ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Surfactant therapy has revolutionized neonatal care and is used routinely for preterm infants with respiratory distress syndrome. Recent investigation has further elucidated the function of surfactant-associated proteins and their contribution toward surfactant and lung immune defense functions. As the field of neonatology moves away from intubation and mechanical ventilation of preterm infants at birth toward more aggressive use of nasal continuous positive airway pressure, the optimal timing of exogenous surfactant therapy remains unclear. Evidence suggests that preterm neonates with bronchopulmonary dysplasia and prolonged mechanical ventilation also experience surfactant dysfunction; however, exogenous surfactant therapy beyond the first week of life has not been well studied. Surfactant replacement therapy has been studied for use in other respiratory disorders, including meconium aspiration syndrome and pneumonia. Commercial surfactant preparations currently available are not optimal, given the variability of surfactant protein content and their susceptibility to inhibition. Further progress in the treatment of neonatal respiratory disorders may include the development of “designer” surfactant preparations.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Neonatal sepsis is a significant cause of morbidity and mortality in the neonatal intensive care unit. The epidemiology of neonatal infections is complex; however, they are in large part secondary to developmentally immature host defense mechanisms. These immunodeficiencies, which are exaggerated in premature and sick neonates, include quantitative and qualitative deficits in phagocytes, complement components, cytokines, and immunoglobulins. Therapies that modulate or augment host defenses may attenuate the virulence of neonatal infections. In this paper, we have reviewed immunotherapies that modulate the immune system of the neonate, including: intravenous immunoglobulins, myeloid hematopoietic growth factors, and granulocyte transfusions. Future studies should focus on investigating other abnormalities of neonatal host defense and/or combined immunotherapy approaches in an attempt to circumvent the immaturity of host defense and potentially reduce both the incidence and severity of neonatal sepsis.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Despite the knowledge that excess amounts of oxygen in the blood (hyperoxia) can be damaging to preterm infants, there is a wide variation in approaches to oxygen therapy within neonatal intensive care units. This is predominantly determined by institutional or individual practices or preferences and might stem from a lack of understanding of the relative merits and demerits of the different techniques of oxygen monitoring in extremely preterm babies who are different from more mature babies. This article provides the physiological rationale and evidence from recent clinical studies suggesting that keeping the oxygen therapy to an “acceptable” minimum in premature babies does not do any harm and may be even advantageous.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Several epidemiologic studies have shown that intrauterine growth retardation is a risk factor for the development of cardiovascular disease in later life. In this review, we discuss these epidemiologic studies and animal models that have been developed to investigate the pathophysiology of this phenomenon. We discuss data suggesting that intrauterine growth retardation leads to fetal exposure to maternal glucocorticoids. In addition, we present other data showing that fetal exposure of glucocorticoids during specific times of fetal development results in focal and segmental glomerulosclerosis, a reduced number of nephrons, hypertension, and diabetes. These studies suggest that at critical times during fetal development fetal injury programs the development of cardiovascular disease and diabetes in later life.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The incidence of primary vesicoureteral reflux is about 1% to 2% of the general population and is as high as 50% in siblings as well as offspring of affected patients, suggesting autosomal dominant inheritance. The current diagnosis of vesicoureteral reflux involves voiding cystourethrograms, which are invasive and costly. Consequently, vesicoureteral reflux screening in siblings and offspring is not routinely practiced, because of the known high risk. Early detection of vesicoureteral reflux will be valuable for prevention of reflux nephropathy, because the incidence of reflux nephropathy can be reduced effectively by antibiotic prophylaxis. Furthermore, the presence of reflux nephropathy can only be accurately assessed currently by dimercapto-succinic acid nuclear scans, which are costly, time and labor intensive, and often require conscious sedation by a pediatric anesthesiology team. As a result, the clinical assessment of reflux nephropathy is also not routinely practiced. There is a pressing need to develop less invasive and less costly tests for the early diagnosis of primary vesicoureteric reflux and reflux nephropathy. Recent molecular and genetic studies have greatly increased our understanding of vesicoureteral reflux and provide a promise of novel non-invasive tests. Targeted disruption of angiotensin type II receptor and uroplakin III genes result in the phenotype of primary vesicoureteral reflux. There are characteristic patterns of message and protein changes in the knockout animals, providing the basis for detection of genetic mutations leading to vesicoureteral reflux in humans by studying differential gene expression by functional genomics methodology. The urothelium is also known to secrete proteins into the urine. Preliminary studies showed unique fingerprints in urinary protein patterns in children with primary VUR, providing the basis for developing novel noninvasive molecular diagnostic tests of vesicoureteral reflux by proteomics methodology.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Continued improvements in imaging technology have changed many of the traditional diagnostic algorithms for evaluating pediatric renal disease. Newer imaging modalities offer more accurate, specific, and early diagnoses, but can be time consuming and costly. Less invasive modalities, such as ultrasound, computed tomography, and magnetic resonance imaging have widespread applications in pediatric practice. The risks of radiation exposure, contrast toxicity, and sedation or anesthesia versus the potential benefits of obtaining precise diagnostic information should always be considerations before electing any imaging procedure in children.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Amiodarone has gained recognition as an antiarrhythmic medication after recent publication of the newly revised American Heart Association guidelines for pediatric resuscitation. Although support for the widespread use of amiodarone in adults has been supported by research, the few pediatric studies demonstrate limited efficacy and highlight the need for additional data. Because of the nature of the need for this type of resuscitation medication, controlled prospective studies will be difficult to obtain if not morally contraindicated. This article reviews the properties of amiodarone and the pertinent pediatric studies to provide healthcare providers supplemental information regarding amiodarone when choosing antiarrhythmics for acute resuscitation. Individual providers need to discern whether the pediatric data available supports widespread acceptance into current treatment regimens.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID