Seminars in Fetal and Neonatal Medicine via MedWorm.com

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Sat, 17 Dec 2011 11:03:57 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Diversity of microbes in amniotic fluid

Seminars in Fetal and Neonatal Medicine — Mon, 05 Dec 2011 05:00:00 +0100

Summary: Recent polymerase chain reaction (PCR)-based studies estimate the prevalence of microbial invasion of the amniotic cavity (MIAC) to be ≥30–50% higher than that detected by cultivation-based methods. Some species that have been long implicated in causing MIAC remain among the common invaders (e.g. Ureaplasma spp., Mycoplasma spp., Fusobacterium spp. Streptococcus spp., Bacteroides spp. and Prevotella spp.). Yet we now know from studies based on PCR of the 16S ribosomal DNA that cultivation-resistant anaerobes belonging to the family Fusobacteriaceae (particularly Sneathia sanguinegens, and Leptotrichia spp.) are also commonly found in amniotic fluid. Other diverse microbes detected by PCR of amniotic fluid include as-yet uncultivated and uncharacterized species. The presence of...

Editorial

Seminars in Fetal and Neonatal Medicine — Thu, 24 Nov 2011 05:00:00 +0100

Research efforts over the past decade have yielded substantial insights into the mechanisms by which chorioamnionitis leads to preterm labor. Unfortunately, the majority of this scientific knowledge has not translated into novel clinical strategies for the prevention and treatment of this adverse pregnancy outcome. Timely diagnosis, effective obstetrical management and the reduction of neonatal morbidities remain formidable challenges for clinicians caring for these mothers and infants. Furthermore, we are just beginning to understand relationships between maternal conditions such as periodontitis, the microbiome responsible for chorioamnionitis and preterm birth and the mechanisms responsible for brain and lung injury. The following issue of Seminars in Maternal and Fetal Medicine will re...

Proteomics/diagnosis of chorioamnionitis and of relationships with the fetal exposome

Seminars in Fetal and Neonatal Medicine — Mon, 21 Nov 2011 05:00:00 +0100

Summary: Proteomics, a relatively young science, originally emerged as a complement to genomics research. By definition, the goal of proteomics is to provide a snapshot of all the proteins within an organism, tissue or biological sample at a given moment. Proteomics has the ability to single out one or more proteins (biomarkers) that change consistently in affected subjects as compared to those disease-free. From a proteomics perspective, chorioamnionitis poses both challenges and opportunities. Challenges relate to the dynamic course of the inflammatory process, and compartmentalization of the gestational sac in relation to the maternal compartment. An inability to evaluate the amniotic fluid non-invasively and repeatedly for meaningful changes in its proteome, and lack of a true gold sta...

Alcohol, Drugs and Medication in Pregnancy

Seminars in Fetal and Neonatal Medicine — Wed, 09 Nov 2011 05:00:00 +0100

This textbook summarizes the long term consequences in children who have been exposed in utero to various drugs and substances of misuse. The authors have explored findings of recent research in this area and provided a scientific basis for the clinical decision-making process. The book is divided into four sections containing 16 chapters written by a group of authors from the UK, USA, Canada and France, thus truly providing a global perspective. (Source: Seminars in Fetal and Neonatal Medicine)

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Mon, 10 Oct 2011 11:14:58 +0100

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Evidence for the clinical management of chorioamnionitis

Seminars in Fetal and Neonatal Medicine — Mon, 03 Oct 2011 04:00:00 +0100

Summary: Acute chorioamnionitis or intra-amniotic infection is defined by maternal fever in association with at least one additional clinical criterion including maternal or fetal tachycardia, maternal leukocytosis, uterine tenderness, or foul amniotic fluid odor. In clinically uncertain cases, the diagnosis can be augmented by routine laboratory studies (e.g. white blood cell count and differential count and acute phase reactants) and assays done on amniotic fluid. In general, the clinical management of chorioamnionitis is based on observational or cohort studies; only a few randomized controlled trials have been done. Prompt administration of antibiotics and delivery decrease maternal and neonatal morbidity. The most commonly used antibiotic regimen is ampicillin and gentamicin. Recent e...

Intrauterine infection and preterm labor

Seminars in Fetal and Neonatal Medicine — Mon, 26 Sep 2011 04:00:00 +0100

Summary: Preterm labor is defined as labor that begins before 37 completed weeks of pregnancy. More than 12% of infants born in the USA are preterm. At least 40% of preterm births are associated with intrauterine infection. Toll-like receptors (TLRs) are members of a family of cell-surface proteins responsible for recognition of a diverse spectrum of bacterial, viral and fungal pathogens. TLRs initiate the host innate (i.e. non-adaptive) immune response, inducing a proinflammatory cascade involving cytokines, chemokines, prostaglandins, and other effector molecules that result in the characteristic phenomena of labor, such as uterine contractions and rupture of fetal membranes. These cascades may also be activated by mechanisms that are not primarily infectious but are accompanied by infla...

Neonatal portal vein thrombosis: Diagnosis and management

Seminars in Fetal and Neonatal Medicine — Mon, 19 Sep 2011 04:00:00 +0100

Summary: Neonatal portal vein thrombosis (PVT) is an increasingly recognized event. Patients are generally asymptomatic in the neonatal period. The diagnosis is made with Doppler ultrasound. Umbilical catheterization, exchange transfusion and sepsis are risk factors for neonatal PVT. Thrombophilia is possibly a contributing risk factor. Although there are potential serious acute complications such as hepatic necrosis, the outcome is good in the majority of cases, followed up to 8 years of age. Thrombus resolution occurs in 30–70% in days to months. Liver lobe atrophy may occur following PVT, and does not appear to be associated with any impairment of liver function. Non-occlusive thrombosis is more likely to resolve than non-occlusive thrombosis. A subset of patients without resolution i...

Microbiota of the upper and lower genital tract

Seminars in Fetal and Neonatal Medicine — Thu, 15 Sep 2011 04:00:00 +0100

Summary: Our understanding of the bacterial species inhabiting the female genital tract has been limited primarily by our ability to detect them. Early investigations using microscopy and culture-based techniques identified lactobacilli as the predominant members of the vaginal microbiota and suggested that these organisms might serve a protective function at the mucosal surface. Improvements in cultivation techniques and the development of molecular-based detection strategies validated these early findings and enabled us to recognize that the microbiota of the female genital tract is much more complex than previously suspected. Disruption of the vaginal microbial community due to invasion of exogenous organisms or by overgrowth of one or more endogenous species has important health implic...

Prevention of preterm birth

Seminars in Fetal and Neonatal Medicine — Wed, 07 Sep 2011 04:00:00 +0100

Summary: Preterm birth (delivery before 37 completed weeks of gestation) is common and rates are increasing. In the past, medical efforts focused on ameliorating the consequences of prematurity rather than preventing its occurrence. This approach resulted in improved neonatal outcomes, but it remains costly in terms of both the suffering of infants and their families and the economic burden on society. Increased understanding of the pathophysiology of preterm labor has altered the approach to this problem, with increased focus on preventive strategies. Primary prevention is a limited strategy which involves public education, smoking cessation, improved nutritional status and avoidance of late preterm births. Secondary prevention focuses on recurrent preterm birth which is the most recognis...

Perinatal infection, inflammation, and retinopathy of prematurity

Seminars in Fetal and Neonatal Medicine — Wed, 07 Sep 2011 04:00:00 +0100

Summary: The major known risk factors for retinopathy of prematurity (ROP) are extremely low gestational age, exposure to high levels of oxygen early after birth (phase I) and relatively lower oxygen levels later (phase II). In this review, we summarize recent data suggesting that exposure to perinatal infection/inflammation is associated with an increased risk for ROP. Part of this effect might be due to direct exposure of the developing retina to circulating products of infection and/or inflammation. Another potential mechanism that deserves exploration is that inflammation and/or oxidative stress can modify the known increased risk of oxygen-associated ROP. Taken together, accumulating evidence suggests that prenatal, perinatal, and postnatal systemic inflammation contribute to a ‘pre...

Thrombotic and bleeding disorders in perinatal medicine

Seminars in Fetal and Neonatal Medicine — Mon, 05 Sep 2011 04:00:00 +0100

Hemostasis is a dynamic process, which evolves in-utero. The term “Developmental Haemostasis”, describes the age-related physiological changes of the coagulation system as it develops progressively over time from fetal, neonatal, pediatric to adult systems. In neonates and infants multiple reference samples are required to define the normal ranges of coagulation proteins for age, because these patients have rapidly evolving systems; blood sampling in the young is technically difficult; microtechniques are required and greater variability in plasma concentrations of coagulation proteins necessitates the use of large patient numbers to establish normative data. While acknowledging all these obstacles, Monagle et al. in the first manuscript of this special issue, focus on developmental c...

Developmental haemostasis: Secondary haemostasis

Seminars in Fetal and Neonatal Medicine — Mon, 29 Aug 2011 04:00:00 +0100

Summary: The haemostatic system is a complex interaction between the vasculature, cellular components and plasma proteins that interact to maintain haemostasis in the healthy body. The haemostatic system can be further defined as primary, secondary and tertiary haemostasis to better define the interdependent mechanisms that combine to maintain haemostasis. The term ‘developmental haemostasis’ was first introduced by Maureen Andrews in the 1980s to describe the age-related physiological changes of the coagulation system as it develops progressively over time from fetal, neonatal, paediatric to adult and geriatric systems. This paper will focus on developmental changes in secondary haemostasis, that is, the plasma protein changes that occur with age, particularly during the fetal and neo...

Inflammatory response in acute chorioamnionitis

Seminars in Fetal and Neonatal Medicine — Thu, 25 Aug 2011 04:00:00 +0100

Summary: Acute chorioamnionitis is the principal antecedent of premature birth and an important contributor to specific neonatal and other complications that may extend throughout subsequent life. A large number of studies have addressed surrogate markers of in-utero inflammation including cytokines, chemokines, pathogen-associated molecular patterns, and elicited host proteins. However, chorioamnionitis means inflammation occurring within the chorioamnion and the only practical direct measure available to assess this finding in most placentas is histopathology. The maternal and fetal inflammatory response to the presence of organisms within the placental membranes, so-called histologic chorioamnionitis, is the focus of this review. The issues addressed are the nature and origin of the eli...

Neonatal renal vein thrombosis

Seminars in Fetal and Neonatal Medicine — Thu, 25 Aug 2011 04:00:00 +0100

Summary: Neonatal renal vein thrombosis (RVT) continues to pose significant challenges for pediatric hematologists and nephrologists. The precise mechanism for the onset and propagation of renal thrombosis within the neonatal population is unclear, but there is suggestion that acquired and/or inherited thrombophilia traits may increase the risk for renal thromboembolic disease during the newborn period. This review summarizes the most recent studies of neonatal RVT, examining its most common features, the prevalence of acquired and inherited prothrombotic risk factors among these patients, and evaluates their short and long term renal and thrombotic outcomes as they may relate to these risk factors. Although there is some consensus regarding the management of neonatal RVT, the most recent ...

Perinatal inflammation and lung injury

Seminars in Fetal and Neonatal Medicine — Mon, 22 Aug 2011 04:00:00 +0100

Summary: Bronchopulmonary dysplasia (BPD) remains the major morbidity of extreme preterm birth. The incidence of BPD has remained stable despite recent efforts to reduce postnatal exposures to volutrauma and hyperoxia. This review will focus on recent clinical and experimental insights that provide support for the concept that the ‘new BPD’ is the result of inflammation-mediated injury and altered lung development during a window of vulnerability in genetically susceptible infants that is modified by maternal and postnatal exposures. (Source: Seminars in Fetal and Neonatal Medicine)

Management of pregnancy and delivery in women with inherited bleeding disorders

Seminars in Fetal and Neonatal Medicine — Fri, 19 Aug 2011 04:00:00 +0100

Summary: Women with inherited bleeding disorders present a wide spectrum of clinical symptoms that vary from mild or moderate bleeding tendency to severe episodes. Monthly haemostatic changes affect these women during menstruation and ovulation. These events may be associated with significant bleeding and pain leading to the limitations in conducting daily activities and adverse effect on quality of life. Likewise, pregnancy and delivery are critical times for affected women. During pregnancy, they may be at greater risk of miscarriage and bleeding complications. In particular, recurrent miscarriage was observed in women with type 3 von Willebrand disease, afibrinogenaemia and severe factor XIII deficiency, and an optimal therapeutic plan is required during their pregnancy. Precautions mus...

