The purpose of this review is to examine synthetic and natural oxytocin use in pregnancy and post-partum. We distinguished synthetic oxytocin (Syntocinon®) use in labor as a uterine contraction stimulant in two parts: the first is for induction or augmentation of labor; the second for prevention of post-partum hemorrhage (PPH).Oxytocin, key hormone in the process of childbirth and lactation, is a strong smooth muscle stimulant. For this reason it is widely used to induce/augment labor and to prevent and cure PPH.However, Syntocinon® can penetrate the placenta and reach fetal circulation, thus causing various systemic effects on mother and fetus. Oxytocin plays an important role as a neurotransmitter in the central nervous system, affecting numerous neuro-behavioral functions and it is involved in many types of parental behavior in humans and animals. It is, in fact, involved in a wide variety of physiological and pathological functions such as sexual activity, penile erection, ejaculation, pregnancy, uterus contractions, milk ejection, maternal behavior, social bonding, and stress. Oxytocin has a decisive role in the process of “bonding” between mother and child and in that of social affiliation.We therefore explored the opportunity to reduce the use of Syntocinon® in labor ward as a precautionary measure.Finally, we place the emphasis on some techniques that will probably increase the production of endogenous oxytocin. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)
本综述的目的是检查合成和天然催产素在妊娠和产后的使用。我们区分合成催产素(Syntocinon®)在分娩中作为子宫收缩兴奋剂的使用分为两部分:第一是用于诱导或增强分娩;二是预防产后出血(PPH)。催产素是分娩和哺乳过程中的关键激素，是一种强效平滑肌兴奋剂。因此，它被广泛用于诱导/促进分娩和预防和治疗PPH。然而，Syntocinon®可以穿透胎盘，进入胎儿循环，从而对母亲和胎儿造成各种系统影响。催产素在中枢神经系统中作为一种神经递质发挥着重要作用，影响着许多神经行为功能，并与人类和动物的许多类型的亲代行为有关。事实上，它涉及到各种生理和病理功能，如性活动、阴茎勃起、射精、怀孕、子宫收缩、乳汁喷射、母性行为、社会关系和压力。催产素在母亲和孩子之间的“结合”过程和社会关系中起着决定性的作用。因此，我们探索了减少Syntocinon®作为预防措施在产房使用的机会。最后，我们将重点放在一些可能会增加内源性催产素产生的技术上。第11届国际新生儿学与卫星会议论稿·卡利亚里(意大利)·2015年10月26 -31日·从子宫到成人特约编辑:Vassilios Fanos(意大利卡利亚里)，Michele Mussap(意大利热那亚)，Antonio Del Vecchio(意大利巴里)，Bo Sun(中国上海)，Dorret I. Boomsma(荷兰阿姆斯特丹)，Gavino Faa(意大利卡利亚里)，Antonio Giordano(美国费城)
{"title":"How to reduce synthetic oxytocin administration and stimulate the production of endogenous oxytocin in childbirth","authors":"A. Ragusa","doi":"10.7363/040228","DOIUrl":"https://doi.org/10.7363/040228","url":null,"abstract":"The purpose of this review is to examine synthetic and natural oxytocin use in pregnancy and post-partum. We distinguished synthetic oxytocin (Syntocinon®) use in labor as a uterine contraction stimulant in two parts: the first is for induction or augmentation of labor; the second for prevention of post-partum hemorrhage (PPH).Oxytocin, key hormone in the process of childbirth and lactation, is a strong smooth muscle stimulant. For this reason it is widely used to induce/augment labor and to prevent and cure PPH.However, Syntocinon® can penetrate the placenta and reach fetal circulation, thus causing various systemic effects on mother and fetus. Oxytocin plays an important role as a neurotransmitter in the central nervous system, affecting numerous neuro-behavioral functions and it is involved in many types of parental behavior in humans and animals. It is, in fact, involved in a wide variety of physiological and pathological functions such as sexual activity, penile erection, ejaculation, pregnancy, uterus contractions, milk ejection, maternal behavior, social bonding, and stress. Oxytocin has a decisive role in the process of “bonding” between mother and child and in that of social affiliation.We therefore explored the opportunity to reduce the use of Syntocinon® in labor ward as a precautionary measure.Finally, we place the emphasis on some techniques that will probably increase the production of endogenous oxytocin. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2015-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71290279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pediatric urology is a pediatric speciality dedicated to the diagnosis and treatment of congenital and acquired genitourinary tract diseases. It is a speciality that is rapidly changing, thanks to the technological development that has been emerging in recent years. There have been important diagnostic and therapeutic news. Congenital anomalies of the kidneys and urinary tract (CAKUT) include various entities of structural malformations that result from defects in their morphogenesis. Clinical research and genetic studies on the origins of CAKUT are quickly evolving, with significant growth of high-quality research. Management goals of CAKUT include prevention of febrile urinary tract infections (UTIs) in newborns and toddles and renal injury, while minimizing the morbidity of treatment and follow-up. Treatment options include observation with or without continuous antibiotic prophylaxis (CAP) and surgical correction. Now, randomized controlled studies show that children with normal urinary tracts or low-grade vesicoureteral reflux (VUR) do not benefit from prophylaxis. All children with known mechanical or functional obstructions of the urinary tract are considered to have UTI. Functional obstruction often results from lower urinary tract dysfunction (LUTD) of either neurogenic or non-neurogenic origin and dilating VUR. The role of bladder and bowel dysfunction (BBD) in children with UTI and the long-term risk of renal scarring have shed new light on treatment strategies. Often it is BBD, rather than reflux, that causes UTI in children older than 2 years. Pediatric urology has evolved in recent years, with a greater focus on bladder and renal function, minimally invasive treatment, evidence-based interventions, and guideline adherence. Other topics in pediatric urology include urinary incontinence in children with special needs and the use of robot-assisted laparoscopic surgery (RALS) in children, with advantages over conventional laparoscopic surgery. Proceedings of the 11 th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26 th -31 st , 2015 · From the womb to the adult Guest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)
小儿泌尿外科是一门致力于诊断和治疗先天性和获得性泌尿生殖系统疾病的儿科专业。由于近年来出现的技术发展，这是一项正在迅速变化的专业。有重要的诊断和治疗方面的消息。肾脏和泌尿道先天性异常(先天性异常)包括由形态发生缺陷引起的各种结构畸形。随着高质量研究的显著增长，关于CAKUT起源的临床研究和遗传学研究正在迅速发展。CAKUT的管理目标包括预防新生儿和幼儿的发热性尿路感染(UTIs)和肾脏损伤，同时尽量减少治疗和随访的发病率。治疗方案包括观察有无持续抗生素预防(CAP)和手术矫正。现在，随机对照研究表明，尿路正常或低级别膀胱输尿管反流(VUR)的儿童不能从预防中获益。所有已知有机械或功能性尿路阻塞的儿童都被认为患有尿路感染。功能性梗阻通常是由神经源性或非神经源性下尿路功能障碍(LUTD)和VUR扩张引起的。膀胱和肠功能障碍(BBD)在尿路感染儿童中的作用以及肾脏瘢痕形成的长期风险为治疗策略提供了新的思路。通常是BBD，而不是反流，导致2岁以上儿童尿路感染。近年来，儿科泌尿外科发展迅速，越来越关注膀胱和肾脏功能、微创治疗、循证干预和指南依从性。儿童泌尿外科的其他主题包括有特殊需要的儿童尿失禁和在儿童中使用机器人辅助腹腔镜手术(RALS)，它比传统腹腔镜手术有优势。第11届国际新生儿学与卫星会议会议记录·卡利亚里(意大利)·2015年10月26日-31日·从子宫到成人客座编辑:Vassilios Fanos(意大利卡利亚里)，Michele Mussap(意大利热那亚)，Antonio Del Vecchio(意大利巴里)，Bo Sun(中国上海)，Dorret I. Boomsma(荷兰阿姆斯特丹)，Gavino Faa(意大利卡利亚里)，Antonio Giordano(美国费城)
{"title":"News on pediatric urology","authors":"Giuseppe Masnata, Valeria Manca, L. Chia, F. Esu","doi":"10.7363/040225","DOIUrl":"https://doi.org/10.7363/040225","url":null,"abstract":"Pediatric urology is a pediatric speciality dedicated to the diagnosis and treatment of congenital and acquired genitourinary tract diseases. It is a speciality that is rapidly changing, thanks to the technological development that has been emerging in recent years. There have been important diagnostic and therapeutic news. Congenital anomalies of the kidneys and urinary tract (CAKUT) include various entities of structural malformations that result from defects in their morphogenesis. Clinical research and genetic studies on the origins of CAKUT are quickly evolving, with significant growth of high-quality research. Management goals of CAKUT include prevention of febrile urinary tract infections (UTIs) in newborns and toddles and renal injury, while minimizing the morbidity of treatment and follow-up. Treatment options