEC. More recent studies have focused on the provision of donor human milk or an exclusive human milk diet in the endeavor to prevent NEC while still maintaining adequate nutrition to the premature infant...
December 2018: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30115546/a-critical-analysis-of-risk-factors-for-necrotizing-enterocolitis
#18
REVIEW
Allison Thomas Rose, Ravi Mangal Patel
Necrotizing enterocolitis (NEC) is the most common serious gastrointestinal morbidity in preterm infants. A number of risk factors for NEC have been reported in the literature. With the exception of decreasing gestational age, decreasing birth weight and formula feeding, there is disagreement on the importance of reported risk factors with uncertain causality. Causal risk factors may be observed at any time before the onset of NEC, including prior to an infant's birth. The purpose of this review is to examine the existing literature and summarize risk factors for NEC...
December 2018: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30100524/necrotizing-enterocolitis-comes-in-different-forms-historical-perspectives-and-defining-the-disease
#19
REVIEW
J Neu, N Modi, M Caplan
The specific cause of what is commonly referred to as necrotizing enterocolitis (NEC) disease has been elusive largely because it is becoming clear that this entity represents more than one disease with multifactorial pathogenic mechanisms. Furthermore, finding clear and consistent diagnostic biomarkers will be difficult until the different subsets of what we are calling this disease are better delineated. In this introductory chapter, we discuss different disease entities that are frequently termed "NEC" in the newborn infant...
December 2018: Seminars in Fetal & Neonatal Medicine
https://read.qxmd.com/read/30082194/an-update-on-biomarkers-of-necrotizing-enterocolitis
#20
REVIEW
Pak Cheung Ng
Necrotizing enterocolitis (NEC) remains a devastating surgical emergency with high morbidity and mortality in preterm infants. Slow but steady progress has been made in past years searching for novel biomarkers of NEC, for both surveillance and diagnostic purposes. This review primarily focuses on recent discoveries: clinical applications of different categories of biomarkers for surveillance, early diagnosis, and predicting severity and prognosis; and understanding of pathophysiological mechanisms as a basis to rationalize the search for 'gut-associated specific biomarkers' of NEC...
December 2018: Seminars in Fetal & Neonatal Medicine
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