Diagnosis and management of neonatal purpura fulminans

Seminars in Fetal and Neonatal Medicine — Fri, 12 Aug 2011 04:00:00 +0100

Summary: Neonatal purpura fulminans is a rare, life-threatening condition, caused by congenital or acquired deficiencies of protein C or S. The condition is often fatal unless there is early recognition of the clinical symptoms, prompt diagnosis, and judicious replacement therapy is initiated. The clinical presentation is that of acute disseminated intravascular coagulation and hemorrhagic skin necrosis. The management includes an acute phase of replacement therapy with fresh frozen plasma or protein C concentrate and a maintenance therapy that includes anticoagulation with warfarin or low molecular weight heparin. This review focuses on the management of severe protein C deficiency. (Source: Seminars in Fetal and Neonatal Medicine)

Thrombophilia testing in neonates and infants with thrombosis

Seminars in Fetal and Neonatal Medicine — Thu, 11 Aug 2011 04:00:00 +0100

Summary: In neonates and infants with idiopathic venous thrombosis (VTE) and in pediatric populations in which thromboses were associated with medical diseases, inherited thrombophilia (IT) have been described as risk factors. Follow-up data for VTE recurrence in neonates suggest a recurrence rate between 3% in provoked and 21% in idiopathic VTE. Apart from underlying medical conditions, recently reported systematic reviews on pediatric VTE have shown significant associations between factor V G1691A, factor II G20210A, and deficiencies of protein C, protein S and antithrombin, even more pronounced when combined IT were involved. Independent from the age at first VTE onset, the pooled odds ratios (OR: single IT) for VTE ranged from 2.4 for the factor II G20210A mutation to 9.4 in neonates a...

Diagnosis and management of neonatal thrombocytopenia

Seminars in Fetal and Neonatal Medicine — Thu, 11 Aug 2011 04:00:00 +0100

Summary: Thrombocytopenia is the most common haematological abnormality in newborns admitted to neonatal care units and serves as an important indicator of underlying pathological processes of mother or child. In most cases thrombocytopenia is mild to moderate and resolves within the first weeks of life without any intervention. However, in some neonates thrombocytopenia is severe or may reflect an inborn platelet disorder. As clinical course and outcome of thrombocytopenia depend on the aetiology of thrombocytopenia, an appropriate work-up is essential to guide therapy in neonates with thrombocytopenia and to avoid severe bleeding. (Source: Seminars in Fetal and Neonatal Medicine)

Institution-based prospective inception cohort studies in neonatal rare disease research

Seminars in Fetal and Neonatal Medicine — Mon, 08 Aug 2011 04:00:00 +0100

The objective of this perspective article is to provide an overview of salient issues in the design and application of institution-based prospective inception cohort studies in neonatal rare disease research, with emphasis on quality assurance measures. Rigorous implementation of the prospective inception cohort study is challenging, and application to neonates renders it even more difficult. However, when performed collaboratively among institutions employing uniform methods and quality assurance mechanisms, institution-based prospective inception cohort studies can provide optimal observational evidence to inform the design and execution of RCTs in this special pediatric population. (Source: Seminars in Fetal and Neonatal Medicine)

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Thu, 04 Aug 2011 18:24:43 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Old and new antithrombotic drugs in neonates and infants

Seminars in Fetal and Neonatal Medicine — Thu, 04 Aug 2011 04:00:00 +0100

Summary: Thromboembolic complications are becoming more frequent in children and the use of anticoagulation has increased considerably. The most widely used agents in children, heparin, low molecular weight heparin, and warfarin all have limitations which are exaggerated in children. This has led to the study of newer agents with improved pharmacologic properties such as bivalirudin, argatroban, and fondaparinux. Clinical trials are under way to assess several new oral anticoagulants that are in late phase studies or already licensed in adults. Based on the completed studies in children, several recommendations for the use of currently available agents (bivalirudin, argatroban, and fondaparinux) are suggested for clinical use today. Additional studies need to be conducted for the these age...

Diagnosis and management of central-line-associated thrombosis in newborns and infants

Seminars in Fetal and Neonatal Medicine — Tue, 02 Aug 2011 04:00:00 +0100

Summary: Although the use of central lines has many valuable applications in neonates and infants, they may cause serious mechanical, infectious and thrombotic complications. In fact, the use of central lines is the main cause for thrombosis in this age group. The frequency of central-line-related thrombosis in neonates and infants is reported to be as low as 1% when including only symptomatic cases, around 44% when systematically screened for thrombosis, and as high as 65% in autopsy studies. The risk factors for line-related thrombosis in neonates and infants include those associated with the underlying medical conditions, the duration of the line in situ, the placement of the umbilical artery catheter and the therapy used through the line. The contribution of inherited and acquired thro...

Developmental hemostasis: Primary hemostasis and evaluation of platelet function in neonates

Seminars in Fetal and Neonatal Medicine — Tue, 02 Aug 2011 04:00:00 +0100

This article reviews platelet function, assessed by various techniques, and its development in the premature as well as healthy term neonate. (Source: Seminars in Fetal and Neonatal Medicine)

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Thu, 07 Jul 2011 20:54:44 +0100

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Mitochondrial hepatopathies in the newborn period

Seminars in Fetal and Neonatal Medicine — Wed, 15 Jun 2011 23:00:00 +0100

Summary: Mitochondrial disorders recognized in the neonatal period usually present as a metabolic crisis combined with one or several organ manifestations. Liver disorder in association with a respiratory chain deficiency may be overlooked since liver dysfunction is common in severely sick newborn infants. Lactacidosis, hypoglycemia, elevated serum transaminases and conjugated bilirubin are common signs of mitochondrial hepatopathy. Hepatosplenomegaly may occur in severe cases. A clinical picture with fetal growth restriction, postnatal lactacidosis, hypoglycemia, coagulopathy, and cholestasis, especially in combination with neurological symptoms or renal tubulopathy, should alert the neonatologist to direct investigations on mitochondrial disorder. A normal lactate level does not exclude ...

Mitochondrial disorders caused by mutations in respiratory chain assembly factors

Seminars in Fetal and Neonatal Medicine — Wed, 15 Jun 2011 23:00:00 +0100

Summary: Mitochondrial diseases involve the dysfunction of the oxidative phosphorylation (OXPHOS) system. This group of diseases presents with heterogeneous clinical symptoms affecting mainly organs with high energy demands. Defects in the multimeric complexes comprising the OXPHOS system have a dual genetic origin, mitochondrial or nuclear DNA. Although many nuclear DNA mutations involve genes coding for subunits of the respiratory complexes, the majority of mutations found to date affect factors that do not form part of the final complexes. These assembly factors or chaperones have multiple functions ranging from cofactor insertion to proper assembly/stability of the complexes. Although significant progress has been made in the last few years in the discovery of new assembly factors, the...

Therapy for mitochondrial disorders: Little proof, high research activity, some promise

Seminars in Fetal and Neonatal Medicine — Tue, 14 Jun 2011 23:00:00 +0100

Summary: Mitochondrial disorders are a common group of metabolic diseases, the largest subgroup being the respiratory chain deficiencies. The most severe forms of mitochondrial dysfunction manifest in the neonatal period, rendering this group of patients the most challenging for therapy development. Heterogeneity of molecular backgrounds in the whole mitochondrial disease group has hindered therapy trials, but promising results are being gained from studies on animal models. Here I review strategies that have been tested or that can be proposed to be feasible as intervention. Many of these strategies aim to slow down the disease progression or are palliative in nature. However, currently very little evidence for any kind of therapeutic tools is available from double-blind controlled studie...

Mitochondrial disorders in the perinatal period

Seminars in Fetal and Neonatal Medicine — Sun, 12 Jun 2011 23:00:00 +0100

Mitochondrial disorders, the group of diseases associated with abnormalities of oxidative phosphorylation (OXPHOS), have an incidence of at least 1:5000 live births and are thus among the most common genetically inherited diseases. They present with a high degree of phenotypic diversity, including severity, tissue distribution and age of onset, for which the mnemonic ‘any age, any symptom, any organ’ was applied. A set of major and minor disease criteria, based on clinical, histopathological, enzymatic, functional and molecular findings have been proposed for the diagnosis of a mitochondrial disorder in pediatric patients. Typical OXPHOS syndromes are not usually recognizable early in the neonatal period. In the newborn infant, the presenting sign may be ‘collapse’ requiring resusc...

Myth: Gastroesophageal reflux is a pathological entity in the preterm infant

Seminars in Fetal and Neonatal Medicine — Thu, 09 Jun 2011 23:00:00 +0100

Summary: There is concern about possible consequences of gastroesophageal reflux (GER) in preterm infants. GER is perceived to be a frequent condition in these infants, often causing an exhaustive investigation and expensive therapy. We review current evidence for and against an association between GER and apnea, failure to thrive, wheezing and respiratory diseases. Although there are some limitations to the methodologies currently used for detecting GER, there is clearly a lack of unequivocal evidence supporting a causal relationship between GER and its assumed consequences, particularly in preterm infants. Despite physiologic data that stimulation of laryngeal efferents by GER may induce apnea, there is little evidence for a causal relationship between GER and apnea. Studies on preterm i...

Mitochondrial DNA mutations and depletion in pediatric medicine

Seminars in Fetal and Neonatal Medicine — Tue, 07 Jun 2011 23:00:00 +0100

This article will focus on the primary mitochondrial DNA mutations and mtDNA depletion syndromes related to neonatal–infant human pathology. (Source: Seminars in Fetal and Neonatal Medicine)

Myth: Tocolysis for prevention of preterm birth has a major role in modern obstetrics

Seminars in Fetal and Neonatal Medicine — Sun, 05 Jun 2011 23:00:00 +0100

Summary: Tocolytics are widely used to reduce uterine activity in the context of preterm labour. Growing evidence that bacterial colonization of fetal membranes and amniotic fluid triggers an inflammatory response in mother and fetus and leads to preterm labour and long term neurological and respiratory complications in the neonate also raises questions about the desirability of prolonging pregnancy in this context. Combined with recent meta-analyses that fail to demonstrate improvements in neonatal outcome with tocolytic use, and a poor maternal/fetal side-effect profile, the case for continued use of these drugs needs to be questioned. (Source: Seminars in Fetal and Neonatal Medicine)

Developmental aspects of respiratory chain from fetus to infancy

Seminars in Fetal and Neonatal Medicine — Sun, 05 Jun 2011 23:00:00 +0100

Summary: Reviewing the recent literature on the role of mitochondria during fetal development paradoxically reveals two features: the importance of mitochondria in these early developmental phases, and the scarcity of information available for humans. Indeed, most of the available information on the role of mitochondria during development comes from studies of animal models that do not necessarily strictly apply to humans. In this paper, we attempted to collect information existing on humans, together with data from animal studies essentially presented as corroboration. This makes clear that a complex interacting network of energetic, genetic and epigenetic factors governs the impact of mitochondrial function on early development in humans. This complexity presumably also accounts for our ...

Myth: Neonatology is evidence-based

Seminars in Fetal and Neonatal Medicine — Wed, 01 Jun 2011 23:00:00 +0100

Summary: The practice of evidence-based medicine involves the judicious use of current best evidence in the care of individual patients. Decisions about diagnosis, prognosis and treating patients require knowledge of the probability and value of outcomes. Decision analysis illustrates how probabilities and values help define one another, and each are important. Whereas initial probability estimates can be obtained by ‘searching for the best evidence’, values belong to individuals. Obtaining values from patients or parents is sometimes difficult and requires a respectful, thoughtful, systematic approach, but only after doing this is neonatal care evidence-based. (Source: Seminars in Fetal and Neonatal Medicine)

Myth: Cerebral palsy cannot be predicted by neonatal brain imaging

Seminars in Fetal and Neonatal Medicine — Wed, 01 Jun 2011 23:00:00 +0100

Summary: There is controversy in the literature about the value of brain imaging in neonates regarding the prediction of cerebral palsy (CP). The aim of this review was to unravel the myth that CP cannot be predicted by neuroimaging in neonates. Major intracranial lesions in the preterm infant should be recognized with sequential cranial ultrasound and will predict those with non-ambulatory CP. Magnetic resonance imaging (MRI) at term-equivalent age will refine the prediction by assessment of myelination of the posterior limb of the internal capsule. Prediction of motor outcome in preterm infants with subtle white matter injury remains difficult, even with conventional MRI. MRI is a better tool to predict outcome in the term infant with hypoxic-ischaemic encephalopathy or neonatal stroke. ...

Myth: mechanical ventilation is a therapeutic relic

Seminars in Fetal and Neonatal Medicine — Sun, 29 May 2011 23:00:00 +0100

Summary: Non-invasive respiratory support techniques such as continuous positive airway pressure (CPAP) have been increasingly used for management of surfactant-deficient lung disease in preterm infants. The successful use of this approach depends upon the condition of the baby at birth and requires the establishment of spontaneous breathing at birth. The reported advantages of CPAP in observational studies demonstrating a reduction in chronic lung disease have not been substantiated in recently reported well-designed randomised trials. This approach is now more established in larger and more mature preterm infants, and proper patient selection with close observation should be exercised when used in extremely low gestational age infants. (Source: Seminars in Fetal and Neonatal Medicine)

Metabolic disorders of fetal life: Glycogenoses and mitochondrial defects of the mitochondrial respiratory chain

Seminars in Fetal and Neonatal Medicine — Sun, 29 May 2011 23:00:00 +0100

Summary: Two major groups of inborn errors of energy metabolism are reviewed –glycogenoses and defects of the mitochondrial respiratory chain – to see how often these disorders present in fetal life or neonatally. After some general considerations on energy metabolism in the pre- and postnatal development of the human infant, different glycogen storage diseases and mitochondrial encephalomyopathies are surveyed. General conclusions are that: (i) disorders of glycogen metabolism are more likely to cause ‘fetal disease’ than defects of the respiratory chain; (ii) mitochondrial encephalomyopathies, especially those due to defects of the nuclear genome, are frequent causes of neonatal or infantile diseases, typically Leigh syndrome, but usually do not cause fetal distress; (iii) notabl...

Infantile mitochondrial encephalopathy

Seminars in Fetal and Neonatal Medicine — Thu, 26 May 2011 23:00:00 +0100

Summary: Individually rare, when taken as a whole, genetic inborn errors of metabolism (IEM) account for a significant proportion of early onset encephalopathy. Prompt diagnosis is crucial to assess appropriate investigation and can sometimes warrant successful therapy. Recent improvements in technology and expansion of knowledge on the biochemical and molecular basis of these disorders allow astute child neurologists and paediatricians to improve the early diagnosis of these genetically determined defects. However, because of rarity and heterogeneity of these disorders, IEM encephalopathies are still a formidable challenge for most physicians. The most frequent cause of childhood IEM encephalopathy is mitochondrial disease, whose biochemical ‘signature’ is faulty energy supply due to ...

Preface

Seminars in Fetal and Neonatal Medicine — Tue, 24 May 2011 23:00:00 +0100

The new millennium is considered to be the age of evidence-based medicine. While that appears to be true in many areas of perinatal and neonatal medicine, some traditions die hard and many practices continue despite either a lack of support or even when there is clinical evidence to the contrary. (Source: Seminars in Fetal and Neonatal Medicine)

Neonatal cardiomyopathies and metabolic crises due to oxidative phosphorylation defects

Seminars in Fetal and Neonatal Medicine — Tue, 24 May 2011 23:00:00 +0100

Summary: Neonatal cardiomyopathies due to mitochondrial oxidative phosphorylation (OXPHOS) defects are extremely severe conditions which can be either isolated or included in a multi-organ disease, with or without metabolic crises, of which profound lactic acidosis is the prominent feature. Cardiomyopathy is more often hypertrophic than dilated. Antenatal manifestations such as fetal cardiomyopathy, arrhythmia and/or hydrops have been reported. Pathophysiological mechanisms are complex, going beyond ATP deficiency of the high-energy-consuming neonatal myocardium. Birth is a key metabolic period when the myocardium switches ATP production from anaerobic glycolysis to mitochondrial fatty acid oxidation and OXPHOS. Heart-specificity of the defect may be related to the specific localization o...

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Thu, 19 May 2011 20:17:43 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Neonatal muscular manifestations in mitochondrial disorders

Seminars in Fetal and Neonatal Medicine — Wed, 18 May 2011 23:00:00 +0100

Summary: During the last decade rapid development has occurred in defining nuclear gene mutations causing mitochondrial disease. Some of these newly defined gene mutations cause neonatal or early infantile onset of disease, often associated with severe progressive encephalomyopathy combined with other multi-organ involvement such as cardiomyopathy or hepatopathy and with early death. Findings suggesting myopathy in neonates are hypotonia, muscle weakness and wasting, and arthrogryposis. We aim to describe the clinical findings of patients with mitochondrial disease presenting with muscular manifestations in the neonatal period or in early infancy and in whom the genetic defect has been characterized. The majority of patients with neonatal onset of mitochondrial disease have mutations in nu...

Myth: Babies would choose prelabour caesarean section

Seminars in Fetal and Neonatal Medicine — Thu, 12 May 2011 23:00:00 +0100

Summary: Interest in rising caesarean section (CS) rates focuses on the putative relative effects on maternal health and perinatal mortality, especially in ‘non-medical’, ‘request’ or ‘repeat’ planned prelabour CS (PLCS). Shortening pregnancy and avoiding labour affect fetal maturity. Babies who do not experience labour have significantly increased respiratory and other morbidities that may have profound effects on development, determining immediate and potentially life-long disease. It is thus surprising that obstetricians do not advocate awaiting or inducing labour even in women considering CS. Mothers must be fully informed of all the evidence before they can give valid consent and make decisions on their baby’s behalf. New evidence about immunological and metabolic differ...

Recent advances in neonatal surgery

Seminars in Fetal and Neonatal Medicine — Mon, 02 May 2011 23:00:00 +0100

Over the past decade, tremendous advances have been made in understanding neonatal surgical conditions and many novel medical and surgical approaches have been developed that appear promising. At the same time, these advances continue to highlight the many unsolved problems that require further study. The distinguished authors are leaders in their respective fields and they provide a comprehensive compilation of the evolution of advances in neonatal surgery including the impact of prenatal diagnosis and therapy, current treatment of abdominal wall defects, advances in the treatment of congenital diaphragmatic hernia, application of minimally invasive surgery, progress in the treatment of neonatal short bowel syndrome and advances in the treatment of necrotizing enterocolitis. (Source: Semi...

Minimally invasive surgery in the neonate

Seminars in Fetal and Neonatal Medicine — Thu, 28 Apr 2011 23:00:00 +0100

Summary: The advent of minimally invasive surgical techniques in the neonate has been delayed due to the limited working space and the unique physiology of the newborn. In the last decade, with the introduction of new instruments and techniques, many of the initial problems have been solved making minimally invasive surgery feasible for a variety of indications in the neonate and a favored approach in specialized centers around the world. Although an increasing number of reports document the feasibility of this exciting technique, data demonstrating its benefit compared to conventional surgery is limited. This review focuses on recent developments in minimally invasive surgery in neonates and the evidence for its use. (Source: Seminars in Fetal and Neonatal Medicine)

Impact of prenatal diagnosis and therapy on neonatal surgery

Seminars in Fetal and Neonatal Medicine — Thu, 28 Apr 2011 23:00:00 +0100

Summary: The field of neonatal surgery is now inextricably linked to the field of obstetrics. Neonatologists and surgical specialists experienced with the postnatal management and outcomes of infants with various disorders now look in utero along with obstetricians and fetal medicine specialists to characterize the development and well-being of fetuses with congenital anomalies with a goal to optimize fetal, perinatal and postnatal management. The purpose of this article is to examine how prenatal diagnosis and therapy has influenced neonatal surgery. An overview of prenatal diagnosis and the evolution of fetal therapy are provided. In addition, we review the impact of prenatal diagnosis and therapy on the management and outcomes of infants with specific anomalies, including congenital lun...

Myth: All surfactants are alike

Seminars in Fetal and Neonatal Medicine — Sun, 24 Apr 2011 23:00:00 +0100

Summary: There are several surfactant preparations available to the clinician, none of which are alike. They differ in their phospholipid and surfactant protein (SP) composition as well as dosing, yet they all have been shown to be clinically effective as surfactants. Head-to-head randomized clinical trials comparing surfactants have shown some advantages of preparations that contain SP-B and SP-C, primarily in short-term clinical outcomes. A new synthetic surfactant that contains a phospholipid mixture and a peptide resembling SP-B has shown promise as a potential alternative to animal-derived surfactants. (Source: Seminars in Fetal and Neonatal Medicine)

Necrotizing enterocolitis: An update

Seminars in Fetal and Neonatal Medicine — Sun, 24 Apr 2011 23:00:00 +0100

Summary: Necrotizing enterocolitis (NEC) is a leading cause of death among patients in the neonatal intensive care unit, carrying a mortality rate of 15–30%. Its pathogenesis is multifactorial and involves an overreactive response of the immune system to an insult. This leads to increased intestinal permeability, bacterial translocation, and sepsis. There are many inflammatory mediators involved in this process, but thus far none has been shown to be a suitable target for preventive or therapeutic measures. NEC usually occurs in the second week of life after the initiation of enteral feeds, and the diagnosis is made based on physical examination findings, laboratory studies, and abdominal radiographs. Neonates with NEC are followed with serial abdominal examinations and radiographs, and ...

Myth: Group B streptococcal infection in pregnancy: Comprehended and conquered

Seminars in Fetal and Neonatal Medicine — Wed, 13 Apr 2011 23:00:00 +0100

Summary: Group B streptococcus (GBS) is a common inhabitant of the bowel, and frequently colonises the vagina. It rarely causes disease, except in neonates, where it is the most common cause of serious neonatal infection. Although GBS can be transmitted sexually, it is common even in adults who have never been sexually active and is not a sexually transmitted disease. Currently, the most widely used effective method for detecting colonisation is taking a low vaginal and rectal swab and culturing GBS using enriched media culture. GBS cannot reliably be eradicated by antibiotic treatment but intravenous penicillin given to the mother during labour can prevent up to 90% of early onset GBS disease. Screening and antibiotic prophylaxis has resulted in an 80% fall in early onset disease in the U...

Myth: Necrotizing enterocolitis: Probiotics will end the disease, and surgical intervention improves the outcome

Seminars in Fetal and Neonatal Medicine — Sun, 10 Apr 2011 23:00:00 +0100

Summary: Necrotizing enterocolitis remains an important contributor to neonatal morbidity and mortality. Recent studies suggest that probiotic supplementation may reduce the risk of the disease in premature infants, and some authors recommend that this approach is ready to be utilized as standard-of-care. Once necrotizing enterocolitis is diagnosed and progresses toward peritonitis or perforation, surgical intervention is thought to improve the outcome, and investigators have suggested that peritoneal drainage is as effective as an exploratory laparotomy. In this chapter, we review the current state of knowledge, and suggest that additional studies are necessary to confirm that probiotics will end this disease, and that surgical intervention may not significantly improve the outcome after ...

Neonatal abdominal wall defects

Seminars in Fetal and Neonatal Medicine — Wed, 06 Apr 2011 23:00:00 +0100

Summary: Gastroschisis and omphalocele are the two most common congenital abdominal wall defects. Both are frequently detected prenatally due to routine maternal serum screening and fetal ultrasound. Prenatal diagnosis may influence timing, mode and location of delivery. Prognosis for gastroschisis is primarily determined by the degree of bowel injury, whereas prognosis for omphalocele is related to the number and severity of associated anomalies. The surgical management of both conditions consists of closure of the abdominal wall defect, while minimizing the risk of injury to the abdominal viscera either through direct trauma or due to increased intra-abdominal pressure. Options include primary closure or a variety of staged approaches. Long-term outcome is favorable in most cases; howeve...

Congenital diaphragmatic hernia: Still a moving target

Seminars in Fetal and Neonatal Medicine — Sun, 03 Apr 2011 23:00:00 +0100

Summary: The primary therapeutic target for congenital diaphragmatic hernia (CDH) patients has shifted from emergency surgical repair towards a non-operative emergency of the newborn treated by interdisciplinary teams. The increased understanding of the epidemiological and pathophysiological aspects of CDH have led to an improved knowledge and application of prenatal diagnosis, postnatal ventilation strategies, treatment of associated pulmonary hypertension and the role of extracorporeal membrane oxygenation therapy. In the surgical field, the perspectives have changed with delayed CDH repair, the introduction of minimally invasive surgery and use of prosthetic material for closure of large defects. With decreased mortality, long term multi-organ morbidity has increased in some survivors. ...

