Seminars in Fetal & Neonatal Medicine最新文献

英文中文

The value of thromboelastography to neonatology 血栓弹性成像对新生儿科的价值。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2025.101610

Francesca Manzoni , Ludovica Raymo , Vittoria Carolina Bronzoni , Andrea Tomaselli , Stefano Ghirardello , Monica Fumagalli , Giacomo Cavallaro , Genny Raffaeli

Hemostatic derangements are common in critically ill and premature neonates. Nevertheless, hemostasis assessment in neonates is still challenging. The hemostatic system undergoes age-related physiological changes during its maturation and exhibits quantitative and qualitative differences between infants and adults. Conventional coagulation tests are mainly responsive to procoagulant factors, regardless of the contribution of cellular elements, anticoagulants and fibrinolytic contributors and, therefore, their role in predicting bleeding in neonatal acquired coagulopathy is somewhat limited. Viscoelastic coagulation tests offer a promising alternative, enabling a bedside and real-time assessment of the entire hemostatic process in short turn-around times with a limited amount of blood. These tests allow a targeted hemostatic monitoring and a tailored management of blood products and anticoagulation. The routine use of VCTs in the NICU remains limited, especially for premature infants, due to the lack of established normative ranges. In this review we will provide an overview of the main evidence related to the clinical application of viscoelastic monitoring in the neonatal setting.

止血失常在重症和早产新生儿中很常见。然而，新生儿的止血评估仍具有挑战性。止血系统在成熟过程中会发生与年龄相关的生理变化，婴儿与成人在数量和质量上都存在差异。传统的凝血试验主要对促凝血因子做出反应，而不考虑细胞元素、抗凝剂和纤维蛋白溶解剂的作用，因此在预测新生儿获得性凝血病的出血方面作用有限。粘弹性凝血试验提供了一种很有前景的替代方法，只需少量血液就能在短时间内对整个止血过程进行床旁实时评估。通过这些检测，可对止血过程进行有针对性的监测，并对血液制品和抗凝剂进行有针对性的管理。由于缺乏既定的标准范围，VCT 在新生儿重症监护室中的常规使用仍然有限，尤其是在早产儿中。在本综述中，我们将概述与新生儿粘弹性监测临床应用相关的主要证据。

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引用次数: 0

Prenatal diagnosis and treatment of congenital anemias

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2025.101613

Yair J. Blumenfeld

引用次数: 0

Should granulocyte transfusion therapy for septic neutropenic neonates be resurrected?

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2025.101616

Shelley M. Lawrence

Nearly half a century ago, granulocyte transfusions were trialed in critically ill, septic, neutropenic neonates and showed improved survival when used concurrently with antimicrobials. Benefits were particularly noteworthy for Gram-negative and fungal infections. The introduction of granulocyte colony-stimulating factor into clinical medicine in 1991 and inherent problems associated with granulocyte procurement for transfusion caused granulocyte transfusions to become nearly extinct for this patient population. Simultaneous technological and clinical management advancements have enabled the survival of younger neonates, who are at the highest risk for neutropenia and neonatal sepsis. These infants have well-documented developmental deficiencies in the number and functional capabilities of their neutrophils compared to older patients. A continued surge in antimicrobial resistance and an increasing number of Gram-negative infections have created an urgent need for clinicians to rethink old therapies and consider new ones. This review details the evolution of granulocyte transfusions and whether they should be resurrected in neonatal patients.

