http://pediatrics.aappublications.org:80 This feed contains articles for Pediatrics Subject Collection "Premature & Newborn" Pediatrics http://pediatrics.aappublications.org:80 http://pediatrics.aappublications.org:80/cgi/content/short/30/11/447?rss=1 Case 1 Presentation Case 1 Presentation Case 2 Presentation Case 3 Presentation Case 1 Discussion Case 2 Discussion Case 3 Discussion A previously healthy 9-year-old girl presents with a 1-week history of intermittent confusion, dysphagia, visual changes, and involuntary movements of the face and left hand. During this period, she has had two episodes of disorientation and memory loss that were not associated with alteration in consciousness or behavioral changes. The involuntary movements of the left arm and leg have become progressively worse throughout the week. The facial movements are described as lip smacking and excessive blinking. Four days ago, she complained of one episode of diplopia. She denies nausea, vomiting, fever, symptoms of uppe ... Vo, M. Patel, A. M. Chorny, V. Sood, J. Klein, T. J. Chhabra, S. 2009-11-01 doi:10.1542/pir.30-11-447 Index of Suspicion American Academy of Pediatrics 11 30 452 447 2009-11-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/30/11/453?rss=1 Presentation Presentation Diagnosis: Right Diaphragmatic... Summary Suggested Reading A 20-year-old primigravida woman delivers a term female infant weighing 3,112 g via caesarean section under spinal anesthesia. The mother's antenatal test results are unremarkable, including a negative group B beta-hemolytic Streptococcus (GBS) screen at 33 to 34 weeks' gestation. Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. Physical examination results are normal. Four hours after delivery, the infant develops tachypnea, grunting, and "blue" lower extremities. Supplemental oxygen is provided, blood and urine cultures are performed, and empiric treatment with intravenous ampicillin and cefotaxime is initiated. A chest radiograph reveals a normal cardia ... Sabnis, H. Sood, B. G. Zilberman, M. Becker, C. 2009-11-01 doi:10.1542/pir.30-11-453 Visual Diagnosis: Sepsis, Respiratory Distress, and a Persistent Right Lung Opacification in a Newborn American Academy of Pediatrics 11 30 456 453 2009-11-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/10/11/e527?rss=1 Expert versus novice clinical data gathering, cognitive modeling strategies, and physical skills for evaluating medical problems differ markedly in complexity, clinical accuracy, and speed. Experts' mental models develop during a decade of education and practical training. Clinical experts use data-based clinical information flow in near real-time to assess complex intensive care unit (ICU) situations and to act definitively and correctly within 2 to 30 seconds of acute problem recognition. Critical care bedside medical management of unstable neonates, when parents are present, challenges all existing clinical processes and computerized information systems. Success is currently-site dependent. Details are very important. The critical care expert's working mental model is a temporally sequenced, multidimensional, physiologically based matrix, in which 20 to 60 simultaneous clinical variables can be assimilated nearly instantaneously. The mental data-seeking exercise follows an expert's cognitive pattern of simultaneously developing answers, while still seeking more data. Any computerized, paperless incarnation of clinical data management in NICUs should have instant data access at the bedside for full support of focused, expert-level, cognitive work and decision making. High-speed information reporting is essential in all ICU environments. Critical care clinicians often are interrupted by a more urgent situation. Standard computer access/use/log-off is very difficult to incorporate seamlessly into a NICU workflow. Critical care physicians report feeling cognitively blinded by computer-related fragmentation of the temporally flowing clinical data streams. Nurses are distracted by time-consuming, adult-designed charting systems requiring typed data entry. Reports are slow and fragmented. Neonatologists and criticalists find that existing computerized charting methods in NICUs waste time. Without bedside data tracking, quick understanding of the overall situation of a particular patient, at