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Tue, 15 Mar 2011 22:08:31 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Neonatal short bowel syndrome

Seminars in Fetal and Neonatal Medicine — Mon, 14 Mar 2011 00:00:00 +0100

Summary: Neonatal short bowel syndrome is a disease with a high morbidity and mortality. The management of these patients is complex and requires a multidisciplinary approach. Recent advances in medical and surgical treatment options have improved outcomes. The following review highlights salient points in the management of this challenging patient population. (Source: Seminars in Fetal and Neonatal Medicine)

Rapid methods for targeted prenatal diagnosis of common chromosome aneuploidies

Seminars in Fetal and Neonatal Medicine — Mon, 14 Feb 2011 00:00:00 +0100

Summary: Improvements in non-invasive screening methods for trisomy 21 (Down syndrome) and other aneuploidies during the first and second trimester of pregnancy have radically changed the indications for prenatal diagnosis over the last decade. Consequently, there was a need for rapid tests for the detection of common chromosome aneuploidies resulting in the development of molecular methods for the rapid, targeted detection of (an)euploidies of the chromosomes 13, 18, 21 and the sex chromosomes. The analysis of large series of prenatal samples has shown that such tests can detect the great majority of chromosome abnormalities in prenatal diagnosis. This resulted in lively discussions on whether conventional karyotyping should remain the standard method for the majority of prenatal cases or...

Clinical perinatal genetics

Seminars in Fetal and Neonatal Medicine — Wed, 09 Feb 2011 00:00:00 +0100

During the last two decades there has been a huge increase in genetic knowledge and a rapid development of new techniques for genetic analysis. The resolution of chromosome analysis has increased 100-fold through the use of fluorescent in-situ hybridization and comparative genome hybridization (array-CGH), and since the introduction of these methods in the clinical setting a large number of new microdeletion and duplication syndromes has been described. In addition, we have learned that normal variants are comprised not only of single nuclotide polymorphism, but also of variation in copy numbers, so-called CNVs. After the publication of the human DNA sequence in 2001 and the delineation of our approximately 20,000 genes, knowledge of the effect of mutations has led to an improved understan...

Disorders of sex development

Seminars in Fetal and Neonatal Medicine — Tue, 08 Feb 2011 00:00:00 +0100

Summary: Infants born with ambiguous genitalia represent a complex clinical challenge. A systematic clinical investigation aims at determining the hormone production and which anatomical structures are present in order to understand at what level the sex differentiation has been affected; chromosomal, gonadal or hormonal synthesis and action levels. The increased genetic knowledge in the field has opened up new diagnostic possibilities. Sex development requires the balanced and sequential activation of transcription factors, signaling molecules and hormones. It has recently been shown that not only testis but also normal ovarian development is an active process. Genes involved in gonadal disorders of sex development often act in a gene dosage-dependent manner, with different effects in XY ...

Array technology in prenatal diagnosis

Seminars in Fetal and Neonatal Medicine — Thu, 06 Jan 2011 00:00:00 +0100

Summary: Array technology, here termed molecular karyotyping, is an attractive alternative to conventional karyotyping for prenatal diagnosis given the increase in resolution as well as faster report times. We review the benefits and limitations of this technique for the detection of pathogenic genomic imbalances, address the challenges raised in the interpretation of copy number variations, discuss practical considerations for the routine implementation of molecular karyotyping in prenatal diagnosis, and identify areas where more research is desired to enable large scale introduction of the technique(s). (Source: Seminars in Fetal and Neonatal Medicine)

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Wed, 29 Dec 2010 02:53:11 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

A newborn with unusual morphology: some practical aspects

Seminars in Fetal and Neonatal Medicine — Fri, 24 Dec 2010 00:00:00 +0100

Summary: Newborns with an unusual phenotype with or without malformations are common in the practice of every paediatrician. Determining whether the phenotype is a variation of normal or should be considered abnormal and, if the latter, also finding the cause can be extremely difficult. Here the main steps that should be followed in the diagnostic procedures are discussed. A careful family history and detailed physical examination remain the hallmarks of the investigations in all newborns. Very frequently clinical photographs will facilitate discussing patients with colleagues. Additional investigations usually include radiological examinations of all body parts that show abnormalities, and screening of the heart, kidneys, eyes and hearing. The studies with the highest yield are cytogeneti...

Preimplantation genetic diagnosis: twenty years of practice

Seminars in Fetal and Neonatal Medicine — Wed, 22 Dec 2010 00:00:00 +0100

Summary: More than two decades after the first clinical application, preimplantation genetic diagnosis (PGD) is an established medical procedure and an accepted alternative to conventional prenatal diagnosis for patients at high risk of transmitting a genetic disorder to their offspring. The great advantage of PGD is that the diagnostic procedure is made already at the embryo stage, before transfer to the patient, and the need for pregnancy termination is thereby avoided. However, PGD can only be performed in connection with in-vitro fertilisation followed by embryo biopsy and genetic analysis of single cells, a complex and cumbersome procedure for both the couple as well as the professionals involved in the treatment. However, for couples at high risk of having an affected child, PGD may ...

Genetic evaluation of the floppy infant

Seminars in Fetal and Neonatal Medicine — Mon, 06 Dec 2010 00:00:00 +0100

Summary: Hypotonia in infants in the first year of life is a common diagnostic and management challenge for pediatricians and neonatologists. Several published clinical studies have shown that a substantial proportion of cases are accounted for by genetic disorders. Rapid advances in biotechnology, bioinformatics, and molecular genetic testing have made it possible to offer specific genetic diagnoses in a timely manner. The value of clinical examination in the localization of hypotonia within the nervous system as the first step towards a diagnosis cannot be overemphasized. Due importance should be given to specific features on examination and in the selection of appropriate laboratory tests to minimize laboratory costs. Inborn errors of metabolism, although infrequently encountered, are o...

Development of new postnatal diagnostic methods for chromosome disorders

Seminars in Fetal and Neonatal Medicine — Mon, 29 Nov 2010 00:00:00 +0100

Summary: Chromosome imbalances are the leading cause of intellectual and developmental disabilities in the population. This paper reviews the current methods used to diagnose chromosome abnormalities in children including karyotyping, fluorescence in situ hybridization and microarray technologies. Advances in molecular cytogenetics, especially with the use of microarrays, have substantially increased the detection of chromosome abnormalities in children with disabilities and congenital anomalies above that achievable with conventional cytogenetic banding and light microscopy. (Source: Seminars in Fetal and Neonatal Medicine)

Non-invasive prenatal diagnosis by fetal nucleic acid analysis in maternal plasma: the coming of age

Seminars in Fetal and Neonatal Medicine — Mon, 15 Nov 2010 00:00:00 +0100

Summary: Prenatal diagnosis is an important part of obstetrics care. In the current prenatal programmes, definitive diagnosis of fetal genetic or chromosomal conditions is conducted through fetal sampling by amniocentesis or chorionic villus sampling. To obviate the risks of fetal miscarriage that are associated with the invasive sampling procedures, we have been developing non-invasive prenatal diagnostic tests based on cell-free fetal DNA analysis from maternal plasma. To date, fetal sex and rhesus D status determination by circulating fetal DNA analysis is performed clinically in many centres. Strategies for the non-invasive diagnosis of monogenic diseases have been developed. Accurate detection of fetal trisomy 21 by next-generation sequencing has been achieved. Many of the non-invasiv...

ST analysis of fetal electrocardiography in labor

Seminars in Fetal and Neonatal Medicine — Tue, 09 Nov 2010 00:00:00 +0100

Summary: Since its introduction more than 40 years ago, electronic fetal monitoring has become widely used for intrapartum surveillance to determine fetal wellbeing in labor. Although fetal hypoxia and acidosis are reflected in changes in fetal heart rate, there is no evidence that cardiotocography has been effective in reducing neonatal morbidity related to fetal distress occurring during labor. Indeed the specificity of this tool is poor and in many instances the incorporation of electronic fetal monitoring into intrapartum care has merely led to an increase in medical intervention rather than an improvement in neonatal outcome. Fetal electrocardiography (ECG) analysis provides an additional method for assessing the response of the fetus to hypoxia and in particular to the development of...

Haemodynamics edition of seminars in fetal and neonatal medicine

Seminars in Fetal and Neonatal Medicine — Tue, 09 Nov 2010 00:00:00 +0100

Haemodynamics or the movement of blood is vital to life and yet, even in adults, it is surprisingly difficult to study. In neonatology and fetal medicine these problems are amplified several times by the pragmatic issues of small size in neonates and both small size and lack of direct access in fetal medicine. In neonatology, we’re good at direct measures of pressure and oxygen levels in the blood stream but have limited means with which to measure the most important determinant of tissue oxygen delivery, which is blood flow. In fetal medicine, even these parameters cannot be measured directly. Both specialties are dependent on indirect measurement methodologies and considerable research efforts have gone into using these methods to understand haemodynamic pathophysiology in the fetus an...

Ethical issues in perinatal genetics

Seminars in Fetal and Neonatal Medicine — Mon, 08 Nov 2010 00:00:00 +0100

This article introduces perinatologists to the ethical principles of beneficence and respect for autonomy and uses these ethical principles to articulate the ethical concept of the fetus as a patient. Together these constitute an ethical framework that we apply to risk assessment, in response to which women may be divided into four groups: prenatal genetic counseling, and the responsible management of pregnancies complicated by genetic anomalies of the fetus. (Source: Seminars in Fetal and Neonatal Medicine)

Techniques for assessing cardiac output and fetal cardiac function

Seminars in Fetal and Neonatal Medicine — Mon, 08 Nov 2010 00:00:00 +0100

Summary: Fetal echocardiography was initially used to diagnose structural heart disease, but recent interest has focused on functional assessment. Effects of extracardiac conditions on the cardiac function such as volume overload (in the recipient in twin–twin transfusion syndrome), a hyperdynamic circulation (arterio-venous malformation), cardiac compression (diaphragmatic hernia, lung tumours) and increased placental resistance (intrauterine growth restriction and placental insufficiency) can be studied by ultrasound and may guide decisions for intervention or delivery. A variety of functional tests can be used, but there is no single clinical standard. For some specific conditions, however, certain tests have shown diagnostic value. (Source: Seminars in Fetal and Neonatal Medicine)

Cardiac magnetic resonance in the study of neonatal haemodynamics

Seminars in Fetal and Neonatal Medicine — Mon, 25 Oct 2010 00:00:00 +0100

Summary: Circulatory failure plays a key role in the pathogenesis of mortality and key morbidity such as cerebral injury in the preterm infant. However awareness of the pathophysiology of circulatory failure itself is not well understood. Similarly there is significant uncertainty over optimal treatment approaches, particularly for inotropic therapies.Current uncertainties are perpetuated by difficulties with accurately assessing circulatory function. Cardiac magnetic resonance (CMR) imaging has produced significant advances in understanding of adult circulatory function, and acts as a powerful biomarker for interventional studies. Although routine circulatory assessment by CMR in the neonatal population is not currently a realistic goal, it could provide insights into pathophysiology; and...

Selective reduction and termination of multiple pregnancies

Seminars in Fetal and Neonatal Medicine — Sat, 16 Oct 2010 16:01:49 +0100

Summary: The substantial increase in high order multiple pregnancies in the last two decades as a result of assisted reproductive techniques has necessitated the development of multifetal pregnancy reduction as a management tool to decrease fetal number and improve perinatal survival. The evidence in favour of reduction in pregnancies with more than four fetuses to twins is undisputed. Despite the recent improvements in expectant management of triplets with reasonable perinatal outcomes, the evidence suggests that reduction to twins significantly reduces the risk of preterm delivery without an increase in miscarriage rates. Recent advances in vascular-occlusive techniques have allowed the possibility of selective termination in monochorionic pregnancies in the presence of discordant anomal...

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Sat, 16 Oct 2010 16:01:49 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Examination of the fetal cardiovascular system

Seminars in Fetal and Neonatal Medicine — Tue, 28 Sep 2010 00:00:00 +0100

This article reviews important characteristics of arterial and venous Doppler waveform analysis, individual vascular beds and their clinical application in fetal evaluation. (Source: Seminars in Fetal and Neonatal Medicine)

Dynamic contrast-enhanced magnetic resonance imaging: definitive imaging of placental function?

