Seminars in Fetal & Neonatal Medicine最新文献

英文中文

High-frequency jet ventilation in ELBW infants: A review and update ELBW 婴儿的高频喷射通气：回顾与更新。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-12-01 DOI: 10.1016/j.siny.2024.101566

Evan D. Richards , Robert M. DiBlasi

引用次数: 0

Assessment of Global Burden due to neonatal encephalopathy: An economic evaluation 新生儿脑病造成的全球负担评估：经济评估。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-12-01 DOI: 10.1016/j.siny.2024.101560

Ramesh Vidavalur , Kiran More , Vinod K. Bhutani

Neonatal encephalopathy (NE) is a significant cause of neonatal mortality in low- and middle-income (LAMI) countries, with far-reaching impacts on families and national human capital. Quantifying the disease burden in monetary terms is crucial for resource allocation and public health prioritization, yet data on the economic impact of NE-related neonatal mortality and prevention is limited. This study estimates the country-specific disease burden and economic impacts of NE for the ten countries with the highest death tolls in 2019. Using data from the Global Burden of Disease (GBD) Collaborative Network, we analyzed NE-specific mortality trends and calculated years of life lost (YLLs) based on life expectancy, with and without age weighting and discounting. Economic losses were evaluated using the value per statistical life (VSL) and value per statistical life year (VSLY) methodologies, with sensitivity analyses incorporating variable discount rates. In 2019, the ten countries with the highest NE burden was estimated at 138,763 neonatal deaths. YLLs ranged from 4.5 million with discounting to 9.8 million without. While nine of these countries reduced overall neonatal mortality from 2010 to 2019, six saw rising NE-specific mortality. Economic losses were estimated at $80 billion using the VSL method and between $72 billion and $163 billion using VSLY. Despite overall progress in reducing neonatal mortality, targeted funded strategies are needed to address NE in LAMI countries. Burden of NE could be reduced with improved strategic access to quality antenatal care and effective peripartum practices through efficient and enhanced resource allocation.

新生儿脑病（NE）是中低收入国家新生儿死亡的一个重要原因，对家庭和国家人力资本具有深远影响。以货币形式量化疾病负担对于资源分配和确定公共卫生优先事项至关重要，然而，与NE相关的新生儿死亡和预防对经济影响的数据却十分有限。本研究估算了2019年死亡人数最多的十个国家的NE疾病负担和经济影响。利用全球疾病负担（GBD）协作网络提供的数据，我们分析了NE特异性死亡率趋势，并根据预期寿命计算了生命损失年数（YLLs），包括年龄加权和贴现以及非年龄加权和贴现。经济损失的评估采用了每统计寿命价值 (VSL) 和每统计寿命年价值 (VSLY) 方法，并结合可变贴现率进行了敏感性分析。据估计，2019 年，新生儿死亡率最高的十个国家共造成 138,763 例新生儿死亡。折算后的实际寿命年数从 450 万到 980 万不等。从 2010 年到 2019 年，其中 9 个国家的新生儿总死亡率有所下降，但 6 个国家的 NE 具体死亡率有所上升。采用 VSL 方法估计经济损失为 800 亿美元，采用 VSLY 方法估计经济损失为 720 亿美元至 1,630 亿美元。尽管在降低新生儿死亡率方面取得了总体进展，但仍需要有针对性的资助战略来解决拉美和中东地区国家的NE问题。通过提高资源分配的效率和力度，改善优质产前护理和有效围产期保健的战略途径，可以减轻新生儿死亡率的负担。

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Management of patent ductus arteriosus – Evidence to practice 动脉导管未闭的管理--从证据到实践。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-12-01 DOI: 10.1016/j.siny.2024.101565

Samir Gupta , Steven M. Donn

Over the past last 50 years, patent ductus arteriosus (PDA) continues to be the leading hot topic debated worldwide in search of best treatment approach and the uncertainty around whether to treat or not treat a PDA. With the availability of bedside echocardiography and the increasing number of neonatologists acquiring this skill, on one hand there is better understanding of PDA physiology during transitional circulation and objectivity in management, but on the other hand clinicians are uncertain about benefits in health outcomes. Evidence from recent trials utilizing early selective treatment guided by bedside echocardiography should help in dispelling some myths if not providing the answer about how to manage the PDA.

在过去的 50 年中，动脉导管未闭（PDA）一直是全世界争论的热点话题，人们一直在寻找最佳的治疗方法，并对是否治疗 PDA 持不确定态度。随着床旁超声心动图的普及以及越来越多的新生儿科医生掌握了这一技能，一方面，人们对 PDA 在过渡循环期间的生理机能有了更好的了解，管理也更加客观，但另一方面，临床医生对其对健康的益处并不确定。最近利用床旁超声心动图指导早期选择性治疗的试验所提供的证据，即使不能解答如何处理 PDA 的问题，也应有助于消除一些迷思。

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Control of breathing in preterm infants 早产儿的呼吸控制。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-12-01 DOI: 10.1016/j.siny.2024.101559

Daniel M. Mammel , Mark C. Mammel

引用次数: 0

Late preterm and early term birth: Challenges and dilemmas in clinical practice 晚期早产和早产：临床实践中的挑战和困境。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-12-01 DOI: 10.1016/j.siny.2024.101564

Elaine M. Boyle, Frances J. Mielewczyk, Caroline Mulvaney

The major focus of neonatal research for many years has been the smallest and most vulnerable infants born before 32 weeks of gestation. More recently it has become clear that a gradient of risk for adverse outcomes spans the whole spectrum of gestational age, from those born at the margins of viability, to those born close to their estimated date of delivery. Whilst effect sizes may be smaller for the more mature babies born late preterm and early term, the size of the problem is related to very large numbers with less severe difficulties, yet whose problems affect many domains of health, development and education, and may have impact across the whole life course. Our knowledge of the mechanisms and influencing factors contributing to outcomes of individuals born late preterm and early term is inadequate. The unique challenges associated with managing pregnancies, babies, children, adults and families affected by late preterm or early term birth in the face of limited evidence mandate further research to guide practice and optimise short- and long-term outcomes.

多年来，新生儿研究的重点一直是妊娠 32 周前出生的最小和最脆弱的婴儿。最近的研究表明，不良后果的风险梯度横跨整个胎龄范围，从那些出生时处于存活边缘的婴儿，到那些出生时接近预产期的婴儿。虽然对早产晚期和早产儿的影响可能较小，但问题的严重程度与大量存在较轻问题的婴儿有关，这些婴儿的问题影响到健康、发育和教育等多个领域，并可能对整个生命过程产生影响。我们对导致晚期早产儿和早产儿结局的机制和影响因素还缺乏足够的了解。在证据有限的情况下，管理受晚期早产或早产影响的孕妇、婴儿、儿童、成人和家庭所面临的独特挑战需要进一步的研究来指导实践，并优化短期和长期的结果。

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Advocating for neonatology presence at births between 20 and 25 weeks of gestation 倡导新生儿科在妊娠 20 至 25 周的新生儿中开展工作。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-12-01 DOI: 10.1016/j.siny.2024.101541

Amos Grünebaum , Renee McLeod-Sordjan , Michael Grosso , Frank A. Chervenak

Extreme preterm births between 20 and 25 weeks’ gestation present significant challenges in neonatal care and ethics. This manuscript advocates for neonatology presence from 20 weeks onwards to optimize outcomes. Neonatology attendance ensures accurate gestational age assessment, immediate intervention, and informed decision-making. Survival rates for extremely preterm infants have improved significantly, ranging from 0 to 37 % at 22 weeks to 31–78 % at 24 weeks. However, outcomes vary widely based on factors such as healthcare access and socioeconomic conditions. We propose using “preterm birth between 20 and 25 weeks” instead of “periviability” for clarity in clinical protocols and parental counseling. Ethical considerations, including potential overtreatment and parental autonomy, are addressed through clear guidelines. While challenges exist in implementing this approach, particularly in smaller or rural hospitals, solutions such as strengthening regional networks and telemedicine can address these issues. Despite concerns about resource allocation, we argue that the benefits of neonatologist attendance outweigh the challenges, providing the best opportunity for survival and optimal outcomes in these ethically complex situations.

妊娠 20 到 25 周之间的极早产给新生儿护理和伦理带来了巨大挑战。本手稿主张新生儿科从 20 周起就应介入，以优化预后。新生儿科出诊可确保准确的胎龄评估、即时干预和知情决策。极早产儿的存活率已显著提高，从 22 周时的 0% 到 37% 到 24 周时的 31-78%。然而，由于医疗条件和社会经济条件等因素的不同，结果也大相径庭。我们建议使用 "20 到 25 周早产 "来代替 "围产期"，以便在临床方案和家长咨询中更加清晰。伦理方面的考虑，包括潜在的过度治疗和父母的自主权，都将通过明确的指导原则来解决。虽然这种方法在实施过程中存在挑战，尤其是在小型医院或农村医院，但加强区域网络和远程医疗等解决方案可以解决这些问题。尽管存在资源分配方面的担忧，但我们认为新生儿科医生出诊的益处大于挑战，为这些伦理上复杂的情况提供了最佳的生存机会和最佳结果。

