Download or read book Lack Of Guidelines Or Recommendations For The Use Of Inhaled Nitric Oxide In Preterm Infants Less Than 34 Weeks Gestational Age written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BackgroundThe National Institute of Health (NIH) consensus panel in 2011 and Committee on Fetus and Newborn (COFN) of American Academy of Pediatrics (AAP) in 2014 concluded that the use of inhaled nitric oxide (iNO) in preterm infants 34 weeks gestational age (PTIs) is not recommended. Despite these recommendations, iNO use in Level III and Level IV NICUs is steadily increasing every year in California, USA. There are no published guidelines for iNO use in PTIs. We studied if there were any consistent patterns with iNO use in PTIs in the 4 Level III NICUs from a large Health Maintenance Organizations. MethodsRetrospective review of prospectively entered data in PTIs with iNO treatment during their NICU stay and to describe the variations before, during or after initiation of iNO Rx.ResultsWe found the following variations and or lack of documentation before, during or after iNO therapy in PTIs: 1. baseline oxygenation index or oxygen saturation index, 2. informing parents about off-label use of iNO, 3. using high frequency ventilation to optimize lung recruitment, 4. monitoring pre-and post-ductal oxygen saturation by pulse oximeter (SpO2), 5. weaning iNO based on SpO2 rather than PaO2, 6. echocardiogram to assess for pulmonary hypertension, 7. evaluation to rule out sepsis, 8. targeting a certain hematocrit to improve oxygen delivery.ConclusionsSignificant variations exist regarding indications, work up and follow up before or during iNO treatment in PTIs. There is an urgent need to provide management guidelines to both Level III and Level IV NICUs. Providing guidelines based on the results from randomized, controlled clinical trials may decrease unnecessary use of iNO, and potentially decrease adverse effects and cost in this high-risk population.Future DirectionsWe propose the following minimum criteria prior to starting iNO Rx in PTIs: 1. OI 20, 2. Pre- and post-ductal SpO2 >5%, 3. Patient on HFOV, 4. Echocardiographic evidence for PPHN, such as, tricuspid regurgitation jet gradient >36 mm Hg or presence of septal flattening in systole. Regarding starting dose of iNO, 10-20 ppm may be appropriate. Response to iNO Rx using pre-ductal SpO2 between 88-92%. Oxygen delivery may be optimized by keeping hematocrit >35%. Establish iNO Registry and record detailed data from all PTIs on iNO Rx.
Download or read book Inhaled Nitric Oxide in Preterm Infants written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-05-09 with total page 310 pages. Available in PDF, EPUB and Kindle. Book excerpt: Neonatal lung disease is the most common complication of preterm delivery, and results in significant morbidity and mortality. Preterm infants suffer from both acute and chronic respiratory failure as a result of anatomic and biochemical disruption of lung function, lung inflammation and oxidative stress, nutritional deficiencies, and arrest of tracheobronchial and pulmonary vascular growth. Treatment for acute respiratory failure often contributes to evolving bronchopulmonary dysplasia (BPD) and chronic respiratory failure, due to barotrauma and oxygen toxicity from prolonged respiratory support, deficient nutrition, as well as immaturity of lung growth, vascular development and immunologic defenses. Pulmonary hypertension may occur in association with acute and/or chronic respiratory failure. Multiple etiologies make finding an effective treatment for respiratory failure in preterm infants challenging. Disorders related to prematurity and respiratory distress are among the leading causes of infant mortality in the U.S. Treatment options for respiratory failure in preterm infants include a variety of modalities. Prenatal steroids, antibiotics, exogenous surfactant replacement, tidal volume ventilation, conventional ventilation, continuous positive airway pressure, high flow oxygen administration, and high frequency ventilation are all used as therapeutic modalities. Treatment of preterm infants with inhaled nitric oxide (iNO) as a rescue therapy for refractory hypoxemic respiratory failure is an extension of the relative success of the treatment of term and near term infants with iNO. Inhaled NO has demonstrated efficacy in improving oxygenation and reducing the need for extracorporeal membrane oxygenation (ECMO) in late preterm infants born after 34 weeks gestation and full term infants with respiratory failure, with no evidence of long term benefits. Despite the approved use of iNO in full term and late preterm infants, the developmentally distinct mechanisms of respiratory failure and differing cardiovascular, pulmonary, and pharmacokinetic characteristics of more immature infants require systematic study of the short and long term outcomes for preterm infants treated with iNO to prevent or treat respiratory failure. The Cochrane review acknowledged very limited data on long term outcomes of preterm infants treated with iNO. If iNO is beneficial, the number need to treat would be very large. Papers published or presented from 2007 to present report conflicting results as to whether, in preterm infants, iNO has beneficial, adverse, or no effects on long term neurodevelopmental and pulmonary outcomes. Despite the ongoing controversy, iNO continues to be used for hypoxemic respiratory failure in preterm infants less than 34 weeks gestation even with potential harm to the developing lungs and brain. There is an urgent need to weigh the current evidence as to whether iNO is a safe and effective treatment in preterm infants. We sought to identify and synthesize evidence addressing the following questions: 1. Does inhaled nitric oxide (iNO) therapy increase survival and/or reduce the occurrence or severity of bronchopulmonary dysplasia (BPD) among premature infants who receive respiratory support? 