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Meconium
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Meike Schuster, Justin S. Brandt
A policy of routine endotracheal intubation at birth with MSAF in neonates who are otherwise vigorous does not improve neonatal outcomes over routine resuscitation [35]. Neither the American Academy of Pediatrics (AAP) nor the American Heart Association recommends routine endotracheal suctioning for nonvigorous infants [36, 37]. In 2015, the AAP’s Neonatal Resuscitation Program issued updated guidelines, which discouraged routine intubation of nonvigorous fetuses born through MSAF after an RCT showing that the rate of MAS and neonatal mortality was equal in those who were intubated and those who were not [38, 39]. Several studies have since evaluated the impact of this change in management. Comparing outcomes of intubated neonates to those who were not, the studies found similar rates of MAS, inhaled nitric oxide and extracorporeal membrane oxygenation (ECMO), and morbidity and mortality, but lower rates of intubation (2.3% vs. 0.6%) and admission to the NICU (3.8% vs. 3.1%) [40–44]. One RCT following the change in recommendation found an increased risk of MAS (RR 1.4, 95% CI 0.792 – 2.470) and death (13.6% vs. 7.5%, p < 0.05) in those nonvigorous infants who were intubated in the delivery room [45]. Two large meta-analyses in 2020 revealed no difference in the rate of MAS between those infants intubated and those not intubated (RR 0.98, 95% CI 0.71–1.35) [46, 47]. In summary, the routine endotracheal intubation of nonvigorous newborns with MSAF should be avoided and discouraged.
Transplantation and Organ Donation
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
An exciting development in donation and transplantation is the use of DCD hearts. The shortage of hearts for transplantation is particularly acute with only 25% of DBD donors going on to donate their hearts, primarily for the reason of impaired function. UK centres use both techniques of NRP and machine perfusion to re-perfuse and assess the heart in DCD patients. Over 100 such DCD transplanted hearts have been successfully performed in the UK as of August 2020, representing the largest global experience of this highly successful technique (Figure 36.6).
Regulation of Cell Functions
Published in Enrique Pimentel, Handbook of Growth Factors, 2017
A macromolecule present in the marrow supernatant of C57BL/6J (B6) (Fv-2n) mice is capable of rapidly shutting down BFU-E DNA synthesis in vitro. This compound, termed negative regulatory protein (NRP), appears to be specific to the BFU-E.528 The NRP would act during the S phase of the cycle and its action on BFU-E can be opposed by IL-3. The action of NRP on BFU-E DNA synthesis is similar to that of TGF-β, but NRP and TGF-β are different molecules.
Vertical Transmission of SARS-CoV-2 from COVID-19 Infected Pregnant Women: A Review on Intrauterine Transmission
Published in Fetal and Pediatric Pathology, 2021
Saima Naz, Tayyaba Rahat, Farah Naz Memon
Zeng [14] followed 33 neonates born to COVID-19 infected mothers. The diagnosis and management of newborns followed the guidelines of National Health Commission and the Chinese Perinatal-Neonatal SARS-CoV-2 Committee [24, 25]. According to these guidelines, delivery occurred in negative pressure isolation rooms, resuscitation of the newborns followed the Neonatal Resuscitation Program guidelines, physicians used protective equipment, delayed cord clamping and mother-baby contact were avoided. SARS-CoV-2 RT-PCR tests of newborns were performed on nasopharyngeal and rectal swab samples. Nasopharyngeal and anal swabs of two newborns were positive for SARS-CoV-2 on days 2 and 4 and negative on day 6. Swabs of a third newborn were positive on days 2 and 4 and negative on day 7. All 3 newborns developed Covid-19 symptoms. As strict guidelines were followed, the possibility of vertical transmission cannot be ruled out.
How general pediatricians learn procedures: implications for training and practice
Published in Medical Education Online, 2021
Maya S. Iyer, David P. Way, Daniel J. Schumacher, Charmaine B. Lo, Laurel K. Leslie
A number of GPeds reported that a portion of their practice is performed in emergency department (ED) (n = 7 of 51; 13.7%), labor and delivery (L&D) (n = 4 of 51; 7.8%), and newborn nursery (n = 14 of 51; 27.5%) settings. While these GPeds spent less than 40% of their time in these acute care settings (38%, 20%, and 28% respectively), they were more likely to report performing common procedures such as reductions of dislocations (ED), incision and drainage of abscesses (ED), and bag mask ventilation (L&D, newborn nursery). The most common non-ACGME procedure performed was circumcision (newborn nursery). These same GPeds said that they learned these specific procedures either on-the-job by observing colleagues or through formal life support skill classes (Pediatric Advanced Life Support or Neonatal Resuscitation Program).
Yield of meconium in non-vigorous neonates undergoing endotracheal suctioning and profile of all neonates born through meconium-stained amniotic fluid: a prospective observational study
Published in Paediatrics and International Child Health, 2018
V. R. Viraraghavan, Sushma Nangia, B. H. Prathik, Babu S. Madarkar, Deepshika Rani, Arvind Saili
Delivery room management of MSAF has undergone significant changes in the past four decades. Recommendations have changed from routine oropharyngeal suctioning and intubation followed by tracheal suctioning of all neonates born through MSAF in the 1970s to selective intubation and tracheal suctioning of only non-vigorous ones in the early 2000 [9]. The recent Neonatal Resuscitation Programme (NRP) 2015 recommendation has suggested that endotracheal (ET) suctioning of non-vigorous neonates born through MSAF might be of no proven benefit and that initiation of positive pressure ventilation must be the priority; suctioning might be used to aid intubation if the airway is obstructed with meconium [10]. The level of evidence as the basis of this recommendation was weak (level IIb), and the necessity for definite randomised controlled trials (RCTs) in this aspect was indicated. The most recent RCT which was published after the NRP 2015 recommendations came into being has also shown that tracheal suctioning in non-vigorous neonates does not affect the outcome in these neonates [11].