Seminars in Fetal and Neonatal Medicine via MedWorm.com

Title Page/Aims and Scope/Editorial Board

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

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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...

Title Page/Aims and Scope/Editorial Board

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

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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...

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)

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)

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

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Title Page/Aims and Scope/Editorial Board

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

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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

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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

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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...

Corrigendum to: “Normal and abnormal maternal metabolism during pregnancy” [Seminars in Fetal & Neonatal Medicine 14 (2009) 66–71]

Seminars in Fetal and Neonatal Medicine — Wed, 26 Aug 2009 00:00:00 +0100

It has been brought to the authors' attention that there was an error in figure 4 of this published paper. The correct version of figure 4 is reproduced below. (Source: Seminars in Fetal and Neonatal Medicine)

Chronic lung disease of prematurity: A short history

Seminars in Fetal and Neonatal Medicine — Fri, 21 Aug 2009 00:00:00 +0100

Summary: Chronic lung disease of prematurity (CLD) is commonly considered to be a consequence of assisted ventilation. However, prior to the description in 1967 of bronchopulmonary dysplasia (BPD), following ventilator therapy for respiratory distress syndrome, Wilson–Mikity syndrome (WMS) had been described in very preterm infants on minimal oxygen supplementation. In the 1970s and 1980s, many infants treated with assisted ventilation required prolonged mechanical ventilation after developing radiographic features of coarse infiltrates, severe hyperinflation, and microcystic changes, associated with hypercarbemia and the need for increased inspired oxygen concentrations. Some infants died and showed evidence of pulmonary fibrosis, obstructive bronchiolitis, and dysplastic change. The ro...

Neonatal cerebral sinovenous thrombosis

Seminars in Fetal and Neonatal Medicine — Thu, 20 Aug 2009 23:00:00 +0100

Summary: Cerebral sinovenous thrombosis (CSVT) is an uncommon condition among paediatric patients involving major sinuses, with a preponderant occurrence in neonates. The clinical presentation is unspecific, either early, within 48h from birth, or later. An early presentation may be accompanied by several comorbidities (respiratory distress, poor tone, fetal distress, asphyxia), whereas a later presentation is more often associated with conventional neurological signs such as seizures, lethargy, apnoea and poor feeding. These differences in clinical presentation render the neuroradiological diagnosis difficult, in particular before the introduction of magnetic resonance imaging. The interest in CSVT is based on the complex pathogenesis, often resulting from a combination of inherited and a...

Ex-utero intrapartum therapy

Seminars in Fetal and Neonatal Medicine — Mon, 17 Aug 2009 00:00:00 +0100

Summary: The ex-utero intrapartum therapy (EXIT) procedure was designed to secure the airway at delivery in fetuses who had undergone tracheal occlusion for severe congenital diaphragmatic hernia. The EXIT was then adapted for deliveries where the airway may be difficult to secure, such as large neck masses or congenital high airway obstruction. Subsequently, use of EXIT has been extended to fetal anomalies where resuscitation may be compromised, including large thoracic masses, severe congenital diaphragmatic hernia, or pulmonary agenesis. The key to EXIT is preservation of uteroplacental blood flow and gas exchange, using inhalational agents to provide uterine relaxation, and maintenance of uterine volume by amnioinfusion and only partial exposure of the fetus. This provides time for pro...

Diagnostic management of neonatal stroke

Seminars in Fetal and Neonatal Medicine — Sun, 16 Aug 2009 23:00:00 +0100

Summary: In this paper the clinical presentation of neonatal arterial ischaemic stroke (NAIS) and neonatal cerebral sinovenous thrombosis (NCSVT) is briefly summarised; then a structured hierarchical diagnostic flow is proposed to discern clinical phenotypes underlying neonatal (ischaemic as well as haemorrhagic) stroke. The diagnostic flow proposed following clinical detection or chance imaging finding is an initial step towards standardisation of the mechanisms leading to stroke. For NAIS the sequence is: infection, trauma, embolism, arteriopathy, other, primary thrombosis and unclassified; for NCSVT the sequence is: infection, trauma, venopathy, other, primary thrombosis and unclassified. Such standardisation should guide attempts at prevention and treatment. The analysis of a retrospec...

Sonographic stroke templates

Seminars in Fetal and Neonatal Medicine — Sun, 16 Aug 2009 23:00:00 +0100

Summary: This chapter provides arterial and venous stroke templates, designed with neonatal brain ultrasound as the viewpoint and adult stroke templates as the basis. Images change with maturation of the stages of infarction: swelling, necrosis, organisation and tissue loss. Adult templates permit recognition of well-delineated stroke types observed in the newborn brain. All circle of Willis arteries can be involved, as can their perforator branches. Middle cerebral artery (MCA) truncal stroke (anterior or posterior) is an important entity, with different prognosis than complete MCA stroke. Knowledge of these templates also aids in the definition of combinations of infarction (e.g. internal carotid artery stroke or pial plus perforator stroke) and of interarterial watershed injury. Venous ...

Neonatal arterial ischaemic stroke: obstetric issues

Seminars in Fetal and Neonatal Medicine — Sun, 16 Aug 2009 23:00:00 +0100

Summary: Perinatal arterial ischaemic stroke (PAIS) is increasingly recognised as an important cause of neurological morbidity in children. The aetiology remains unclear although perinatal risk factors have been identified from limited case series. Risk factors for PAIS in term infants are different from those in preterm infants. Maternal primiparity, infertility, cocaine use, prothrombotic disorders, prolonged rupture of membranes, abnormal cardiotocograph, instrumental deliveries and emergency caesarean sections are reported risk factors in term infants. Uncomplicated vaginal delivery and prelabour caesarean section are uncommon in cases of PAIS. The presence of multiple risk factors increases the odds of developing PAIS. For preterm babies, fetal heart abnormalities, twin–twin transfu...

Etiology and treatment of perinatal stroke; a role for prothrombotic coagulation factors?

Seminars in Fetal and Neonatal Medicine — Sun, 09 Aug 2009 23:00:00 +0100

This article is an overview of studies of prothrombotic risk factors in both neonatal arterial ischemic stroke and cerebral sinovenous thrombosis. Although prothrombotic coagulation factors are present in more than half of the cases, we conclude that they most likely play a minor role in the pathogenesis of perinatal stroke. Current therapeutic guidelines focusing on thrombosis are based on expert opinion and recommend low molecular weight or unfractionated heparin for cardioembolic arterial ischemic stroke, antiplatelet or anticoagulant therapy for recurrent arterial ischemic stroke, and low molecular weight heparin or unfractionated heparin for sinovenous thrombosis without hemorrhage and/or when extension of the thrombotic process occurs. (Source: Seminars in Fetal and Neonatal Medicine...

Prenatal stroke

Seminars in Fetal and Neonatal Medicine — Sun, 09 Aug 2009 23:00:00 +0100

We describe established prenatal stroke in subgroups similar to postnatal stroke: arterial (forebrain or hindbrain) infarction, venous thrombosis, primary lobar haemorrhage. This longitudinal classification should facilitate the study of risk factors and mechanisms. Forebrain lesions of arterial type present as porencephaly, (hemi)hydranencephaly, multicystic encephalopathy or schizencephaly. Venous prenatal forebrain stroke presents as simple porencephaly (in some of genetic nature) and sinus thrombosis. A list of rare porencephaly-like conditions is added for differentiation from arterial and venous porencephaly. Hindbrain infarctions (so far the only reported variants seem to be of arterial nature) present as brainstem disconnection, focal brainstem destruction, uni- or bilateral cerebe...

Epidemiology and classification of perinatal stroke

Seminars in Fetal and Neonatal Medicine — Thu, 06 Aug 2009 23:00:00 +0100

Summary: Stroke is an important cause of mortality and chronic morbidity in infants and children. Case definitions for perinatal stroke have varied among studies by clinical and laboratory criteria. A recent US National Institutes of Health workshop on perinatal stroke provided consensus recommendations on the definition and classification of perinatal stroke. The incidence of perinatal stroke has been estimated at 1 in 1600 to 5000 births. The clinical presentation of perinatal stroke depends on the time of diagnosis, acute or delayed, but most will present with seizures. Risk factors for perinatal stroke have not been well studied. Several maternal and neonatal disorders have been reported in infants with perinatal stroke. Children who suffer perinatal stroke typically develop long-term ...