Seminars in Fetal and Neonatal Medicine — Mon, 20 Sep 2010 00:00:00 +0100

Summary: The placenta constitutes a complex circulatory interface between the mother and fetus, but the relationship between the maternal and fetal circulation is still very difficult to study in vivo. There is growing evidence that magnetic resonance imaging (MRI) is useful and safe during pregnancy, and MRI is increasingly used for fetal and placental anatomical imaging. MRI functional imaging is now a modern obstetric tool and has the potential to provide new insights into the physiology of the human placenta. Placental perfusion has been studied during the first pass of an MR contrast agent, by arterial spin labeling, diffusion imaging, T1 and T2 relaxation time measurement using echo-planar imaging, and by a combination of magnetization transfer with established stereological methods....

Specific complications of monochorionic twin pregnancies: twin–twin transfusion syndrome and twin reversed arterial perfusion sequence

Seminars in Fetal and Neonatal Medicine — Sun, 19 Sep 2010 23:00:00 +0100

Summary: Monochorionic twins are subjected to specific complications which originate in either imbalance or abnormality of the single placenta serving two twins. This unequal placental sharing can cause complications including twin–twin transfusion syndrome (TTTS), twin anemia–polycythemia sequence (TAPS), selective intrauterine growth restriction or twin reversed arterial perfusion sequence (TRAP). Monochorionicity also makes the management of these specific complications as well as that of a severe malformation in one twin hazardous since the spontaneous death of one twin exposes the co-twin to a risk of exsanguination into the dead twin and its placenta. The latter is responsible for the death of the co-twin in up to 20% of the cases and in ischemic sequelae in about the same propor...

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Sat, 28 Aug 2010 08:57:04 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Multiple pregnancy

Seminars in Fetal and Neonatal Medicine — Sun, 22 Aug 2010 23:00:00 +0100

This issue of Seminars in Fetal and Neonatal Medicine discusses the controversial and complex aspects that surround the management of some multiple pregnancies. The rate of multiple pregnancies is increasing worldwide. Variations in rates of twins and higher order pregnancies are related to the use of assisted conception techniques and also the deferment of pregnancy leading to a rise in maternal age of pregnancy. The rise in rates of multiple pregnancy has been highest in the United States, but a worldwide trend exists. Over the last 5 years or so there has been a general trend with assisted reproduction techniques into replacing fewer embryos at transfer. This has led to a fall in higher order pregnancies and therefore the need for selective fetal reduction. This potential option reduci...

Multiples clinic: a model for antenatal care

Seminars in Fetal and Neonatal Medicine — Sun, 01 Aug 2010 23:00:00 +0100

This article aims to describe models of care that can be given in such a clinic, acknowledging that one model will not fit all. The scant evidence that exists is presented along with selected examples of individual complications. (Source: Seminars in Fetal and Neonatal Medicine)

Selective intrauterine growth restriction in monochorionic twins: pathophysiology, diagnostic approach and management dilemmas

Seminars in Fetal and Neonatal Medicine — Sun, 01 Aug 2010 23:00:00 +0100

Summary: Selective intrauterine growth restriction (sIUGR) in monochorionic twins is associated with a substantial increase in perinatal mortality and morbidity for both twins. Clinical evolution depends on the combination of the effects of placental insufficiency in the IUGR twin with inter-twin blood transfer through placental anastomoses. Classification of sIUGR into types according to the characteristics of umbilical artery diastolic flow in the IUGR twin permits the differentiation of clinical and prognostic groups. sIUGR type I has normal diastolic flow and relatively good outcome. Type II is defined by persistently absent/reverse end-diastolic flow and is associated with a high risk of intrauterine demise of the IUGR twin and/or very preterm delivery. Type III is defined by the pres...

Does neonatal and infant neurodevelopmental morbidity of multiples and singletons differ?

Seminars in Fetal and Neonatal Medicine — Thu, 29 Jul 2010 23:00:00 +0100

Summary: The mortality and morbidity of twins may differ from that in singletons because of the greater incidence of intrauterine growth restriction, higher rates of prematurity, zygosity and even from the presence of a same age sibling during childhood. Early outcomes appear poorer for twins, but any differences are lost when corrections for gestation and growth restriction are made. Some studies show poorer cognitive outcomes for twins; larger and more recent studies show small but significant differences even when confounders are taken into account. Cerebral palsy rates are considerably higher in twins, especially with the death of a co-twin. Behavioural outcomes are broadly similar in twins and singletons, with growth and gestation being more important determinants than plurality. Psyc...

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Sat, 24 Jul 2010 07:34:37 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Point-of-care ultrasound in the neonatal intensive care unit: international perspectives

Seminars in Fetal and Neonatal Medicine — Wed, 21 Jul 2010 00:00:00 +0100

Summary: To explore international variation in implementation of point-of-care ultrasound in the neonatal intensive care unit (NICU), contributions were invited from neonatologists and paediatric cardiologists in six countries. The contributors show variation in national implementation that ranges from almost total coverage through to a minority of NICUs having point-of-care ultrasound capability. To a varying degree in all systems the main barriers have been concerns from the consultative specialties that traditionally use ultrasound, relating to the risk of misdiagnosis but also involving different clinical needs, liability concerns and lack of outcome-based evidence. All contributors agreed that safe point-of-care ultrasound depends on close collaboration with the consultative specialti...

Preterm and term labour in multiple pregnancies

Seminars in Fetal and Neonatal Medicine — Tue, 20 Jul 2010 23:00:00 +0100

This article reviews aspects of preterm birth in twins and higher order multiples including epidemiology, prediction and prevention of preterm labour and potential mechanisms controlling onset of parturition. Evidence relating to the management of labour in preterm and term multiples is also discussed. (Source: Seminars in Fetal and Neonatal Medicine)

Genetics and developmental pathology of twinning

Seminars in Fetal and Neonatal Medicine — Tue, 20 Jul 2010 23:00:00 +0100

Summary: Twin pregnancy is associated with a high risk of congenital malformations. This review covers the risk of such anomalies in both dizygotic and monozygotic twin pregnancies, and discusses current insights into the associations relating to zygosity, chorionicity and genetic factors. The pathological basis of specific malformations unique to the monochorionic twinning process, including conjoined twinning and twin reversed arterial perfusion (TRAP) sequence, is discussed in more detail, and factors contributing to the higher perinatal mortality rate in multiple pregnancies are addressed. (Source: Seminars in Fetal and Neonatal Medicine)

Epidemiology of multiple pregnancy and the effect of assisted conception

Seminars in Fetal and Neonatal Medicine — Wed, 14 Jul 2010 23:00:00 +0100

This article examines the impact of assisted conception on the incidence of multiple pregnancies and associated complications. It explores some of the reasons for the strong association between assisted reproductive technology and multiple pregnancies and suggests possible ways of addressing this continuing problem. (Source: Seminars in Fetal and Neonatal Medicine)

Hypoxia-inducible factor (HIF) and HIF-stabilizing agents in neonatal care

Seminars in Fetal and Neonatal Medicine — Sun, 04 Jul 2010 23:00:00 +0100

Summary: Oxygen is essential for multicellular existence. Its reduction to water by the mitochondrial electron transport chain forms the cornerstone of aerobic metabolism. Conditions in which oxygen is limiting for electron transport result in bioenergetic collapse in metazoans. However, compared with postnatal existence, all of mammalian development occurs in a hypoxic environment in utero. Not just an epiphenomenon, this ‘physiological hypoxia’ is required for the activation of a transcriptional response mediated by the hypoxia-inducible factor (HIF) family of transcriptional regulators that coordinates the expression of hundreds of genes, many with developmentally critical functions. Oxygen tension, therefore, is a morphogen. Understanding the physiological significance of hypoxia r...

Near-infrared spectroscopy: A methodology-focused review

Seminars in Fetal and Neonatal Medicine — Mon, 28 Jun 2010 00:00:00 +0100

Abstract: Near infrared spectroscopy (NIRS) is a light-based technology used to monitor tissue oxygen status. Refinements to the method since it was first described have extended its applicability to different research and clinical settings due to its non-invasiveness, instrument portability and ease of use.Classic NIRS recordings, based in the Beer-Lambert law, can be used for the trend monitoring of changes in tissue perfusion-oxygenation parting from an arbitrary zero point. However, in order to derive intermittently quantitative values in absolute terms, certain manoeuvres must be performed. More recently, the evolution of the technique has led to the development of instruments that provide an absolute value of regional hemoglobin saturation in a continuous manner.This review will focu...

Single twin demise: consequence for survivors

Seminars in Fetal and Neonatal Medicine — Sun, 27 Jun 2010 23:00:00 +0100

Summary: Multiple pregnancies, the majority of which are twins, are at substantially higher risk of fetal morbidity and mortality when compared with singleton pregnancies. Single fetal demise occurs in up to 6.2% of all twin pregnancies. It may cause considerable risk for the co-twin including increased risk of fetal loss, premature delivery, neurovascular injury and end-organ damage. In this review we seek to summarise the most contemporary literature on the aetiology of single twin demise, the pathophysiology of injury to the surviving twin and the evidence for current management strategies. (Source: Seminars in Fetal and Neonatal Medicine)

Patient selection and prognostication with hypothermia treatment

Seminars in Fetal and Neonatal Medicine — Sun, 27 Jun 2010 23:00:00 +0100

Summary: For infants with perinatal hypoxia–ischaemia, the ability to give an accurate prognosis at different ages enables the clinician to make decisions on the continuation of management, and also assists in discussions regarding further treatment and prognosis with parents and families. This review suggests which outcome markers are still valid, which need new ‘cut-off values’ and which can no longer be used in cooled infants. The main focus is on convenient bedside technologies such as the amplitude-integrated electroencephalogram that can be easily applied in routine clinical practice. (Source: Seminars in Fetal and Neonatal Medicine)

Neonatologist-performed functional echocardiography in the neonatal intensive care unit

Seminars in Fetal and Neonatal Medicine — Mon, 21 Jun 2010 00:00:00 +0100

Summary: The use of point-of-care functional ultrasound to assess cardiovascular function is gaining interest in the neonatal intensive care unit (NICU). The modality has been in use in adult intensive care units for some time and has often guided management. Clinical signs such as heart rate, blood pressure, and capillary refill time, which physicians traditionally have relied upon, provide limited insight into the adequacy of systemic blood flow and organ perfusion. Enhanced cardiovascular imaging and hemodynamic evaluation offers novel insights regarding the contribution of the ductus arteriosus, myocardial performance and pulmonary hemodynamics to ongoing clinical instability. In addition, it allows more accurate delineation of the nature of the underlying disease process and facilitat...

Mechanisms of hypothermic neuroprotection

Seminars in Fetal and Neonatal Medicine — Sun, 20 Jun 2010 23:00:00 +0100

Summary: There is now compelling clinical evidence that prolonged, moderate cerebral hypothermia initiated within a few hours after severe hypoxia–ischemia and continued until resolution of the acute phase of delayed cell death can reduce subsequent neuronal loss and improve behavioral recovery in term infants and adults after cardiac arrest. Perhaps surprisingly, the specific mechanisms of hypothermic neuroprotection remain unclear, at least in part because hypothermia suppresses a broad range of potential injurious factors. In the present review we critically examine proposed mechanisms in relation to the known window of opportunity for effective protection with hypothermia. Better knowledge of the mechanisms of hypothermia is critical to help guide the rational development of future c...

Potential biomarkers for hypoxic–ischemic encephalopathy

Seminars in Fetal and Neonatal Medicine — Sun, 20 Jun 2010 23:00:00 +0100

Summary: Cerebral hypothermia reduces brain injury and improves behavioral recovery after hypoxia–ischemia (HI) at birth. However, using current enrolment criteria many infants are not helped, and conversely, a significant proportion of control infants survive without disability. In order to further improve treatment we need better biomarkers of injury. A ‘true’ biomarker for the phase of evolving, ‘treatable’ injury would allow us to identify not only whether infants are at risk of damage, but also whether they are still able to benefit from intervention. Even a less specific measure that allowed either more precise early identification of infants at risk of adverse neurodevelopmental outcome would reduce the variance of outcome of trials, improving trial power while reducing th...

