NeoReviews最新文献

Neonates requiring intensive care and prolonged hospitalizations often undergo procedures and therapies that predispose them to pain, agitation, and delirium. Early recognition and treatment of these symptoms can decrease morbidity and mortality. While nonpharmacologic interventions can be beneficial, they often are insufficient in managing symptoms of pain, agitation, and delirium. Familiarity with the pharmacologic concepts and therapies used to target different pathophysiological mechanisms of pain and agitation will increase the neonatal clinician's ability to effectively use and tailor these medications to each patient's needs. In this review, we summarize the pathophysiology, impact, assessment, and management options for each symptom so clinicians can individualize care and use targeted pharmacologic therapies to effectively and safely treat symptoms in various clinical scenarios. We also discuss the importance of protocol use to ensure judicious medication initiation and titration to minimize long-term neurodevelopmental effects of pain, agitation, delirium, and their associated pharmacotherapies.

As the field of neonatal-perinatal medicine rapidly expands, it faces significant challenges in community and private practice settings, where resources are often limited. Although there have been significant advances in medical and surgical management, workforce shortages, restructuring of training programs, and the increasing acuity of cases threaten the delivery of high-quality care in these environments. These issues are further exacerbated by an aging workforce and fewer applicants for neonatal-perinatal medicine fellowship positions. Furthermore, changes in requirements by the Accreditation Council for Graduate Medical Education have reduced exposure to neonatology during medical school and pediatric residency training. This has created gaps in clinical experience and competence, especially critical for independent practice in settings with limited resources. This article identifies the current challenges faced by neonatologists in community and private practice settings and describes potential solutions.

Severe combined immunodeficiency (SCID) is a rare and life-threatening disease, characterized by an intrinsic defect of the hematopoietic stem cell that disrupts appropriate T lymphocyte maturation. Previously, early diagnosis of SCID used to require an experienced physician who identified patients with abnormal absolute lymphocyte count and distinct clinical manifestations. Over the past few decades, the implementation of universal newborn screening has enhanced our diagnostic capabilities. The Pediatric Immune Deficiency Treatment Consortium updated the definitions of SCID in 2022, providing a comprehensive approach to differentiate patients with typical SCID from leaky or atypical SCID, and Omenn syndrome from those without SCID. SCID is caused by multiple genetic abnormalities with different phenotypes involving T cells and possibly natural killer cells, and B cells. The management of patients with SCID requires a multifocal approach with early interventions to prevent infections and the concurrent planning of a curative therapy such as hematopoietic stem cell transplantation or, in some cases, gene therapy. Early intervention in affected patients with the absence of infection is a predictor of good long-term outcomes, but because of evolving bone marrow transplant and gene therapy techniques, patients need to be monitored long term to assess for possible late side effects. This review will focus on the most common genetic causes of SCID and their distinct characteristics, acute management, and curative options.

Listeriosis, an invasive disease caused by Listeria monocytogenes, is an uncommon cause of perinatal infection with a high risk of morbidity in neonates. Pregnant persons can acquire this foodborne pathogen from deli meats and unprocessed cheese, placing their neonate at risk. In the past 10 years, whole-genome sequencing has been used to track L monocytogenes isolates from clinical samples and those obtained from food processing facilities in the United States. Over time, use of this robust public health surveillance system may lead to a reduction of invasive listeriosis among immunocompromised patients. This review will summarize the epidemiology, pathogenesis, clinical presentation, management, and outcomes of pregnant persons and neonates with invasive Listeria disease.