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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.
In this issue of Clinics in Perinatology, guest editors Drs. Heather C. Kaplan and Munish Gupta bring their considerable expertise to the topic of Quality Improvement. In recent years, the growing use of quality improvement (QI) methods to apply evidence-based practices to clinical care has resulted in a greater penetration of QI methods in neonatal intensive care units across the world and a more sophisticated appreciation of how best to use them. This issue provides important updates in these areas as well as looks at the future of QI in perinatology. - Contains 15 practice-oriented topics including frameworks for quality improvement: Lean Six Sigma and the model for improvement in perinatology; sustaining improvement in perinatology; recent progress in global health quality improvement in perinatology; measuring equity for quality improvement in perinatology; pursuing equity for all mothers and newborns through population health: the role of perinatal quality collaboratives; and more. - Provides in-depth clinical reviews on quality improvement in perinatology, offering actionable insights for clinical practice. - Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.
In this issue of Clinics in Perinatology, guest editor Manuel Sanchez Luna brings his considerable expertise to the topic of Respiratory Management. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field; Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews.
In consultation with Consulting Editor, Dr. Lucky Jain, Drs. Maximo Vento and Waldemar Carlo have put together a state-of the-art issue of the Clinics in Perinatology devoted to Perinatal Pharmacology. Clinical review articles are specifically devoted to the following: Monitoring and assessment of oxygenation in infants; Oxygen toxicity in neonates; New methods for non-invasive oxygen administration; Targeting oxygen in preterm and term infants starting at birth; Newborn resuscitation in settings without access to supplemental oxygen; Noninvasive versus invasive ventilatory support; Nasal SIMV versus Nasal CPAP before and after invasive ventilatory support; Is high-flow cannula inferior to CPAP for neonates?; Intermittent hypoxia: Importance; Closed-loop control of inspired oxygen in neonates: Compliance with targets; Meta-analysis oxygenation saturation targeting trials: Do infant subgroups matter?; Targets of oxygen saturation to optimize eye outcomes; Achieved oxygenation saturations and outcome in extremely preterm infants; Pulmonary hypertension in preterm infants; and Current recommendations and practice of oxygen therapy in preterm infants. Readers will come away with the latest information on oxygen therapy as they seek to utilize evidence-based recommendations to improve patient outcomes.
The Guest Editors have collaborated on a state-of-the-art presentation of current clinical reviews on Quality in Neonatal Care. Top experts have prepared articles in the following areas: Standardizing Practices: How and why to standardize, using checklists, measuring variation; Health Informatics and Patient Safety; Using Statistical Process Control to Drive Improvement in Neonatal Care; Improving Value in Neonatal Intensive Care; Culture and Context in Quality of Care: Improving Teamwork and Resilience; Has Quality Improvement Improved Neonatal Outcomes; National Quality Measures in Perinatal Care; Perinatal and Obstetric Quality Initiatives; Family Involvement in Quality Improvement; Perinatal Quality Improvement: A Global Perspective; Delivery Room Care / Golden Hour; Respiratory Care and Bronchopulmonary Dysplasia; Reducing Incidence of Necrotizing Enterocolitis; Alarm Safety and Alarm Fatigue; and Patient Safety: Reducing Unplanned Extubations. Readers will come away with the clinical information they need improve quality in the NICU.
Dr. Mimouni and Dr. Koletzko have assembled some of the world's leaders on breast milk for preterm infants to provide a current overview of the benefits and barriers. Authors address the following topics: Preterm human milk macronutrient composition; Bed-side human milk analysis in the NICU; Human milk fortification; DHA supplements; Potential benefits of bioactive proteins in human milk for preterm infants; New insights into variations of metabolite and hormone contents in human milk; Immune properties of human milk in relation to preterm infant feeding; Human milk oligosaccharides; Treatment and quality of banked human milk; Use of donor milk: collection, storage and safety; Postnatal CMV infection through human milk in preterm infants: Transmission, clinical presentation, and prevention; NEC and human milk feeding; Neurodevelopmental outcomes of preterm infants fed human milk; Evidence-based methods that promote human milk feeding of preterm infants; and Human flavor learning: the breastfeeding experience. Lactiation consultants, NICU nurses, and neonatologists will find these clinical review articles to be very valuable.
The Guest Editors have assembled top experts to provide the most current and clinically relevant articles devoted to Birth Asyphyxia. Articles in this issue are devoted to: Neonatal Transition After Birth; Pathophysiology of Birth Asphyxia; Perinatal Asphyxia from the Obstetrical Standpoint: Diagnosis and Interventions; Stillbirths: U.S. and Global Perspectives; Novel Approaches to Resuscitation and the Impact on Birth Asphyxia; Multiorgan Dysfunction and its Management After Birth Asphyxia; Neonatal Encephalopathy and Update on Therapeutic Hypothermia and Other Novel Therapeutics; Biomarkers in Neonatal Encephalopathy; Imaging and Other Diagnostics in Neonatal Encephalopathy; Asphyxia in the Premature Infant; The role of the NeoNeuro Unit for Birth Asphyxia; Long-term Cognitive Outcomes of Birth Asphyxia and the Contribution of Identified Perinatal Asphyxia to Cerebral Palsy; Global Burden, Epidemiologic Trends, and Prevention of Intrapartum Related Deaths in Low-resource Settings; and Neonatal Resuscitation in Low-resource Settings.
Along with Consulting Editor, Dr. Lucky Jain, Dr. Goudy has created a current issue that looks at ENT issues with newborns. Expert authors from top institutions have submitted clinical reviews on the following topics: Airway anomalies; Fetal evaluation and airway management; Hearing loss and failed NBHS; Aspiration and dysphagia in the new born; Cleft lip and palate; Microtia and facial anomalies; Cranial synostosis; Pierre Robin sequence; Vascular malformations; Choanal atresia and other nasal masses; Congenital neck masses; Subglottic stenosis; Tracheostomy in the newborn; and Stridor. Readers will come away with the information they need to make informed clinical decisions to improve patient outcomes.
The impact of cardiovascular disease on an infant extends from the fetal period to well beyond childhood. Perinatalogists and neonatologists can impact maternal and fetal health through wide range of diagnostic modalities and interventional techniques. For our edition focused on cardiovascular health, we sought to encompass the breadth of knowledge that would be the most relevant for the bed side clinician. Our goal was to assemble contents that would allow a clinician to quickly peruse the journal, and then be prepared to make a medical decision. The interaction between cardiology and perinatology/neonatology includes genetics, diagnostics, interventions, counseling, routine stabilization and day to day care. Ultimately, the goal is to establish the foundation for a healthy adult. For this reason, we have even included chapters on topics that are significant on a day to day basis (such as the proper environment for a newborn) and a long term basis (like the overall neurodevelopmental impact of our interventions). Hopefully, whether in the middle of the night as an emergency reference or during the day as a reliable guide, this edition of Clinics in perinatology will be an important bedside tool for anyone that participates in the care of a patient with perinatal heart disease.
There is general consensus regarding threshold levels that describe the gray zone on the limits of viability, and gestational age alone should not be used solely in making a decision. This issue will bring light to the latest thoughts and clinical recommendations for delivery during the periviable period. Top thought leaders and clinicians have submitted articles in the following areas: Consequences of Birth at Periviable Gestions on Organ Systems; Medical and Surgical Interventions Before Birth; NICU Care: Nutrition/NEC; Pulmonary Care and Circulatory Support; NICU Stay and Microbiome; and Ethical Considerations and Counseling, to name a few. Readers will come away with the most current content written on this topic and details that can be incorporated into clinical care.