Preterm birth interrupts the normal developmental progression of most organs, particularly when birth occurs at the lowest level of viability. An immediate task is to successfully transition to a post-natal life without a placental circulation. To do this demands careful management of the cardiorespiratory systems. To best help the fragile preterm infant at this demanding time, care-givers must remember two most pressing goals. These are first to maintain adequacy of gas exchange and delivery, while simultaneously minimizing any secondary injury to the fragile preterm lung. However, after these immediate priorities in the delivery room, the longer term effects of an immature lung development and its associated problems come to the forefront. These problems include the inflammation of perinatal infection, oxygen, and invasive mechanical ventilation. Both the immaturity itself, and secondary lung injury and its inflammation – collectively will often lead to the condition termed bronchopulmonary dysplasia (BPD). Although many of these infants may eventually be discharged to home without a need for oxygen supplementation or pulmonary medications, the long-term impact of interrupted lung development and secondary lung injury remain serious concerns. It is now well recognized that mechanical ventilation is pivotal to developing secondary lung injury and BPD. Consequently, a great deal of time and effort has been put into the development and application of non-invasive ventilator (NIV) approaches to supporting respiratory function in neonates. Since the landmark publication by Gregory and colleagues in 1967, nasal continuous positive airway pressure (nCPAP) has been the most commonly applied approach to NIV. This approach has been supported by the recent generation of randomized controlled trials. However, cumulatively these trials have shown only a small reduction in rates of BPD. Outside of the trial data, despite the wider application of nCPAP, rates of BPD remain relatively unchanged over recent years. This has led to investigations of other NIV approaches including nasal ventilation and high flow nasal cannula therapy. Not only have available modes increased, but so have the interfaces through which these modes may be applied. In the issue of Clinic in Perinatology, readers will find an up-to-date review of non-invasive approaches to supporting preterm respiratory function. This draws on the expertise of leading investigators in the field. This issue reviews the physiologic mechanisms by which the various approaches to NIV may support respiratory function; the evidence base supporting different NIV approaches; and adjunctive aspects of NIV therapy including their use during neonatal transport and the application of other supportive therapies such as inhaled NO.
Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163(7):1723–9. 3. Walsh MC, Wilson-Costello D, Zadell A, et al. Safety, reliability, and validity of a physiologic definition of bronchopulmonary dysplasia ...
... use of TH for term and near-term infants with moderate or severe HIE moved from experimental to routine, both the challenges and the potential of this treatment emerged as hot topics of debate and exploration among neonatologists.
Top authors were selected to write clinical review articles devoted to Advances in Respiratory Care of the Newborn.
... and combination (multiple episodes with different pathogens or a single polymicrobial episode) infection had a higher incidence of hearing impairment than those with no infections and those with CoNS infections.4 Other studies have ...
Retrieved February 8, 2008, from www.ismp.org/tools/highalertmedications.pdf Institute of Medicine: Crossing the quality chasm of national ... Lesar, A., Mitchell, P., and Sommo, P.: Medication safety in critically ill children.
American Journal of Cardiovascular Drugs, 4, 87. ... Predefined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications. ... Hematology/oncology Clinics of North America, 24, 215.
May serve as a bridge between patient and caregivers (Gilliland, 2002) [ii] Professional nurse • Provides physical and emotional support, though not always on a continual basis • Critical factor in the achievement of improved birth ...
In this issue, guest editors bring their considerable expertise to this important topic. Provides in-depth reviews on the latest updates in the field, providing actionable insights for clinical practice.
Urologic issues are particularly important as urologic complications are among the leading causes of long-term ... and anticholinergics.37 Bladder augmentation and reconstruction are indicated with renal deterioration despite maximal ...
New to this edition is an emphasis on clinical judgment skills and a new chapter on children with integumentary dysfunction.