Current and Potentially New Management Strategies for Perinatal Hypoxic-Ischemic Encephalopathy

PEDIATRICS ◽  
1990 ◽  
Vol 85 (6) ◽  
pp. 961-968 ◽  
Author(s):  
Robert C. Vannucci
Keyword(s):  
Neonatal Intensive Care ◽  
Management Strategies ◽  
Newborn Infants ◽  
Standard Of Care ◽  
Neonatal Intensive Care Units ◽  
Future Research ◽  
Optimal Management ◽  
Ischemic Brain ◽  
The Brain ◽  
Ischemic Encephalopathy

Given the current dilemma in the brain-oriented therapy of newborn infants sustaining cerebral hypoxia-ischemia, it is not surprising that management strategies vary widely among neonatal intensive care units.9 Thus, there is no uniform standard of care, and it remains for future research to uncover new and effective modes of therapy for the neurologically compromised infant. Prevention, or at least optimal management, of prepartum and intrapartum asphyxia remains the best available means of reducing the incidence and severity of peninatal hypoxic-ischemic brain damage.

Indian Health Service—By One Who Provides It

PEDIATRICS ◽  
1974 ◽  
Vol 53 (6) ◽  
pp. 950-950
Author(s):  
Henry M. Sondheimer
Keyword(s):  
Health Service ◽  
Neonatal Intensive Care ◽  
Close Contact ◽  
Newborn Infants ◽  
Neonatal Intensive Care Units ◽  
Indian Health Service ◽  
Transit System ◽  
Indian Health ◽  
Sick Newborn ◽  
Seriously Ill

As one of the "young, highly idealistic physicians, just out of internship or residency . . ." and currently in the Indian Health Service, I read the Commentaries of Drs. Mortimer and Kemberling with great interest. Although it is unfair to extrapolate from my experiences at one hospital to the entire Indian Health Service, I believe a practicing pediatrician in the field may comment. Dr. Mortimer may be surprised to hear that sick newborn infants at our hospital are cared for not by aides but by physicians in close contact with the Arizona Newborn Transit System in Phoenix (250 miles away), and that seriously ill newborns are transferred to one of the two neonatal intensive care units in Phoenix under the auspices of this system.

Through the Looking Glass—Or, Look Before You Leap

PEDIATRICS ◽  
1982 ◽  
Vol 70 (6) ◽  
pp. 1001-1003
Author(s):  
GEORGE CASSADY
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Newborn Infants ◽  
Neonatal Intensive Care Units ◽  
Careful Study ◽  
Chest Tubes ◽  
Newborn Intensive Care ◽  
Deep Thought ◽  
Looking Glass

Nurses are now so active in newborn intensive care units that exchange transfusions, lumbar punctures, vascular catheterizations, placement of chest tubes, and many other complex and complicated but time-consuming procedures need no longer burden the busy physician. According to the neonatologists in charge, specially educated nurses are independently performing these and many other tasks in most neonatal intensive care units (NICUs). Assuming that similar practices exist in those units not assessed and that nurses are in fact doing what the neonatologists say they are, these amazing observations deserve careful study and deep thought by all who care for newborn infants.

Digital Scrapbooking as a Standard of Care in Neonatal Intensive Care Units: Initial Experience

2012 ◽  
Vol 31 (3) ◽  
pp. 162-168 ◽  
Author(s):  
Muhammad T. Subhani ◽  
Ifrah Kanwal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Standard Of Care ◽  
Neonatal Intensive Care Units ◽  
Initial Experience ◽  
Digital Photo ◽  
Ancillary Staff

In this article, we describe a digital photo scrapbooking project as a standard of care for the parents of infants admitted in a neonatal intensive care unit (NICU). Photographs were taken from birth until discharge or expiry at special moments during the infant’s hospitalization and used to create a digital scrapbook with daily notes by the parents. The scrapbook and original photos were provided on a CD at discharge or at expiry. Parents and their families unanimously appreciated the photos and the opportunity to record their thoughts, and considered the CDs as a lifetime treasure. Digital photo journaling could be implemented as a standard of care at other institutions with a commitment from the nursing and ancillary staff of the NICU and labor and delivery department, with possible support from volunteers.

