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Fetal Growth Restriction
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Juliana Gevaerd Martins, Alfred Abuhamad
FGR neonates frequently require assistance with ventilation and feeding, especially if born preterm. FGR neonates < 32 weeks or < 1500 g requires special care, usually in a tertiary care center [10]. Workup of the etiology of FGR should be completed if not already done prenatally [10]. Hypoglycemia, polycythemia, and coagulopathies are common, and may need treatment. Involvement of the neonatology team on counseling the patient prior to delivery on expectations in the intensive care unit may be helpful for families [10].
Major Issues Related to Progress in NEC
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
The disease we call necrotizing enterocolitis (NEC) has been eloquently described in several publications (1–3). NEC has received considerable attention in the past 5 decades, but not much progress has been made in its treatment or prevention. Over these past 50 years, a new medical discipline called “neonatology” has developed, and the incidence of NEC has been associated with the evolution of this new field. Neonatology has been highly successful in improving the survival of babies who never would have survived 50 years ago. Although a large number of these infants are surviving with no or minimal morbidities, all too many still develop adverse outcomes. Among these are bronchopulmonary dysplasia, intracranial hemorrhages, periventricular leukomalacia, and NEC. In this review, a historical perspective will be provided in the area of NEC research and clinical care and where we currently stand in terms of making progress in its eradication. This review focuses on major issues involved in our lack of progress, including the following: 1) Defining the disease and differentiating it from other neonatal intestinal problems—the “imposters.” Major examples will include spontaneous intestinal perforation (SIP) and food-related sensitivity (FPIES). 2) Animal and in vitro models that recapitulate the major forms of “NEC.” 3) Systems and multiomic approaches to evaluate overall pathophysiology in the human. 4) How various environmental factors such as antibiotics can adversely affect the intestinal microbiota and hence the developing gastrointestinal (GI) tract and the mucosal immune system.
What Promotes Joy
Published in Eve Shapiro, Joy in Medicine?, 2020
I am an assistant professor of pediatrics and an attending neonatologist at a quaternary care pediatric hospital. I came here in 2012 after completing my fellowship training. I spent six years in pediatric residency and doing a neonatology fellowship. I’ve been on the clinical/ academic track. I wanted a hybrid position combining clinical care with academics so I could also conduct research, teach, publish and write. In the NICU, there is high acuity and thus a high potential for burnout if you do that 100% of the time, so for me academic neonatology is a nice balance and a chance to contribute new knowledge to the field as well as mentor the next generation of neonatologists.
A 29-year-old woman presenting for urgent cesarean hysterectomy: a multidisciplinary care challenge
Published in Baylor University Medical Center Proceedings, 2023
Claudia Serrano, Jessica C. Ehrig, Michael P. Hofkamp
The placenta accreta team was rapidly assembled, consisting of an accreta surgeon; members from urology, anesthesiology, and neonatology services; and operating room circulator nurses and surgical technicians. A standardized cesarean hysterectomy checklist was used to direct care. When the patient arrived in the operating room, an arterial line was placed for continuous blood pressure monitoring. More than 12 hours had elapsed since her last dose of enoxaparin, and she received a combined spinal epidural with 11.25 mg hyperbaric bupivacaine 0.75%, 15 mcg of fentanyl, and 0.2 mg of preservative-free morphine administered in the intrathecal space. Bilateral ureteral stents were then placed by an urologist. An abdominal incision was made and the fascia and recti muscles were separated. Ultrasound mapping of the uterus using a sterile probe cover was performed to identify a site for uterine incision that would avoid the placenta. The neonate was delivered and neonatal care was provided by the neonatology team in attendance. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. After delivery of the neonate, general endotracheal anesthesia was induced. A supracervical hysterectomy was performed and was complicated by extensive adhesions from the anterior abdominal wall to anterior uterus. The patient received a bilateral transversus abdominus plane block under ultrasound guidance prior to emergence to facilitate postoperative analgesia.
The limits of viability of extremely preterm infants
Published in Baylor University Medical Center Proceedings, 2022
Michael H. Malloy, Leonard K. Wang
Are there truly any limits on the gestational age at which contemporary neonatologists will refrain from attempting to resuscitate an extremely preterm infant? The 1971 edition of Shaeffer and Avery’s textbook, Diseases of the Newborn, estimated the limit of viability to be around 28 weeks’ gestation and/or 1000 g.1 Yet, since the early 1970s when the practice of neonatology was just beginning and neonatal intensive care units were proliferating, the success at resuscitating these small infants as measured by mortality has been remarkable.2–4 Current neonatology literature seems to view the issue of improving the outcome of those infants born at 23 weeks or less as an opportunity to do more research in fine-tuning the care of these infants.5 Ethical arguments for and against resuscitation of these small infants range from individualizing probability calculations to determine likelihood of survival, to utilizing cost-benefit analyses to attempt to justify resuscitation, and arguing against intervening in the lives of these infants as means for a caretaker’s self-aggrandizement in creating a life rather than in rescuing a life in jeopardy.6–11
Components of interprofessional education programs in neonatal medicine: A focused BEME review: BEME Guide No. 73
Published in Medical Teacher, 2022
S. Parmekar, R. Shah, G. Gokulakrishnan, S. Gowda, D. Castillo, S. Iniguez, J. Gallegos, A. Sisson, S. Thammasitboon, M. Pammi
The number of learners in each study ranged from 13 to greater than 700. Seven studies provided instruction to fewer than 100 learners, an additional 7 studies instructed 100–220 learners, and 2 studies enrolled more than 600 learners (Figure 2(C)). The distribution of learners across multiple professions is shown in Figure 2(D). Learners included nurses, respiratory therapists, neonatal nurse practitioners, patient care technicians, unit communication associates, parents, early interventionists, physicians (neonatologists, anesthesiologists, obstetricians), traditional birth attendants, and medical trainees (neonatology fellows, pediatric residents, midwifery students, physician assistant students, and nursing students). Six studies included two different categories of learners, and the remaining 11 had three or more learner categories.