NeoReviews最新文献

Chronic hypertension complicates 1 to 2% of pregnancies and significantly increases maternal and fetal morbidity. This review presents a patient case of severe chronic hypertension with multiple comorbidities, requiring 5 antihypertensive agents for blood pressure control, culminating in preterm delivery for fetal compromise. We discuss current definitions, risks, treatment options, and key clinical trials (Chronic Hypertension and Pregnancy, Hypertension and Preeclampsia Intervention Trial at Near Term-II) for the management of hypertension in pregnancy, highlighting gaps in the management of severe, refractory cases of chronic hypertension.

Congenital diaphragmatic hernia (CDH) presents a complex challenge in neonatal care, requiring tailored pharmacological strategies to manage its distinct cardiorespiratory pathophysiology. CDH is commonly associated with pulmonary hypertension, impaired myocardial function, and adverse cardiorespiratory interactions, contributing to significant morbidity and mortality. Effective pharmacotherapy must address these interconnected factors while minimizing complications or side effects. Despite limited randomized controlled trial data specific to CDH, recent reports highlight the benefits of a precision medicine approach, focusing on individualized treatments based on evolving pathophysiology. Therapeutic interventions primarily involve pulmonary vasodilators, inotropes and vasopressors, prostaglandins, and corticosteroids; each agent has a distinct physiologic effect, and use needs to be tailored to the specific patient pathophysiology. Targeted neonatal echocardiography has emerged as a valuable tool for optimizing treatment decisions by providing real-time insights into ventricular performance and hemodynamic status. In this review, we explore the shift from a generalized pharmacological approach to targeted interventions based on evolving patient physiology. We discuss key therapeutic principles and the role of different drug classes in optimizing the management of infants with CDH throughout their intensive care journey.

Respiratory syncytial virus (RSV) poses a critical global health challenge, causing more than 33.1 million acute lower respiratory tract infections and more than 118 000 deaths annually in children younger than 5 years of age. The burden falls disproportionately on infants younger than 12 months of age, with devastating impacts on health care systems worldwide. Prevention strategies have evolved from early vaccine attempts through first-generation monoclonal antibodies to current next-generation antibodies with extended half-lives and novel vaccination approaches in pregnant persons. These recent advances demonstrate unprecedented efficacy, with clinical trials showing reduction rates exceeding 70% in RSV-associated hospitalizations across diverse infant populations. Although economic analyses suggest favorable cost-benefit ratios, implementation raises important considerations regarding health care delivery systems and global access equity. This comprehensive review synthesizes evidence-based guidelines, evaluates implementation challenges, and explores future directions for RSV prevention, with particular attention to regional variations in health care delivery and emerging challenges from changing climate patterns affecting RSV seasonality.