Anoxic-Ischemic Encephalopathy

2021 ◽  
pp. 485-488
Author(s):  
Tia Chakraborty ◽  
Jennifer E. Fugate
Keyword(s):  
Cardiac Arrest ◽  
Prognostic Factors ◽  
Brain Injury ◽  
Cardiopulmonary Resuscitation ◽  
Respiratory Arrest ◽  
Clinical State ◽  
Ischemic Brain Injury ◽  
Ischemic Brain ◽  
The Brain ◽  
Ischemic Encephalopathy

Anoxic-ischemic brain injury occurs when no blood is flowing to the brain. Neurologists commonly encounter this clinical state when evaluating comatose patients who have had a cardiac arrest and prolonged cardiopulmonary resuscitation attempts. Anoxic-ischemic injury may also occur in primary respiratory arrest or severe hypoxemia (eg, asphyxia, anaphylaxis, drug intoxication), but it is less well understood in these circumstances. This chapter reviews the pathophysiologic factors, clinical management, and prognostic factors in anoxic-ischemic brain injury.

Why Are We Trimming Peripherally Inserted Central Venous Catheters?

2004 ◽  
Vol 23 (3) ◽  
pp. 82-83 ◽  
Author(s):  
Carol Trotter
Keyword(s):  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Insertion Site ◽  
Standard Of Care ◽  
Central Venous Catheters ◽  
Neonatal Intensive Care Units ◽  
Central Venous ◽  
Intravenous Access ◽  
Catheter Insertion Site ◽  
Catheter Tip

PERIPHERALLY INSERTED CENTRAL venous catheters (PICCs) are used as the standard of care for longterm intravenous access in neonates treated in neonatal intensive care units. Little evidence supports many of the practices associated with PICC lines, however. Some practices needing more evidence include catheter tip placement in very low birth weight neonates, the catheter insertion site, the catheter material, insertion site dressings, and mechanisms to prevent catheter-related sepsis. Of particular concern is the practice of trimming the excess length off the distal end of the catheter prior to insertion.

The Comparison of Hemoglobin Values Measured by Blood and Continuous Non-Invasive Monitoring (SpHb) in Newborn Infants

2020 ◽  
Author(s):  
Halil Kazanasmaz ◽  
Mahmut Demir
Keyword(s):  
Neonatal Intensive Care ◽  
Venous Blood ◽  
Newborn Infants ◽  
Blood Sampling ◽  
Neonatal Intensive Care Units ◽  
P Value ◽  
Invasive Monitoring ◽  
Non Invasive ◽  
The Difference ◽  
Venous Blood Sampling

Abstract Objective Hemoglobin (Hb) measurement is one of the most commonly used laboratory tests in medical practice. Unnecessary blood sampling, especially in neonatal intensive care units (NICUs), contributes to iatrogenic anemia. Continuous non-invasive monitoring of total Hb (SpHb) was compared with invasive venous blood samples (tHb) in NICU patients. Methods Three hundred and ten patients were identified in NICU. Non-invasive Hb measurement was performed immediately before venous blood sampling and comparison of invasive with non-invasive values was undertaken. Results There was a strongly positive correlation between SpHb and tHb (r = 0.965, p < 0.001). Bland–Altman analysis was performed in 95% limits of agreement for Hb values measured by both methods. The mean bias between tHb and SpHb measurements was 0.05 g/dl (−1.85 to 1.96). In Passing–Bablok regression analysis, the CUSUM test p value was found to be 0.98 for Hb levels measured by SpHb and tHb; and the difference between the methods was not significant. Conclusion In newborns, SpHb method offers reliable Hb values, which are comparable with the more traditional tHb method. Continuous non-invasive monitoring of total Hb may help prevent unnecessary blood sampling and iatrogenic anemia. Further clinical studies are required for the effectiveness of the method in critically ill patients with circulatory disorders.

scholarly journals Bedside surgery in the newborn infants: survey of the Italian society of pediatric surgery

2020 ◽  
Vol 46 (1) ◽  
Author(s):  
Gloria Pelizzo ◽  
Pietro Bagolan ◽  
Francesco Morini ◽  
Mariagrazia Aceti ◽  
Daniele Alberti ◽  
...  
Keyword(s):  
Pediatric Surgery ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Central Italy ◽  
Newborn Infants ◽  
Venous Catheter ◽  
Italian Society ◽  
Neonatal Intensive Care Units ◽  
Preterm Neonates ◽  
General Data