Preterm arterial ischemic stroke

Seminars in Fetal and Neonatal Medicine — Tue, 04 Aug 2009 23:00:00 +0100

Summary: Most studies about perinatal arterial ischemic stroke (PAIS) exclude preterm infants. In a prospectively studied hospital-based population, 42% of our 73 newborn infants with PAIS had a gestational age (GA) ≤36 weeks. PAIS was present on the left in 61% of the preterm infants and bilateral in 7%. The middle cerebral artery (MCA) was most often affected. Involvement of the lenticulostriate branches was common among preterm infants with GA of 28–32 weeks, and involvement of the MCA main branch was seen in almost all with a GA>33 weeks. Twin-to-twin transfusion syndrome, fetal heart rate abnormality and hypoglycemia were independent risk factors. No maternal risk factors could be identified.Comparing neurodevelopmental outcome, infants with a main branch MCA infarct, irrespective...

Resuscitation at birth and cognition at 8 years of age: a cohort study

Seminars in Fetal and Neonatal Medicine — Sun, 02 Aug 2009 23:00:00 +0100

The authors aim to determine whether infants receiving resuscitation after birth, in the absence of symptoms of hypoxic ischaemic encephalopathy (HIE), demonstrate a reduced intelligence quotient (IQ) score in childhood. Three groups of infants born ≥36 weeks' gestation are selected from the Avon Longitudinal Study of Parents and Children (ALSPAC, UK): (Source: Seminars in Fetal and Neonatal Medicine)

Outcomes of perinatal arterial ischemic stroke and cerebral sinovenous thrombosis

Seminars in Fetal and Neonatal Medicine — Sun, 02 Aug 2009 23:00:00 +0100

Summary: Perinatal stroke can result in cerebral palsy, cognitive impairment, epilepsy, and sensory deficits. While some children only experience one type of disability, severe disabilities often cluster together. Death associated with perinatal stroke is rare, and often associated with other comorbidities. Clinical and radiographic factors can help predict outcome, but additional as-yet unknown factors appear to contribute to outcome as well. Rehabilitation can ameliorate deficits, and advances in rehabilitation technology and in adult stroke rehabilitation offer promise to pediatric perinatal stroke patients. (Source: Seminars in Fetal and Neonatal Medicine)

Magnetic resonance imaging in neonatal stroke

Seminars in Fetal and Neonatal Medicine — Sun, 26 Jul 2009 23:00:00 +0100

Summary: Neonatal stroke occurs in 1 in 2300–5000 live births, the incidence of which is lower than that in adults, but still higher than that in childhood. The higher incidence of perinatal stroke in preterm and term infants compared to stroke in childhood may be partly explained by higher detection rates using routine fetal ultrasound and postnatal cranial sonography. In addition, there is greater availability of magnetic resonance imaging (MRI) for neuroimaging in preterm and full-term infants, which is due in part to the availability of MR-compatible incubators and MR systems at or near the neonatal intensive care unit. In addition, the wide range of MR techniques, such as T2-, diffusion- and susceptibility-weighted imaging allows improved visualization and quantification of neonatal...

Fetal thoracic and bladder shunts

Seminars in Fetal and Neonatal Medicine — Tue, 14 Jul 2009 00:00:00 +0100

Summary: Congenital obstructive lesions involving the bladder and the lung can lead to serious complications for the newborn. The in-utero placement of a diverting shunt in the fetal bladder or thoracic cavity can decrease the morbidity and mortality associated with these obstructive conditions. This review focuses on the indications for prenatal evaluation, technique, and outcomes for those fetuses with a lower urinary tract obstruction, congenital pleural effusion or macrocystic congenital cystic adenomatoid malformation after placement of a vesicoamniotic or thoracoamniotic shunt. (Source: Seminars in Fetal and Neonatal Medicine)

The North American Fetal Therapy Network (NAFTNet): a new approach to collaborative research in fetal diagnosis and therapy

Seminars in Fetal and Neonatal Medicine — Fri, 26 Jun 2009 00:00:00 +0100

Summary: In August 2004, the National Institutes of Health organized a ‘Workshop on Fetal Therapy’ to develop a plan for the maternal–fetal, surgical, and neonatal evaluation and treatment of pregnancies that might benefit from in-utero therapy. At the completion of the workshop several recommendations were made, foremost of which was the ‘formation of a cooperative group of clinical investigators to help set a national agenda for research and clinical progress in the field of fetal therapy’. Somewhat by coincidence, a multidisciplinary ‘Fetal Therapy Working Group’ that had been formed earlier in the year was well-positioned to accept this national mandate and proposed development of a North American Fetal Therapy Network (NAFTNet) to foster collaborative research between ac...

Title Page/Aims and Scope/Editorial Board

Seminars in Fetal and Neonatal Medicine — Thu, 25 Jun 2009 08:51:21 +0100

(Source: Seminars in Fetal and Neonatal Medicine)

Stem cell and genetic therapies for the fetus

Seminars in Fetal and Neonatal Medicine — Mon, 22 Jun 2009 00:00:00 +0100

Summary: Advances in prenatal diagnosis have led to the prenatal management of a variety of congenital diseases. Although prenatal stem cell and gene therapy await clinical application, they offer tremendous potential for the treatment of many genetic disorders. Normal developmental events in the fetus offer unique biologic advantages for the engraftment of hematopoietic stem cells and efficient gene transfer that are not present after birth. Although barriers to hematopoietic stem cell engraftment exist, progress has been made and preclinical studies are now underway for strategies based on prenatal tolerance induction to facilitate postnatal cellular transplantation. Similarly, in-utero gene therapy shows experimental promise for a host of diseases and proof-in-principle has been demonst...

Anesthesia for fetal surgery

Seminars in Fetal and Neonatal Medicine — Mon, 22 Jun 2009 00:00:00 +0100

Summary: Fetal surgery pushes the limits of knowledge and therapy beyond conventional paradigms by treating the developing fetus as a patient. Providing anesthesia for fetal surgery is challenging for many reasons. It requires integration of both obstetric and pediatric anesthesia practice. Two patients must be anesthetized for the benefit of one, and there is little margin for error. Many disciplines are involved, and communication must be effective. Conducting anesthetic research with vulnerable populations, such as pregnant women and their fetuses, is difficult, and many questions remain unanswered. Work must be done in the study of possible neurotoxicity caused by exposure of developing brain to anesthetic agents. The effects of stress on the developing fetus must also be further exami...

Twin-to-twin transfusion syndrome: current understanding of pathophysiology, in-utero therapy and impact for future development

Seminars in Fetal and Neonatal Medicine — Fri, 19 Jun 2009 00:00:00 +0100

Summary: Whereas monochorionic twins account for only 30% of twin gestations, they contribute to a disproportionate extent to the overall twin perinatal morbidity and mortality. Twin-to-twin transfusion syndrome can occur at any point in a monochorionic gestation but is associated with significant increases in both morbidity and mortality when it develops before 26 weeks of gestation. It is still not possible to predict accurately those pregnancies that will be affected. This has resulted in the practice of routine ultrasound surveillance beginning at the end of the first trimester. Our understanding of the physiology still has many gaps but there is an increased recognition of the heterogeneity that exists especially in the early stages of the disease. The role of the cardiovascular respo...

Fetal myelomeningocele: Natural history, pathophysiology, and in-utero intervention

Seminars in Fetal and Neonatal Medicine — Fri, 19 Jun 2009 00:00:00 +0100

Summary: Myelomeningocele (MMC) is a common birth defect that is associated with significant lifelong morbidity. Little progress has been made in the postnatal surgical management of the child with spina bifida. Postnatal surgery is aimed at covering the exposed spinal cord, preventing infection, and treating hydrocephalus with a ventricular shunt. In-utero repair of open spina bifida is now performed in selected patients and presents an additional therapeutic alternative for expectant mothers carrying a fetus with MMC. It is estimated that about 400 fetal operations have now been performed for MMC worldwide. Despite this large experience, the technique remains of unproven benefit. Preliminary results suggest that fetal surgery results in reversal of hindbrain herniation (the Chiari II mal...