Therapeutic hypothermia translates to the NICU

Seminars in Fetal and Neonatal Medicine — Wed, 16 Jun 2010 23:00:00 +0100

Brain injury around the time of birth remains one of the great tragedies of life. Nearly all affected newborns were normal before birth, and the majority of those with moderate to severe encephalopathy will either die or go on to develop neurodevelopmental disabilities. Even amongst survivors who are not disabled in infancy, at least half will show learning problems at school. Despite major advances in obstetric and neonatal care, the incidence of acute encephalopathy has remained discouragingly unchanged in the developed world for decades, at around 1 to 3/1000 live births. (Source: Seminars in Fetal and Neonatal Medicine)

Oxygen toxicity: chemistry and biology of reactive oxygen species

Seminars in Fetal and Neonatal Medicine — Sun, 23 May 2010 23:00:00 +0100

Summary: Oxygen has a central role in the evolution of complex life on Earth mainly because of the biochemical symmetry of oxygenic photosynthesis and aerobic respiration that can maintain homeostasis within our planet biosphere. Oxygen can also produce toxic molecules, reactive oxygen species (ROS). ROS is a collective term that includes both oxygen radicals and certain oxidizing agents that are easily converted into radicals. They can be produced from both endogenous and exogenous substances. ROS play a dual role in biological systems, since they can be either harmful or beneficial to living systems. They can be considered a double-edged sword because on the one hand oxygen-dependent reactions and aerobic respiration have significant advantages but, on the other, overproduction of ROS ha...

Oxygen as a therapeutic agent in neonatology: a comprehensive approach

Seminars in Fetal and Neonatal Medicine — Sun, 23 May 2010 23:00:00 +0100

Oxygen is among the most common elements in nature and probably one of the most frequently employed drugs in neonatology. As a final acceptor of highly energised electrons, oxygen is the key element of aerobic metabolism. Thus, oxidative phosphorylation, which couples the Krebs cycle with the electron transport chain in the mitochondria, allows living organisms to very efficiently extract energy from basic nutrients. However, as by-products of oxidative metabolism, reactive oxygen species (ROS) are produced, some of which are highly reactive free radicals that are capable of causing structural and functional damage to nearby standing molecules. Other ROS will act as signalling molecules implicated in the regulation of metabolic pathways. When the equilibrium between production of free radi...

Peripheral oxygenation and management in the perinatal period

Seminars in Fetal and Neonatal Medicine — Thu, 20 May 2010 23:00:00 +0100

Summary: The mechanisms for the adequate provision of oxygen to the peripheral tissues are complex. They involve control of the microcirculation and peripheral blood flow, the position of the oxygen dissociation curve including the proportion of fetal and adult haemoglobin, blood gases and viscosity. Systemic blood pressure appears to have little effect, at least in the non-shocked state. The adequate delivery of oxygen (DO2) depends on consumption (VO2), which is variable. The balance between VO2 and DO2 is given by fractional oxygen extraction (FOE=VO2/DO2). FOE varies from organ to organ and with levels of activity. Measurements of FOE for the whole body produce a range of about 0.15–0.33, i.e. the body consumes 15–33% of oxygen transported. (Source: Seminars in Fetal and Neonatal M...

Long term consequences of oxygen therapy in the neonatal period

Seminars in Fetal and Neonatal Medicine — Sun, 09 May 2010 23:00:00 +0100

Summary: Preterm and term infants are frequently exposed to high concentrations of oxygen for prolonged periods. In experimental models, high and prolonged oxygen exposures cause delayed alveolar septation and a bronchopulmonary dysplasia phenotype. Often, however, the oxygen exposure is tolerated in that the infants recover without severe lung or systemic injury. Multiple exposures change oxygen sensitivity in adult and newborn animals. Examples are antenatal corticosteroids, inflammatory mediators or preconditioning with oxygen, which will increase tolerance to oxygen injury. Intrauterine growth restriction or postnatal nutritional deficits will increase oxygen injury. Different infants probably have quite variable sensitivities to oxygen injury, but there are no biomarkers available to ...

Maturation of the antioxidant system and the effects on preterm birth

Seminars in Fetal and Neonatal Medicine — Sun, 09 May 2010 23:00:00 +0100

Summary: The study of the interplay of the generation of reactive oxygen and nitrogen species with their related antioxidant enzymes at the maternal–placental–fetal interfaces during normal and abnormal pregnancy is in its ‘infancy’. Our understanding of the role of antioxidant systems during fetal and neonatal development is constantly changing with research better defining the biological roles of these highly reactive species and the maintenance of optimal oxidant/antioxidant balance. The antioxidant enzyme system is upregulated during the last 15% of gestation, a timeframe when non-enzymatic antioxidants are also crossing the placenta in increasing concentrations. These developmental changes provide for the transition from the relative hypoxia of intrauterine development to the ...

Resuscitation of the term and preterm infant

Seminars in Fetal and Neonatal Medicine — Thu, 06 May 2010 23:00:00 +0100

Summary: Resuscitation is one of the most frequently performed procedures in the neonatal period. Since the most recent guidelines from the International Liaison Committee on Resuscitation (ILCOR) appeared in 2005, experimental and clinical research has introduced changes regarding the different components of the procedure, with the common denominator being the least aggressive to the baby. Babies should be kept warm, avoiding suctioning as a general rule, adjusting pressure, volume and oxygen to the minimum to achieve stabilisation without causing harm to the airways or oxidative stress, and applying all the available technology in the delivery room before transportation to the neonatal intensive care unit. The response to ventilation should primarily be assessed by the heart rate. Babies...

Monitoring oxygen saturation and heart rate in the early neonatal period

Seminars in Fetal and Neonatal Medicine — Mon, 03 May 2010 23:00:00 +0100

Summary: Pulse oximetry is commonly used to assist clinicians in assessment and management of newly born infants in the delivery room (DR). In many DRs, pulse oximetry is now the standard of care for managing high risk infants, enabling immediate and dynamic assessment of oxygenation and heart rate. However, there is little evidence that using pulse oximetry in the DR improves short and long term outcomes. We review the current literature on using pulse oximetry to measure oxygen saturation and heart rate and how to apply current evidence to management in the DR. (Source: Seminars in Fetal and Neonatal Medicine)

Hyperoxia-derived lung damage in preterm infants

Seminars in Fetal and Neonatal Medicine — Thu, 29 Apr 2010 23:00:00 +0100

Summary: Hyperoxia-induced lung injury is characterized by an influx of inflammatory cells, increased pulmonary permeability, endothelial and epithelial cell death. This review highlights the mechanistic aspects of inflammation, vascular leak and cell death. The focus will be on agents that contribute to hyperoxia-induced lung injury in developmentally appropriate animal models, and those that have been detected in human premature neonates. (Source: Seminars in Fetal and Neonatal Medicine)

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Fri, 23 Apr 2010 15:39:35 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Techniques for therapeutic hypothermia during transport and in hospital for perinatal asphyxial encephalopathy

Seminars in Fetal and Neonatal Medicine — Mon, 19 Apr 2010 23:00:00 +0100

We describe our experience of passive cooling before and during the transfer of infants with encephalopathy to cooling centres in a major city in the UK. (Source: Seminars in Fetal and Neonatal Medicine)

Ethics and hypothermia treatment

Seminars in Fetal and Neonatal Medicine — Sun, 11 Apr 2010 23:00:00 +0100

This article reviews ethical issues that arose during the design of the original clinical trials, the implications of accumulating evidence of safety and efficacy, and the problems of ensuring informed parental participation in treatment decisions. (Source: Seminars in Fetal and Neonatal Medicine)

Maternal smoking during pregnancy and regional brain volumes in preterm infants

Seminars in Fetal and Neonatal Medicine — Wed, 07 Apr 2010 23:00:00 +0100

In this study, the authors evaluate the association between maternal smoking during pregnancy and both brain volumes plus head circumference at term age in VLBW (≤1500g) and/or VLGA ( (Source: Seminars in Fetal and Neonatal Medicine)

Magnetic resonance biomarkers of neuroprotective effects in infants with hypoxic ischemic encephalopathy

Seminars in Fetal and Neonatal Medicine — Thu, 01 Apr 2010 23:00:00 +0100

Summary: Evaluation of infants with hypoxic ischemic encephalopathy by magnetic resonance spectroscopy and imaging is useful to direct clinical care, and may assist the evaluation of candidate neuroprotective therapies. Cerebral metabolites measured by magnetic resonance spectroscopy, and visual analysis of magnetic resonance images during the first 30 days after birth accurately predict later neurological outcome and are valid biomarkers of the key physiological processes underlying brain injury in neonatal hypoxic ischemic encephalopathy. Visual assessment of magnetic resonance images may also be a suitable surrogate outcome in studies of neuroprotective therapies but current magnetic resonance methods are relatively inefficient for use in early phase, first in human infant studies of no...

Systemic complications and hypothermia

Seminars in Fetal and Neonatal Medicine — Mon, 15 Mar 2010 00:00:00 +0100

Summary: Cooling for neonatal hypoxic–ischemic encephalopathy is a novel and promising neuroprotective therapy that requires significant understanding of how cooling affects all organ systems and interventions used to treat systemic complications of cooling in an intensive care setting. As cooling is used more widely and has been newly introduced in neonatal units, continued surveillance of its use in clinical practice is mandatory. Units offering cooling should strongly consider joining a registry (e.g. the Vermont–Oxford Neonatal Encephalopathy Registry in the USA or the TOBY Register in the UK) that facilitates benchmarking of short-term adverse effects and long-term outcomes of cooling and that supports local quality improvement efforts. (Source: Seminars in Fetal and Neonatal Medi...

Synergistic neuroprotective therapies with hypothermia

Seminars in Fetal and Neonatal Medicine — Mon, 08 Mar 2010 00:00:00 +0100

Summary: Neuroprotection is a major health care priority, given the enormous burden of human suffering and financial cost caused by perinatal brain damage. With the advent of hypothermia as therapy for term hypoxic–ischemic encephalopathy, there is hope for repair and protection of the brain after a profound neonatal insult. However, it is clear from the published clinical trials and animal studies that hypothermia alone will not provide complete protection or stimulate the repair that is necessary for normal neurodevelopmental outcome. This review critically discusses drugs used to treat seizures after hypoxia–ischemia in the neonate with attention to evidence of possible synergies for therapy. In addition, other agents such as xenon, N-acetylcysteine, erythropoietin, melatonin and ca...

Hypothermia: a systematic review and meta-analysis of clinical trials

Seminars in Fetal and Neonatal Medicine — Mon, 08 Mar 2010 00:00:00 +0100

Summary: Hypothermia is a potential neuroprotective intervention to treat neonatal post-asphyxial (hypoxic–ischemic) encephalopathy (HIE). In this meta-analysis of 13 clinical trials published to date, therapeutic hypothermia was associated with a highly reproducible reduction in the risk of the combined outcome of mortality or moderate-to-severe neurodevelopmental disability in childhood. This improvement was internally consistent, as shown by significant reductions in the individual risk for death, moderate-to-severe neurodevelopmental disability, severe cerebral palsy, cognitive delay, and psychomotor delay. Patients in the hypothermia group had higher incidences of arrhythmia and thrombocytopenia; however, these were not clinically important. This analysis supports the use of hypothe...

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Wed, 03 Mar 2010 16:33:41 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Increased risk of adverse neurological development for late preterm infants

Seminars in Fetal and Neonatal Medicine — Thu, 11 Feb 2010 00:00:00 +0100

In this retrospective cohort study, the authors assess the risks of late prematurity for cerebral palsy (CP), developmental delay/mental retardation (DD/MR) and seizure disorders in early childhood. Hospitalization and outpatient databases from the Northern California Kaiser Permanente Medical Care Program include 141,321 children >30 weeks born between 2000 and 2004. Presence of CP, DD/MR, and seizures is based on ICD-9 CM codes. Cox proportional hazard models are used for each of the outcomes, with crude and adjusted hazard ratios calculated for each gestational age group. The authors observe a three-fold increased risk of CP (OR 3.39; 95% CI 2.54–4.52) and significantly higher rates of DD/MR (OR 1.25; 95% CI 1.01–1.54) for late preterm infants compared with term infants. It is concl...

Chronic bilirubin encephalopathy: diagnosis and outcome

Seminars in Fetal and Neonatal Medicine — Fri, 29 Jan 2010 00:00:00 +0100

Summary: Chronic bilirubin encephalopathy (kernicterus) can be diagnosed using semi-objective criteria based on history, physical and neurological examination and laboratory findings including auditory brainstem responses and magnetic resonance imaging. Classical kernicterus is a well-described clinical tetrad of (i) abnormal motor control, movements and muscle tone, (ii) an auditory processing disturbance with or without hearing loss, (iii) oculomotor impairments, especially impairment of upward vertical gaze, and (iv) dysplasia of the enamel of deciduous teeth. Subtle kernicterus or bilirubin-induced neurologic dysfunction (BIND) refers to individuals with subtle neurodevelopmental disabilities without classical findings of kernicterus that, after careful evaluation and consideration, ap...