2. Are there short term risks of iNO therapy among premature infants who receive respiratory support? 3. Are there effects of iNO therapy on long term pulmonary and/or neurodevelopmental outcomes among premature infants who receive respiratory support? 4. Does the effect of iNO therapy on BPD and/or death or neurodevelopmental impairment vary across subpopulations of premature infants? 5. Does the effect of iNO therapy on BPD and/or death or neurodevelopmental impairment vary by timing of initiation, mode of delivery, dose and duration, or concurrent therapies?
Download or read book Preterm Birth written by Institute of Medicine and published by National Academies Press. This book was released on 2007-05-23 with total page 791 pages. Available in PDF, EPUB and Kindle. Book excerpt: The increasing prevalence of preterm birth in the United States is a complex public health problem that requires multifaceted solutions. Preterm birth is a cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, sociodemographic and neighborhood characteristics, environmental exposure, medical conditions, infertility treatments, and biological factors. Many of these factors co-occur, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups. While advances in perinatal and neonatal care have improved survival for preterm infants, those infants who do survive have a greater risk than infants born at term for developmental disabilities, health problems, and poor growth. The birth of a preterm infant can also bring considerable emotional and economic costs to families and have implications for public-sector services, such as health insurance, educational, and other social support systems. Preterm Birth assesses the problem with respect to both its causes and outcomes. This book addresses the need for research involving clinical, basic, behavioral, and social science disciplines. By defining and addressing the health and economic consequences of premature birth, this book will be of particular interest to health care professionals, public health officials, policy makers, professional associations and clinical, basic, behavioral, and social science researchers.
Download or read book NATIONAL SURVEY ON THE USE OF INHALED NITRIC OXIDE IN PRETERM INFANTS WITH HYPOXIC RESPIRATORY FAILURE written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and AimsDespite lack of clear evidence for use of iNO (inhaled NO) in preterm babies with hypoxic respiratory failure, it is used in clinical practise1.MethodA structured survey was conducted on the use of inhaled nitric oxide in preterm infants (u226432 weeks' gestation) to gain an understanding of current clinical practice in the UK (United Kingdom). The survey was distributed to Neonatology Consultants in 21 neonatal operational delivery networks in UK via an online hyperlink and responses were collected between September 2016 and February 2017.ResultsNearly half of neonatologists who responded will routinely offer iNO to babies born 24 to 26 weeks gestation with hypoxic respiratory failure even in absence of clinical or echocardiographic evidence of PHT (pulmonary hypertension). 4% respondents will not offer iNO to babies born 29+1 to 32 weeks with hypoxic respiratory failure with clinical and echocardiography evidence of PHT. Only one third of respondents have a guideline in their unit for use of iNO in preterm babies. The most common starting dose of iNO is 20 ppm. Years of experience did not have any influence on threshold to offer iNO to preterm babies.ConclusionGreat variation is observed in threshold to offer iNO in preterm babies with hypoxic respiratory failure. Majority of neonatologists use clinical or echocardiography evidence of PHT as a guide to offer iNO to babies
Download or read book Pediatric and Neonatal Mechanical Ventilation written by Peter C. Rimensberger and published by Springer. This book was released on 2014-11-12 with total page 1584 pages. Available in PDF, EPUB and Kindle. Book excerpt: Written by outstanding authorities from all over the world, this comprehensive new textbook on pediatric and neonatal ventilation puts the focus on the effective delivery of respiratory support to children, infants and newborns. In the early chapters, developmental issues concerning the respiratory system are considered, physiological and mechanical principles are introduced and airway management and conventional and alternative ventilation techniques are discussed. Thereafter, the rational use of mechanical ventilation in various pediatric and neonatal pathologies is explained, with the emphasis on a practical step-by-step approach. Respiratory monitoring and safety issues in ventilated patients are considered in detail, and many other topics of interest to the bedside clinician are covered, including the ethics of withdrawal of respiratory support and educational issues. Throughout, the text is complemented by numerous illustrations and key information is clearly summarized in tables and lists.
