NeoReviews最新文献

Choanal atresia (CA) and choanal stenosis (CS) are congenital obstruction or narrowing of the choanae, respectively. Neonates with bilateral CA present with respiratory distress shortly after birth and require patency of the oral airway and surgical correction of the defect, whereas patients with unilateral CA/CS can present later in infancy or even into adulthood and can often be managed medically. It is important to differentiate the symptoms of CA/CS from other causes of congenital nasal obstruction so that the appropriate medical and/or surgical management can be determined. A variety of embryologic explanations exist for the cause of CA/CS, with failed rupture of the oronasal membrane being the predominant theory. It is important to evaluate affected neonates for other anomalies based on risk factors and phenotypical features, as almost 75% of patients with CA/CS have associated craniofacial abnormalities or syndromes. Definitive diagnosis of CA/CS includes nasal endoscopy and computed tomography. Although a variety of surgical repair techniques exist for CA/CS, the transpalatal and endoscopic transnasal approaches are the mainstay, with the former reserved for nasal passages unable to accommodate an endoscope and surgical instruments simultaneously. Postoperative care includes saline rinses, frequent suctioning, and intranasal corticosteroids. Patients should be followed by an otolaryngologist for a minimum of 1 year after repair to monitor for restenosis.

Ex-utero intrapartum treatment (EXIT) is a complex procedure that allows for surgical placement of a secure airway during delivery for neonates with concern for significant obstructive airway or intrathoracic pathology. The goal of this procedure is to facilitate extrauterine transition to minimize prolonged hypoxia or cardiorespiratory collapse. The EXIT procedure can be categorized to include EXIT to airway, EXIT to resection, EXIT to extracorporeal membrane oxygenation, and EXIT to separation. Extensive multidisciplinary care coordination is needed to minimize morbidity and mortality in the pregnant person and neonate associated with the procedure. In this article, we summarize the indications for the EXIT procedure, describe the specific components of the procedure, and review the outcomes, risks, and complications in affected neonates.

The neonatal intensive care unit (NICU) is a data-rich environment that is an ideal setting for the implementation of machine learning (ML) and artificial intelligence (AI) in clinical decision support (CDS). Despite their potential, ML and AI applications are rarely used in clinical practice because of infrastructure and technical limitations. In this article, we review the technical requirements for data acquisition solutions, storage, and processing needed to handle the varied sources of data generated by hospitalized newborns. In addition, we describe the challenges for integrating structured and unstructured data from electronic health records, bedside monitors, imaging, and other sources and we consider the ethical and legal implications of using ML and AI for CDS. Finally, we emphasize that the study and application of ML and AI models in CDS requires rigorous research and quality improvement methodology. The NICUs that realize the potential of ML and AI in quality improvement and clinical research applications will be uniquely positioned to apply their findings to improve neonatal outcomes.

Prematurity can affect visual outcomes and lead to chronic ocular conditions such as strabismus, refractive error, and amblyopia. Infants born prematurely can also have significant visual impairment resulting from retinopathy of prematurity or cortical visual impairment. This review summarizes ophthalmic outcomes to consider in the preterm infant.