ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The impetus for shorter hospital stay of mother and newborn infant after delivery is based on economic constraints and parental preference. Earlier published studies did not demonstrate any increase in morbidity rate with shorter stay, but these studies were limited by methodologic flaws and biases that limited the validity and generalizability of the conclusions. More recent studies showed that readmission rates increased with shorter stay and that the severity of illness of readmitted infants may have increased. In addition, the interpretation of current newborn screening tests may not be applicable when performed prior to early discharge. In light of recent changes in neonatal hospital length of stay, a careful review and update of current guidelines and practices for newborn care are required.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Management of painful procedures in the neonate is less than optimal. Although evidence exists to support the infant's capacity to feel pain at birth, health professionals do not prescribe or administer adequate analgesia. This is largely because of the lack of published data on the safety and efficacy of pharmacologic interventions and lack of sufficient understanding of the benefits of nonpharmacologic measures. In this review, recent research on the safety and efficacy of pharmacologic and nonpharmacologic interventions for managing painful procedures in the neonate is summarized.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Kangaroo Mother Intervention (KMI) started in 1978 in Colombia as a way of dealing with overcrowding and scarcity of resources in hospitals caring for low birth weight infants. Currently the intervention comprises three components: kangaroo position (skin-to-skin contact), kangaroo nutrition (exclusive or nearly exclusive breast-feeding), and kangaroo discharge policies (early discharge in kangaroo position regardless of weight or gestational age). Different authors have adopted and adapted diverse components of the KMI to suit the particular needs of their parents. We discuss different modalities of kangaroo care reported in developed and in developing countries and also describe in some detail the components of the whole KMI program. In addition, results from a systematic review of kangaroo-related papers published in English between 1991 and 1995 are provided, together with a summary of current knowledge (evidence-based) and research needs.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Nitric oxide production appears to be decreased in infants with persistent pulmonary hypertension (PPHN). Inhaled nitric oxide may improve oxygenation by two mechanisms: increased pulmonary blood flow and improved ventilation-perfusion matching. Nitric oxide inhalation has been tested in newborns with PPHN, congenital heart diseases, and bronchopulmonary dysplasia. We present a review of the articles concerning inhaled nitric oxide for infants with PPHN. Overall, 59% of the neonates had an initial improvement in oxygenation in response to nitric oxide inhalation. A sustained response was observed in 60% of the infants. Patients with extrapulmonary shunting, clear chest radiographs, and adequate lung volume seem to have a better response, whereas patients with congenital diaphragmatic hernia, severe sepsis, and alveolar capillary dysplasia are more likely to fail. To define the benefit-risk ratio, six prospective randomized trials are currently in progress.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Renovascular disease is a frequent cause of severe hypertension in children and may result in significant morbidity or mortality. Most children presenting with renovascular hypertension have few if any symptoms, but devastating neurologic injury and congestive heart failure are still too often observed. Several new radiographic techniques have been used to detect renovascular lesions, but none has yet demonstrated consistently superior results when compared with intra-arterial digital subtraction angiography. Renal venous renin sampling, duplex ultrasonography, and captopril-enhanced renal scintigraphy may be useful diagnostic adjuncts. Therapeutic objectives include cure of hypertension and restoration or preservation of renal function. At many institutions, percutaneous transluminal angioplasty has become the treatment of choice for patients with renal transplant artery stenosis and discrete, nonostial stenoses caused by fibromuscular dysplasia. More extensive lesions generally respond well to surgical correction. Chronic pharmacologic therapy is reserved for patients who do not respond to angioplasty or in cases in which the location or extent of involvement of the renal arterial system precludes surgical revascularization. Nephrectomy is usually reserved for kidneys that have minuscule function or irreparable vascular anomalies. An individualized approach to therapy is increasingly emphasized.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Pulmonary surfactant is routinely used for treatment of premature babies with respiratory distress syndrome, and its use in full-term infants with respiratory failure is now under extensive clinical investigation. Several clinical reports have shown that intratracheal instillation of large doses of bovine and porcine lung-derived surfactant preparations has the potential to improve blood oxygenation and ventilation efficiency in full-term neonates with respiratory distress syndrome, meconium aspiration syndrome, pneumonia, pulmonary hemorrhage, and lung hypoplasia. These findings are suggestive of secondary surfactant deficiency or surfactant dysfunction in the pathogenesis of respiratory failure in full-term infants. Further clinical investigation with multicenter, randomized, controlled clinical trials is warranted to verify new indications of surfactant application for these diseases.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Automated forms of peritoneal dialysis are used by the majority of children receiving chronic renal replacement therapy. Hemodialysis is performed in a smaller but substantial population of patients. Studies of peritoneal membrane solute transport conducted with exchange volumes standardized by body surface area reveal similar characteristics in children and adults. Target urea clearance and creatinine clearance values that define “adequate” dialysis for the pediatric peritoneal dialysis and hemodialysis populations have not yet been determined. Limited data are available to characterize the ideal dialysis access, whereas the clinical complications of infection, growth retardation, and patient mortality receive a great deal of attention.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Primary nephrotic syndrome encompasses the spectrum of minimal change disease, focal segmental glomerulosclerosis, and related disorders. It is a common cause of morbidity and, more rarely, of mortality in children. Recent progress has permitted us to better understand the mechanism of proteinuria and how it causes the other findings of nephrosis. Developments related to the pathogenesis of nephrosis and why some patients develop focal segmental glomerulosclerosis are less striking, but recent studies have indicated useful directions for subsequent work in these areas. Finally, application of newer concepts to treatment has provided both a better prognosis for these diseases and decreased morbidity from treatment.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID