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Paul J Rozance, Joseph I Wolfsdorf
This article covers several aspects of the clinical management of neonatal hypoglycemia that have recently evolved, reviewing the evidence informing these recommended changes in practice. Topics covered include use of buccal dextrose gel, rationale for avoiding the traditional "mini dextrose bolus," and benefits of direct breastfeeding for the treatment of asymptomatic hypoglycemia in at-risk newborns. The reasons for increasing use of more accurate point-of-care devices for measuring neonatal glucose concentrations are discussed, as well as the implications of different published opinions regarding the determination of readiness for discharge and the most important considerations when making this determination...
April 2019: Pediatric Clinics of North America
Gustavo A Cortes-Puentes, Richard A Oeckler, John J Marini
Skillfully implemented mechanical ventilation (MV) may prove of immense benefit in restoring physiologic homeostasis. However, since hemodynamic instability is a primary factor influencing mortality in acute respiratory distress syndrome (ARDS), clinicians should be vigilant regarding the potentially deleterious effects of MV on right ventricular (RV) function and pulmonary vascular mechanics (PVM). During both spontaneous and positive pressure MV (PPMV), tidal changes in pleural pressure (PPL ), transpulmonary pressure (PTP , the difference between alveolar pressure and PPL ), and lung volume influence key components of hemodynamics: preload, afterload, heart rate, and myocardial contractility...
September 2018: Annals of Translational Medicine
Rashmin C Savani
Over 50 years after its first description, Bronchopulmonary Dysplasia (BPD) remains a devastating pulmonary complication in preterm infants with respiratory failure and develops in 30-50% of infants less than 1000-gram birth weight. It is thought to involve ventilator- and oxygen-induced damage to an immature lung that results in an inflammatory response and ends in aberrant lung development with dysregulated angiogenesis and alveolarization. Significant morbidity and mortality are associated with this most common chronic lung disease of childhood...
November 2018: Seminars in Perinatology
Rory E Morty
Bronchopulmonary dysplasia (BPD) continues to be one of the most common complications of preterm birth and is characterized histopathologically by impaired lung alveolarization. Extremely preterm born infants remain at high risk for the development of BPD, highlighting a pressing need for continued efforts to understand the pathomechanisms at play in affected infants. This brief review summarizes recent progress in our understanding of the how the development of the newborn lung is stunted, highlighting recent reports on roles for growth factor signaling, oxidative stress, inflammation, the extracellular matrix and proteolysis, non-coding RNA, and fibroblast and epithelial cell plasticity...
November 2018: Seminars in Perinatology
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
Pradeep M Jayaram, Manoj K Mohan, Ibrahim Farid, Stephen Lindow
Background Magnesium sulfate is an accepted intervention for fetal neuroprotection. There are some perceived differences in the international recommendations on the use magnesium sulfate for fetal neuroprotection in preterm labor. Content This systematic review analyses the available clinical guidelines for the use of magnesium sulfate for fetal neuroprotection and compares the recommendations, and assesses the quality of guidelines. This provides the consensus, differences and explores the areas for future collaborative research...
October 20, 2018: Journal of Perinatal Medicine
Nicola Goodall
No abstract text is available yet for this article.
November 15, 2018: Archives of Disease in Childhood. Education and Practice Edition
Jacqueline Huvanandana, Cindy Thamrin, Murray Hinder, Alistair McEwan, Mark B Tracy
AIM: To evaluate cerebral autoregulation changes in preterm infants receiving a loading dose of caffeine base. METHODS: In a cohort of 30 preterm infants, we extracted measures of cerebral autoregulation using time and frequency domain techniques to determine the correlation between mean arterial pressure (MAP) and tissue oxygenation index (TOI) signals. These measures included the cerebral oximetry index (COx), cross-correlation and coherence measures, and were extracted prior to caffeine loading and in the 2 hours following administration of 10 mg/kg caffeine base...
November 7, 2018: Acta Paediatrica
Catalina Bazacliu, Josef Neu
NEC is a devastating disease that, once present, is very difficult to treat. In the absence of an etiologic treatment, preventive measures are required. Advances in decoding the pathophysiology of NEC are being made but a more comprehensive understanding is needed for the targeting of preventative strategies. A better definition of the disease as well as diagnostic criteria are needed to be able to specifically label a disease as NEC. Multiple environmental factors combined with host susceptibility appear to contribute to enhanced risks for developing this disease...
November 2, 2018: Current Pediatric Reviews
Maureen M Black
Brain development begins shortly after conception and continues throughout early childhood and into adolescence and early adulthood. During the first 1,000 days (conception to age 2), brain development is rapid, with nutrition playing an important role in the expression of the genetic code. Recent animal and human findings have illustrated that the timing, chronicity, and severity of nutritional deficiencies has differential effects on brain development and on subsequent cognitive and emotional processes. Evidence from intervention trials and longitudinal studies has shown the interactive nature of environmental influences on brain functioning and cognition over time, opening new opportunities for interventions to prevent or overcome potential adversities, including nutritional deficiencies...
2018: Nestlé Nutrition Institute Workshop Series
Shalonda K Slater, Scott W Powers, Hope L O'Brien
PURPOSE OF REVIEW: The current review presents findings from investigations of migraine in children. The presentation of pediatric migraine, related consequences, and medication treatments are reviewed. RECENT FINDINGS: A number of advancements have been made in the study of the presentation, disability, and treatments for migraine in children. However, recent research suggests that not all approaches are equally effective in the treatment of migraine in children...
December 2018: Current Opinion in Pediatrics
Kent A Willis, Mark F Weems
Patent ductus arteriosus (PDA) is prevalent in premature newborns and has been linked to the development of bronchopulmonary dysplasia (BPD), a serious pulmonary complication of premature birth. Although a causal relationship has not been proven, the link is greatest among infants born at lower gestational age who are treated with mechanical ventilation in the presence of a large ductal shunt. Despite strong association in epidemiological studies, treatment of a patent ductus arteriosus has not been shown to prevent BPD, and some therapies may increase the risk of BPD...
October 20, 2018: Congenital Heart Disease
David A Osborn, John Kh Sinn, Lisa J Jones
BACKGROUND: Infant formulas containing hydrolysed proteins have been widely advocated for preventing allergic disease in infants, in place of standard cow's milk formula (CMF). However, it is unclear whether the clinical trial evidence supports this. OBJECTIVES: To compare effects on allergic disease when infants are fed a hydrolysed formula versus CMF or human breast milk. If hydrolysed formulas are effective, to determine what type of hydrolysed formula is most effective, including extensively or partially hydrolysed formula (EHF/PHF)...
October 19, 2018: Cochrane Database of Systematic Reviews
Shadwa Hassan, Anthony Gonzalez, Seleshi Demissie, Kashun Morawakkoralage, Pushpom James
Nebulized normal saline is frequently prescribed for the treatment of bronchiolitis or bronchial asthma exacerbations. We aimed to reinforce guidelines care by educating providers on the futility of saline administration. Frequency and indications for nebulized normal saline prescription were documented from November 1, 2014, to April 1, 2015, and then again, after dissemination of educational material to providers, from November 1, 2016, to April 1, 2017. A total of 263 patients had bronchiolitis and 470 had asthma...
November 2018: Clinical Pediatrics
Anand Narayanan, Prerna Batra, Mohammed Mounis Akbar Faridi, Deepika Harit
OBJECTIVES:  Partial arterial pressure of oxygen/fraction of oxygen in inspired air (PaO2 /FiO2 ) ratio has been used as a predictor of outcome in some neonatal conditions, but has not been used in meconium aspiration syndrome (MAS). This study was conducted with the objective to study if the PaO2 /FiO2 ratio of < 200 at 6, 12, and 24 hours of life can predict mortality in neonates with MAS. STUDY DESIGN:  Two hundred neonates with MAS were included in the study...
October 3, 2018: American Journal of Perinatology
Ufuk Cakir, Cuneyt Tayman
OBJECTIVE:  Patent ductus arteriosus (PDA) is an important clinical problem associated with mortality and serious morbidities. It is thought that serum osmolality may affect ductal patency. We aimed to investigate the importance of serum osmolality related to ductal patency in preterm infants. STUDY DESIGN:  Our study was conducted between January 2013 and December 2017. Premature infants, birth weight <1,500 g and gestational age <32 weeks were included in the study...
October 6, 2018: American Journal of Perinatology
Vikramaditya Dumpa, Vineet Bhandari
Bronchopulmonary dysplasia (BPD) is a complex disorder with multiple factors implicated in its etiopathogenesis. Despite the scientific advances in the field of neonatology, the incidence of BPD has remained somewhat constant due to increased survival of extremely premature infants. Surfactant deficiency in the immature lung, exposure to invasive mechanical ventilation leading to volutrauma, barotrauma and lung inflammation are some of the critical contributing factors to the pathogenesis of BPD. Hence, strategies to prevent BPD in the postnatal period revolve around mitigation of this injury and inflammation...
November 2018: Seminars in Perinatology
Jaclyn Quirt, Kyla J Hildebrand, Jorge Mazza, Francisco Noya, Harold Kim
Asthma is the most common respiratory disorder in Canada. Despite significant improvement in the diagnosis and management of this disorder, the majority of Canadians with asthma remain poorly controlled. In most patients, however, control can be achieved through the use of avoidance measures and appropriate pharmacological interventions. Inhaled corticosteroids (ICS) represent the standard of care for the majority of patients. Combination ICS/long-acting beta2 -agonist inhalers are preferred for most adults who fail to achieve control with ICS therapy...
2018: Allergy, Asthma, and Clinical Immunology
C Peters, A S P van Trotsenburg, N Schoenmakers
Congenital hypothyroidism (CH) may be primary, due to a defect affecting the thyroid gland itself, or central, due to impaired thyroid-stimulating hormone (TSH)-mediated stimulation of the thyroid gland as a result of hypothalamic or pituitary pathology. Primary CH is the most common neonatal endocrine disorder, traditionally subdivided into thyroid dysgenesis (TD), referring to a spectrum of thyroid developmental abnormalities, and dyshormonogenesis, where a defective molecular pathway for thyroid hormonogenesis results in failure of hormone production by a structurally intact gland...
September 24, 2018: European Journal of Endocrinology
Abanti Chaudhuri, Scott M Sutherland
Elevated blood pressures (BP) are common among hospitalized children and, if not recognized and treated promptly, can lead to potentially significant consequences. Even though we have normative BP data and well-developed guidelines for the diagnosis and management of hypertension (HTN) in the ambulatory setting, our understanding of elevated BPs and their relationship to HTN in hospitalized children is limited. Several issues have hampered our ability to diagnose and manage HTN in the inpatient setting including the common presence of physiologic conditions, which are associated with transient BP elevations (i...
August 31, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
2018-10-31 01:54:18
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