the bedside, at a particular moment is virtually impossible. New computerization introduces change that often disrupts generations-old clinical workflow functions and may have many unintended consequences. Planning, developing, or purchasing and implementing effective systems for totally computerizing an NICU is an interdisciplinary work in progress. Drummond, W. H. 2009-11-01 doi:10.1542/neo.10-11-e527 Neonatal Informatics--Dream of a Paperless NICU: Part Two: Understanding Clinical Expertise American Academy of Pediatrics 11 10 537 527 2009-11-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/10/11/e538?rss=1 Comprehensive first-trimester pregnancy evaluation is a work in progress. The evolution of screening strategies has distilled a combination of maternal factors, early pregnancy analytes in maternal serum, and fetal sonographic parameters into carefully derived risk assessment algorithms. This integrated approach, almost continually supplemented by new information derived from large population-based studies, individualizes assessment to each mother-placenta-fetus triad. Early and accurate, this assessment potentiates informed decision-making and prenatal management. Invasive testing can be limited to those at high risk, decreasing procedure-related losses of unaffected fetuses. Advance warning of preeclampsia and other placenta-based disorders allows stratification of care and opens new windows to prevention therapy. Viewing of anomalies, even complex congenital heart disease, using the steadily advancing three- and four-dimensional capabilities now available, allows prenatal diagnosis and intrauterine surgical management. Comprehensive risk assessment in early pregnancy is transforming prenatal care. Miller, J. Harman, C. 2009-11-01 doi:10.1542/neo.10-11-e538 Comprehensive First-trimester Prenatal Assessment American Academy of Pediatrics 11 10 549 538 2009-11-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/10/11/e550?rss=1 Retinopathy of prematurity (ROP) is a clinically multifactorial process characterized by the aberrant vascularization of the retina that has potentially devastating effects on vision in preterm infants. Despite an appreciation for the postnatal risk factors that contribute to the development of ROP, this condition continues to be a major cause of childhood blindness. Studies using the mouse model of oxygen-induced retinopathy (OIR) have identified new therapeutic targets that may be used to guide treatment and determine which babies are at highest risk for ROP development. Such factors include the hypoxia-driven proteins vascular endothelial growth factor (VEGF) and erythropoietin (EPO) as well as the maternally derived factors insulin-like growth factor-1 (IGF-1) and omega-3 polyunsaturated fatty acids (PUFAs). Each has been demonstrated to have phase-specific effects on the pathogenesis of ROP. Through an understanding of the contribution of the IGF-1 pathway to the development of ROP in particular, a new algorithm has been developed (WINROPTM) that uses postnatal weight gain to identify infants at highest risk for ROP in an attempt to target therapy and resources more effectively. Heidary, G. Lofqvist, C. Mantagos, I. S. Vanderveen, D. K. Hellstrom, A. Smith, L. E. 2009-11-01 doi:10.1542/neo.10-11-e550 Retinopathy of Prematurity: Clinical Insights from Molecular Studies American Academy of Pediatrics 11 10 557 550 2009-11-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/10/11/e558?rss=1 Sodium bicarbonate is an ideal buffer for the treatment of metabolic acidosis if the following conditions are present: 1) the desired pH is close to 6.1, 2) the recipient has the ability to excrete instantly any additional carbon dioxide generated, and 3) the additional osmoles do not shift the pKa of all buffers downward. Unfortunately, none of these three conditions are met. Intravenous sodium bicarbonate might provide a benefit if the patient who has metabolic acidosis needs more extracellular fluid volume (eg, those who have lactic acidosis). However, in trials comparing the effect of sodium bicarbonate with sodium chloride or albumin, sodium bicarbonate was not superior. Consequently, the intravenous administration of sodium bicarbonate is not recommended for the treatment of newborns who have metabolic acidosis. Poland, R. L. 2009-11-01 