Download or read book Questions from NeoReviews written by Henry C. Lee and published by . This book was released on 2020 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Enhance your knowledge of neonatal-perinatal medicine and/or study for Neonatal-Perinatal Medicine board certification or recertification with this new study guide from the editors of NeoReviews. This new guide includes more than 1,200 questions previously published in NeoReviews from January 2007 to December 2017. Each question is followed by a short explanation of the correct answer with references, including the original article. Chapters include Cardiology Dermatology Endocrinology ENT and Ophthalmology Fluids, Electrolytes, Nutrition Gastrointestinal Genetics and Inborn Errors of Metabolism Hematology/Oncology Immunology Infectious Diseases Maternal-Fetal Medicine Neonatal Resuscitation Neurology Renal Respiratory Statistics, Research, Health Services, and Ethics
Download or read book Essentials of Pediatric Anesthesiology written by Alan David Kaye and published by Cambridge University Press. This book was released on 2014-10-16 with total page 435 pages. Available in PDF, EPUB and Kindle. Book excerpt: Provides a clinically relevant and easy-to-read review of all key topics, written and edited by leading pediatric anesthesiology physicians.
Download or read book Perinatal Intensive Care written by Silvio Aladjem and published by . This book was released on 1977 with total page 472 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Early Exclusively Non Invasive Inhaled Nitric Oxide In Spontaneously Breathing Preterm And Term Neonates With Arterial Pulmonary Hypertension written by Corinna Mirjam Gebauer and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and aims: Inhaled nitric oxide (iNO) is an approved therapy for neonates with mechanical ventilation for hypoxic respiratory failure (HRF). Little is known about the early non-invasive iNO treatment of persistent pulmonary hypertension (PPH) via nasal cannula or mask. We studied this practice in spontaneously breathing term and preterm infants, hypothesizing that it would be associated with reduced oxygen requirements.Methods: In our electronic medical records (2011 to 2017) we identified 123 inborn neonates receiving iNO. Whereof 46 singletons with PPH were exclusively spontaneously breathing on respiratory support via nasal continuous positive airway pressure (CPAP) receiving non-invasive iNO treatment starting within their first 12 hours of life. In all infants HRF (persistent supplemental oxygen >30%) was accompanied by echocardiographically proven PPH. Results: 46 neonates receiving non-invasive iNO were studied with a median birth weight of 2629g (740g u2013 4680g) and a median gestational age of 35 weeks (24+6 weeks u2013 41+6 weeks) including 10 preterm infants u2264 30 weeks. Median duration of non-invasive iNO application was 24 hours (1,5 hours u2013 168 hours) with a mean starting dose of 20 ppm. Fractional oxygen requirements dropped with initiation of non-invasive iNO from median 60% to 25% (p
Download or read book Guidelines for Perinatal Care written by American Academy of Pediatrics and published by . This book was released on 1997 with total page 436 pages. Available in PDF, EPUB and Kindle. Book excerpt: This guide has been developed jointly by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, and is designed for use by all personnel involved in the care of pregnant women, their foetuses, and their neonates.
Download or read book Surfactant Replacement Therapy written by Donald L. Shapiro and published by Alan R. Liss. This book was released on 1989 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book The Newborn Lung written by Eduardo Bancalari and published by Elsevier Health Sciences. This book was released on 2018-06-19 with total page 464 pages. Available in PDF, EPUB and Kindle. Book excerpt: Dr. Richard Polin’s Neonatology Questions and Controversies series highlights the most challenging aspects of neonatal care, offering trustworthy guidance on up-to-date diagnostic and treatment options in the field. In each volume, renowned experts address the clinical problems of greatest concern to today’s practitioners, helping you handle difficult practice issues and provide optimal, evidence-based care to every patient. Stay fully up to date in this fast-changing field with The Newborn Lung, 3rd Edition. The most current clinical information throughout, including key management strategies that may reduce some of the chronic sequelae of neonatal respiratory failure. New content on the role of microbiome in lung injury and lung development. Current coverage of non-invasive respiratory support, perinatal events and their influence on lung development and injury, cell-based lung therapy, automation of respiratory support, and oxygenation targeting in preterm infants. Consistent chapter organization to help you find information quickly and easily. The most authoritative advice available from world-class neonatologists who share their knowledge of new trends and developments in neonatal care. Purchase each volume individually, or get the entire 7-volume set! Gastroenterology and Nutrition Hematology, Immunology and Genetics Hemodynamics and Cardiology Infectious Disease and Pharmacology New Volume! Nephrology and Fluid/Electrolyte Physiology Neurology The Newborn Lung
Download or read book Essentials of Anesthesia for Infants and Neonates written by Mary Ellen McCann and published by Cambridge University Press. This book was released on 2018-02-22 with total page 465 pages. Available in PDF, EPUB and Kindle. Book excerpt: A practical, comprehensive guide to the special needs of infants and neonates undergoing anesthesia.
Download or read book Pediatric Board Study Guide written by Osama Naga and published by Springer. This book was released on 2015-03-27 with total page 611 pages. Available in PDF, EPUB and Kindle. Book excerpt: Covers the most frequently asked and tested points on the pediatric board exam. Each chapter offers a quick review of specific diseases and conditions clinicians need to know during the patient encounter. Easy-to-use and comprehensive, clinicians will find this guide to be the ideal final resource needed before taking the pediatric board exam.
Download or read book Neonatal Hematology written by Pedro A. de Alarcón and published by Cambridge University Press. This book was released on 2021-02-18 with total page 501 pages. Available in PDF, EPUB and Kindle. Book excerpt: An essential guide to the pathogenesis, diagnosis and management of hematologic problems in the neonate, covering erythrocyte disorders, leukocyte disorders, immunologic disorders and hemostatic disorders. Guidance is practical, including blood test interpretation, advice on transfusions and reference ranges for hematological values.
Download or read book Pocket Notes on Neonatology written by Mark W. Davies and published by Elsevier Australia. This book was released on 2008 with total page 194 pages. Available in PDF, EPUB and Kindle. Book excerpt: This little pocket guide has been designed as a ready reference to guide junior medical officers and nursing staff who care for infants admitted to intensive and special care.
Download or read book Neonatal Care A Compendium of Aap Clinical Practice Guidelines and Policies written by American Academy of Pediatrics (AAP) and published by . This book was released on 2023-03-14 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Neonatal Care: A Compendium of AAP Clinical Practice Guidelines and Policies, 2nd Edition, contains the collected AAP clinical practice guidelines, policy statements, and clinical and technical reports related to the quality care of newborns and infants. Find more than 50 of the most recent and trustworthy recommendations from the AAP Committee on Fetus and Newborn, organized into 9 sections for easy reference including the highly anticipated "Clinical Practice Guideline Revision: Diagnosis and Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation." Each statement or report contains an abstract overview, a concise presentation and critique of the available data, and a summary of the findings and/or recommendations, along with a current and comprehensive bibliography.