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The peripheral chemoreflex and fetal defenses against intrapartum hypoxic-ischemic brain injury at term gestation 外周化学反射和胎儿对临产缺氧缺血性脑损伤的防御能力。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101543

Christopher A. Lear , Simerdeep K. Dhillon , Masahiro Nakao , Benjamin A. Lear , Antoniya Georgieva , Austin Ugwumadu , Peter R. Stone , Laura Bennet , Alistair J. Gunn

Fetal hypoxemia is ubiquitous during labor and, when severe, is associated with perinatal death and long-term neurodevelopmental disability. Adverse outcomes are highly associated with barriers to care, such that developing countries have a disproportionate burden of perinatal injury. The prevalence of hypoxemia and its link to injury can be obscure, simply because the healthy fetus has robust coordinated defense mechanisms, spearheaded by the peripheral chemoreflex, such that hypoxemia only becomes apparent in the minority of cases associated with stillbirth, severe metabolic acidemia or adverse neurodevelopmental outcomes. This represents only the extreme end of the spectrum, when defense mechanisms have failed due to severe/prolonged hypoxemia, or the fetal defenses are compromised by additional risk factors. Understanding the fetal defenses to hypoxemia and when the fetus begins to decompensate is crucial to understanding perinatal health and disease, by linking antenatal health, intrapartum events, the neonatal trajectory and ultimately life-long neurodevelopmental health.

胎儿低氧血症在分娩过程中无处不在，严重时会导致围产期死亡和长期神经发育障碍。不良后果与护理障碍密切相关，因此发展中国家的围产期损伤负担过重。低氧血症的发生率及其与损伤的联系可能并不明显，原因很简单，健康的胎儿在外周化学反射的作用下具有强大的协调防御机制，因此只有在与死胎、严重代谢性酸血症或不良神经发育结局相关的少数情况下，低氧血症才会显现出来。这只是极端的情况，即由于严重/长期低氧血症导致防御机制失效，或其他风险因素损害了胎儿的防御能力。了解胎儿对低氧血症的防御能力以及胎儿何时开始失代偿，对于了解围产期健康和疾病至关重要，因为它将产前健康、产中事件、新生儿轨迹以及最终的终生神经发育健康联系在一起。

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引用次数: 0

Bedside monitoring tools and advanced signal processing approaches to monitor critically-ill infants 床旁监测工具和先进的信号处理方法，用于监测重症婴儿。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101544

R.B. Govindan , Kenneth A. Loparo

There is a substantial body of literature that supports neonatal monitoring and signal analysis of the collected data to provide valuable insights for improving patient clinical care and to inform new research studies. This comprehensive monitoring approach extends beyond the collection of conventional vital signs to include the acquisition of continuous waveform data from patient monitors and other bedside medical devices. This paper discusses the necessary infrastructure for waveform retrieval from bedside monitors, and explores options provided by leading healthcare companies, third-party vendors or academic research teams to implement scalable monitoring systems across entire critical care units. Additionally, we discuss the application of advanced signal processing that transcend traditional statistics, including heart rate variability in both the time- and frequency-domains, spectral analysis of EEG, and cerebral pressure autoregulation. The infrastructures and signal processing techniques outlined here are indispensable tools for intensivists, empowering them to enhance care for critically ill infants. In addition, we briefly address the emergence of advanced tools for fetal monitoring.

有大量文献支持对新生儿进行监测并对所收集的数据进行信号分析，从而为改善患者临床护理提供有价值的见解，并为新的研究提供信息。这种全面的监护方法不仅包括收集传统的生命体征，还包括从患者监护仪和其他床旁医疗设备获取连续波形数据。本文讨论了从床旁监护仪检索波形所需的基础设施，并探讨了由领先的医疗保健公司、第三方供应商或学术研究团队提供的在整个重症监护病房实施可扩展监护系统的方案。此外，我们还讨论了超越传统统计的高级信号处理的应用，包括时域和频域的心率变异性、脑电图频谱分析和脑压自动调节。这里概述的基础设施和信号处理技术是重症监护医生不可或缺的工具，使他们有能力加强对重症婴儿的护理。此外，我们还简要介绍了用于胎儿监护的先进工具。

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引用次数: 0

Advancing our knowledge of placental function and how it relates to the developing fetal brain 进一步了解胎盘功能及其与胎儿大脑发育的关系。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101549

Aine Fox , Breda Hayes , Emma Doyle

Perinatal medicine has made significant advancements in recent decades. This has improved care and outcomes for infants. As we strive to improve neurodevelopmental outcomes, we must understand the influence the maternal/placental/fetal (MPF) triad has on fetal development and postnatal health and disease.