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引用次数: 0

Health and societal infant mortality burden of neonatal hemolytic disorders

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2025.101620

Ramesh Vidavalur , Vinod K. Bhutani

Hemolytic disorders in neonates, once exceedingly common causes of infant mortality, have become increasingly rare and now largely non-fatal. Global advancements in neonatal care and deeper understanding of the mechanisms of neonatal hemolysis have significantly improved survival outcomes, particularly among those in high-income countries. However, regional disparities persist due to non-equitable healthcare access. Their long-lasting health consequences have been attributed to social, demographic factors that are most likely amenable to healthcare governance. In this review, we focus our attention to neonatal hemolytic disorders to i) analyze data resourced from the Global Burden of Disease (GBD) 2021 report; ii) study the trends in infant mortality rates (IMR) as related to hemolytic disorders including its severe complication, extreme hyperbilirubinemia (EHB-IMR); iii) evaluate geospatial disparities among GBD super regions; and iv) examine these trends in relation to the socio-demographic index (SDI) of the countries that comprise the “super-regions”. From 1991 to 2021, global EHB-related IMR has declined significantly, from 73 to 25 per 100,000 live births. By 2021, EHB and kernicterus accounted for only 0.7 % of all under-five deaths. High-income countries have dramatically minimized hemolytic disease fatalities, but matched progress eludes regions like South Asia and sub-Saharan Africa. The inverse relationship between SDI and EHB-IMR highlight these national disparities to manifest as slower decline in IMR. In order to achieve equitable healthcare access for all regions, an improved understanding of the societal risk factors would guide re-engineering solutions that are also empowered by audited resource utilization to evaluate remedial governance policies.

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引用次数: 0

A practical review of iron deficiency in pregnancy

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2025.101611

Kimberly A. Moyle

Iron deficiency is a highly prevalent nutritional deficiency and the most common cause of anemia worldwide. Pregnant individuals are particularly susceptible due to increased demands to support expanding maternal blood volume and fetal growth. Iron deficiency and iron deficiency anemia are associated with maternal and neonatal morbidity, including preterm birth, preeclampsia, postpartum hemorrhage, and low birth weight. Iron is essential to support the rapidly growing fetal brain. Maternal iron deficiency is linked to cognitive delays, motor impairment, and neuropsychiatric disease in the offspring with effects lasting beyond childhood. Despite its high prevalence and profound clinical implications, it remains underdiagnosed and undertreated in pregnancy. This is potentiated by a lack of consensus regarding laboratory diagnosis and recommendations for screening and treatment. Here, we review the physiology, clinical implications, diagnosis, and treatment of iron deficiency in pregnancy.

引用次数: 0

A practical guide to reducing/eliminating red blood cell transfusions in the neonatal intensive care unit 新生儿重症监护室减少/消除输注红细胞的实用指南。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2024.101545

Robin K. Ohls , Timothy M. Bahr , Thomas G. Peterson , Robert D. Christensen

Red blood cell transfusions can be lifesaving for neonates with severe anemia or acute massive hemorrhage. However, it is imperative to understand that red cell transfusions convey unique and significant risks for neonates. The extremely rare risks of transmitting a viral, bacterial, or other microbial infection, or causing circulatory overload are well known and are part of blood transfusion informed consent. Less well known, and not always part of the consent process, are more common risks of transfusing the smallest and most immature NICU patients; specifically, multiple transfusions may worsen inflammatory conditions (particularly pulmonary inflammation), and in certain subsets are associated with retinopathy of prematurity and neurodevelopmental delay. Instituting non-pharmacological transfusion-avoidance techniques reduces transfusion rates. Pharmacological transfusion-avoidance, specifically erythropoietic stimulating agents, further reduces the risk of needing a transfusion. The protocols described herein constitute an efficient and cost-effective transfusion-avoidance program. Using these protocols, many NICU patients can remain transfusion-free.

对于患有严重贫血或急性大出血的新生儿来说，输注红细胞可以挽救他们的生命。然而，我们必须明白，输注红细胞对新生儿具有独特而重大的风险。传播病毒、细菌或其他微生物感染或导致循环负荷过重的风险极为罕见，这是众所周知的，也是输血知情同意书的一部分。给最小和最不成熟的新生儿重症监护病房患者输血的风险则不那么为人所知，也不总是同意程序的一部分；具体来说，多次输血可能会加重炎症（尤其是肺部炎症），在某些亚群中还与早产儿视网膜病变和神经发育迟缓有关。采用非药物避免输血技术可降低输血率。药物避免输血，特别是促红细胞生成剂，可进一步降低需要输血的风险。本文介绍的规程是一项高效且经济的避免输血计划。使用这些方案，许多新生儿重症监护病房的患者都可以避免输血。

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引用次数: 0

Revised World Health Organization (WHO) classification of G6PD gene variants: Relevance to neonatal hyperbilirubinemia

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2025.101619

Jon F. Watchko , Vinod K. Bhutani

The WHO recently revised their classification schema for G6PD gene variants. Notably, the previously separate Class II (severe enzyme deficiency; <10 % normal) and Class III (moderate enzyme deficiency; 10–60 % normal) variant groups are now combined into a single new category designated as Class B. Class B variants exhibit G6PD enzymatic activity in the <45 % of normal range. This welcome and prudent reclassification far better aligns with the neonatal hyperbilirubinemia risk reported in neonates with i) former “less severe” Class III variants including G6PD A- and ii) female neonates heterozygous for deficient alleles.

世界卫生组织最近修订了 G6PD 基因变异的分类模式。值得注意的是，以前单独划分的 II 类（严重酶缺乏症，即 G6PD 基因变异）现在被划分为 G6PD 基因变异；

引用次数: 0

Recent advances in NICU platelet transfusions

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2025.101609

Patricia Davenport, Martha Sola-Visner

引用次数: 0

Neonatal/perinatal diagnosis of hemolysis using ETCOc 使用 ETCOc 诊断新生儿/围产期溶血。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2024.101547

Robert D. Christensen , Timothy M. Bahr , Robin K. Ohls , Kenneth J. Moise Jr.

Hemolysis is a pathological shortening of the red blood cell lifespan. When hemolysis occurs in a neonate, hazardous hyperbilirubinemia and severe anemia could result. Hemolysis can be diagnosed, and its severity quantified, by the non-invasive measurement of carbon monoxide (CO) in exhaled breath. The point-of-care measurement is called “End-tidal CO corrected for ambient CO” (ETCOc). Herein we explain how ETCOc measurements can be used to diagnose and manage various perinatal/neonatal hemolytic disorders. We provide information regarding five clinical situations; 1) facilitating a precise diagnosis among neonates presenting with anemia or jaundice of unknown etiology, 2) monitoring fetal hemolysis with serial measurements of mothers during pregnancy, 3) measuring the duration of hemolysis in neonates with hemolytic disease, 4) measuring neonates who require phototherapy, to determine whether they have hemolytic vs. non-hemolytic jaundice, and 5) measuring all neonates in the birth hospital as part of a jaundice-detection and management program.

溶血是红细胞寿命缩短的一种病理现象。新生儿发生溶血时，可能会导致危险的高胆红素血症和严重贫血。溶血可通过无创测量呼出气体中的一氧化碳 (CO) 来诊断，并量化其严重程度。这种护理点测量方法被称为 "根据环境 CO 校正的潮气末 CO"（ETCOc）。在此，我们将解释如何利用 ETCOc 测量来诊断和处理各种围产期/新生儿溶血性疾病。我们提供了有关五种临床情况的信息：1）便于对病因不明的贫血或黄疸新生儿进行精确诊断；2）通过对孕期母亲进行连续测量来监测胎儿溶血情况；3）测量患有溶血性疾病的新生儿的溶血持续时间；4）测量需要光疗的新生儿，以确定他们是否患有溶血性黄疸或非溶血性黄疸；5）测量出生医院的所有新生儿，作为黄疸检测和管理计划的一部分。

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引用次数: 0

Iron supplementation for infants in the NICU: What preparation, how much, and how long is optimal?

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2025-03-01 DOI: 10.1016/j.siny.2025.101612

Sandra Juul , Kendell German

Infants born preterm or with other perinatal risk factors are at added risk for both iron deficiency and overload. Insufficient iron supplementation in the perinatal period is associated with long-term neurodevelopmental effects. Based on this, iron supplements must be targeted to infants’ individual iron needs to avoid the adverse effects of both iron deficiency and overload. Enteral iron supplements have been the gold standard in iron supplementation of neonates for many years. However, emerging parenteral formulations may provide an alternative for some infants, such as those who are unable to tolerate oral supplements or who are refractory to enteral supplementation. Optimal dosing and timing of supplementation is an area of ongoing research. In this review, we will summarize available enteral and parenteral iron formulations, review iron measurement parameters, and identify outstanding questions and ongoing research.

引用次数: 0

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