Abstract Introduction This is the report of the first official survey from the Italian Society of Pediatric Surgery (ISPS) to appraise the distribution and organization of bedside surgery in the neonatal intensive care units (NICU) in Italy. Methods A questionnaire requesting general data, staff data and workload data of the centers was developed and sent by means of an online cloud-based software instrument to all Italian pediatric surgery Units. Results The survey was answered by 34 (65%) out of 52 centers. NICU bedside surgery is reported in 81.8% of the pediatric surgery centers. A lower prevalence of bedside surgical practice in the NICU was reported for Southern Italy and the islands than for Northern Italy and Central Italy (Southern <Northern<Central, p < 0.03). The most frequent clinical characteristics of neonates was preterm neonates with birthweight < 1200 g, with cardiorespiratory instability and/or ventilatory dependence. The most frequently selected indications to surgery were pneumothorax, pleural effusion, pericardial effusion, central venous catheter (CVC) positioning, intestinal perforation, patent ductus arteriosus ligation and congenital diaphragmatic hernia. More than 60% of respondents report no institutional recommendations and dedicated informed consent on bedside surgical procedures. The lack of dedicated areas and infrastructures is considered a relative contraindication to the performance of bedside surgery. Conclusion Bedside surgery is performed in the majority of the Italian pediatric surgery centers included in this census. The introduction of a national set of surgery guidelines would be widely welcomed.

scholarly journals Management of Barrett’s Esophagus

2000 ◽  
Vol 14 (suppl d) ◽  
pp. 35D-43D ◽  
Author(s):  
Ziad Younes ◽  
Mark D Duncan ◽  
John W Harmon
Keyword(s):  
Clinical Practice ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Management Strategies ◽  
Standard Of Care ◽  
High Grade Dysplasia ◽  
Future Research ◽  
High Grade ◽  
Endoscopic Ablation ◽  
Ablative Techniques

There have been major recent advances in the understanding of the pathogenesis and epidemiology of Barrett’s esophagus and adenocarcinoma of the esophagus. The advent of potent acid suppression with proton pump inhibitors and safe, minimally invasive antireflux procedures has made alleviating symptoms and eliminating peptic complications achievable goals for the vast majority of patients. Endoscopic surveillance of Barrett’s esophagus is considered the standard of care and is widely used in clinical practice. Neither medical nor surgical antireflux procedures, however, result in the regression of Barrett’s esophagus in any consistent manner. Thermal and chemical endoscopic ablation techniques show promise in both the management of high grade dysplasia and the reversal of Barrett’s esophagus, but these techniques are still of unproven benefit, and can be costly and risky. Therefore, prospective and controlled studies with long term follow-up are needed before incorporating ablative techniques into routine clinical practice. Management of high grade dysplasia remains controversial. Alternative management strategies include surveillance, resection or ablation, tailored to the individual patient and the available expertise. Targets for future research include defining appropriate surveillance intervals; finding biological markers that identify patients at higher risk of progressing to cancer; defining the cancer risk and the appropriate management of patients with short segment Barrett’s esophagus; understanding the natural history of dysplasia and comparing alternatives for the management of high grade dysplasia; and studying whether surgical management can delay or prevent the progression to dysplasia and adenocarcinoma.

Early warning- and track and trigger systems for newborn infants

2017 ◽  
Vol 21 (1) ◽  
pp. 112-120 ◽  
Author(s):  
Nicolay Mortensen ◽  
Johan Henrik Augustsson ◽  
Jorunn Ulriksen ◽  
Unni Tveit Hinna ◽  
Georg M Schmölzer ◽  
...  
Keyword(s):  
Heart Rate ◽  
Intensive Care ◽  
Respiratory Rate ◽  
Intensive Care Units ◽  
Early Warning ◽  
Neonatal Intensive Care ◽  
Newborn Infants ◽  
Scoring Systems ◽  
Neonatal Intensive Care Units ◽  
Early Warning Scores

Tools for clinical assessment and escalation of observation and treatment are insufficiently established in the newborn population. We aimed to provide an overview over early warning- and track and trigger systems for newborn infants and performed a nonsystematic review based on a search in Medline and Cinahl until November 2015. Search terms included ‘infant, newborn’, ‘early warning score’, and ‘track and trigger’. Experts in the field were contacted for identification of unpublished systems. Outcome measures included reference values for physiological parameters including respiratory rate and heart rate, and ways of quantifying the extent of deviations from the reference. Only four neonatal early warning scores were published in full detail, and one system for infants with cardiac disease was considered as having a more general applicability. Temperature, respiratory rate, heart rate, SpO2, capillary refill time, and level of consciousness were parameters commonly included, but the definition and quantification of ‘abnormal’ varied slightly. The available scoring systems were designed for term and near-term infants in postpartum wards, not neonatal intensive care units. In conclusion, there is a limited availability of neonatal early warning scores. Scoring systems for high-risk neonates in neonatal intensive care units and preterm infants were not identified.

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