Open fetal surgery for life-threatening fetal anomalies

Seminars in Fetal and Neonatal Medicine — Fri, 19 Jun 2009 00:00:00 +0100

Summary: After more than two decades of experimental and clinical work, fetal surgery is an accepted treatment option for highly selected fetuses with life-threatening anomalies. Fetal lung masses associated with hydrops are usually fatal. These lesions can be resected in utero if they are predominantly solid or multicystic. Fetal sacrococcygeal teratoma complicated with progressive high output cardiac failure may benefit from in-utero resection of the tumor. Important lessons have been learned about perioperative management and maternal, fetal, and neonatal outcomes after open fetal surgery. (Source: Seminars in Fetal and Neonatal Medicine)

Lessons from the current literature

Seminars in Fetal and Neonatal Medicine — Tue, 28 Apr 2009 23:00:00 +0100

The authors aim to identify clinical predictors of progressive white matter (WM) injury, through evaluation of 133 infants born (Source: Seminars in Fetal and Neonatal Medicine)

Fetal and neonatal infection

Seminars in Fetal and Neonatal Medicine — Wed, 15 Apr 2009 23:00:00 +0100

Great efforts are made to optimize the care of pregnant women and to protect fetuses and newborn infants from acquiring vertically transmitted infections. Progress in the field makes continuous updating of the information to physicians, midwives and parents important. The field of perinatal infections is, however, diverse with wide variation in the spectrum between different regions of the world. It's obvious that all pathogens and aspects of this field cannot be covered. The now presented issue may be seen as an independent follow-up of Congenital and Opportunistic infections published in Seminars in Fetal & Neonatal Medicine in May 2007, and the reviews represent overviews of some important organisms responsible for perinatal morbidity and mortality. The authors are all experts in their ...

Bacterial vaginosis: A problematic infection from both a perinatal and neonatal perspective

Seminars in Fetal and Neonatal Medicine — Sun, 12 Apr 2009 23:00:00 +0100

Summary: Bacterial vaginosis (BV) infections are common in women of reproductive age and are easily diagnosed and treatable. Aside from being an annoyance when symptoms of discharge, odor, and pruritus occur in the gravid female, BV infections increase risk of late miscarriage, preterm labor, preterm premature rupture of membranes, and, consequently, preterm delivery. Antepartum and puerperal issues such as chorioamnionitis and endometritis are increased in the context of maternal BV. Moreover, the morbidities and mortality of preterm delivery are consequently increased as a result of BV during pregnancy. Although the pathology associated with BV appears to result from inflammation, more investigation is needed in terms of designing guidelines for appropriate screening and treatment for th...

Tuberculosis and tuberculosis/HIV co-infection in pregnancy

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

Summary: Both tuberculosis (TB) and human immunodeficiency virus (HIV) affect women aged 15–29 years. This is the prime childbearing age group with an increasing mortality due to HIV. The key to the prevention of neonatal TB among these women is early recognition of TB, based primarily on maternal history and relevant investigations of the mother and newborn. There are World Health Organization (WHO) guidelines for maternal prophylaxis and therapy and prophylaxis to the newborn on the stage of the maternal disease. In HIV-infected women, CD4 counts should be monitored urgently as a guide to antiretroviral (ARV) prophylaxis. When the CD4 count is (Source: Seminars in Fetal and Neonatal Medicine)

Enterovirus infections in neonates

Seminars in Fetal and Neonatal Medicine — Fri, 20 Mar 2009 00:00:00 +0100

Summary: Enteroviruses, which include echoviruses, coxsackie A and B viruses, polioviruses and the ‘numbered’ enteroviruses, are among the most common viruses causing disease in humans. A large proportion of enteroviral infections occur in neonates and infants. There is a wide spectrum of clinical manifestations that can be caused by enterovirus infection with varying degrees of severity. In the neonatal age group, enteroviral infections are associated with significant morbidity and mortality, particularly when infection occurs antenatally. This review provides a detailed overview of the epidemiology and clinical features of enterovirus infections in the neonatal period. In addition, laboratory features and diagnostic investigations are discussed. A review of the currently available da...

Infection and stillbirth

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

Summary: Infection may cause stillbirth by several mechanisms, including direct infection, placental damage, and severe maternal illness. Various organisms have been associated with stillbirth, including many bacteria, viruses, and protozoa. In developed countries, between 10% and 25% of stillbirths may be caused by an infection, whereas in developing countries, which have much higher stillbirth rates, the contribution of infection is much greater. In developed countries, ascending bacterial infection, both before and after membrane rupture, with organisms such as Escherichia coli, group B streptococci, and Ureaplasma urealyticum is usually the most common infectious cause of stillbirth. However, in areas where syphilis is prevalent, up to half of all stillbirths may be caused by this infe...

Listeriosis

Seminars in Fetal and Neonatal Medicine — Tue, 24 Feb 2009 00:00:00 +0100

Summary: Listeria monocytogenes, a small, facultative anaerobic, Gram-positive motile bacillus, is an important cause of foodborne illness which disproportionately affects pregnant women and their newborns. Listeria infects many types of animals and contaminates numerous foods including vegetables, milk, chicken and beef. This organism has a unique proclivity to infect the fetoplacental unit with the ability to invade cells, multiply intracellularly and be transmitted cell-to-cell. The organism possesses several virulence factors, including internalin A and internalin B, which facilitate the direct invasion of cells. Cell-to-cell transmission is promoted by the bacterial surface protein ActA which is regulated by a transcriptional activator known as positive regulatory factor A. Both innat...

Parvovirus B19 infection

Seminars in Fetal and Neonatal Medicine — Tue, 24 Feb 2009 00:00:00 +0100

Summary: Human parvovirus B19 (B19) is common in society. Among adults, more than 50% have contracted the infection and immunity is believed to last lifelong. Infection occurs in a few percent of pregnancies, and albeit rare it can then cause fetal anemia, non-immune fetal hydrops and fetal death. Among cases with fetal demise, B19 is found in significant numbers, especially in the second and third trimesters of pregnancy. There is no specific treatment or prophylaxis available against B19 infection, but counseling of non-immune mothers and active monitoring of confirmed maternal infections with intervention to correct fetal anemia is likely to decrease mortality. Passive immunization also has potential to resolve fetal complications, but needs further study. (Source: Seminars in Fetal and...

Neonatal herpes simplex virus infection

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

Summary: Herpes simplex virus (HSV) infection in the neonate is a rare event with severe consequences for the child even if adequately treated with antiviral drugs. Mothers with primary genital herpes infections late in pregnancy or at delivery have a high risk of transferring the infection to the child, while the risk of transfer in mothers with recurrent genital infections is only a few percent. Neonatal herpes localized in skin-eye-mouth has no mortality and morbidity after antiviral treatment. In neonatal disseminated and central nervous system disease, early treatment is a predictor for better outcome. The morbidity in survivors is high; after herpes encephalitis, only one-third of children have normal development. While awaiting vaccines or reliable predictors for prevention of neona...

Congenital and opportunistic infections: Ureaplasma species and Mycoplasma hominis

Seminars in Fetal and Neonatal Medicine — Wed, 24 Dec 2008 00:00:00 +0100

Summary: There is strong evidence from clinical and experimental animal studies that ureaplasmas can invade the amnionic sac and induce an inflammatory response resulting in chorioamnionitis, preterm labor and neonatal lung injury. The ability of Ureaplasma spp. and Mycoplasma hominis to cause pneumonia, bacteremia, and meningitis in newborns can no longer be questioned. The association of Ureaplasma spp. with bronchopulmonary dysplasia has been supported by the majority of observational studies, but proof of causality is still lacking. The availability of molecular diagnostic technologies has enabled the designation of the two Ureaplasma biovars as individual species, but additional work must be done to establish whether there is differential pathogenicity between the Ureaplasma spp. or a...

Varicella in the fetus and newborn

Seminars in Fetal and Neonatal Medicine — Mon, 22 Dec 2008 00:00:00 +0100

Summary: Varicella (chickenpox) in pregnancy is unusual because most women of childbearing age are immune. It can, however, cause significant morbidity for the pregnant woman and in rare cases cause congenital varicella syndrome. The incidence of congenital varicella syndrome after maternal varicella during the first two trimesters is (Source: Seminars in Fetal and Neonatal Medicine)