doi:10.1542/neo.10-11-e558 Dogma Disputed: Why Intravenous Sodium Bicarbonate Doesn't Work American Academy of Pediatrics 11 10 563 558 2009-11-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/10/11/e564?rss=1 Case Presentation Case Presentation Case Discussion References A 5-week-old previously well female born at 41 weeks gestational age presents to the pediatric emergency department in the winter with a 2-day history of poor feeding. Her mother is concerned that the baby is more tired than usual, "is not getting enough to eat," and is having difficulty latching on to the breast. The mother explains that 2 weeks ago, the infant developed a dry cough and began having emesis after each feeding. She describes the emesis as nonbilious and nonbloody and approximately 1 ounce. An outside pediatrician prescribed a cough and cold medication and told the mother that the emesis was "normal baby spit-up." Three days ago, the infant developed projectile vomiting immediately following each feeding. ... Posner, K. R. 2009-11-01 doi:10.1542/neo.10-11-e564 Index of Suspicion in the Nursery: My Baby is Breathing Funny and Won't Eat American Academy of Pediatrics 11 10 566 564 2009-11-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/10/11/e567?rss=1 Electronic Fetal Monitoring Case Review Series Electronic Fetal Monitoring Case... Case Presentation Reference Electronic fetal monitoring (EFM) is a popular technology used to establish fetal well-being. Despite its widespread use, terminology used to describe patterns seen on the monitor has not been consistent until recently. In 1997, the National Institute of Child Health and Human Development (NICHD) Research Planning Workshop published guidelines for interpretation of fetal tracings. This publication was the culmination of 2 years of work by a panel of experts in the field of fetal monitoring and was endorsed in 2005 by both the American College of Obstetricians and Gynecologists (ACOG) and the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). In 2008, ACOG, NICHD, and th ... Druzin, M. L. Peterson, N. 2009-11-01 doi:10.1542/neo.10-11-e567 Strip of the Month: November 2009 American Academy of Pediatrics 11 10 574 567 2009-11-01 ARTICLES http://pediatrics.aappublications.org:80?rss=1 Wambach, J. Morley, S. C. 2009-11-01 doi:10.1542/neo.10-11-e575 Visual Diagnosis: Skin Ulcerations in a Preterm Newborn (Click here) American Academy of Pediatrics 11 10 575 2009-11-01 VISUAL DIAGNOSIS http://pediatrics.aappublications.org:80/cgi/content/short/124/5/e835?rss=1 OBJECTIVE: We studied patterns of prenatal corticosteroid use, respiratory distress syndrome, and associated mortality rates to assess the congruence between knowledge and clinical practice related to such prophylaxis. METHODS: We used data on all live births in the United States (for the years 1989-1991, 1995-1997, and 2002-2004) and Nova Scotia, Canada (for the years 1988-2007). Gestational age-specific temporal trends in infant deaths resulting from respiratory distress syndrome were quantified in the United States, and gestational age-specific temporal trends in corticosteroid use and morbidity (respiratory distress syndrome and intraventricular hemorrhage) were quantified in Nova Scotia. RESULTS: In the United States, infant deaths associated with respiratory distress syndrome decreased by 48% (95% confidence interval: 46%-50%) from 1989-1991 to 1995-1997 and then decreased by another 18% (95% confidence interval: 15%-22%) by 2002-2004. The latter mortality reduction was evident at 28 to 32 weeks but not 33 to 36 weeks of gestation. Corticosteroid use at 28 to 32 weeks was high in Nova Scotia and increased from 30.7% in 1988-1989 to 50.0% in 1996-1997 and to 52.9% in 2006-2007, whereas rates of use at 33 to 36 weeks were much lower (eg, 6.7%, 17.0%, and 15.7% at 34 weeks in the 3 periods). Increased corticosteroid use at 33 and 34 weeks was estimated to reduce respiratory distress syndrome substantially. CONCLUSION: Addressing the knowledge-practice gap in corticosteroid use at 33 to 34 weeks should reduce infant morbidity and mortality rates. Joseph, K. S. Nette, F. Scott, H. Vincer, M. J. 2009-11-01 doi:10.1542/peds.2009-0905 Prenatal Corticosteroid Prophylaxis for Women Delivering at Late Preterm Gestation American Academy of Pediatrics 5 124 843 835 2009-11-01 ARTICLES