Our understanding of the MPF triad remains incomplete, however research is continuing to develop our understanding. Through further research and incorporating what is currently known into how we deliver perinatal care, we have the opportunity to improve outcomes for infants.

This review focuses on what is currently known about the structure and function of the placenta and the influence of the MPF triad. Current modalities for assessment of the MPF triad and future avenues for research will also be discussed.

Understanding the relationship between the MPF triad, neurodevelopment and long-term health and disease has the potential to open new avenues for disease prevention and treatment through the lifespan.

近几十年来，围产医学取得了长足的进步。这改善了婴儿的护理和预后。当我们努力改善神经发育结果时，我们必须了解母体/胎盘/胎儿（MPF）三要素对胎儿发育和产后健康及疾病的影响。我们对母体/胎盘/胎儿三位一体的理解仍不全面，但研究仍在不断深入。通过进一步研究，并将目前已知的知识融入围产期保健服务中，我们将有机会改善婴儿的预后。本综述重点介绍目前已知的胎盘结构和功能以及 MPF 三联征的影响。此外，还将讨论目前评估 MPF 三联征的方法以及未来的研究方向。了解多孔胎盘三联体、神经发育和长期健康与疾病之间的关系有可能为预防和治疗整个生命周期的疾病开辟新的途径。

引用次数: 0

Brain care bundles applied over each and successive generations 在每一代和连续几代人身上应用大脑护理捆绑包。

IF 2.9 3区医学 Q1 PEDIATRICS

Seminars in Fetal & Neonatal Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.siny.2024.101558

Mark S. Scher , Susan Ludington , Valerie Smith , Stina Klemming , Betsy Pilon

Worldwide polycrises continue to challenge the World Health Organization's proposed 2030 sustainable development goals. Continuity of brain care bundles helps attain these goals by sustaining brain health over successive generations. Factors representing social drivers of health must incorporate transdisciplinary care into equitable intervention choices. Drivers are more effectively addressed by combining maternal and pediatric assessments to address morbidity and mortality across each lifespan. Care bundles comprise at least three evidenced-based interventions collectively implemented during a clinical experience to achieve a desired outcome. Synergy among stakeholders prioritize communication, responsibility, compliance and trust when choosing bundles in response to changing clinical conditions. A prenatal transdisciplinary model continues after birth with infant and family-centered developmental care practices through discharge to supplement essential skin-to-skin contact. Fetal-neonatal neurology training encourages participation in this model of brain health care to more effectively choose neurodiagnostic and neuroprotective options. Shared clinical decisions evaluate interventions from conception through the first 1000 days. At least eighty percent of brain connectivity will have been completed during this first critical/sensitive period of neuroplasticity. The developmental origins of health and disease concept offers neurology subspecialists a life-course perspective when choosing brain health strategies. Toxic stressor interplay from reproductive and pregnancy diseases and adversities potentially impairs embryonic, fetal and neonatal brain development. Continued exposures throughout maturation and aging worsen outcome risks, particularly during adolescence and reproductive senescence. Intragenerational and transgenerational use of care bundles will guide neuromonitoring and neuroprotection choices that strengthen preventive neurology strategies.

世界范围内的多重危机继续对世界卫生组织提出的 2030 年可持续发展目标构成挑战。持续性的脑护理捆绑服务有助于通过维持一代又一代人的脑健康来实现这些目标。健康的社会驱动因素必须将跨学科护理纳入公平的干预选择中。将孕产妇和儿科评估结合起来，更有效地应对各种驱动因素，以解决每个生命周期的发病率和死亡率问题。护理捆绑包括至少三种以证据为基础的干预措施，在临床实践中共同实施，以达到预期效果。在根据不断变化的临床条件选择护理包时，利益相关者之间的协同作用将优先考虑沟通、责任、合规性和信任。产前跨学科模式在婴儿出生后继续开展以婴儿和家庭为中心的发育护理实践，直至出院，以补充必要的肌肤接触。胎儿-新生儿神经病学培训鼓励参与这种脑健康护理模式，以便更有效地选择神经诊断和神经保护方案。共同临床决策可评估从受孕到出生后 1000 天内的干预措施。在神经可塑性的第一个关键/敏感时期，至少有 80% 的大脑连接已经完成。健康和疾病的发展起源概念为神经病学亚专科医生在选择大脑健康策略时提供了一个生命过程的视角。生殖和妊娠期疾病及逆境造成的有毒压力相互作用可能会损害胚胎、胎儿和新生儿的大脑发育。在整个成熟和衰老过程中持续暴露于有毒物质会使结果风险恶化，尤其是在青春期和生殖衰老期。代内和跨代使用护理捆绑将指导神经监测和神经保护的选择，从而加强预防性神经病学战略。

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