MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Clinics in Perinatology' source. Fri, 27 Jan 2012 18:06:10 +0100 http://www.medworm.com/index.php?rid=5437320&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811001187%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437320 Wed, 23 Nov 2011 10:48:18 +0100 5437320 http://www.medworm.com/index.php?rid=5437318&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000984%2Fabstract%3Frss%3Dyes Many high-risk and preterm infants have difficulty with successful feeding and subsequent optimal growth during their stay in the neonatal intensive care unit as well as in the months after discharge. Environmental, procedural, and medical issues necessary for treatment of the hospitalized infant present challenges for the development of successful eating skills. Emerging data describe eating as a predictable neurodevelopmental process that depends on the infant’s organization of physiologic processes, motor tone and movement, level of arousal, and ability to simultaneously regulate these processes. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437318 Wed, 23 Nov 2011 10:48:18 +0100 5437318 http://www.medworm.com/index.php?rid=5437316&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000996%2Fabstract%3Frss%3Dyes This article highlights the research findings suggesting that prenatal maternal stress, postnatal maternal care, and infant neglect/abuse can lead to epigenetic variation, which may have long-term effects on stress responsivity, neuronal plasticity, and behavior. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437316 Wed, 23 Nov 2011 10:48:18 +0100 5437316 http://www.medworm.com/index.php?rid=5437315&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811001072%2Fabstract%3Frss%3Dyes The knowledge that neonatal emotional experience and associated learning processes are critical in the maturation of prefronto-limbic circuits emphasizes the importance of preterm and neonatal care. The further improvement of care and intervention strategies requires a deeper understanding of epigenetic mechanisms mediating experience-induced synaptic reorganization underlying the emergence of emotional and cognitive behavioral traits. Interdisciplinary research efforts are needed in which pediatricians and developmental biologists and psychologists merge their knowledge, concepts, and methodology. The hope is that the translational relevance of research efforts can be improved through a greater interaction between basic and clinical scientists. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437315 Wed, 23 Nov 2011 10:48:18 +0100 5437315 http://www.medworm.com/index.php?rid=5437314&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS009551081100100X%2Fabstract%3Frss%3Dyes Much of the early development of the human visual system occurs while the preterm infant is in the neonatal intensive care unit (NICU). Critical events and processes happen between 20 and 40 weeks’ gestational age, before the onset of vision at term birth. Knowledge of the development of the visual system and the timing of the processes involved is essential to adapting NICU care to support all neurosensory development including visual development. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437314 Wed, 23 Nov 2011 10:48:18 +0100 5437314 http://www.medworm.com/index.php?rid=5437307&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811001096%2Fabstract%3Frss%3Dyes In a recent article published in the magazine New Yorker entitled, “A Child in Time,” Jerome Groopman captures the journey of a prematurely born infant into adulthood and cites the many advances that have helped secure a better future for the tiniest of preterm infants. The caption accompanying a picture on the front page aptly reads, “Recent advances have boosted parents’ hopes, but uncertainties remain.” Indeed, a day in a high-risk developmental follow-up clinic examining these growing infants will reveal the broad spectrum of outcomes that await them—from frank cerebral palsy to a brilliant young child completely unaware of the close scare of preterm birth. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437307 Wed, 23 Nov 2011 10:48:18 +0100 5437307 http://www.medworm.com/index.php?rid=5437306&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811001175%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437306 Wed, 23 Nov 2011 10:48:18 +0100 5437306 http://www.medworm.com/index.php?rid=5437305&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811001254%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437305 Wed, 23 Nov 2011 10:48:18 +0100 5437305 http://www.medworm.com/index.php?rid=5437304&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811001151%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437304 Wed, 23 Nov 2011 10:48:18 +0100 5437304 http://www.medworm.com/index.php?rid=5437303&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS009551081100114X%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437303 Wed, 23 Nov 2011 10:48:18 +0100 5437303 http://www.medworm.com/index.php?rid=5437317&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000972%2Fabstract%3Frss%3Dyes Neonatology has optimized medical outcomes for high-risk newborns yet neurodevelopmental outcomes continue to be a concern. Basic science, clinical research, and environmental design perspectives have shown the impact of the caregiving environment on the developing brain and the role of professional caregivers in providing supportive intervention to both infants and their families. This recognition has prompted a focus on early developmentally supportive care (DSC) for high-risk newborns both in the hospital and in community follow up. DSC has emerged as a recognized standard of care in most neonatal intensive care units. Still, many questions remain and much integrative research is needed. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437317 Fri, 28 Oct 2011 04:00:00 +0100 5437317 http://www.medworm.com/index.php?rid=5437310&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811001047%2Fabstract%3Frss%3Dyes Despite advances in knowledge and technology, accurate prediction of later neuromotor outcomes for infants born preterm remains somewhat elusive. Here we review some of the most recent findings regarding the differential effects of preterm birth and suboptimal fetal growth on neurodevelopment. Evidence from transcranial magnetic stimulation studies is presented that suggests neuromotor development may more directly influence cognitive outcomes than previously recognised. We discuss the role of neuroplasticity in both exacerbating and improving these postnatal outcomes, and possible therapeutic targets for manipulating this. Finally, some developmental care practices that might affect long-term outcomes for these children are discussed. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437310 Wed, 26 Oct 2011 04:00:00 +0100 5437310 http://www.medworm.com/index.php?rid=5437319&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811001060%2Fabstract%3Frss%3Dyes This article describes the optimal environment for developmental care in the neonatal intensive care unit. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437319 Mon, 24 Oct 2011 04:00:00 +0100 5437319 http://www.medworm.com/index.php?rid=5437313&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811001035%2Fabstract%3Frss%3Dyes Auditory perception and learning take place during the third trimester of gestation. Fetuses and newborns who lack typical auditory experience can go on to develop typical socioemotional attachment and language, given a supportive environment. For hospitalized preterm infants in developmentally sensitive neonatal intensive care units, detrimental effects of deviant early auditory experience may be remediated by later experience, but much is unknown about the causes of language deficits of prematurity. Prenatal auditory stimulation programs that incorporate audio speakers against the maternal belly should be discouraged because of possible overstimulation effects on the developing auditory system and sleep/wake state organization. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437313 Mon, 24 Oct 2011 04:00:00 +0100 5437313 http://www.medworm.com/index.php?rid=5437312&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811001059%2Fabstract%3Frss%3Dyes Early life infant-caregiver attachment is a dynamic, bidirectional process that involving both the infant and caregiver. Infant attachment appears to have a dual function. First, it ensures the infant remains close to the caregiver in order to receive necessary care for survival. Second, the quality of attachment and its associated sensory stimuli organize the brain to define the infant’s cognitive and emotional development. Here we present attachment within an historical view and highlight the importance of integrating human and animal research in understanding infant care. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437312 Wed, 19 Oct 2011 04:00:00 +0100 5437312 http://www.medworm.com/index.php?rid=5437309&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811001011%2Fabstract%3Frss%3Dyes The natural environment provides a flux of concurrent stimulation to all our senses, and the integration of information from different sensory systems is a fundamental feature of perception and cognition. How information from the different senses is integrated has long been of concern to several scientific disciplines, including psychology, cognitive science, and the neurosciences, each with different questions and methodologies. In this article, I briefly explore some of these recent advances in the understanding of the development of sensory integration and organization and discuss implications of these advances for the care and management of the preterm infant. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437309 Mon, 17 Oct 2011 04:00:00 +0100 5437309 http://www.medworm.com/index.php?rid=5437311&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811001023%2Fabstract%3Frss%3Dyes This article reviews the development of the senses of taste and smell, which provide information on the flavor of foods, and discusses how innate predispositions interact with early-life feeding experiences to form children’s dietary preferences and habits. A basic understanding of the development and functioning of the chemical senses during early childhood may assist in forming evidence-based strategies to improve children’s diets, especially for those who experience a discontinuity or disruption in early flavor experiences. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437311 Fri, 14 Oct 2011 04:00:00 +0100 5437311 http://www.medworm.com/index.php?rid=5437308&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811001084%2Fabstract%3Frss%3Dyes Advances in neonatal care have led to better survival for high-risk newborns, but serious questions remain regarding neurodevelopmental outcomes. The impact on the developing brain of the physical, care-giving, and family environments has received growing attention. In large part, the catalyst for bringing these research findings into clinical practice came from national meetings and study groups of scientists, clinicians, administrators, and architects headed by Dr Stanley Graven. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5437308 Mon, 10 Oct 2011 04:00:00 +0100 5437308 http://www.medworm.com/index.php?rid=5204303&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000765%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204303 Thu, 01 Sep 2011 04:00:00 +0100 5204303 http://www.medworm.com/index.php?rid=5204302&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000613%2Fabstract%3Frss%3Dyes Quality improvement initiatives have been successfully employed in many areas of medicine, but few have been implemented in preventing prematurity (or preterm birth), which continues to be one of the most common complications in obstetrics, and the leading cause of perinatal morbidity and mortality in the United States. Due to the complex nature of the causes of prematurity, developing and instituting a quality improvement program to prevent prematurity can be challenging. However, using proven quality improvement principles and techniques, along with institutional will and commitment, are invaluable in rapidly implementing evidence-based initiatives for the prevention of preterm births. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204302 Thu, 01 Sep 2011 04:00:00 +0100 5204302 http://www.medworm.com/index.php?rid=5204301&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000650%2Fabstract%3Frss%3Dyes This article is a reevaluation of the concept of term pregnancy in light of current data. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204301 Thu, 01 Sep 2011 04:00:00 +0100 5204301 http://www.medworm.com/index.php?rid=5204300&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS009551081100056X%2Fabstract%3Frss%3Dyes Prematurity is one of the leading causes of infant morbidity and mortality globally. Over the years, however, advances in medicine and technology have enhanced the ability to care for babies at very early gestations. There has also been a shift in the distribution of births away from term/post-term gestations and toward earlier gestational ages. These changes have added to the burden of premature births. The focus of this article is to present both sides of the story, one that highlights the many problems and morbidities faced by this subgroup of premature infants and the other that justifies their early delivery. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204300 Thu, 01 Sep 2011 04:00:00 +0100 5204300 http://www.medworm.com/index.php?rid=5204299&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000649%2Fabstract%3Frss%3Dyes There is no controversy that women at risk of preterm delivery before 32 to 34 weeks' gestational age should be treated with antenatal steroids. Three recent meta-analyses by the Cochrane Collaboration on the benefits of antenatal steroids, the choice of steroid and dosing, and repeat doses of corticosteroids comprehensively summarize the available clinical information to about 2007. However, there are many unanswered questions about which steroid and dose to use and about their use in selected populations. This review focuses on those areas of uncertainty. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204299 Thu, 01 Sep 2011 04:00:00 +0100 5204299 http://www.medworm.com/index.php?rid=5204297&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000601%2Fabstract%3Frss%3Dyes Late preterm and early term infants are at higher risk for short-term and long-term morbidities and mortality than term infants. Such outcomes are influenced by many factors, the strongest of which is gestational age. Counseling and educating women and families about risks of late preterm and early term births is helpful for timing and route of delivery, managing the pregnancy and infant, and prognosticating outcomes for infants. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204297 Thu, 01 Sep 2011 04:00:00 +0100 5204297 http://www.medworm.com/index.php?rid=5204296&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000558%2Fabstract%3Frss%3Dyes Decision-making for extremely immature preterm infants at the margins of viability is ethically, professionally, and emotionally complicated. A standard for prenatal consultation should be developed incorporating assessment of parental decision-making preferences and styles, a communication process involving a reciprocal exchange of information, and effective strategies for decisional deliberation, guided by and consistent with parental moral framework. Professional caregivers providing perinatal consultations or end-of-life counseling for extremely preterm infants should be sensitive to these issues and be taught flexibility in counseling techniques adhering to consistent guidelines. Emphasis must shift away from physician beliefs and behaviors about the boundaries of viability. (Sourc... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204296 Thu, 01 Sep 2011 04:00:00 +0100 5204296 http://www.medworm.com/index.php?rid=5204295&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000637%2Fabstract%3Frss%3Dyes This article reviews and discusses potential antenatal and postnatal neuroprotective approaches targeted at the numerous risk factors associated with cerebral palsy among preterm infants, including magnesium sulfate. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204295 Thu, 01 Sep 2011 04:00:00 +0100 5204295 http://www.medworm.com/index.php?rid=5204294&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000625%2Fabstract%3Frss%3Dyes This article reviews preterm outcomes, recognizing that multiple factors influence neuromaturation and lead to a range of neurodevelopmental disabilities, dysfunctions, and altered CNS processing. Ways to protect preterm infants and support their growth and development in and beyond intensive care are examined. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204294 Thu, 01 Sep 2011 04:00:00 +0100 5204294 http://www.medworm.com/index.php?rid=5204292&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000522%2Fabstract%3Frss%3Dyes Chronic, subacute decidual hemorrhage (ie, abruptio placenta and retrochorionic hematoma formation) is an important contributor to preterm parturition. Such hemorrhage induces thrombin from decidual tissue factor, which plays a pivotal role in the development of preterm premature rupture of membranes and preterm delivery by acting through protease-activated receptors to promote the production of pro-inflammatory cytokines, and matrix-degrading metalloproteinases. Severe, acute abruption can lead to maternal and fetal mortality. Current management of abruption is individualized based on severity of disease, underlying etiology, and gestational age. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204292 Thu, 01 Sep 2011 04:00:00 +0100 5204292 http://www.medworm.com/index.php?rid=5204290&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000583%2Fabstract%3Frss%3Dyes This article focuses on select key issues and questions highlighting the need to develop a better understanding of which particular subgroups of pregnant women may be especially vulnerable to the potentially detrimental effects of maternal stress, and under what circumstances and at which stages of gestation. Issues related to the characterization and assessment of maternal stress and candidate biologic mechanisms are addressed. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204290 Thu, 01 Sep 2011 04:00:00 +0100 5204290 http://www.medworm.com/index.php?rid=5204289&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000571%2Fabstract%3Frss%3Dyes Preterm birth, defined as a pregnancy ending at less than 37 completed weeks of gestation, is the leading cause of infant mortality in the United States. The occurrence of preterm births rose steadily from 9.4% of all pregnancies in the United States in 1981 to 12.8% in 2006, before declining to 12.7% in 2007 and 12.3% in 2008. Most of the increase was attributable to increases in multiple gestations. Recent research has sought to understand this condition by evaluating its familial occurrence and both clinical and pathologic information to derive an etiologically homogeneous categorization. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204289 Thu, 01 Sep 2011 04:00:00 +0100 5204289 http://www.medworm.com/index.php?rid=5204288&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000662%2Fabstract%3Frss%3Dyes This is an exciting time in perinatal medicine. While preterm birth remains a major public health problem and the leading cause of perinatal and infant mortality, progress in several areas has resulted in a decrease in the rate of prematurity and the amelioration of its impact on infants and families. Clinical research trials have shown improved outcomes for babies as the result of interventions applied during pregnancy to reduce the risk of preterm birth, and during labor and in the nursery to reduce neonatal morbidity. Perinatal quality improvement techniques are being applied to increase the use of prophylaxis with antenatal corticosteroids to decrease neonatal respiratory morbidity, to reduce nonmedically indicated inductions and cesarean deliveries associated with significant neonatal... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204288 Thu, 01 Sep 2011 04:00:00 +0100 5204288 http://www.medworm.com/index.php?rid=5204287&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000674%2Fabstract%3Frss%3Dyes Why humans triumphed 45,000 years ago, emerging as the dominant ape of that age, but without any clear biologic underpinnings to help explain this leap, helps put into context the social-ecological framework for advancement of the human race. Scientists believe that the gains came from the emergence of collective intelligence nested in communities, rather than individuals, and through rapid interaction and collective behavior, which accelerated the pace of progress. This idea holds hope for health promotion as well, which has become a victim of an excessive focus on the individual and his/her disease management, ignoring the importance of the environment and collective behavior. Proponents of the social ecological framework feel an urgent need to integrate these two seemingly divergent app... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204287 Thu, 01 Sep 2011 04:00:00 +0100 5204287 http://www.medworm.com/index.php?rid=5204286&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000753%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204286 Thu, 01 Sep 2011 04:00:00 +0100 5204286 http://www.medworm.com/index.php?rid=5204285&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000947%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204285 Thu, 01 Sep 2011 04:00:00 +0100 5204285 http://www.medworm.com/index.php?rid=5204284&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS009551081100073X%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204284 Thu, 01 Sep 2011 04:00:00 +0100 5204284 http://www.medworm.com/index.php?rid=5204283&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000728%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204283 Thu, 01 Sep 2011 04:00:00 +0100 5204283 http://www.medworm.com/index.php?rid=5204298&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000595%2Fabstract%3Frss%3Dyes This article asserts that miscommunication between the specialties, fostered by separate definitions, metrics, and outcomes, is an impediment to optimal care. Solutions are suggested for improving communication and outcomes. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204298 Tue, 26 Jul 2011 04:00:00 +0100 5204298 http://www.medworm.com/index.php?rid=5204293&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000534%2Fabstract%3Frss%3Dyes This article reviews common medical indications for preterm delivery and the available evidence supporting delivery before 37 weeks of gestation. In many conditions, few data exist to guide optimal timing of delivery and management is guided by expert opinion. Ultimately, an individual assessment must be made in each case to weigh the risks that pregnancy continuation poses to the mother and/or fetus with the risks of prematurity and its associated morbidities. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204293 Tue, 26 Jul 2011 04:00:00 +0100 5204293 http://www.medworm.com/index.php?rid=5204291&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000546%2Fabstract%3Frss%3Dyes This article explores the epidemiologic, clinical, and animal data that exist to support this conceptual paradigm as well as proposed mechanisms through which to potentially mitigate the adversity of prematurity. Truly successful interventions are not likely to occur until the pathogenesis of preterm birth and the role of inflammation in causing not only parturition but also fetal and neonatal injury is fully elucidated. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=5204291 Mon, 18 Jul 2011 04:00:00 +0100 5204291 http://www.medworm.com/index.php?rid=4901349&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000443%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901349 Tue, 31 May 2011 23:00:00 +0100 4901349 http://www.medworm.com/index.php?rid=4901348&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000297%2Fabstract%3Frss%3Dyes This article provides background about the human microbiota and its relationship to the developing immune system as well as the relationship of mode of delivery on the colonization of the infant intestine, development of the immune system, and subsequent childhood allergies, asthma, and autoimmune diseases. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901348 Tue, 31 May 2011 23:00:00 +0100 4901348 http://www.medworm.com/index.php?rid=4901347&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000224%2Fabstract%3Frss%3Dyes This article examines data from a recent systematic evidence review on term deliveries conducted for the National Institutes of Health Consensus Conference sponsored by the Agency for Healthcare Research and Quality on vaginal birth after caesarean, from a meta-analysis of associated perinatal outcomes, and subsequent publications that meet stringent quality review standards. We present a summary of fetal and neonatal outcomes emphasizing information that clinicians and patients need to make decisions regarding mode of delivery after prior cesarean and look for areas where future studies may provide important insights. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901347 Tue, 31 May 2011 23:00:00 +0100 4901347 http://www.medworm.com/index.php?rid=4901346&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000339%2Fabstract%3Frss%3Dyes Nearly 1 in 3 pregnant women in the United States undergo cesarean. This trend is contrary to the national goal of decreasing cesarean delivery in low-risk women. The decline in vaginal birth after cesarean (VBAC) contributes to the continual increase in cesarean deliveries. Prior cesarean delivery is the most common indication for cesarean and accounts for more than one-third of all cesareans. The appropriate use and safety of cesarean and VBAC are of concern not only at the individual patient and clinician level but they also have far-reaching public health and policy implications at the national level. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901346 Tue, 31 May 2011 23:00:00 +0100 4901346 http://www.medworm.com/index.php?rid=4901342&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000248%2Fabstract%3Frss%3Dyes Women who undergo a trial of labor after a previous cesarean delivery (TOLAC) have special needs prenatally and during the intrapartum period. Counseling about the choice of TOLAC versus an elective repeat cesarean delivery involves complex statistical concepts. Prenatal counseling that is patient centered, individualized, and presented in a way that addresses the health literacy and health numeracy of the recipient encompasses best practices that support patient decision making. Evidence-based practices during labor that support vaginal birth and increase patient satisfaction are of special value for this population. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901342 Tue, 31 May 2011 23:00:00 +0100 4901342 http://www.medworm.com/index.php?rid=4901341&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000327%2Fabstract%3Frss%3Dyes Cesarean delivery rates in the United States have reached an all-time high. The current rate of 31% is 6 times higher than the 1970s rate. Many factors including physician preference and hospital accessibility account for this trend. A decreased vaginal birth after cesarean (VBAC) rate and an increased repeat cesarean rate have important consequences for women in future pregnancies. Because of these considerations, VBAC has been an important issue within the obstetric community for over 3 decades. Identifying the best candidates for VBAC using factors available to the obstetrician can increase the VBAC success rate while minimizing maternal morbidity. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901341 Tue, 31 May 2011 23:00:00 +0100 4901341 http://www.medworm.com/index.php?rid=4901340&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000236%2Fabstract%3Frss%3Dyes This article presents an ethical framework for the informed consent process for TOLAC. Three conclusions are reached. For women with one previous low transverse incision, TOLAC and elective repeat cesarean delivery should be offered. Obstetricians should recommend against TOLAC when a pregnant woman has had a previous classical incision. TOLAC after two previous low transverse incisions may be offered provided that the informed consent process presents the uncertainties of the evidence. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901340 Tue, 31 May 2011 23:00:00 +0100 4901340 http://www.medworm.com/index.php?rid=4901338&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS009551081100025X%2Fabstract%3Frss%3Dyes This article considers 5 categories of factors that seem to be influencing rates of TOLAC and vaginal birth after cesarean: opinion leaders and professional guidelines, hospital facilities and cesarean availability, reimbursement for providing TOLAC, medical liability, and patient-level factors. An evidence base and strategies to provide guidance to create a safe environment for vaginal birth after cesarean are needed. Obstetric information systems are critical to this effort. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901338 Tue, 31 May 2011 23:00:00 +0100 4901338 http://www.medworm.com/index.php?rid=4901337&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000285%2Fabstract%3Frss%3Dyes Cesarean delivery is the most common major surgical procedure for women in the United States, with 1.4 million surgeries annually. In 2008, nearly one-third (32.3%) of US births were by cesarean delivery. Cesarean delivery rates have increased rapidly in the United States in recent years because of an increasing primary cesarean delivery rate and a declining vaginal birth after cesarean (VBAC) rate. In 2007, the VBAC rate was 8.3% in a 22-state reporting area. The US VBAC rate was lowest among 14 industrialized countries; 3 countries had VBAC rates greater than 50%. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901337 Tue, 31 May 2011 23:00:00 +0100 4901337 http://www.medworm.com/index.php?rid=4901335&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000340%2Fabstract%3Frss%3Dyes It is hard to believe that in this day and age of nanomedicine, regenerative medicine, and other major medical advances, we are still debating the best way to deliver a baby! In fact, this debate has recently escalated due largely to a rapid rise in cesarean sections worldwide. The issue is arguably complex, with multiple competing interests and considerations. There is also the overlay of risk tolerance, as parents and clinicians struggle to balance the risk of transient but commonly seen complications, with the rare chance of a catastrophic event. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901335 Tue, 31 May 2011 23:00:00 +0100 4901335 http://www.medworm.com/index.php?rid=4901334&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000431%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901334 Tue, 31 May 2011 23:00:00 +0100 4901334 http://www.medworm.com/index.php?rid=4901333&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000509%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901333 Tue, 31 May 2011 23:00:00 +0100 4901333 http://www.medworm.com/index.php?rid=4901332&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000418%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901332 Tue, 31 May 2011 23:00:00 +0100 4901332 http://www.medworm.com/index.php?rid=4901331&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000406%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901331 Tue, 31 May 2011 23:00:00 +0100 4901331 http://www.medworm.com/index.php?rid=4901344&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000303%2Fabstract%3Frss%3Dyes Uterine rupture, which involves complete separation of the uterine wall, occurs in about 1% of those attempting vaginal birth after cesarean. Because uterine rupture is one of the most significant complications of a trial of labor (TOL) after previous cesarean, identifying those at increased risk of uterine rupture is paramount to the safety of a TOL after previous cesarean birth. It seems that both antepartum demographic characteristics and intrapartum factors modify the risk of uterine rupture. The ability to reliably predict an individual's a priori risk for intrapartum uterine rupture remains a major area of investigation. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901344 Sun, 17 Apr 2011 23:00:00 +0100 4901344 http://www.medworm.com/index.php?rid=4901343&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000273%2Fabstract%3Frss%3Dyes Cesarean delivery is common and increasing over time. A prior cesarean birth increases the risk of both elective and emergency cesarean births and uterine rupture in a subsequent pregnancy. A range of factors, including labor characteristics, may influence the risk of these outcomes in the next pregnancy. Intrapartum factors associated with successful vaginal birth and lower risk of uterine rupture include the spontaneous onset of labor and advanced cervical dilatation. In contrast, need for induction and augmentation of labor are both factors associated with an increased likelihood of unsuccessful vaginal birth and risk of uterine rupture. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901343 Sun, 17 Apr 2011 23:00:00 +0100 4901343 http://www.medworm.com/index.php?rid=4901336&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000352%2Fabstract%3Frss%3Dyes Cesarean delivery rates in the United States have now reached their highest levels ever, accounting for almost one third of all births. The inexorable rise in cesarean deliveries, especially in the last 15 years, has been fueled by a steady increase in primary cesareans and a sharp and persistent decrease in vaginal birth after cesarean (VBAC). The precise reasons behind these two trends are not entirely clear, but most agree that that multiple medical and societal forces are impacting choices for route of delivery. One thing remains certain, however: as long as these two individual trends continue, total cesarean delivery rates will continue to increase. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901336 Sun, 17 Apr 2011 23:00:00 +0100 4901336 http://www.medworm.com/index.php?rid=4901345&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000315%2Fabstract%3Frss%3Dyes Placenta accreta is a significant source of obstetric morbidity and mortality. Its incidence is increasing as a direct consequence of the increasing cesarean section rate, which reflects increased rates of maternal obesity, increased numbers of multiple gestations secondary to assisted reproductive technology, physician concern about litigation for adverse obstetric outcome, and a decline in the use of operative vaginal delivery for both cephalic and breech presentations. Optimum management for most cases requires elective cesarean hysterectomy, ideally performed at about 34 weeks' gestation. A multidisciplinary approach produces the best outcomes. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901345 Wed, 13 Apr 2011 23:00:00 +0100 4901345 http://www.medworm.com/index.php?rid=4901339&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000261%2Fabstract%3Frss%3Dyes This article explores the medical and legal risks of trial of labor after cesarean. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4901339 Wed, 13 Apr 2011 23:00:00 +0100 4901339 http://www.medworm.com/index.php?rid=4590452&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000030%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590452 Tue, 01 Mar 2011 00:00:00 +0100 4590452 http://www.medworm.com/index.php?rid=4590451&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001405%2Fabstract%3Frss%3Dyes This article focuses on prior clinical studies of STAN and future research directions. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590451 Tue, 01 Mar 2011 00:00:00 +0100 4590451 http://www.medworm.com/index.php?rid=4590450&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001399%2Fabstract%3Frss%3Dyes This article discusses specific fetal ECG changes and their significance and the use of the STAN system. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590450 Tue, 01 Mar 2011 00:00:00 +0100 4590450 http://www.medworm.com/index.php?rid=4590449&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001326%2Fabstract%3Frss%3Dyes Electronic fetal monitoring (EFM) using cardiotocography is a common tool used during labor and delivery for assessment of fetal well-being. It has largely replaced the use of intermittent auscultation and fetal scalp pH sampling. However, data suggesting improved clinical outcomes with the use of EFM are sparse. In this review, the history of EFM is revisited from its inception in the 1960s to current practice, interpretations, and future research goals. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590449 Tue, 01 Mar 2011 00:00:00 +0100 4590449 http://www.medworm.com/index.php?rid=4590448&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001363%2Fabstract%3Frss%3Dyes Aortic isthmus acts as an arterial watershed between the cerebral and placental circulations, connecting 2 parallel fetal ventricular pumps. It plays a crucial role in the fetal circulatory dynamics. Information about aortic isthmus blood flow may improve the management of sick fetuses. However, perceived technical difficulties limit the clinical use of aortic isthmus Doppler for fetal hemodynamic monitoring. Changes in aortic isthmus blood flow pattern seem to reflect fetal cardiovascular status accurately and predict perinatal and long-term neurodevelopmental outcome in intrauterine growth restriction. This review evaluates the available scientific information and discusses the role of aortic isthmus in fetal circulation. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590448 Tue, 01 Mar 2011 00:00:00 +0100 4590448 http://www.medworm.com/index.php?rid=4590447&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001314%2Fabstract%3Frss%3Dyes Evaluation of venous Doppler parameters has significantly contributed to the understanding of the vascular mechanisms that lead to fetal growth restriction (FGR) and subsequent fetal deterioration in the setting of progressive placental dysfunction. Venous redistribution of umbilical venous blood flow away from the fetal liver precedes fetal growth delay. Venous Doppler examination allows adjustment of monitoring intervals in recognition of accelerating fetal deterioration. The timing of delivery in early-onset FGR remains challenging because gestational age has an overriding effect on the neonatal outcome until the late second trimester and randomized trials of specific delivery triggers are lacking. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590447 Tue, 01 Mar 2011 00:00:00 +0100 4590447 http://www.medworm.com/index.php?rid=4590446&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001338%2Fabstract%3Frss%3Dyes This article is a review of the role of the MCA in these 2 conditions. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590446 Tue, 01 Mar 2011 00:00:00 +0100 4590446 http://www.medworm.com/index.php?rid=4590445&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS009551081000134X%2Fabstract%3Frss%3Dyes Antepartum fetal surveillance with Doppler ultrasound of umbilical artery has shown significant diagnostic efficacy in identifying fetal compromise in pregnancies complicated with fetal growth restriction (FGR). Its effectiveness in decreasing perinatal mortality has been shown by randomized clinical trials (Level I evidence). This test is the only antepartum fetal test that has shown this level of effectiveness and should be the standard of practice in managing FGR (Level A recommendation). The overall management considerations should encompass other standard fetal monitoring tests (Level B and C recommendations). (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590445 Tue, 01 Mar 2011 00:00:00 +0100 4590445 http://www.medworm.com/index.php?rid=4590444&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001387%2Fabstract%3Frss%3Dyes In the second half of the twentieth century, true antepartum fetal assessment became possible, mainly due to the advent of real-time ultrasound. Initially, the most widely used form of antepartum fetal assessment was electronic fetal heart rate monitoring, through the nonstress test or the oxytocin-induced contraction stress test. It was soon realized, however, that these forms of monitoring had significant limitations. The biophysical profile allows a more thorough evaluation of fetal well-being and has the potential to significantly reduce the false-positive rate of the nonstress test/contraction stress test. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590444 Tue, 01 Mar 2011 00:00:00 +0100 4590444 http://www.medworm.com/index.php?rid=4590443&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001351%2Fabstract%3Frss%3Dyes Owing to the frequent use of bedside ultrasound, much is known about the regulation of and normative values for amniotic fluid volume and the mechanisms by which this fluid is regulated. The management protocols for conditions with extremes of amniotic fluid volume have become more exact, resulting in interventions more likely to improve outcome. Much is still unclear; there are no tools to measure amniotic fluid volume with precision, and measurement of fetal urinary output is cumbersome and error-prone. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590443 Tue, 01 Mar 2011 00:00:00 +0100 4590443 http://www.medworm.com/index.php?rid=4590442&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001429%2Fabstract%3Frss%3Dyes This article will focus on how to improve on IUGR detection. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590442 Tue, 01 Mar 2011 00:00:00 +0100 4590442 http://www.medworm.com/index.php?rid=4590441&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001375%2Fabstract%3Frss%3Dyes Measures of placental dysfunction, including maternal serum analytes and Doppler studies, have been linked to adverse pregnancy outcomes, although the predictive ability of any single one is poor. Improved knowledge of the multifactorial nature of many of the adverse outcomes of pregnancy has sparked interest in the use of multi-parameter models that combine maternal serum analytes with measures of placental structure and blood flow. The combination of various first-trimester and second-trimester analytes and uterine artery Doppler screening show promise as potential screening tools, but large prospective studies are needed to further define their role in clinical practice. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590441 Tue, 01 Mar 2011 00:00:00 +0100 4590441 http://www.medworm.com/index.php?rid=4590440&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001417%2Fabstract%3Frss%3Dyes It has been a great privilege for us to be invited as guest editors for this edition of Clinics in Perinatology devoted to Fetal Monitoring. Recent developments in perinatology especially with respect to attempts at steamlining the terminology used in categorizing intrapartum fetal monitoring demonstrate the importance of the chosen topic for this edition. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590440 Tue, 01 Mar 2011 00:00:00 +0100 4590440 http://www.medworm.com/index.php?rid=4590439&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000029%2Fabstract%3Frss%3Dyes The daunting challenge of monitoring a fetus and ensuring its safe passage to normal spontaneous birth is foremost in the minds of all who work in this field. The task would be somewhat simpler if we knew which fetus was at high risk for morbidity and in utero demise; we could then deploy our best technology and resources to keep a tight vigil and intervene when the risk became too high. Yet, a substantial number of fetal accidents occur in low-risk or no-risk pregnancies. The story doesn’t end here; the wide range of fetal physiologic measures—and the overlapping circles of normal and abnormal—make the challenge all the more difficult. It is not surprising, therefore, that several reviews of the published literature have come to pretty much the same conclusion: nearly forty years af... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590439 Tue, 01 Mar 2011 00:00:00 +0100 4590439 http://www.medworm.com/index.php?rid=4590438&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000145%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590438 Tue, 01 Mar 2011 00:00:00 +0100 4590438 http://www.medworm.com/index.php?rid=4590437&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000212%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590437 Tue, 01 Mar 2011 00:00:00 +0100 4590437 http://www.medworm.com/index.php?rid=4590436&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510811000121%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590436 Tue, 01 Mar 2011 00:00:00 +0100 4590436 http://www.medworm.com/index.php?rid=4590435&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS009551081100011X%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4590435 Tue, 01 Mar 2011 00:00:00 +0100 4590435 http://www.medworm.com/index.php?rid=4257981&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001065%2Fabstract%3Frss%3Dyes This article discusses the evidence on efficacy of ECD, current recommendations in the United States, and risks and morbidity related to ECD. Although the benefit of ECD in preventing MTCT of HIV is substantial, some questions remain. Specifically, the benefit of ECD for women with very low viral loads or for women using combination antiretroviral regimens is unclear, as is the timeframe after onset of labor or rupture of membranes within which ECD will still confer preventive benefits. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4257981 Wed, 01 Dec 2010 00:00:00 +0100 4257981 http://www.medworm.com/index.php?rid=4167152&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001211%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167152 Mon, 15 Nov 2010 22:59:56 +0100 4167152 http://www.medworm.com/index.php?rid=4167151&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000990%2Fabstract%3Frss%3Dyes This article reviews current knowledge of the pharmacology of these drugs during pregnancy and in the newborn period, highlighting those pharmacologic issues critical to the safe and effective use of antiretrovirals in these populations. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167151 Mon, 15 Nov 2010 22:59:56 +0100 4167151 http://www.medworm.com/index.php?rid=4167150&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001053%2Fabstract%3Frss%3Dyes This article discusses the significance, contribution, and management of perinatal transmission of HIV in prematurity. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167150 Mon, 15 Nov 2010 22:59:56 +0100 4167150 http://www.medworm.com/index.php?rid=4167149&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000953%2Fabstract%3Frss%3Dyes This article reviews the recommendations and evidence for the treatment of HIV-1–infected infants. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167149 Mon, 15 Nov 2010 22:59:56 +0100 4167149 http://www.medworm.com/index.php?rid=4167148&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001016%2Fabstract%3Frss%3Dyes This article presents the pertinent management considerations needed for clinicians to provide optimal care to the HIV-exposed infant. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167148 Mon, 15 Nov 2010 22:59:56 +0100 4167148 http://www.medworm.com/index.php?rid=4167147&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001041%2Fabstract%3Frss%3Dyes This article summarizes the epidemiologic data on the risks and benefits of various infant feeding practices for HIV-infected women living in different contexts. Artificial feeding can prevent a large proportion of mother-to-child HIV transmission but also is associated with increases in morbidity and mortality among exposed-uninfected and HIV-infected children. Antiretroviral drugs can be used during lactation and reduce risks of transmission. For most of the developing world, the health and survival benefits of breastfeeding exceed the risks of HIV transmission, especially when antiretroviral interventions are provided. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167147 Mon, 15 Nov 2010 22:59:56 +0100 4167147 http://www.medworm.com/index.php?rid=4167146&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001028%2Fabstract%3Frss%3Dyes This article covers HIV drug resistance among pregnant women and the implications of transmission of resistant HIV to the infant. Resistance to antiretroviral drugs may be acquired or can emerge while HIV-infected pregnant women are on antiretroviral therapy, either before or during pregnancy. Resistance to antiretroviral drugs among HIV-infected infants may be acquired from the mother in utero or during the intrapartum period. Resistance may also emerge from exposure to antiretroviral drugs given to the infant for prophylaxis against HIV transmission. In settings where breastfeeding is practiced, ongoing transmission of HIV from breastfeeding may lead to transmission of resistant HIV from the mother. If the mother is taking antiretroviral drugs while breastfeeding, resistance to antiretro... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167146 Mon, 15 Nov 2010 22:59:56 +0100 4167146 http://www.medworm.com/index.php?rid=4167145&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000941%2Fabstract%3Frss%3Dyes Breastfeeding accounts for about 40% of mother-to-child transmission of HIV-1 worldwide and carries an estimated risk of transmission of 0.9% per month after the first month of breastfeeding. It is recommended that HIV-1–infected women completely avoid breastfeeding in settings where safe feeding alternatives exist. However, as replacement feeding is not safely available in many parts of the world, and because breastfeeding provides optimal nutrition and protection against other infant infections, there is intense ongoing research to make breastfeeding safe for HIV-1–infected mothers in resource-limited settings. More research is needed to determine the optimal duration of breastfeeding, optimal weaning practices, and which individual antiretroviral prophylactic regimen is best for HIV... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167145 Mon, 15 Nov 2010 22:59:56 +0100 4167145 http://www.medworm.com/index.php?rid=4167144&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000989%2Fabstract%3Frss%3Dyes This article reviews what is known about the immune mechanisms of susceptibility and resistance to mother-to-child transmission (MTCT) of HIV-1 and summarizes studies that have used passive or active immunization strategies to interrupt MTCT of HIV-1. Potentially modifiable infectious cofactors that may enhance transmission and/or disease progression (especially in the developing world) are described. An effective prophylactic vaccine against HIV-1 infection needs to be deployed as part of the Extended Program of Immunization recommended by the World Health Organization for use in developing countries, so it is important to understand how the infant immune system responds to HIV-1 antigens, both in natural infection and presented by candidate vaccines. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167144 Mon, 15 Nov 2010 22:59:55 +0100 4167144 http://www.medworm.com/index.php?rid=4167143&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001065%2Fabstract%3Frss%3Dyes This article discusses the evidence on efficacy of ECD, current recommendations in the United States, and risks and morbidity related to ECD. Although the benefit of ECD in preventing MTCT of HIV is substantial, some questions remain. Specifically, the benefit of ECD for women with very low viral loads or for women using combination antiretroviral regimens is unclear, as is the timeframe after onset of labor or rupture of membranes within which ECD will still confer preventive benefits. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167143 Mon, 15 Nov 2010 22:59:55 +0100 4167143 http://www.medworm.com/index.php?rid=4167142&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001004%2Fabstract%3Frss%3Dyes The World Health Organization's Strategic Approaches to the Prevention of HIV Infection in Infants includes 4 components: primary prevention of HIV-1 infection; prevention of unintended pregnancies among HIV-1–infected women; prevention of transmission of HIV-1 infection from mothers to children; and provision of ongoing support, care, and treatment to HIV-1–infected women and their families. This review focuses on antiretrovirals for secondary prevention of HIV-1 infection–prevention of HIV-1 transmission from an HIV-1–infected woman to her child. Antiretroviral strategies to prevent the mother-to-child transmission of HIV-1 in nonbreastfeeding populations comprise antiretroviral treatment of HIV-1–infected pregnant women needing antiretrovirals for their own health, antiretrovi... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167142 Mon, 15 Nov 2010 22:59:54 +0100 4167142 http://www.medworm.com/index.php?rid=4167141&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001077%2Fabstract%3Frss%3Dyes Diagnosis and management of perinatally acquired human immunodeficiency virus infection poses many challenges in the areas of diagnosis, clinical and psychosocial intervention, and public health policy. Diagnostic tests have evolved over the years and many are currently used in the perinatal setting. Considerable progress has been realized in each of these areas through cooperative efforts of laboratory scientists, clinical teams, and stakeholders. However, there remain multiple challenges to address in the future. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167141 Mon, 15 Nov 2010 22:59:54 +0100 4167141 http://www.medworm.com/index.php?rid=4167140&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000965%2Fabstract%3Frss%3Dyes Great progress has been made in understanding the pathogenesis, treatment, and transmission of HIV and the factors influencing the risk of mother-to-child transmission (MTCT). Many questions regarding the molecular evolution and genetic diversity of HIV in the context of MTCT remain unanswered. Further research to identify the selective factors governing which variants are transmitted, how the compartmentalization of HIV in different cells and tissues contributes to transmission, and the influence of host immunity, viral diversity, and recombination on MTCT may provide insight into new prevention strategies and the development of an effective HIV vaccine. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167140 Mon, 15 Nov 2010 22:59:54 +0100 4167140 http://www.medworm.com/index.php?rid=4167139&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000977%2Fabstract%3Frss%3Dyes This article summarizes what is known about the pathogenetic mechanisms and routes of MTCT of HIV-1, and includes virologic, immunologic, genetic, and mucosal aspects of transmission. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167139 Mon, 15 Nov 2010 22:59:53 +0100 4167139 http://www.medworm.com/index.php?rid=4167138&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001119%2Fabstract%3Frss%3Dyes This article reviews the epidemiology of perinatal (HIV)-1 in the United States in the past 2 decades and the international HIV epidemic among pregnant women and their infants. Since the peak of 1700 reported cases of pediatric AIDS in 1992, there has been dramatic progress in decreasing perinatal HIV transmission in the United States with fewer than 50 new cases of AIDS annually (>96% reduction) and fewer than 300 annual perinatal HIV transmissions in 2005. This success has been due to use of combination antiretrovirals given to mothers during pregnancy and labor/delivery, obstetric interventions that reduce the risk of transmission, provision of zidovudine (ZDV) prophylaxis for 6 weeks to HIV-exposed newborns and use of formula. Internationally, the burden of mother-to-child HIV transmis... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167138 Mon, 15 Nov 2010 22:59:52 +0100 4167138 http://www.medworm.com/index.php?rid=4167137&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001107%2Fabstract%3Frss%3Dyes These are exciting times in the prevention of perinatal (mother-to-child) transmission of HIV and the clinical care and treatment of pregnant HIV-positive women and their children. Since the first cases of AIDS in infants and young children were described in the United States in the early 1980s, tremendous progress has been made in the prevention and care of HIV infection in infants and children. The Centers for Disease Control and Prevention reports a more than 90% decline in the number of perinatally acquired AIDS cases in children in the United States during the past 16 years and potent new antiretroviral regimens are highly effective in preventing progression of disease and improving the quality of life. The December 2010 issue of Clinics in Perinatology entitled “Perinatal HIV Infec... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167137 Mon, 15 Nov 2010 22:59:52 +0100 4167137 http://www.medworm.com/index.php?rid=4167136&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001120%2Fabstract%3Frss%3Dyes One of the greatest challenges in clinical medicine is the excruciatingly long gap between the timing of medical innovations and their implementation into day-to-day practice. Estimates vary, but most experts agree that it takes as many as 15–20 years for recommendations emerging from sound science (such as randomized controlled trials) to become standard of care. Efforts to reduce perinatal HIV transmission are, however, a shining example of how this paradigm can be changed. Recommendations emerging from the Pediatric AIDS Clinical Trials Group 076 (PACTG076) protocol, which was published in 1994, and subsequent studies to reduce mother-to-child transmission of HIV have been widely embraced and incorporated into practice where resources are available. Using a combination of intervention... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167136 Mon, 15 Nov 2010 22:59:52 +0100 4167136 http://www.medworm.com/index.php?rid=4167135&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS009551081000120X%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167135 Mon, 15 Nov 2010 22:59:52 +0100 4167135 http://www.medworm.com/index.php?rid=4167134&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001259%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167134 Mon, 15 Nov 2010 22:59:52 +0100 4167134 http://www.medworm.com/index.php?rid=4167133&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810001181%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167133 Mon, 15 Nov 2010 22:59:52 +0100 4167133 http://www.medworm.com/index.php?rid=4167132&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS009551081000117X%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=4167132 Mon, 15 Nov 2010 22:59:52 +0100 4167132 http://www.medworm.com/index.php?rid=3924305&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000898%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924305 Tue, 31 Aug 2010 23:00:00 +0100 3924305 http://www.medworm.com/index.php?rid=3924304&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000758%2Fabstract%3Frss%3Dyes Current strategies to prevent infection-related preterm birth and its associated neonatal morbidities have had limited success. Improved understanding of the pathogen-host interactions underlying altered colonization of the lower genital tract is necessary before significant progress can be made. The application of novel diagnostic techniques such as broad range PCR and proteomic analysis contribute to our knowledge of the diversity and abundance of microbial species invading the amniotic cavity as well as the resultant inflammatory response. Preterm infants delivered following intrauterine infection may respond differently to subsequent infectious challenges in the neonatal intensive care unit. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924304 Tue, 31 Aug 2010 23:00:00 +0100 3924304 http://www.medworm.com/index.php?rid=3924303&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000710%2Fabstract%3Frss%3Dyes This article summarizes current studies evaluating pharmacologic interventions in experimental models of bacterial meningitis and discusses how the knowledge gathered could translate into more effective therapies. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924303 Tue, 31 Aug 2010 23:00:00 +0100 3924303 http://www.medworm.com/index.php?rid=3924302&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000795%2Fabstract%3Frss%3Dyes This article describes strategies to prevent 2 important healthcare associated infections in the neonatal intensive care unit: central line–associated bloodstream infections and catheter-associated urinary tract infections. Hand hygiene is discussed as the cornerstone for prevention of all healthcare associated infections. Specific recommendations for education and training of health care personnel who insert and maintain central venous catheters and urinary tract catheters are made and best practices for insertion and maintenance of these catheters are discussed. Throughout this article, the emphasis is on prevention of these high morbidity and mortality healthcare associated infections. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924302 Tue, 31 Aug 2010 23:00:00 +0100 3924302 http://www.medworm.com/index.php?rid=3924301&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000709%2Fabstract%3Frss%3Dyes Ventilator-associated pneumonia (VAP) is one of the leading causes of preventable morbidity and mortality in neonatal intensive care units. This review examines the epidemiology and pathogenesis of VAP in neonates as well as the dilemmas faced by caregivers to diagnose and prevent VAP. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924301 Tue, 31 Aug 2010 23:00:00 +0100 3924301 http://www.medworm.com/index.php?rid=3924300&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000771%2Fabstract%3Frss%3Dyes The highest incidence of invasive candidal infection (ICI) occurs in extremely preterm infants ( (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924300 Tue, 31 Aug 2010 23:00:00 +0100 3924300 http://www.medworm.com/index.php?rid=3924299&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000722%2Fabstract%3Frss%3Dyes Acute phase reactants, pro and antiinflammatory mediators including chemokines and cytokines, and cell-surface antigens are nonspecific biomarkers that have been extensively studied for the diagnosis and management of late-onset neonatal sepsis (LONS) and necrotizing enterocolitis. It is expected that the next generation of biomarkers and tests will be more specific, will pinpoint the precise disease entity, and will provide crucial information on the exact pathogen or category of microorganism and its antibiotic profile within hours of clinical presentation. Research on molecular pathogen detection and proteomic profiling has shown promising results. Academic-industry partnerships are vital for successful development of new diagnostic biomarkers for LONS, which are sensitive, inexpensive,... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924299 Tue, 31 Aug 2010 23:00:00 +0100 3924299 http://www.medworm.com/index.php?rid=3924298&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS009551081000076X%2Fabstract%3Frss%3Dyes Early detection of late-onset neonatal sepsis, before the onset of obvious and potentially catastrophic clinical signs, is an important goal in neonatal medicine. Sepsis causes a well-known series of physiologic changes including abnormalities of blood pressure, respiration, temperature, and heart rate, and less well-known changes in heart rate variability. Although vital signs are frequently or continuously monitored in patients in the neonatal intensive care unit (NICU), changes in these parameters are subtle in the early phase of sepsis and difficult to interpret using traditional NICU monitoring tools. A new tool, continuous monitoring of heart rate characteristics (HRC), is now available for clinical use. Recent research has established that 2 abnormalities of HRC that have long been ... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924298 Tue, 31 Aug 2010 23:00:00 +0100 3924298 http://www.medworm.com/index.php?rid=3924297&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000734%2Fabstract%3Frss%3Dyes Bacterial translocation from the gastrointestinal tract is an important pathway initiating late-onset sepsis and necrotizing enterocolitis in very low-birth-weight infants. The emerging intestinal microbiota, nascent intestinal epithelia, naive immunity, and suboptimal nutrition (lack of breast milk) have roles in facilitating bacterial translocation. Feeding lactoferrin, probiotics, or prebiotics has presented exciting possibilities to prevent bacterial translocation in preterm infants, and clinical trials will identify the most safe and efficacious prevention and treatment strategies. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924297 Tue, 31 Aug 2010 23:00:00 +0100 3924297 http://www.medworm.com/index.php?rid=3924296&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000783%2Fabstract%3Frss%3Dyes Antimicrobial-resistant pathogens are of increasing concern in the neonatal intensive care unit population. A myriad of resistance mechanisms exist in microorganisms, and management can be complex because broad-spectrum antibiotics are increasingly needed. Control and prevention of antibiotic-resistant organisms (AROs) require an interdisciplinary team with continual surveillance. Judicious use of antibiotics; minimizing exposure to risk factors, when feasible; and effective hand hygiene are crucial interventions to reduce infection and transmission of AROs. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924296 Tue, 31 Aug 2010 23:00:00 +0100 3924296 http://www.medworm.com/index.php?rid=3924295&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000692%2Fabstract%3Frss%3Dyes This article reviews the changing epidemiology, clinical manifestations, and treatment of S aureus in neonates. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924295 Tue, 31 Aug 2010 23:00:00 +0100 3924295 http://www.medworm.com/index.php?rid=3924294&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000801%2Fabstract%3Frss%3Dyes This issue of Clinics in Perinatology focuses on healthcare associated infections (HAIs) in the neonatal intensive care unit (NICU). Although early-onset infections are often more dramatic in their presentation, HAIs are 50-100 times more common in neonates, increase length of stay, and add tens of millions of dollars to annual healthcare expenditures. For many years the assumption has been that most HAIs in the NICU are not preventable and cause minimal morbidity and mortality. In fact, the converse is true; most HAIs in neonates are preventable, and these infections (even those due to “low virulence organisms”) are associated with increased mortality and morbidities, including neurodevelopmental impairment. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924294 Tue, 31 Aug 2010 23:00:00 +0100 3924294 http://www.medworm.com/index.php?rid=3924293&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000886%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924293 Tue, 31 Aug 2010 23:00:00 +0100 3924293 http://www.medworm.com/index.php?rid=3924292&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS009551081000103X%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924292 Tue, 31 Aug 2010 23:00:00 +0100 3924292 http://www.medworm.com/index.php?rid=3924291&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000862%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924291 Tue, 31 Aug 2010 23:00:00 +0100 3924291 http://www.medworm.com/index.php?rid=3924290&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000850%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3924290 Tue, 31 Aug 2010 23:00:00 +0100 3924290 http://www.medworm.com/index.php?rid=3635314&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000606%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635314 Mon, 31 May 2010 23:00:00 +0100 3635314 http://www.medworm.com/index.php?rid=3635313&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000229%2Fabstract%3Frss%3Dyes Infections are a major cause of neonatal death in developing countries. High-quality information on the burden of early-onset neonatal sepsis and sepsis-related deaths is limited in most of these settings. Simple preventive and treatment strategies have the potential to save many newborns from sepsis-related death. Implementation of public health programs targeting newborn health will assist attainment of Millennium Development Goals of reduction in child mortality. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635313 Mon, 31 May 2010 23:00:00 +0100 3635313 http://www.medworm.com/index.php?rid=3635312&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510809001110%2Fabstract%3Frss%3Dyes Because of inadequate sample sizes of randomized controlled trials, few immunologic interventions to treat or prevent neonatal sepsis have been reliably evaluated. International collaboration is essential in achieving timely, adequate samples to assess effects on mortality or disability-free survival reliably. Promising or possible therapeutic interventions in severe or gram-negative sepsis include exchange transfusions, pentoxifylline, and IgM-enriched intravenous immunoglobulin. Promising or possible prophylactic interventions include lactoferrin, with or without a probiotic; selenium; early curtailment of antibiotics after sterile cultures; breast milk; and earlier initiation of colostrum in high risk preterm infants. Prophylactic oral probiotics are safe and effective (P (Source: Clini... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635312 Mon, 31 May 2010 23:00:00 +0100 3635312 http://www.medworm.com/index.php?rid=3635311&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000515%2Fabstract%3Frss%3Dyes Neonatal septic shock is a devastating condition associated with high morbidity and mortality. Definitions for the sepsis continuum and treatment algorithms specific for premature neonates are needed to improve studies of septic shock and assess benefit from clinical interventions. Unique features of the immature immune system and pathophysiologic responses to sepsis, particularly those of extremely preterm infants, necessitate that clinical trials consider them as a separate group. Keen clinical suspicion and knowledge of risk factors will help to identify those neonates at greatest risk for development of septic shock. Genomic and proteomic approaches, particularly those that use very small sample volumes, will increase our understanding of the pathophysiology and direct the development ... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635311 Mon, 31 May 2010 23:00:00 +0100 3635311 http://www.medworm.com/index.php?rid=3635310&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510809001109%2Fabstract%3Frss%3Dyes Early-onset sepsis remains a major diagnostic problem in neonatal medicine. Definitive diagnosis depends on cultures of blood or other normally sterile body fluids. Abnormal hematological counts, acute-phase reactants, and inflammatory cytokines are neither sensitive nor specific, especially at the onset of illness. Combinations of measurements improve diagnostic test performance, but the optimal selection of analytes has not been determined. The best-established use of these laboratory tests is for retrospective determination that an infant was not infected, based on failure to mount an acute-phase response over the following 24 to 48 hours. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635310 Mon, 31 May 2010 23:00:00 +0100 3635310 http://www.medworm.com/index.php?rid=3635309&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000199%2Fabstract%3Frss%3Dyes Several molecular testing options are now or will soon be available for diagnosing bloodstream infections in the neonate. The advantages include the speed at which results would be available and the ability to use those results to tailor empirical therapy and reduce the amount of unnecessary or ineffective antibiotics an infant receives. However, there are still difficult challenges before this potential can be realized. A variety of technological advances are needed, including (1) improved recovery of microorganisms in whole blood extractions, (2) increased assay sensitivity, (3) simpler testing platforms that could be run 24/7, and (4) more assays to detect antibiotic resistance genes to reduce reliance on culture-based protocols for antimicrobial susceptibility testing. Although conside... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635309 Mon, 31 May 2010 23:00:00 +0100 3635309 http://www.medworm.com/index.php?rid=3635308&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510809001122%2Fabstract%3Frss%3Dyes There is accumulating epidemiologic and experimental evidence that intrauterine or postnatal infection with Ureaplasma species is a significant risk factor for adverse pregnancy outcomes and complications of extreme preterm birth such as bronchopulmonary dysplasia and intraventricular hemorrhage. In a cohort of very low birth weight infants, Ureaplasma spp were detected by culture or polymerase chain reaction in respiratory secretions, blood, or cerebrospinal fluid of almost half of the subjects, suggesting that this organism is the most common pathogen affecting this population. This review summarizes the evidence supporting the hypothesis that Ureaplasma-mediated inflammation in different compartments (intrauterine, lung, blood, or brain) during a common developmental window of vulnerabi... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635308 Mon, 31 May 2010 23:00:00 +0100 3635308 http://www.medworm.com/index.php?rid=3635307&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000205%2Fabstract%3Frss%3Dyes This article discusses implementation challenges for clinicians caring for pregnant women and newborns and presents an updated algorithm for neonatal management. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635307 Mon, 31 May 2010 23:00:00 +0100 3635307 http://www.medworm.com/index.php?rid=3635306&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000400%2Fabstract%3Frss%3Dyes Intrauterine infection is a unique pathologic process that raises the risk for early-onset neonatal sepsis (EONS). By acting synergistically with prematurity, EONS increases the risk for adverse neonatal outcomes, including intraventricular hemorrhage and cerebral palsy. Although several pathways for the pathogenesis of fetal damage have been proposed, the basic molecular mechanisms that modulate these events remain incompletely understood. Discovery of clinically and biologically relevant biomarkers able to reveal key pathogenic pathways and predict pregnancies at risk for antenatal fetal damage is a priority. Proteomics provides a unique opportunity to fill this gap. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635306 Mon, 31 May 2010 23:00:00 +0100 3635306 http://www.medworm.com/index.php?rid=3635305&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000217%2Fabstract%3Frss%3Dyes Chorioamnionitis is a common complication of pregnancy associated with significant maternal, perinatal, and long-term adverse outcomes. Adverse maternal outcomes include postpartum infections and sepsis whereas adverse infant outcomes include stillbirth, premature birth, neonatal sepsis, chronic lung disease, and brain injury leading to cerebral palsy and other neurodevelopmental disabilities. Research in the past 2 decades has expanded understanding of the mechanistic links between intra-amniotic infection and preterm delivery as well as morbidities of preterm and term infants. Recent and ongoing clinical research into better methods for diagnosing, treating, and preventing chorioamnionitis is likely to have a substantial impact on short and long-term outcomes in the neonate. (Source: Cli... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635305 Mon, 31 May 2010 23:00:00 +0100 3635305 http://www.medworm.com/index.php?rid=3635304&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000503%2Fabstract%3Frss%3Dyes Neonatal sepsis continues to take a devastating toll globally. Although adequate to protect against invasive infection in most newborns, the distinct function of neonatal innate host defense coupled with impairments in adaptive immune responses increases the likelihood of acquiring infection early in life, with subsequent rapid dissemination and death. Unique differences exist between neonates and older populations with respect to the capacity, quantity, and quality of innate host responses to pathogens. Recent characterization of the age-dependent maturation of neonatal innate immune function has identified novel translational approaches that may lead to improved diagnostic, prophylactic, and therapeutic modalities. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635304 Mon, 31 May 2010 23:00:00 +0100 3635304 http://www.medworm.com/index.php?rid=3635303&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000485%2Fabstract%3Frss%3Dyes Perinatal and neonatal practitioners know much about infection, encountering it nearly every working day. Our goal in this issue of the Clinics in Perinatology is to present a state-of-the-art review of the causes, prevention, pathophysiology, diagnosis, and treatment of chorioamnionitis and early-onset neonatal infection. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635303 Mon, 31 May 2010 23:00:00 +0100 3635303 http://www.medworm.com/index.php?rid=3635302&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS009551081000059X%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635302 Mon, 31 May 2010 23:00:00 +0100 3635302 http://www.medworm.com/index.php?rid=3635301&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000643%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635301 Mon, 31 May 2010 23:00:00 +0100 3635301 http://www.medworm.com/index.php?rid=3635300&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000576%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635300 Mon, 31 May 2010 23:00:00 +0100 3635300 http://www.medworm.com/index.php?rid=3635299&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000564%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3635299 Mon, 31 May 2010 23:00:00 +0100 3635299 http://www.medworm.com/index.php?rid=3437499&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS009551081000031X%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437499 Mon, 01 Mar 2010 00:00:00 +0100 3437499 http://www.medworm.com/index.php?rid=3437498&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000163%2Fabstract%3Frss%3Dyes Chronic lung disease (CLD) is one of the most common long-term complications in very preterm infants. Bronchopulmonary dysplasia (BPD) is the most common cause of CLD in infancy. Modern neonatal respiratory care has witnessed the emergence of a new BPD that exhibits decreased fibrosis and emphysema, but also decreased alveolar septation, and microvascular development. CLD encompasses the classic and the new BPD, and recognizes that lung injury can occur in term infants who need aggressive ventilatory support and who develop lung injury as a result, and that CLD is a multisystem disease. Controversy exists on whether quality improvement (QI) methods that implement multiple interventions will be effective in limiting pathology with multiple causes. Caution in generalization of QI findings is... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437498 Mon, 01 Mar 2010 00:00:00 +0100 3437498 http://www.medworm.com/index.php?rid=3437497&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000151%2Fabstract%3Frss%3Dyes Central Line Associated Bloodstream Infections (CLABSIs) have come to be recognized as preventable adverse events that result from lapses in technique at multiple levels of care. CLABSIs are associated with increased mortality and adverse outcomes that may have lifelong consequences. This review provides a summary of evidence-based strategies to reduce CLABSI in the newborn intensive care unit that have been described in the literature over the past decades. Implementation of these strategies in “bundles” is also discussed, citing examples of successful quality improvement collaboratives. The methods of implementation require an understanding of the scientific data and technical developments, as well as knowledge of how to influence change within the unique and complicated milieu of th... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437497 Mon, 01 Mar 2010 00:00:00 +0100 3437497 http://www.medworm.com/index.php?rid=3437496&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS009551081000014X%2Fabstract%3Frss%3Dyes This article reviews the concept of “dose and exposure period” for human milk feeding in the NICU to precisely measure and benchmark the amount and timing of human milk use in the NICU. The critical exposure periods when exclusive or high doses of human milk appear to have the greatest impact on specific morbidities are reviewed. Finally, the current best practices for the use of human milk during and after the NICU stay for premature infants are summarized. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437496 Mon, 01 Mar 2010 00:00:00 +0100 3437496 http://www.medworm.com/index.php?rid=3437495&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000138%2Fabstract%3Frss%3Dyes Comprehensive oxygen management, focused on avoiding hyperoxia and repeated episodes of hypoxia-hyperoxia in very low birth weight infants, has been successfully used for the reduction of retinopathy of prematurity. Building on this experience, the Comprehensive Oxygen Management for the Prevention of Retinopathy of Prematurity quality improvement initiative was developed to facilitate the spread and refinement of these techniques. The initiative focused on staff education and evaluation and redesign of the processes and practices involving oxygen use. Monitoring of the effectiveness of the system changes was supported through audits of clinical practice changes, use of oxygen saturation trending data, and the incidence of retinopathy of prematurity. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437495 Mon, 01 Mar 2010 00:00:00 +0100 3437495 http://www.medworm.com/index.php?rid=3437494&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000126%2Fabstract%3Frss%3Dyes The authors have conducted video review of neonatal resuscitations since 1999. Over this 10-year period 3 phases of our experience have been recognized. Our early reviews helped us recognize what we were doing in the delivery room, an area that had been ignored in improved intervention. It was noted that on many occasions multiple people were trying to accomplish the same task, that bag and mask ventilation was almost exclusively the purview of the respiratory therapists and was not performed well by others, and that infants with low birth weight were often hypothermic on admission. After determining what was being done and how well it was being done, we moved on to how to do it better. This period included making environmental changes by warming the room, the use of occlusive wrap, determ... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437494 Mon, 01 Mar 2010 00:00:00 +0100 3437494 http://www.medworm.com/index.php?rid=3437493&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000102%2Fabstract%3Frss%3Dyes This article highlights the experiences of several recently published efforts demonstrating how coordinated care resulted in improved clinical outcomes. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437493 Mon, 01 Mar 2010 00:00:00 +0100 3437493 http://www.medworm.com/index.php?rid=3437492&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000114%2Fabstract%3Frss%3Dyes This article discusses the concept of pay for performance, examines what potential benefits and risks exist in this model, and investigates how it might achieve the desired goals if implemented in a thoughtful way. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437492 Mon, 01 Mar 2010 00:00:00 +0100 3437492 http://www.medworm.com/index.php?rid=3437491&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000096%2Fabstract%3Frss%3Dyes Improving quality and safety in health care is a major concern for health care providers, the general public, and policy makers. Errors and quality issues are leading causes of morbidity and mortality across the health care industry. There is evidence that patients in the neonatal intensive care unit (NICU) are at high risk for serious medical errors. To facilitate compliance with safe practices, many institutions have established quality-assurance monitoring procedures. Three techniques that have been found useful in the health care setting are failure mode and effects analysis, root cause analysis, and random safety auditing. When used together, these techniques are effective tools for system analysis and redesign focused on providing safe delivery of care in the complex NICU system. (So... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437491 Mon, 01 Mar 2010 00:00:00 +0100 3437491 http://www.medworm.com/index.php?rid=3437490&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000084%2Fabstract%3Frss%3Dyes Human factors analysis (HFE) presents a formidable contribution to quality improvement (QI) in the neonatal intensive care unit (NICU). The science behind the fundamental principles concerning the design of work systems that match the needs of the people who work in them is sound and is applied widely in other safety critical situations. Early application of HFE in NICUs has shown the usefulness of these methods for frontline teams working to improve quality, reliability, and safety. The inclusion of human factors considerations in the design of structure and process has the potential to improve outcomes for patients and families and to improve the comfort and usability of work systems for providers who work in them. New technologies and continual change must be informed and designed throu... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437490 Mon, 01 Mar 2010 00:00:00 +0100 3437490 http://www.medworm.com/index.php?rid=3437489&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000072%2Fabstract%3Frss%3Dyes This article provides a roadmap for your quality measurement journey. It begins with a discussion of 3 approaches to measurement (improvement, accountability and research) and challenges readers to be clear about why they are measuring. Key milestones along the quality measurement journey are then presented and a framework for selecting measures, developing clear operational definitions, building data collection plans, and understanding the variation that exists in data is outlined. The article ends with a discussion of why data need to be linked to improvement strategies. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437489 Mon, 01 Mar 2010 00:00:00 +0100 3437489 http://www.medworm.com/index.php?rid=3437488&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000060%2Fabstract%3Frss%3Dyes This article provides a systematic and pragmatic approach to quality improvement in the neonatal intensive care unit setting. The “model for improvement” serves as the foundation for the approach, and is based on three core questions, followed by cycles of testing: What are we trying to accomplish? How will we know that a change represents an improvement? What changes can we make that will result in continuous improvement? This article reviews these questions in detail and provides specific examples to highlight the practical use of this methodology. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437488 Mon, 01 Mar 2010 00:00:00 +0100 3437488 http://www.medworm.com/index.php?rid=3437487&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000059%2Fabstract%3Frss%3Dyes This article discusses the aspirations, workings, and achievements of the California Perinatal Quality Care Collaborative, a regional collaboration formed to improve perinatal care. While it is never easy to align the often differing fundamental positions held by the various member factions and stakeholder groups, the common goal of a universally agreed-upon mission statement can act as a magnet drawing the various components together. Rapid development of a first quality improvement initiative is an effective strategy to engage the participants in a way that allows them to demonstrate, share, and build upon their individual expertise, and provides them a strong sense of professional accomplishment. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437487 Mon, 01 Mar 2010 00:00:00 +0100 3437487 http://www.medworm.com/index.php?rid=3437486&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000175%2Fabstract%3Frss%3Dyes The Pediatrix BabySteps Clinical Data Warehouse (CDW) is a rich and novel tool allowing unbiased extraction of information from an entire neonatal population care by physicians and advanced practice nurses in Pediatrix Medical Group. Because it represents the practice of newborn medicine ranging from small community intensive care units to some of the largest neonatal intensive care units in the United States, it is highly representative of scope of practice in this country. Its value in defining outcome measures, quality improvement projects, and research continues to grow annually. Now coupled with the BabySteps QualitySteps program for defined clinical quality improvement projects, it represents a robust methodology for meaningful use of an electronic health care record, as designated d... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437486 Mon, 01 Mar 2010 00:00:00 +0100 3437486 http://www.medworm.com/index.php?rid=3437485&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000047%2Fabstract%3Frss%3Dyes The Vermont Oxford Network is a not-for-profit organization established in the late 1980s with the goals of improving the quality and safety of medical care for newborn infants and their families through a coordinated program of research, education, and quality improvement. In this paper the authors discuss the activities and programs sponsored by the Network to achieve those goals. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437485 Mon, 01 Mar 2010 00:00:00 +0100 3437485 http://www.medworm.com/index.php?rid=3437484&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000035%2Fabstract%3Frss%3Dyes Neonatal-Perinatal Medicine has had both its triumphs and its disasters regarding the dissemination of new interventions. Evidence-based medicine (EBM), the integration of clinical expertise, patient values, and best evidence for decision making in patient care, provides a blueprint for how to safely and effectively continue make headway in our rapidly changing field. The principles of EBM have been discussed in multiple articles and primers. EBM involves formulating the appropriate question, finding the evidence, appraising the evidence, and evaluating the clinician's performance in implementing these practices. At an institutional level, this type of thorough evidence review is critical to successful quality improvement projects, particularly if these projects hope to improve clinical ou... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437484 Mon, 01 Mar 2010 00:00:00 +0100 3437484 http://www.medworm.com/index.php?rid=3437483&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000023%2Fabstract%3Frss%3Dyes The “Quality Chasm” exists in neonatal intensive care. Despite years of clinical research in neonatology, therapies continue to be underused, overused, or misused. A key concept in crossing the quality chasm is system redesign. The unpredictability of human factors and the dynamic complexity of the neonatal ICU are not amenable to rigid reductionist control and redesign. Change is best accomplished in this complex adaptive system by use of simple rules: (1) general direction pointing, (2) prohibitions, (3) resource or permission providing. These rules create conditions for purposeful self-organizing behavior, allowing widespread natural experimentation, all focused on generating the desired outcome. (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437483 Mon, 01 Mar 2010 00:00:00 +0100 3437483 http://www.medworm.com/index.php?rid=3437482&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000187%2Fabstract%3Frss%3Dyes As we enter the second decade of the new millennium, the breathtaking changes occurring in medicine represent some of the most significant advances in the delivery of health care since World War II. Not only does the science of medicine continue to progress at an astonishing pace, but the manner in which patients receive the benefits of this science is also changing dramatically. Transparency is the key word in this process. No longer is a paternalistic physician attitude acceptable; “Trust me, I'm the doctor” has now transformed into “show me the data.” Patients and families expect to be informed not only of the options in care, but the likely outcomes of those options so that they can become active participants in the decision-making process. To evaluate outcomes, therefore, the ... Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437482 Mon, 01 Mar 2010 00:00:00 +0100 3437482 http://www.medworm.com/index.php?rid=3437481&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000308%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437481 Mon, 01 Mar 2010 00:00:00 +0100 3437481 http://www.medworm.com/index.php?rid=3437480&cid=s_33214_69_f&fid=33214&url=http%3A%2F%2Fwww.perinatology.theclinics.com%2Farticle%2FPIIS0095510810000424%2Fabstract%3Frss%3Dyes (Source: Clinics in Perinatology) Clinics in Perinatology journals http://www.medworm.com/rss/comments.php?id=3437480 Mon, 01 Mar 2010 00:00:00 +0100 3437480