BOOK
Current Controversies in Perinatology, An Issue of Clinics in Perinatology, E-Book
(2014)
Additional Information
Book Details
Abstract
Neonatal-perinatal medicine has a strong history of evidence based practice but unfortunately there remain many areas of uncertainty and unproven hypotheses and treatments that may harm our highly vulnerable patients. When new ideas are introduced into the labor and delivery room or the NICU we have to evaluate these procedures and therapies before they become accepted as standards of care. We need to learn from the past lessons of grey baby syndrome and chloramphenicol and of kernicterus and sulfonamide antibiotics where therapeutic good intentions actually did more harm than good and increased the mortality rate of premature babies in the NICU.This proposed edition addresses a broad range of current topics in perinatal neonatal practice. The AAP has just issued new guidelines for the approach to a neonate exposed to maternal genital herpes virus infection. The recommendations were not evidence based and are highly controversial as well as confusing. These topics are addressed in a scholarly and objective manner to both address the controversy and help the practitioner make informed decisions.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Current Controversies in Perinatology\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| CME Accreditation Page\r | xii | ||
| Clinics In Perinatology | xiv | ||
| Foreword | xv | ||
| Preface | xix | ||
| Global Challenges, Efforts, and Controversies in Neonatal Care | 749 | ||
| Key points | 749 | ||
| Introduction | 750 | ||
| Challenges | 752 | ||
| The 3 Delays | 752 | ||
| Health Worker Migration | 754 | ||
| Insufficient Supplies | 755 | ||
| Scalability and Sustainability | 755 | ||
| Lack of Effective Prevention Strategies for Preterm Birth | 755 | ||
| Minimal Infrastructure to Track Progress | 759 | ||
| Current efforts | 759 | ||
| Educational Initiatives | 759 | ||
| Task Shifting | 759 | ||
| Clinical Care | 760 | ||
| Essential care for all newborns | 760 | ||
| Special care for small or sick newborns | 760 | ||
| Research and Quality Improvement | 761 | ||
| Community Mobilization | 764 | ||
| Community-Based Interventions | 764 | ||
| Mobile Technology | 765 | ||
| Global Mobilization | 765 | ||
| Controversies | 766 | ||
| Implementation Gaps: We Know What Works, But How Do We Implement and Scale Up? | 766 | ||
| Facility Versus Community Births: Where Do We Focus Our Efforts? | 766 | ||
| Lay Providers: How Much Empowerment Is Too Much? | 767 | ||
| Preterm birth complications | 767 | ||
| Intrapartum-related complications | 768 | ||
| Neonatal infections | 768 | ||
| Educational Initiatives: Are We Draining Local Resources? | 768 | ||
| Stillbirths: Who Is Keeping Track? | 768 | ||
| Resources: Who Comes First, and Are We Outgrowing Ourselves? | 769 | ||
| Summary | 769 | ||
| References | 769 | ||
| Prevention of Preterm Birth in Modern Obstetrics | 773 | ||
| Key points | 773 | ||
| Ineffective interventions | 774 | ||
| Home Tocometry | 774 | ||
| Tocolytics | 774 | ||
| Activity Restriction | 774 | ||
| Interventions of questionable efficacy | 776 | ||
| Treatment of Urogenital Tract Infections | 776 | ||
| Pessary | 776 | ||
| Successful therapy | 778 | ||
| Lifestyle Modifications | 778 | ||
| Progestational Agents | 778 | ||
| Cerclage | 779 | ||
| Interventions to Limit Nonindicated Deliveries Before 39 Weeks of Gestation | 779 | ||
| Summary | 780 | ||
| References | 781 | ||
| Challenges and Controversies in Fetal Diagnosis and Treatment | 787 | ||
| Key points | 787 | ||
| Introduction | 787 | ||
| Etiology of hypoplastic left heart syndrome | 788 | ||
| Hypoplastic left heart syndrome: prenatal diagnosis and psychosocial impact | 789 | ||
| Hypoplastic left heart syndrome: risk factors for adverse outcome | 791 | ||
| Nurse coordinator | 791 | ||
| Fetal cardiologist | 791 | ||
| Maternal fetal medicine expert | 791 | ||
| Cardiothoracic surgery | 791 | ||
| Additional support | 791 | ||
| Hypoplastic left heart syndrome: management strategies | 793 | ||
| Delivery | 793 | ||
| Maternal Hyperoxygenation | 793 | ||
| Fetal Catheter Intervention | 794 | ||
| Summary | 795 | ||
| References | 795 | ||
| Borderline Viability | 799 | ||
| Key points | 799 | ||
| Introduction | 799 | ||
| Legal conflict with guidelines? | 800 | ||
| Argument 1 against guidelines: a trial of assessment and treatment for all | 800 | ||
| Response to mandatory trial of assessment and treatment | 801 | ||
| Premise 1: Assessment of Gestational Age After Birth Is Most Accurate | 801 | ||
| Premise 2: Assessment of Vigorousness Adds Prognostic Information and Therefore Decreases Uncertainty | 802 | ||
| Premise 3: Testing Treatment Responses in First Hours to Days Provides More Facts or Certainty to Help Determine Long-Term ... | 802 | ||
| Premise 4: Treatment Withdrawal Is Ethically Equivalent to Withholding (From the Parents’ Perspective) | 802 | ||
| Preterm birth can be but is most often not an emergency situation | 803 | ||
| Argument 2 against guidelines: they are discriminatory and lack ethical and scientific basis | 803 | ||
| Ageism Within and at the Border of the Gray Zone | 803 | ||
| Response to Ageism | 804 | ||
| Argument 3: doctor knows best | 805 | ||
| Best interest | 805 | ||
| Constrained parental autonomy | 806 | ||
| Uncertainty and harm | 806 | ||
| Debate about counseling | 807 | ||
| Debate about cost | 808 | ||
| Summary | 809 | ||
| References | 809 | ||
| Fetal Programming, Epigenetics, and Adult Onset Disease | 815 | ||
| Key points | 815 | ||
| Introduction | 815 | ||
| Early life programming provides a conceptual infrastructure for how pediatric needs to change | 816 | ||
| Early life programming occurs secondary to significant environmental exposures | 817 | ||
| Epigenetics primer | 821 | ||
| Epigenetic tools | 821 | ||
| Environmental epigenetics as fit for and personalized medicine and fitness | 826 | ||
| Epigenetics as a biomarker and an intervention target | 827 | ||
| Acknowledgments | 827 | ||
| References | 827 | ||
| Comparative Effectiveness and Practice Variation in Neonatal Care | 833 | ||
| Key points | 833 | ||
| Introduction | 833 | ||
| What is comparative effectiveness research? | 834 | ||
| Direct Comparison of Potential Alternative Standards of Care | 834 | ||
| Evaluating a Broad Array of Health-related Outcomes that Are Important to Individuals | 834 | ||
| Incorporating a Wide Variety of Settings and Participants | 834 | ||
| Prioritizing Topics of Interest to Stakeholders | 834 | ||
| How does comparative effectiveness research relate to quality improvement? | 834 | ||
| Study designs for comparative effectiveness research | 835 | ||
| Randomized, Controlled Trials | 835 | ||
| Systematic Review and Metaanalysis | 837 | ||
| Observational Study Design in Comparative Effectiveness Research | 837 | ||
| Data Sources for Observational Study Design | 838 | ||
| Challenges in neonatal comparative effectiveness research | 839 | ||
| Comparing Treatment with Placebo: Efficacy Versus Effectiveness | 839 | ||
| Defining and Measuring Patient-Centered Outcomes | 839 | ||
| Summary | 841 | ||
| References | 841 | ||
| Conquering Racial Disparities in Perinatal Outcomes | 847 | ||
| Key points | 847 | ||
| Infant mortality ranking with a focus on the racial/ethnic widening gap in the United States | 847 | ||
| Regional differences in infant mortality rate in the United States | 850 | ||
| Profile of infant death disparities and causes | 850 | ||
| Differential intergenerational birth outcomes | 851 | ||
| Epigenetic Tools Addressing Racial Disparities in Perinatal Outcomes | 852 | ||
| Improving Perinatal Outcomes Through Community Action: Two Case Studies | 856 | ||
| Case study 1: the Milwaukee Healthy Beginnings Project | 856 | ||
| Analysis design | 858 | ||
| It's Not Your Mother's Marijuana | 877 | ||
| Key points | 877 | ||
| Introduction | 877 | ||
| Epidemiology of Marijuana Use Among Pregnant Women | 878 | ||
| Potential Impact of Medical Marijuana | 878 | ||
| Increasing Potency and Consumption of Marijuana | 880 | ||
| Issues related to marijuana use during pregnancy | 880 | ||
| Screening Pregnant Women for Marijuana Use | 880 | ||
| Effects of Prenatal Marijuana Use | 882 | ||
| Marijuana and Infertility | 883 | ||
| Pregnancy-Related Complications | 883 | ||
| Fetal Growth and Birth Outcomes | 883 | ||
| Fetal growth | 883 | ||
| Birth outcomes | 886 | ||
| Maternal Marijuana Use and Lactation | 886 | ||
| Developmental outcomes of prenatal marijuana exposure: neonatal period to early adulthood | 887 | ||
| Neonatal Withdrawal and Neurobehavior | 887 | ||
| Withdrawal | 887 | ||
| Neurobehavior | 887 | ||
| Prenatal Marijuana Exposure and Outcomes from Late Infancy to Young Adulthood | 887 | ||
| Executive function and attention | 887 | ||
| Academic achievement | 888 | ||
| Behavior problems | 888 | ||
| Summary | 888 | ||
| References | 889 | ||
| Pain Management in Newborns | 895 | ||
| Key points | 895 | ||
| Introduction | 895 | ||
| Historical Perspective | 895 | ||
| Importance of Neonatal Pain | 896 | ||
| Pain assessment | 896 | ||
| Pain Assessment Methods | 897 | ||
| Management of pain | 898 | ||
| Nonpharmacologic Approaches | 898 | ||
| Reduction of painful events | 898 | ||
| Kangaroo care and facilitated tucking | 898 | ||
| Non-nutritive sucking, sucrose and other sweeteners | 899 | ||
| Massage therapy | 899 | ||
| Acupuncture | 899 | ||
| Local Anesthetics | 900 | ||
| Lidocaine infiltration | 900 | ||
| Topical anesthetics | 900 | ||
| Opioid Therapy | 901 | ||
| Morphine | 901 | ||
| Fentanyl | 902 | ||
| Remifentanil, alfentanil, sufentanil | 903 | ||
| Nonopioid Therapies | 903 | ||
| Benzodiazepines | 903 | ||
| Midazolam | 904 | ||
| Lorazepam | 905 | ||
| Other sedatives | 905 | ||
| Phenobarbital | 905 | ||
| Propofol | 905 | ||
| Ketamine | 906 | ||
| Dexmedetomidine | 906 | ||
| Chloral hydrate | 906 | ||
| Acetaminophen (Paracetamol) | 906 | ||
| Nonsteroidal antiinflammatory drugs | 907 | ||
| Implementing pain management in the neonatal intensive care unit: a quality improvement approach | 907 | ||
| Developing Neonatal Intensive Care Unit: Specific Guidelines | 908 | ||
| Analgesia for Invasive Procedures | 908 | ||
| Postoperative Analgesia | 908 | ||
| Analgesia for Mechanical Ventilation | 908 | ||
| Summary | 911 | ||
| References | 912 | ||
| Vascular Endothelial Growth Factor Antagonist Therapy for Retinopathy of Prematurity | 925 | ||
| Key points | 925 | ||
| Introduction | 925 | ||
| The problem: retinopathy of prematurity is increasing worldwide and has different phenotypes | 926 | ||
| Current treatment for retinopathy of prematurity and reasons for better therapies | 926 | ||
| Toward a treatment solution | 930 | ||
| The bevacizumab eliminates the angiogenic threat of retinopathy of prematurity study | 930 | ||
| Consideration of anti-vascular endothelial growth factor agents in severe retinopathy of prematurity: knowledge from animal ... | 932 | ||
| Pro: Evidence That Inhibiting Vascular Endothelial Growth Factor Inhibits Intravitreal Angiogenesis in Severe Retinopathy o ... | 932 | ||
| Con: Evidence That Vascular Endothelial Growth Factor Inhibition Can Lead to Harm | 935 | ||
| Considerations regarding adult/preterm infant size and dose considerations | 937 | ||
| Guidelines if considering anti-vascular endothelial growth factor treatment | 938 | ||
| Future | 939 | ||
| References | 939 | ||
| Preventing Herpes Simplex Virus in the Newborn | 945 | ||
| Key points | 945 | ||
| Viral structure | 945 | ||
| Maternal genital infections during pregnancy | 945 | ||
| Herpes simplex virus in the newborn | 946 | ||
| Risk Factors for Transmission of Herpes Simplex Virus to the Newborn | 946 | ||
| Times of Herpes Simplex Virus Acquisition by the Newborn | 947 | ||
| Disease Classification and Clinical Presentations | 947 | ||
| Disseminated Disease | 947 | ||
| Central Nervous System Disease | 947 | ||
| Skin, Eye, and/or Mouth Disease | 948 | ||
| Diagnostic Modalities for Identifying Infants with Herpes Simplex Virus | 948 | ||
| Viral culture | 948 | ||
| Polymerase chain reaction | 948 | ||
| Specimens to Obtain from Newborn Before Initiating Antiviral Therapy | 948 | ||
| Recommendations for Treatment of Herpes Simplex Virus in the Newborn | 949 | ||
| Prognosis of Herpes Simplex Virus in the Newborn | 949 | ||
| Long-Term Antiviral Suppressive Therapy | 949 | ||
| Approach to an Infant Exposed to Active Maternal Primary or Recurrent Genital Herpes Simplex Virus | 949 | ||
| Testing of women in labor | 950 | ||
| Strategies for Prevention of Herpes Simplex Virus in the Newborn | 951 | ||
| Cesarean delivery | 951 | ||
| Antiviral suppressive therapy | 952 | ||
| Herpes simplex virus vaccine | 952 | ||
| Prevention of maternal herpes simplex virus acquisition during pregnancy | 952 | ||
| Prevention of postnatal acquisition | 953 | ||
| Summary | 953 | ||
| References | 953 | ||
