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Significantly revised and updated, the new second edition updates the science on neonatal encephalopathy presented in the 1st edition. The new 2nd edition recommends a broad evaluation of all potential contributing factors in every case of neonatal encephalopathy, including maternal medical history, obstetric and intrapartum factors, and placental pathology. This recommendation is a shift from the 2003 report, which focused on determining whether or not a hypoxic-ischemic event was the cause of neonatal encephalopathy. Includes new sections on - Placental pathology - Focal ischemic stroke - Neonatal interventions - Patient safety - Significant advances in neuroimaging This report will assist the clinician in evaluating a newborn with encephalopathy to assist in defining both the cause and timing.
This monograph explores the mechanisms and timing of possible etiologic events that contribute to fetal and neonatal neurologic injury. the report presents evidence that most cases of cerebral palsy are a result of multifactorial and unpreventable causes that occur during fetal development or in the newborn after delivery, and not a result of an isolated intrapartum hypoxic event. the report contains a set of criteria that may be used to define (or rule out) an acute intrapartum hypoxic event sufficient to cause or suggest cerebral palsy.
Neonatal seizures represent one of the most frequent neurological events in newborn infants, often reflecting a variety of different pre-, peri-, or postnatal disorders of the central nervous system (CNS). They are also a common manifestation of metabolic abnormality in newborn period and often represent the first sign of neurological dysfunction in neonates. They may be symptomatic or cryptogenic, herald subsequent epilepsy, can be associated with potential morbidity and mortality, and may be used as a factor in considering long-term prognosis. Despite the enormous clinical significance of these events, many aspects of their management are not well supported with evidence- based recommendations. These guidelines are intended to be of use for neonatologists, paediatric neurologists, paediatricians, general practitioners, nurse practitioners, nurses and other health professionals who may be in contact with infants experiencing seizures within the first 28 days of life (age up to 44 weeks postconception). The guidelines are framed so as to be applied by health care providers practicing in a wide range of health care facilities, from those with limited resources to tertiary care centers.
Over the past decade, the hospitalist model has become a dominant system for the delivery of inpatient care. Forces such as national mandates to improve safety and quality, and intense pressure to safely reduce length of hospital stays, are now exerting pressure on neurologists. To meet these challenges, a new neurohospitalist model is emerging. This is the first authoritative text to detail the advances and strategies for treating neurologic disease in a hospital setting. It includes chapters on specific acute neurologic diseases including stroke, epilepsy, neuromuscular disease and traumatic brain injury and also addresses common reasons for neurologic consultation in the hospital including encephalopathy, electrolyte disturbances and neurologic complications of pregnancy. Ethical and structural issues commonly encountered in neurologic inpatients are also addressed. This will be a key resource for any clinician or trainee caring for neurologic patients in the hospital including practising neurologists, internists and trainees across multiple subspecialities.
Neonatal Neurology, Volume 162 in the Handbook of Clinical Neurology, series updates the reader on the latest advances in the study of neurological diseases diagnosed in the fetal and neonatal periods. With recent advances in magnetic resonance imaging, digital electroencephalography recording, and genetic testing and diagnosis, there is expanding awareness relating to early onset neurological conditions and how their early diagnosis can improve prediction of outcome and subsequent neurodevelopmental outcome. This new volume covers diagnosis and management of congenital conditions, including brain malformations, neuromuscular conditions and genetic epilepsies, as well as acquired injury related to peri-partum events, prematurity, critical illness and systemic diseases.
This comprehensive guide thoroughly covers all aspects of neuropalliative care, from symptom-specific considerations, to improving communication between clinicians, patients and families. Neuropalliative Care: A Guide to Improving the Lives of Patients and Families Affected by Neurologic Disease addresses clinical considerations for diseases such as dementia, multiple sclerosis, and severe acute brain injury, as well discussing the other challenges facing palliative care patients that are not currently sufficiently met under current models of care. This includes methods of effective communication, supporting the caregiver, how to make difficult treatment decisions in the face of uncertainty, managing grief, guilt and anger, and treating the pain itself. Written by leaders in the field of neuropalliative care, this book is an exceptional, well-rounded resource of neuropalliative care, serving as a reference for all clinicians caring for patients with neurological disease and their families: neurologists and palliative care specialists, physicians, nurses, chaplains, social workers, as well as trainees in these areas.
Fetal heart rate monitoring affects the lives of millions of women and infants every year in the United States alone. Used by all members of the obstetric team - nurses, students, midwives, and physicians – it is the primary method to assess fetal oxygenation in both the antepartum and intrapartum setting. Improving outcomes and promoting patient safety depends upon correct use and interpretation of fetal heart rate monitoring, and is crucial to daily obstetric practice. This fourth edition provides the obstetrical team a framework within which to interpret and understand fetal heart rate tracings and their implications. The text covers key issues as the physiological basis for monitoring, a discussion of fetal hypoxemia and neonatal encephalopathy, instrumentation and pattern recognition. In addition to an in-depth review of the standardized NICHD nomenclature and three-tiered FHR Category approach, there are chapters on intrapartum and antepartum management as well as fetal central nervous system effects on monitor patterns. Since fetal monitoring is primarily a screening tool there are also discussions on the use of backup methods for evaluation of abnormal patterns. This 4th edition also brings the addition of Lisa A. Miller CNM, JD, who provides a nursing and midwifery perspective as well an enhanced legal and risk management review. This new fourth edition includes: Review of neonatal encephalopathy and recent studies on CP Currentinformation and discussion of most recent NICHD panel recommendations, both antepartum and intrapartum New chapter on Pitfalls in EFM Detailed chapter on risk management, liability & documentation New section on fetal maternal hemorrhage Update on new instrumentation Crucial information on maternal/fetal coincidence and FDA warnings All chapters include updated practice tips and clinical implications for the entire obstetric team Plus, with this edition clinicians have access to a companion website with full text and an image bank for fast & simplified clinical review.
This book gives an exhaustive account of the classification and management of epileptic disorders. It provides clear didactic guidance on the diagnosis and treatment of epileptic syndromes and seizures through thirteen chapters, complemented by a pharmacopoeia and CD ROM of video-EEGs.
Brain dysfunction is a major clinical problem in intensive care, with potentially debilitating long-term consequences for post-ICU patients of any age. The resulting extended length of stay in the ICU and post-discharge cognitive dysfunction are now recognized as major healthcare burdens. This comprehensive clinical text provides intensivists and neurologists with a practical review of the pathophysiology of brain dysfunction and a thorough account of the diagnostic and therapeutic options available. Initial sections review the epidemiology, outcomes, relevant behavioral neurology and biological mechanisms of brain dysfunction. Subsequent sections evaluate the available diagnostic options and preventative and therapeutic interventions, with a final section on clinical encephalopathy syndromes encountered in the ICU. Each chapter is rich in illustrations, with an executive summary and a helpful glossary of terms. Brain Disorders in Critical Illness is a seminal reference for all physicians and neuroscientists interested in the care and outcome of severely ill patients.