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Fri, 22 Jan 2010 16:24:36 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Enduring controversies in the management of hyperbilirubinemia in preterm neonates

Seminars in Fetal and Neonatal Medicine — Mon, 11 Jan 2010 00:00:00 +0100

Summary: Although it is generally believed that preterm infants are at greater risk for the development of bilirubin-associated brain damage than term infants, quantification of the magnitude of this risk has proven elusive, as has a consensus among experts on the level of total serum bilirubin at which therapy should be initiated. Two large randomized studies have been performed that shed some light on the risk hyperbilirubinemia poses for preterm neonates and both studies are reviewed. Additional study is needed to further clarify the risk posed by hyperbilirubinemia in premature neonates and to frame guidelines for phototherapy and exchange transfusion that are more evidence-based. (Source: Seminars in Fetal and Neonatal Medicine)

Screening and early postnatal management strategies to prevent hazardous hyperbilirubinemia in newborns of 35 or more weeks of gestation

Seminars in Fetal and Neonatal Medicine — Fri, 25 Dec 2009 00:00:00 +0100

Summary: Although kernicterus is a rare condition, it is still being reported in North America and Western Europe in addition to less developed parts of the world. The majority of affected infants are term and late-preterm newborns who have been discharged from the nursery as ‘healthy newborns’ yet have subsequently developed extreme hyperbilirubinemia and the classic neurodevelopmental findings associated with kernicterus. Published guidelines provide the basic tools for preventing hazardous hyperbilirubinemia and the two most important of these are a systematic assessment, prior to discharge, of each infant, for the risk of severe hyperbilirubinemia, and appropriate follow-up based on the time of discharge and the risk assessment. The most recent recommendations call for a predischar...

Exploring the genetic architecture of neonatal hyperbilirubinemia

Seminars in Fetal and Neonatal Medicine — Mon, 21 Dec 2009 00:00:00 +0100

Summary: The potential for genetic variation to modulate neonatal hyperbilirubinemia risk is increasingly being recognized. In particular, polymorphisms across three genes involved in bilirubin production and metabolism [glucose-6-phosphate dehydrogenase (G6PD), uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1), and solute carrier organic anion transporter polypeptide 1B1 (SLCO1B1)] may interact with each other and/or environmental contributors to produce significant hyperbilirubinemia. Variant gene co-expression including compound and synergistic heterozygosity enhances hyperbilirubinemia risk, contributing to the etiologic heterogeneity and complex nature of neonatal jaundice. (Source: Seminars in Fetal and Neonatal Medicine)

Seminars in fetal and neonatal medicine “continuing controversies in perinatal jaundice”

Seminars in Fetal and Neonatal Medicine — Mon, 21 Dec 2009 00:00:00 +0100

Hazardous levels of unconjugated bilirubin in human neonates pose a direct threat of brain damage. Current population-based kernicterus incidence estimates for term neonates in developed countries range from 1:30,000 to 1:100,000; although, higher rates have been reported for 1) preterm neonates and 2) newborns in developing countries where acute bilirubin encephalopathy is a serious endemic problem. Reports of kernicterus in term and late-preterm infants have increased in the United States and elsewhere since the 1980s underscoring the need for intensified research on the pathobiology of bilirubin-induced brain injury and strategies aimed at kernicterus prevention, charges echoed at the “Research on Prevention of Bilirubin-Induced Brain Injury and Kernicterus: Bench to Bedside” confer...

Metalloporphyrins in the management of neonatal hyperbilirubinemia

Seminars in Fetal and Neonatal Medicine — Mon, 14 Dec 2009 00:00:00 +0100

Summary: Neonatal jaundice in the first week of life is a common problem in newborns. It is due to an imbalance of bilirubin production and its elimination, which can lead to significantly elevated levels of circulating bilirubin or hyperbilirubinemia. Use of phototherapy and/or exchange transfusion are the current modes for treating neonatal hyperbilirubinemia and preventing any neurologic damage. These strategies, however, only remove bilirubin that has already been formed. Preventing the production of excess bilirubin may be a more logical approach. Synthetic heme analogs, metalloporphyrins, are competitive inhibitors of heme oxygenase, the rate-limiting enzyme in bilirubin production, and their use has been proposed as an attractive alternative strategy for preventing or treating sever...

Editorial

Seminars in Fetal and Neonatal Medicine — Fri, 11 Dec 2009 00:00:00 +0100

The rapid rise in obesity in young women has seen new challenges posed for the management of these women in pregnancy and for their babies. The obesity rate in young pregnant women has doubled in just over ten years in the UK bringing qualitative and quantitative increases in obesity associated with morbidities in pregnancy. The issues range from fetal problems such as miscarriage, congenital anomalies and macrosomia through to medical problems such as hypertension, diabetes, venous thromboembolism, and extend to special considerations around delivery, high operative delivery rates and particular post delivery problems including infection and difficulty breastfeeding. The complications encountered during pregnancy in turn pose particular problems for service delivery in antenatal, intrapar...

Glucose-6-phosphate dehydrogenase deficiency and severe neonatal hyperbilirubinemia: a complexity of interactions between genes and environment

Seminars in Fetal and Neonatal Medicine — Mon, 30 Nov 2009 00:00:00 +0100

Summary: Glucose-6-phosphate dehydrogenase deficiency is a commonly occurring genetic condition, likely to be encountered today in virtually any corner of the globe. Sudden episodes of hemolysis associated with the condition may result in exponential increases in serum total bilirubin concentrations to levels at which bilirubin-induced neurologic damage may occur. The hyperbilirubinemia is the result of complex interactions between genes and environment. Neonatal screening programs coupled with parental and medical caretaker education may be successful in limiting the severity of disease. (Source: Seminars in Fetal and Neonatal Medicine)

Management of maternal obesity prior to and during pregnancy

Seminars in Fetal and Neonatal Medicine — Mon, 30 Nov 2009 00:00:00 +0100

Summary: The prevalence of obesity is high and rising worldwide. The greatest prevalence of obesity is found in the western world and in urban developing countries. There is an increased maternal mortality associated with maternal obesity. There are increased risks of most maternal complications in pregnancy including pre-eclampsia, gestational and pre-existing type 2 diabetes mellitus and thromboembolic disorders. There is an increased perinatal mortality associated with maternal obesity; there are increased risks of congenital malformation, fetal macrosomia and indeed risks for the fetus as a child and adult in the years to come. There are increased risks of complications of pregnancy including caesarean section, traumatic delivery and a reduced chance of breastfeeding. Maternal obesity ...

Bovine lactoferrin supplementation for prevention of late-onset sepsis in very low-birth-weight neonates: a randomized trial

Seminars in Fetal and Neonatal Medicine — Mon, 30 Nov 2009 00:00:00 +0100

In this prospective, multi-center, double-blind, placebo controlled, randomized trial, the authors investigate whether bovine lactoferrin (BLF) can reduce the incidence of late-onset sepsis in VLBW neonates. BLF is a milk glycoprotein involved in innate immune host defenses, and may have antimicrobial and immunomodulation activities (decreasing TNF-α production), as well as promoting a mature and healthy gut. Between October 2007 and July 2008, 472 VLBW infants are randomly assigned to receive the following additive from birth until day 30 (1000 - 1500g) or day 45 (< 1000g) of life: (Source: Seminars in Fetal and Neonatal Medicine)

Hyperbilirubinemia in African American neonates: clinical issues and current challenges

Seminars in Fetal and Neonatal Medicine — Thu, 26 Nov 2009 00:00:00 +0100

Summary: African American neonates evidence a low incidence of hyperbilirubinemia yet account for more than 25% of the reported kernicterus cases in the USA. Glucose-6-phosphate dehydrogenase (G6PD) deficiency accounts for ∼60%, and late preterm gestation and ABO hemolytic disease ∼40% of these cases. Females heterozygous for G6PD A− harbor a population of G6PD-deficient red blood cells and are at risk for hyperbilirubinemia. Pre-discharge bilirubin measurement coupled with gestational age enhances the identification of neonates at hyperbilirubinemia risk. Parental education at the time of birth hospitalization discharge combined with timely follow-up may help to reduce the risk of developing hazardous hyperbilirubinemia. (Source: Seminars in Fetal and Neonatal Medicine)

Setting maternity care standards for women with obesity in pregnancy

Seminars in Fetal and Neonatal Medicine — Thu, 26 Nov 2009 00:00:00 +0100

This article describes the process used to develop standards of maternity care for women with obesity, and the resulting recommendations are presented. (Source: Seminars in Fetal and Neonatal Medicine)

Controversies in bilirubin biochemistry and their clinical relevance

Seminars in Fetal and Neonatal Medicine — Mon, 23 Nov 2009 00:00:00 +0100

Summary: Despite a century of research, several clinically relevant areas of bilirubin biochemistry remain controversial, poorly understood, or unrecognized. These include: (i) The structure and molecularity of bilirubin under physiological environments such as membranes, brain tissue and when bound to proteins. Related to this is the large number of structurally different bilirubin species that may occur in blood under pathological conditions and their potential effects on measurements of bilirubin and free bilirubin. (ii) The mechanism of phototherapy, the neurotoxicity of the photoisomers produced and their influence on measurements of bilirubin and free bilirubin. (iii) The role of membrane transporters in the passage of unconjugated bilirubin across the placenta, intestine, vascular e...

Fatty acid oxidation disorders: maternal health and neonatal outcomes

Seminars in Fetal and Neonatal Medicine — Thu, 19 Nov 2009 00:00:00 +0100

Summary: Mitochondrial fatty acid β-oxidation (FAO) disorders have become an important group of inherited metabolic disorders causing serious pediatric and maternal morbidity and mortality. More than 20 defects affecting β-oxidation have been discovered, characterized by distinct enzyme or transporter deficiencies. This growing number of FAO disorders covers a wide spectrum of phenotypes and are characterized by a wide array of clinical presentations. We discuss the major mitochondrial FAO disorders and the impact they have on maternal health and neonatal outcomes; diagnostic tools and the value of genetic screening are reviewed; and current therapeutic approaches and management strategies are discussed. (Source: Seminars in Fetal and Neonatal Medicine)

Fetal surgery is a clinical reality

Seminars in Fetal and Neonatal Medicine — Mon, 16 Nov 2009 00:00:00 +0100

Summary: An increasing number of fetal anomalies are being diagnosed prior to birth, some of them amenable to fetal surgical intervention. We discuss the current clinical status and recent advances in endoscopic and open surgical interventions. In Europe, fetoscopic interventions are widely embraced, whereas the uptake of open fetal surgery is much less. The indications for each access modality are different, hence they cannot substitute each other. Although the stage of technical experimentation is over, most interventions remain investigational. Today there is level I evidence that fetoscopic laser surgery for twin-to-twin transfusion syndrome is the preferred therapy, but this operation actually takes place on the placenta. In terms of surgery on the fetus, an increasingly frequent indi...

Obesity in pregnancy: prevalence and metabolic consequences

Seminars in Fetal and Neonatal Medicine — Mon, 09 Nov 2009 00:00:00 +0100

Summary: Rates of obesity have increased exponentially worldwide to almost epidemic proportions. This is associated with a marked increase in adverse maternal and perinatal outcomes and subsequent burden on health care resources. In particular, maternal obesity is linked to numerous metabolic complications including subfertility, gestational diabetes, hypertensive disorders of pregnancy and thromboembolism with potential long-term health consequences for both mother and child. The underlying pathophysiology linking maternal obesity and adverse outcomes is complex but is likely to involve alterations in glucose and lipid metabolism, inflammation, perturbances in adipokines and vascular dysfunction all seen in obese women. Intervention studies are underway to determine whether alteration of ...