| Use of Cell-Free Fetal DNA in Maternal Plasma for Noninvasive Prenatal Screening | 957 | ||
| Key points | 957 | ||
| Introduction | 957 | ||
| Fetal cell-free DNA | 959 | ||
| Controversies | 962 | ||
| Summary | 963 | ||
| References | 963 | ||
| Probiotics and Necrotizing Enterocolitis | 967 | ||
| Key points | 967 | ||
| Introduction | 967 | ||
| Necrotizing enterocolitis: more than one disease | 967 | ||
| Microbial ecology of the intestine | 970 | ||
| Probiotics: the controversy | 971 | ||
| Is there a need for regulation of probiotics for use in neonates? | 972 | ||
| Do we have alternatives to probiotics? | 973 | ||
| The future | 974 | ||
| References | 974 | ||
| Informing and Educating Parents About the Risks and Outcomes of Prematurity | 979 | ||
| Key points | 979 | ||
| Introduction | 979 | ||
| Historical perspective | 980 | ||
| We improve each other | 981 | ||
| It’s not what you say but how you say it | 981 | ||
| It’s not just the neonatologist who provides parents information on prematurity | 981 | ||
| It’s okay to cheat | 982 | ||
| More might be better: parents want more detailed information | 983 | ||
| “Don’t forget about us”: information needs of parents of moderate and late premature infants | 984 | ||
| A spoonful of sugar helps the medicine go down: negative prognostic information and parental participation in end-of-life d ... | 984 | ||
| “Teach us so we can learn”: how parents want the information to be presented | 985 | ||
| Different strokes for different folks: communicating evidence to parents | 985 | ||
| “Help us to remember”: parents want written and other supplemental information | 986 | ||
| “Let us see what you see”: parental access to their child’s medical record during the neonatal hospitalization | 987 | ||
| Turning the Titanic: health care system challenges | 987 | ||
| Sending without equipping: communication training for counselors | 988 | ||
| Leave your baggage at the door: minimizing bias when sharing outcome data with parents | 988 | ||
| The debate: providing information for resuscitative decision-making for extremely premature infants | 988 | ||
| Final thoughts: summary | 989 | ||
| References | 990 | ||
| Ethical Issues in DNA Sequencing in the Neonate | 993 | ||
| Key points | 993 | ||
| Introduction | 993 | ||
| Goals of clinical DNA testing in the neonate | 994 | ||
| Key benefits of DNA testing | 994 | ||
| Utility of DNA Testing When a Diagnosis Is Clinically Apparent | 994 | ||
| Ability of DNA Diagnosis to End Further Workup or Screening | 994 | ||
| Treatment Dependent on Molecular Results | 994 | ||
| Key Benefit of DNA Testing to the Family | 994 | ||
| Key problems with DNA testing | 995 | ||
| Testing modalities | 995 | ||
| Polymerase Chain Reaction Detection of Nongermline DNA: Newborn Screening for Severe Combined Immunodeficiency—the T-Cell R ... | 995 | ||
| Pathogenic Variant Screening for High-Risk Infants | 995 | ||
| Germline Chromosome Complement | 996 | ||
| Genome-wide sequencing | 997 | ||
| Summary/discussion | 997 | ||
| References | 997 | ||
| Screening for and Treatments of Congenital Immunodeficiency Diseases | 1001 | ||
| Key points | 1001 | ||
| Introduction | 1001 | ||
| Historical perspectives of newborn screening | 1001 | ||
| Severe combined immunodeficiency: a deadly disorder preventable with early detection and treatment | 1003 | ||
| Screening algorithm | 1005 | ||
| Results of 6 years of screening for severe combined immunodeficiency in the United States | 1006 | ||
| Limitations of the T-cell receptor excision circles assay | 1007 | ||
| Can newborn screening be expanded to detect more immune deficiencies? | 1008 | ||
| Clinical complexities in newborn screening for severe combined immunodeficiency | 1009 | ||
| Practical aspects of newborn screening for severe combined immunodeficiency | 1010 | ||
| Summary | 1011 | ||
| References | 1012 | ||
| Pulse Oximetry in Very Low Birth Weight Infants | 1017 | ||
| Key points | 1017 | ||
| Introduction | 1017 | ||
| Historical perspective | 1018 | ||
| Physiologic principles of pulse oximetry operation | 1018 | ||
| Oxygen saturation targets during resuscitation | 1019 | ||
| Oxygen saturation targets during neonatal intensive care | 1022 | ||
| Ethical Storm over the SUPPORT Trial Consent Form | 1026 | ||
| Technologic advances | 1027 | ||
| References | 1028 | ||
| Index | 1033 |