include observation with or without continuous antibiotic prophylaxis (CAP) and surgical correction. Now, randomized controlled studies show that children with normal urinary tracts or low-grade vesicoureteral reflux (VUR) do not benefit from prophylaxis. All children with known mechanical or functional obstructions of the urinary tract are considered to have UTI. Functional obstruction often results from lower urinary tract dysfunction (LUTD) of either neurogenic or non-neurogenic origin and dilating VUR. The role of bladder and bowel dysfunction (BBD) in children with UTI and the long-term risk of renal scarring have shed new light on treatment strategies. Often it is BBD, rather than reflux, that causes UTI in children older than 2 years. Pediatric urology has evolved in recent years, with a greater focus on bladder and renal function, minimally invasive treatment, evidence-based interventions, and guideline adherence. Other topics in pediatric urology include urinary incontinence in children with special needs and the use of robot-assisted laparoscopic surgery (RALS) in children, with advantages over conventional laparoscopic surgery. Proceedings of the 11 th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26 th -31 st , 2015 · From the womb to the adult Guest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2015-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71290235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Piras, M. Orrù, V. Corda, Federica Maggio, M. Neri, M. E. Malune, S. Cornacchia, P. Zedda, V. Vallerino, M. D'alterio, A. Paoletti
In this paper the authors examined the most important factors that in the pre-conception period can interfere in the evolution of pregnancy. They also reported a method that since the first trimester of pregnancy is able to identify women at higher risk of developing preeclampsia. Proceedings of the 11 th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26 th -31 st , 2015 · From the womb to the adult Guest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)
在本文中，作者检查了最重要的因素，在孕前期可以干扰怀孕的演变。他们还报告了一种方法，从怀孕的前三个月开始，就能识别出患先兆子痫风险较高的女性。第11届国际新生儿学与卫星会议会议记录·卡利亚里(意大利)·2015年10月26日-31日·从子宫到成人客座编辑:Vassilios Fanos(意大利卡利亚里)，Michele Mussap(意大利热那亚)，Antonio Del Vecchio(意大利巴里)，Bo Sun(中国上海)，Dorret I. Boomsma(荷兰阿姆斯特丹)，Gavino Faa(意大利卡利亚里)，Antonio Giordano(美国费城)
{"title":"Risk management in obstetrics: how to reduce the risk?","authors":"B. Piras, M. Orrù, V. Corda, Federica Maggio, M. Neri, M. E. Malune, S. Cornacchia, P. Zedda, V. Vallerino, M. D'alterio, A. Paoletti","doi":"10.7363/040229","DOIUrl":"https://doi.org/10.7363/040229","url":null,"abstract":"In this paper the authors examined the most important factors that in the pre-conception period can interfere in the evolution of pregnancy. They also reported a method that since the first trimester of pregnancy is able to identify women at higher risk of developing preeclampsia. Proceedings of the 11 th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26 th -31 st , 2015 · From the womb to the adult Guest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2015-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71290322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Respiratory tract infections are one of the most common childhood illnesses, especially in pre-school children. These infections impose an enormous burden on both the healthcare system (frequent medical consultations and hospitalizations), and on society (parental absenteeism and loss of productivity). Their recurrence still poses a diagnostic challenge in pediatrics due to the difficulty in discriminating between otherwise healthy children and those with more serious underlying pathologies. Moreover, even if viral agents are typically the main cause being responsible of up to 95% of all upper respiratory tract infections, high antibiotic prescription is often reported in clinical practice. It is well known that frequent inappropriate antibiotic use has now led to a significant increase in bacterial resistance. In this context immunostimulants could be a promising preventive approach. Even if the evidence of effectiveness has been debated in the last years, studies focused on one of these compounds (Pidotimod) have recently attempted to better clarify and define its mechanisms of action both in vitro and in vivo and have provided new evidence of efficacy. Proceedings of the 11 th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26 th -31 st , 2015 · From the womb to the adult Guest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)
呼吸道感染是最常见的儿童疾病之一，尤其是学龄前儿童。这些感染给卫生保健系统(频繁的医疗咨询和住院治疗)和社会(父母缺勤和生产力损失)造成了巨大的负担。由于难以区分其他健康的儿童和那些有更严重的潜在病理的儿童，它们的复发仍然是儿科诊断的挑战。此外，尽管病毒性药物通常是导致高达95%的上呼吸道感染的主要原因，但在临床实践中经常报告高抗生素处方。众所周知，频繁不适当使用抗生素现已导致细菌耐药性显著增加。在这种情况下，免疫刺激剂可能是一种有希望的预防方法。即使有效性的证据在过去几年中一直存在争议，但最近对其中一种化合物(pidomodd)的研究试图更好地阐明和定义其在体外和体内的作用机制，并提供了新的有效性证据。第11届国际新生儿学与卫星会议会议记录·卡利亚里(意大利)·2015年10月26日-31日·从子宫到成人客座编辑:Vassilios Fanos(意大利卡利亚里)，Michele Mussap(意大利热那亚)，Antonio Del Vecchio(意大利巴里)，Bo Sun(中国上海)，Dorret I. Boomsma(荷兰阿姆斯特丹)，Gavino Faa(意大利卡利亚里)，Antonio Giordano(美国费城)
{"title":"Respiratory infections and immunostimulants in childhood: an update","authors":"G. Zuccotti, C. Mameli","doi":"10.7363/040218","DOIUrl":"https://doi.org/10.7363/040218","url":null,"abstract":"Respiratory tract infections are one of the most common childhood illnesses, especially in pre-school children. These infections impose an enormous burden on both the healthcare system (frequent medical consultations and hospitalizations), and on society (parental absenteeism and loss of productivity). Their recurrence still poses a diagnostic challenge in pediatrics due to the difficulty in discriminating between otherwise healthy children and those with more serious underlying pathologies. Moreover, even if viral agents are typically the main cause being responsible of up to 95% of all upper respiratory tract infections, high antibiotic prescription is often reported in clinical practice. It is well known that frequent inappropriate antibiotic use has now led to a significant increase in bacterial resistance. In this context immunostimulants could be a promising preventive approach. Even if the evidence of effectiveness has been debated in the last years, studies focused on one of these compounds (Pidotimod) have recently attempted to better clarify and define its mechanisms of action both in vitro and in vivo and have provided new evidence of efficacy. Proceedings of the 11 th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26 th -31 st , 2015 · From the womb to the adult Guest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2015-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71290565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Inhaled nitric oxide (iNO) has been used in the treatment of pulmonary hypertension in neonates for many years. iNO was approved by the FDA in 1999 for hypoxic respiratory failure (HRF) in term and near term infants, defined as > 34 weeks gestational age (GA). iNO is used for persistent pulmonary hypertension of the newborn (PPHN), secondary pulmonary hypertension caused by congenital heart disease (CHD), congenital diaphragmatic hernia (CDH), meconium aspiration syndrome (MAS), pneumonia, respiratory distress syndrome (RDS), and other pathologies. iNO has its effect locally on the pulmonary vasculature and has been studied extensively regarding its effect on morbidities such as: need for extracorporeal membrane oxygenation (ECMO), oxygen requirements, and mechanical ventilatory support. However, protocols for weaning iNO and for the duration of iNO weaning have not been studied extensively. It has been shown that an abrupt discontinuation leads to rebound pulmonary hypertension. Methods: Electronic literature search and review of published articles on the use of iNO in the neonate. Results: Electronic databases including Medline and PubMed were searched from the years 1995-2015, using the keywords “iNO”, “nitric oxide”, “neonate”, and “weaning nitric oxide.” This search revealed 2,124 articles. Articles were determined to be eligible for review if they included a specific protocol for weaning iNO, and were published in English. 16 articles with specific protocols for iNO weaning have been identified and reviewed. The studies had enrolled a total of 1,735 neonates either at term either preterm and with a mean birth weight of 3.3 kg (± 2 kg). Main diagnoses included MAS, CHD (total anomalous pulmonary venous return [TAPVR], d-transposition of the great vessels [DTGV], atrial septal defect [ASD], pulmonary atresia [PA], hypoplastic left heart syndrome [HLH]), pneumonia, RDS, hyaline membrane disease (HMD), PPHN, CDH, sepsis, pulmonary hypoplasia, pulmonary hemorrhage, hydrops fetalis, and other congenital anomalies. The average dose of iNO was 20 ppm (range = 2-80 ppm). The duration of exposure to iNO was on average 2 ± 2 days (range = 15 min - 7 days). Weaning protocols were highly varied from duration of treatment, duration of time in between iNO decreases, initial dose, adjunctive medications used to wean, and increasing FiO 2 used to wean iNO. The weaning parameters were based on multiple variables including FiO 2 , PaO 2 , O 2 sats, and pulmonary arterial pressure. Conclusion: There is a limited amount of data specific to weaning protocols for nitric oxide. There is no consensus on an appropriate method for weaning of iNO either on its own, or with adjunct medication. Further research to elucidate a strategy for weaning of iNO needs to be done. We propose that weaning iNO in a stepwise approach from 20 ppm in increments of 5 ppm per decrease until 5 ppm; and stepwise by 1 ppm from 5 ppm to off, while monitoring O 2 saturations and
{"title":"Weaning of inhaled nitric oxide: is there a best strategy?","authors":"A. Ware, S. Golombek","doi":"10.7363/040124","DOIUrl":"https://doi.org/10.7363/040124","url":null,"abstract":"Background: Inhaled nitric oxide (iNO) has been used in the treatment of pulmonary hypertension in neonates for many years. iNO was approved by the FDA in 1999 for hypoxic respiratory failure (HRF) in term and near term infants, defined as > 34 weeks gestational age (GA). iNO is used for persistent pulmonary hypertension of the newborn (PPHN), secondary pulmonary hypertension caused by congenital heart disease (CHD), congenital diaphragmatic hernia (CDH), meconium aspiration syndrome (MAS), pneumonia, respiratory distress syndrome (RDS), and other pathologies. iNO has its effect locally on the pulmonary vasculature and has been studied extensively regarding its effect on morbidities such as: need for extracorporeal membrane oxygenation (ECMO), oxygen requirements, and mechanical ventilatory support. However, protocols for weaning iNO and for the duration of iNO weaning have not been studied extensively. It has been shown that an abrupt discontinuation leads to rebound pulmonary hypertension. Methods: Electronic literature search and review of published articles on the use of iNO in the neonate. Results: Electronic databases including Medline and PubMed were searched from the years 1995-2015, using the keywords “iNO”, “nitric oxide”, “neonate”, and “weaning nitric oxide.” This search revealed 2,124 articles. Articles were determined to be eligible for review if they included a specific protocol for weaning iNO, and were published in English. 16 articles with specific protocols for iNO weaning have been identified and reviewed. The studies had enrolled a total of 1,735 neonates either at term either preterm and with a mean birth weight of 3.3 kg (± 2 kg). Main diagnoses included MAS, CHD (total anomalous pulmonary venous return [TAPVR], d-transposition of the great vessels [DTGV], atrial septal defect [ASD], pulmonary atresia [PA], hypoplastic left heart syndrome [HLH]), pneumonia, RDS, hyaline membrane disease (HMD), PPHN, CDH, sepsis, pulmonary hypoplasia, pulmonary hemorrhage, hydrops fetalis, and other congenital anomalies. The average dose of iNO was 20 ppm (range = 2-80 ppm). The duration of exposure to iNO was on average 2 ± 2 days (range = 15 min - 7 days). Weaning protocols were highly varied from duration of treatment, duration of time in between iNO decreases, initial dose, adjunctive medications used to wean, and increasing FiO 2 used to wean iNO. The weaning parameters were based on multiple variables including FiO 2 , PaO 2 , O 2 sats, and pulmonary arterial pressure. Conclusion: There is a limited amount of data specific to weaning protocols for nitric oxide. There is no consensus on an appropriate method for weaning of iNO either on its own, or with adjunct medication. Further research to elucidate a strategy for weaning of iNO needs to be done. We propose that weaning iNO in a stepwise approach from 20 ppm in increments of 5 ppm per decrease until 5 ppm; and stepwise by 1 ppm from 5 ppm to off, while monitoring O 2 saturations and ","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2015-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71290624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nowadays, the narrative approach in Bioethics is more and more considered and used. In our paper we would like to explain why – when we need to take a decision – it is essential and crucial that the patient tells his own history; we also indicate the main consequences that this approach has with reference to the choices at the bed of the patient. Selected Papers of the Congress “Narrative Based Medicine and Communication in Clinical Practice” · Cagliari, Italy · April 14 th , 2014 Guest Editors: Massimiliano Zonza, Vassilios Fanos, Gian Paolo Donzelli
如今，生命伦理学的叙事方法越来越多地被考虑和使用。在我们的论文中，我们想解释为什么——当我们需要做决定时——病人告诉他自己的病史是至关重要的;我们还指出了主要的后果，这种方法有参考选择在床上的病人。2014年4月14日，意大利卡利亚里，客座编辑:Massimiliano Zonza, Vassilios Fanos, Gian Paolo Donzelli
{"title":"The narrative approach in Bioethics","authors":"M. Picozzi","doi":"10.7363/040106","DOIUrl":"https://doi.org/10.7363/040106","url":null,"abstract":"Nowadays, the narrative approach in Bioethics is more and more considered and used. In our paper we would like to explain why – when we need to take a decision – it is essential and crucial that the patient tells his own history; we also indicate the main consequences that this approach has with reference to the choices at the bed of the patient. Selected Papers of the Congress “Narrative Based Medicine and Communication in Clinical Practice” · Cagliari, Italy · April 14 th , 2014 Guest Editors: Massimiliano Zonza, Vassilios Fanos, Gian Paolo Donzelli","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"4 1","pages":"1-4"},"PeriodicalIF":0.4,"publicationDate":"2015-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71290068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As part of analgosedative treatment modalities after delivery (e.g. caesarean related pain, birth related trauma, pre-existing pain syndromes), mothers are treated with different analgosedatives that may also affect the nursing infant. This review aims to summarize the available knowledge on commonly prescribed analgosedatives (opioids, intravenous and inhalational anesthetics, benzodiazepines, non-opioid analgesics, and local anesthetics) during breastfeeding. We propose that the use of systemic non-opioid analgesics, local anesthetics, inhalational or intravenous anesthetics is safe when mothers are nursing. When systemic opioids are used, we recommend pediatricians to consider clinical monitoring of the infant for sedation. The duration of maternal exposure (> 4 days) and the presence of maternal signs of somnolence are hereby of additional relevance. We encourage research groups to report on their specific observations and expertise in order to further validate the current practices and guidance.
{"title":"Maternal analgosedation and breastfeeding: guidance for the pediatrician","authors":"K. Allegaert, J. Anker","doi":"10.7363/040117","DOIUrl":"https://doi.org/10.7363/040117","url":null,"abstract":"As part of analgosedative treatment modalities after delivery (e.g. caesarean related pain, birth related trauma, pre-existing pain syndromes), mothers are treated with different analgosedatives that may also affect the nursing infant. This review aims to summarize the available knowledge on commonly prescribed analgosedatives (opioids, intravenous and inhalational anesthetics, benzodiazepines, non-opioid analgesics, and local anesthetics) during breastfeeding. We propose that the use of systemic non-opioid analgesics, local anesthetics, inhalational or intravenous anesthetics is safe when mothers are nursing. When systemic opioids are used, we recommend pediatricians to consider clinical monitoring of the infant for sedation. The duration of maternal exposure (> 4 days) and the presence of maternal signs of somnolence are hereby of additional relevance. We encourage research groups to report on their specific observations and expertise in order to further validate the current practices and guidance.","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2015-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71290606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this review is to create a complete analysis about tongue-tie (or short lingual frenum or ankyloglossia) according to the most important works published in literature. The analysis allowed us to do a complete evaluation of this problem, from embriology to the therapeutic approach we could use today, focusing our attention on laser-assisted therapy. This review is based on the research on the PubMed Database (www.ncbi.nlm.nih.gov) of studies about lingual frenum written in English between January 1980 and May 2014. The keywords inserted were “lingual frenum”, “frenectomy”, “laser therapy”. We have analyzed: case series, case reports, clinical studies, and also literature reviews in which embryology, physiology, diagnosis and treatment of ankyloglossia were described. We excluded laboratory studies, studies based on animal tests and studies about patients with particular syndromes in which we can also find tongue-tie. The selection criteria allowed us to select 42 articles. The treatment options for the releasing of the frenum are surgically represented by frenotomy (i.e. simple horizontal cut of this training) and frenectomy (i.e. removal). In both cases, the intervention on the short lingual frenum is simple, short-lasting, and without particular complications. Furthermore, this kind of treatment can be carried out with different devices: with the typical cold blade scalpel or by the use of laser, a new method that shows more advantages over the prior art. Laser-assisted therapy permits to intervene on newborns (from 0 to 20 days, when there are breastfeeding problems) without total anesthesia and suture. The Er:YAG, CO2 laser (according to literature data) and Diode laser (according to our experience) are advantageous, safe and effective in tongue-tie treatment.
{"title":"Tongue-tie, from embriology to treatment: a literature review","authors":"M. Dezio, A. Piras, L. Gallottini, G. Denotti","doi":"10.7363/040101","DOIUrl":"https://doi.org/10.7363/040101","url":null,"abstract":"The aim of this review is to create a complete analysis about tongue-tie (or short lingual frenum or ankyloglossia) according to the most important works published in literature. The analysis allowed us to do a complete evaluation of this problem, from embriology to the therapeutic approach we could use today, focusing our attention on laser-assisted therapy. This review is based on the research on the PubMed Database (www.ncbi.nlm.nih.gov) of studies about lingual frenum written in English between January 1980 and May 2014. The keywords inserted were “lingual frenum”, “frenectomy”, “laser therapy”. We have analyzed: case series, case reports, clinical studies, and also literature reviews in which embryology, physiology, diagnosis and treatment of ankyloglossia were described. We excluded laboratory studies, studies based on animal tests and studies about patients with particular syndromes in which we can also find tongue-tie. The selection criteria allowed us to select 42 articles. The treatment options for the releasing of the frenum are surgically represented by frenotomy (i.e. simple horizontal cut of this training) and frenectomy (i.e. removal). In both cases, the intervention on the short lingual frenum is simple, short-lasting, and without particular complications. Furthermore, this kind of treatment can be carried out with different devices: with the typical cold blade scalpel or by the use of laser, a new method that shows more advantages over the prior art. Laser-assisted therapy permits to intervene on newborns (from 0 to 20 days, when there are breastfeeding problems) without total anesthesia and suture. The Er:YAG, CO2 laser (according to literature data) and Diode laser (according to our experience) are advantageous, safe and effective in tongue-tie treatment.","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2015-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71290015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cristina Cavaiuolo, A. Casani, G. D. Manso, L. Orfeo
Objective: The aim of this pilot study was to determine the effect of music by Mozart on heel prick procedural pain in premature infants. Background: Painful procedures are routinely performed in the setting of neonatal intensive care unit (NICU). Pain may exert short- and long-term deleterious effects on premature babies. Many non-pharmacological interventions have been proven efficacious for blunting neonatal pain. Study design: Randomized, controlled trial. Methods: The study was carried out in the NICU of the “G. Rummo” Hospital in Benevento, Italy. The sample consisted of 42 preterm infants, with no hearing loss or significant cerebral lesions on cranial ultrasound. They were randomized to receive heel lance during a music condition or a no-music control condition. We set strict criteria for selecting and delivering the music. Baseline and postprocedural heart rate and transcutaneous oxygen saturation were manually recorded. The Premature Infant Pain Profile (PIPP) score was used to measure the behavioral response to prick. An unpaired t-test was performed for the intergroup comparisons. Results: There were significant differences between groups on heart rate increase, oxygen saturation reduction and PIPP score following the procedure. Conclusions: Listening to Mozart music during heel prick is a simple and inexpensive tool for pain alleviating in preterm stable neonates.
{"title":"Effect of Mozart music on heel prick pain in preterm infants: a pilot randomized controlled trial","authors":"Cristina Cavaiuolo, A. Casani, G. D. Manso, L. Orfeo","doi":"10.7363/040109","DOIUrl":"https://doi.org/10.7363/040109","url":null,"abstract":"Objective: The aim of this pilot study was to determine the effect of music by Mozart on heel prick procedural pain in premature infants. Background: Painful procedures are routinely performed in the setting of neonatal intensive care unit (NICU). Pain may exert short- and long-term deleterious effects on premature babies. Many non-pharmacological interventions have been proven efficacious for blunting neonatal pain. Study design: Randomized, controlled trial. Methods: The study was carried out in the NICU of the “G. Rummo” Hospital in Benevento, Italy. The sample consisted of 42 preterm infants, with no hearing loss or significant cerebral lesions on cranial ultrasound. They were randomized to receive heel lance during a music condition or a no-music control condition. We set strict criteria for selecting and delivering the music. Baseline and postprocedural heart rate and transcutaneous oxygen saturation were manually recorded. The Premature Infant Pain Profile (PIPP) score was used to measure the behavioral response to prick. An unpaired t-test was performed for the intergroup comparisons. Results: There were significant differences between groups on heart rate increase, oxygen saturation reduction and PIPP score following the procedure. Conclusions: Listening to Mozart music during heel prick is a simple and inexpensive tool for pain alleviating in preterm stable neonates.","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2015-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71290389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. A. Alyamovskaya, E. S. Keshishian, E. G. Verchenko, V. Bereznitskaya
We report the use of oral sildenafil in a 7-month-old preterm newborn with severe bronchopulmonary dysplasia and pulmonary arterial hypertension refractory to captopril and inhaled budesonide, and need of consistent oxygenation. Sildenafil was prepared as a powder for oral administration. Oral sildenafil treatment was continued for 11 months. Oxygen supplement was suspended after 4 months and captopril administration was finished after 7 months of sildenafil treatment. There were no adverse effects during the treatment period. The respiratory failure decreased significantly and pulmonary arterial pressure became normal after 7 months of sildenafil treatment.
{"title":"The clinical case of sildenafil administration in a very premature infant with pulmonary hypertension","authors":"G. A. Alyamovskaya, E. S. Keshishian, E. G. Verchenko, V. Bereznitskaya","doi":"10.7363/040108","DOIUrl":"https://doi.org/10.7363/040108","url":null,"abstract":"We report the use of oral sildenafil in a 7-month-old preterm newborn with severe bronchopulmonary dysplasia and pulmonary arterial hypertension refractory to captopril and inhaled budesonide, and need of consistent oxygenation. Sildenafil was prepared as a powder for oral administration. Oral sildenafil treatment was continued for 11 months. Oxygen supplement was suspended after 4 months and captopril administration was finished after 7 months of sildenafil treatment. There were no adverse effects during the treatment period. The respiratory failure decreased significantly and pulmonary arterial pressure became normal after 7 months of sildenafil treatment.","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2015-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71290096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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