Obstetric management of obesity in pregnancy

Seminars in Fetal and Neonatal Medicine — Mon, 02 Nov 2009 00:00:00 +0100

Summary: Rates of obesity among the pregnant population have increased substantially and adiposity has a damaging effect on every aspect of female reproductive life. This review summarises epidemiological data concerning obesity-related complications of pregnancy. Obesity is linked to a number of adverse obstetric outcomes as well as increased maternal and neonatal morbidity and mortality. These complications include miscarriage, congenital abnormalities, pre-eclampsia, gestational diabetes mellitus, iatrogenic preterm delivery, postdates pregnancy with increased rates of induction of labour, caesarean section, postpartum haemorrhage, shoulder dystocia, infection, venous thromboembolism, and increased hospital stay. It is important to consider obese pregnant women as a high risk group with...

Management of prenatally diagnosed congenital diaphragmatic hernia

Seminars in Fetal and Neonatal Medicine — Mon, 02 Nov 2009 00:00:00 +0100

Summary: Congenital diaphragmatic hernia (CDH) is a congenital anomaly that presents with a broad spectrum of severity dependent upon components of pulmonary hypoplasia and pulmonary hypertension. While advances in neonatal care have improved the overall survival of CDH in experienced centers, mortality and morbidity remain high in a subset of CDH infants with severe CDH. The most important prenatal predictor of outcome in left-sided CDH is liver position. More precise and reproducible prenatal predictive parameters need to be developed to allow standardization of results between centers and appropriate design of clinical trials in CDH. Thus far, all randomized trials comparing prenatal intervention to standard postnatal therapy have shown no benefit to prenatal intervention. Although rece...

Obesity and gestational diabetes

Seminars in Fetal and Neonatal Medicine — Fri, 30 Oct 2009 00:00:00 +0100

Summary: The prevalence of both obesity and gestational diabetes mellitus (GDM) is increasing worldwide. GDM affects about 7% of all pregnancies and is defined as any degree of impaired glucose tolerance during gestation. The presence of obesity has a significant impact on both maternal and fetal complications associated with GDM. These complications can be addressed, at least in part, by good glycaemic control during pregnancy. The significance and impact of obesity in women with GDM are discussed in this article, together with treatment options, the need for long-term risk modification and postpartum follow-up. (Source: Seminars in Fetal and Neonatal Medicine)

Author and keyword index

Seminars in Fetal and Neonatal Medicine — Mon, 26 Oct 2009 16:31:50 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Mon, 26 Oct 2009 16:31:49 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Effects of maternal obesity on fetal growth and body composition: implications for programming and future health

Seminars in Fetal and Neonatal Medicine — Mon, 26 Oct 2009 00:00:00 +0100

Summary: Since the hypothesis linking low birth weight and poor fetal growth with future risk of cardiovascular disease was first proposed, there has been much interest in the early origins of disease. As rates of obesity increase and as maternal obesity has become common, interest has been directed towards the early origins of obesity. It is likely that a complex interaction of inherited gene effects and in-utero environment may interact in the developing fetus to programme pathways leading to future obesity. It is clear that maternal metabolism is disturbed in pregnancy in obese women, and that offspring of obese mothers have a higher percentage of body fat and are insulin resistant. This review discusses the ideas contributing to the current working concept of obesity programming, and d...

Maternal obesity: consequences for children, challenges for clinicians and carers

Seminars in Fetal and Neonatal Medicine — Thu, 15 Oct 2009 00:00:00 +0100

Summary: In many industrialised countries almost one in five pregnant women is obese. Maternal obesity has major implications for the fetus and newborn infants, and may have adverse consequences for lifelong health and well-being. We discuss the current epidemiological evidence for the association of maternal obesity with congenital structural neural tube and cardiac defects, fetal macrosomia that predisposes infants to birth injuries and to problems with physiological and metabolic transition, as well as potential for long-term effects secondary to prenatal and neonatal programming effects compounded by a reduction in sustained breastfeeding. We summarise the evidence for the effect of maternal weight management interventions on fetal and neonatal outcomes and discuss areas where further ...

Obesity in pregnancy: outcomes and economics

Seminars in Fetal and Neonatal Medicine — Mon, 12 Oct 2009 00:00:00 +0100

Summary: Maternal obesity is an important aspect of reproductive care. It is the commonest risk factor for maternal mortality in developed countries and is also associated with a wide spectrum of adverse pregnancy outcomes. Maternal obesity may have longer-term implications for the health of the mother and infant, which in turn will have economic implications. Efforts to prevent, manage and treat obesity in pregnancy will be costly, but may pay dividends from reduced future economic costs, and subsequent improvements to maternal and infant health. Decision-makers working in this area of health services should understand whether the problem can be reduced, at what cost; and then, what cost savings and health benefits will accrue in the future from a reduction of the problem. (Source: Semina...

Epidemiology of bronchopulmonary dysplasia

Seminars in Fetal and Neonatal Medicine — Mon, 28 Sep 2009 00:00:00 +0100

Summary: First described more than 40 years ago, bronchopulmonary dysplasia (BPD) remains one of the most serious and vexing challenges in the care of very preterm infants. Affecting approximately one-quarter of infants born (Source: Seminars in Fetal and Neonatal Medicine)

Prologue: Advances in Bronchopulmonary Dysplasia

Seminars in Fetal and Neonatal Medicine — Fri, 25 Sep 2009 00:00:00 +0100

It has been 42 years since our first published report of bronchopulmonary dysplasia (BPD); it is still a problem for premature infants. The original goal of using mechanical ventilation to treat premature infants with respiratory distress syndrome and respiratory failure was to decrease the significant mortality. During the ensuing decades, a decrease in mortality has indeed occurred. Once recognized, it was hoped that a reduction of supplemental oxygen concentrations and ventilatory pressure would eliminate or decrease the incidence of BPD. This has, for the most part, been achieved in the 33 week gestational age infants originally described. Advances in neonatal care and respiratory therapy since 1967 have resulted in the successful ventilation of increasingly more immature infants. As a...

Long-term outcomes of bronchopulmonary dysplasia

Seminars in Fetal and Neonatal Medicine — Tue, 22 Sep 2009 00:00:00 +0100

Summary: As more very preterm infants survive, more survivors will have bronchopulmonary dysplasia (BPD). Children with BPD have higher rates of cognitive, educational and behavioural impairments, and also reduced lung function, through childhood and into early life than would normally be expected. The importance of these neurological and respiratory problems later into adult life needs to be determined. (Source: Seminars in Fetal and Neonatal Medicine)

Ventilatory management and bronchopulmonary dysplasia in preterm infants

Seminars in Fetal and Neonatal Medicine — Fri, 18 Sep 2009 00:00:00 +0100

Summary: Improvements in antenatal and neonatal care have resulted in increased survival of very preterm infants. However, the incidence of bronchopulmonary dysplasia (BPD) has not changed, probably as a consequence of a demographic shift. The underlying pathophysiology of BPD appears to differ for the current population of preterm infants compared to that described by Northway et al., and management strategies should be targeted to limit ventilator-induced lung injury. Non-invasive respiratory support techniques are currently under evaluation, but results of the trials have thus far failed to show a reduction in BPD. This review will focus upon various ventilation modalities for preventing and managing bronchopulmonary dysplasia. (Source: Seminars in Fetal and Neonatal Medicine)

Announcement: The Organizing Committee of the Global Congress of Maternal and infant health (Barcelona, September 22-26, 2010)

Seminars in Fetal and Neonatal Medicine — Fri, 11 Sep 2009 17:58:07 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Editorial

Seminars in Fetal and Neonatal Medicine — Fri, 11 Sep 2009 17:58:06 +0100

The current decade represents a period of renewed and intense interest in focal brain lesions of the newborn. Therefore it is timely and appropriate to compile a series of papers on Perinatal Stroke into an issue of SFNM. The editors' intent has been to provide practical reviews on the major topics of interest in perinatal stroke to inform the practicing neonatologist, paediatric radiologist and even the obstetrician. (Source: Seminars in Fetal and Neonatal Medicine)

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Fri, 11 Sep 2009 17:58:06 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Drug therapies in bronchopulmonary dysplasia: debunking the myths

Seminars in Fetal and Neonatal Medicine — Fri, 11 Sep 2009 00:00:00 +0100

Summary: Bronchopulmonary dysplasia (BPD), also known as chronic lung disease (CLD), is one of the most challenging complications in premature infants. The incidence of BPD has been increasing over the past two decades in parallel with an improvement in the survival of this population. Furthermore, the clinical characteristics and the natural history of infants affected by BPD have changed considerably, and newer definitions to clarify the term ‘BPD’ have also evolved since its first description more than four decades ago. Several drug therapies have also evolved, either to manage these infants' respiratory distress syndrome with an aim to prevent BPD or to manage the established condition. Although there is good evidence to support the ‘routine’ use of some therapies, many other t...

The ‘new’ bronchopulmonary dysplasia: challenges and commentary

Seminars in Fetal and Neonatal Medicine — Fri, 11 Sep 2009 00:00:00 +0100

Summary: Lung development is orchestrated by highly integrated morphogenic programs of interrelated patterns of gene and protein expression. Injury to the developing lung in the canalicular and saccular phases of lung development alters subsequent alveolar and vascular development resulting in simplified alveolar structures, dysmorphic capillary configuration, variable interstitial cellularity and fibroproliferation that are characteristic of the ‘new’ bronchopulmonary dysplasia (BPD). Fetal and neonatal infection, abnormal stretch of the developing airways and alveoli, altered expression of surfactant proteins (or genetically altered proteins), polymorphisms of genes encoding for vascular endothelial growth factors, and reactive oxygen species result in imparied gas exchange in the de...

End of life decisions in chronic lung disease

Seminars in Fetal and Neonatal Medicine — Mon, 07 Sep 2009 00:00:00 +0100

Summary: Staff may be reluctant to discuss end of life decisions in chronic lung disease (CLD) as it is usual for the disease to take a prolonged course and most infants recover to be discharged home without supplemental oxygen. A minority suffer a protracted and very severe illness in spite of treatments. Further intensive care may prolong a distressing death rather than offer any hope of survival. An end of life decision may be made after discussions with parents. Assisted ventilation may be withdrawn, or care redirected to withhold further episodes of assisted ventilation. A lingering death is a risk in infants who have not yet reached the point of dying but whose care has been redirected. Tachypnoea, rib retractions and agitation are distressing for the infant and parents. Palliative c...

Prevention of bronchopulmonary dysplasia

Seminars in Fetal and Neonatal Medicine — Mon, 07 Sep 2009 00:00:00 +0100

Summary: Considerable effort has been devoted to the development of strategies to reduce the incidence of bronchopulmonary dysplasia (BPD), including use of medications, nutritional therapies, and respiratory care practices. Unfortunately, most of these strategies have not been successful. To date, the only two treatments developed specifically to prevent BPD whose efficacy is supported by evidence from randomized, controlled trials are the parenteral administration of vitamin A and corticosteroids. Two other therapies, the use of caffeine for the treatment of apnea of prematurity and aggressive phototherapy for the treatment of hyperbilirubinemia, were evaluated for the improvement of other outcomes and found to reduce BPD. Cohort studies suggest that the use of continuous positive airway...

Prenatal factors in the development of chronic lung disease

Seminars in Fetal and Neonatal Medicine — Mon, 07 Sep 2009 00:00:00 +0100

Summary: Chronic lung disease (CLD), defined as chronic oxygen dependency, is a common outcome of neonatal intensive care. It occurs most frequently in infants born very prematurely, but also in infants born at term who had severe lung disease and those with abnormal antenatal lung growth due particularly to reduction in fetal breathing movements, amniotic fluid volume or intrathoracic space. There are, however, other causes and the importance of antenatal infection/inflammation regarding impairment of antenatal lung growth is increasingly recognised. Affected infants can suffer chronic respiratory morbidity including an excess of respiratory symptoms and lung function abnormalities even in adulthood. Antenatal interventions directed at improving lung growth are available, but require test...

Editorial

Seminars in Fetal and Neonatal Medicine — Mon, 07 Sep 2009 00:00:00 +0100

Despite the myriad of advances in neonatal intensive care in the more than 40 years since Prof. Northway and colleagues first coined the term “bronchopulmonary dysplasia” to describe the aftermath of neonatal mechanical ventilation, the incidence of chronic lung disease has not appreciably changed. Approximately 30–40% of infants weighing less than 1500g at birth sustain chronic lung disease, even with the advent of antenatal corticosteroid treatment, surfactant replacement therapy, and sophisticated techniques for both non-invasive and invasive mechanical ventilation. What has changed, however, is the demographic composition of affected infants, many of whom received only mild or modest respiratory support, suggesting that chronic lung disease may now reflect an alteration in lung d...