is to provide an overview of common electronic clinical decision support (CDS) tools available to help clinicians manage neonatal hyperbilirubinemia. We focus on the guidelines behind their recommendations, their differences, manner of implementation, and future potential. Background: Hyperbilirubinemia assessment is recommended in all preterm and term infants. Various guidelines for the management of hyperbilirubinemia exist, and many guidelines have corresponding electronic CDS tools. The increasingly widespread adoption of electronic health records provides an opportunity for both enhanced integration of CDS tools into daily workflow and automated data collection. Methods: Based on our collective experience in pediatrics, neonatology, and clinical informatics, we identified commonly used CDS tools for neonatal hyperbilirubinemia management. We performed manual searches on the Apple App Store and Google Play Store to identify mobile applications that follow published guidelines for neonatal hyperbilirubinemia management. Conclusions: CDS tools have the potential to improve patient care through increased adherence to guidelines, and to improve the provider experience through workflow integration. In addition, the electronic health record integration of hyperbilirubinemia management tools allows for the collection of data that can be used to refine recommendations over time and inform the development of future guidelines. increasing thresholds for most infants depending on GA and the presence of neurotoxicity risk factors. Treatment thresholds were not changed for infants 35 weeks GA with neurotoxicity risk factors. A web-based tool that automates the NCNC guidelines is available at www.phototherapyguidelines.com. The data entry page requires inputs of gestational age at birth, TB value, and age in hours at the time the TB level was obtained. The results display provides treatment thresholds for initiating phototherapy, and shows the 2004 AAP treatment thresholds for comparison purposes. An API exists for EHR integration. Recently, an abstract reported decreased phototherapy exposure with adoption of the NCNC guidelines, including the avoidance of phototherapy for 34% of TB values above AAP thresholds with no increase in hazardous hyperbilirubinemia (20).
{"title":"A narrative review of electronic clinical decision support tools for hyperbilirubinemia management","authors":"J. Palma, Yassar H. Arain","doi":"10.21037/pm-21-12","DOIUrl":"https://doi.org/10.21037/pm-21-12","url":null,"abstract":"is to provide an overview of common electronic clinical decision support (CDS) tools available to help clinicians manage neonatal hyperbilirubinemia. We focus on the guidelines behind their recommendations, their differences, manner of implementation, and future potential. Background: Hyperbilirubinemia assessment is recommended in all preterm and term infants. Various guidelines for the management of hyperbilirubinemia exist, and many guidelines have corresponding electronic CDS tools. The increasingly widespread adoption of electronic health records provides an opportunity for both enhanced integration of CDS tools into daily workflow and automated data collection. Methods: Based on our collective experience in pediatrics, neonatology, and clinical informatics, we identified commonly used CDS tools for neonatal hyperbilirubinemia management. We performed manual searches on the Apple App Store and Google Play Store to identify mobile applications that follow published guidelines for neonatal hyperbilirubinemia management. Conclusions: CDS tools have the potential to improve patient care through increased adherence to guidelines, and to improve the provider experience through workflow integration. In addition, the electronic health record integration of hyperbilirubinemia management tools allows for the collection of data that can be used to refine recommendations over time and inform the development of future guidelines. increasing thresholds for most infants depending on GA and the presence of neurotoxicity risk factors. Treatment thresholds were not changed for infants 35 weeks GA with neurotoxicity risk factors. A web-based tool that automates the NCNC guidelines is available at www.phototherapyguidelines.com. The data entry page requires inputs of gestational age at birth, TB value, and age in hours at the time the TB level was obtained. The results display provides treatment thresholds for initiating phototherapy, and shows the 2004 AAP treatment thresholds for comparison purposes. An API exists for EHR integration. Recently, an abstract reported decreased phototherapy exposure with adoption of the NCNC guidelines, including the avoidance of phototherapy for 34% of TB values above AAP thresholds with no increase in hazardous hyperbilirubinemia (20).","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48941478","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. Reichman, G. Klinger, S. Zangen, Orna Levitzki, L. Lerner-Geva
: The Israel Neonatal Network (INN) is a voluntary consortium of all neonatal departments in Israel. The Israel National Very Low Birth Weight (VLBW) Infant Database was established in 1995 under the auspices of the INN. The main objectives of the database are the application of quality data for the assessment of morbidity and mortality trends of VLBW infants; benchmarking of individual neonatal unit performance in comparison to national data; quality of care and management; planning of national, regional and institutional structure and policy development; longitudinal developmental assessment and for collaborative research programs. Data are reported for all live born infants of birthweight ≤ 1,500 g, irrespective of the gestational age at birth. From 1995 through 2019, the database includes reports on 39,000 VLBW infants and 33,000 mothers encompassing over 99.5% of all VLBW live births in Israel. The minimal data set includes parental demographic details, maternal pregnancy history, treatments and complications, antenatal care, details of the delivery, infant's status at delivery, infant’s diagnoses, procedures and complications during hospitalization and outcome at discharge. The predominant activity of the database relates to data collection, collation and presentation of the data in unique annual reports for each of the participating Neonatal intensive care units (NICUs) and an annual national report presented to departmental, institutional and governmental health care leaders. The database provides a research platform for all participants in the INN. More than 60 neonatologists, obstetricians and epidemiologists from 15 different hospitals and organizations have undertaken and published studies in the context of the database. The Israel Neonatal Society has promoted, initiated and coordinated two major quality improvement programs encompassing all INN collaborators, aimed at reducing the rate of blood stream infections and the rate of severe intraventricular hemorrhage among very preterm infants.
{"title":"The Israel Neonatal Network and National Very Low Birth Weight Infant Database","authors":"B. Reichman, G. Klinger, S. Zangen, Orna Levitzki, L. Lerner-Geva","doi":"10.21037/pm-21-69","DOIUrl":"https://doi.org/10.21037/pm-21-69","url":null,"abstract":": The Israel Neonatal Network (INN) is a voluntary consortium of all neonatal departments in Israel. The Israel National Very Low Birth Weight (VLBW) Infant Database was established in 1995 under the auspices of the INN. The main objectives of the database are the application of quality data for the assessment of morbidity and mortality trends of VLBW infants; benchmarking of individual neonatal unit performance in comparison to national data; quality of care and management; planning of national, regional and institutional structure and policy development; longitudinal developmental assessment and for collaborative research programs. Data are reported for all live born infants of birthweight ≤ 1,500 g, irrespective of the gestational age at birth. From 1995 through 2019, the database includes reports on 39,000 VLBW infants and 33,000 mothers encompassing over 99.5% of all VLBW live births in Israel. The minimal data set includes parental demographic details, maternal pregnancy history, treatments and complications, antenatal care, details of the delivery, infant's status at delivery, infant’s diagnoses, procedures and complications during hospitalization and outcome at discharge. The predominant activity of the database relates to data collection, collation and presentation of the data in unique annual reports for each of the participating Neonatal intensive care units (NICUs) and an annual national report presented to departmental, institutional and governmental health care leaders. The database provides a research platform for all participants in the INN. More than 60 neonatologists, obstetricians and epidemiologists from 15 different hospitals and organizations have undertaken and published studies in the context of the database. The Israel Neonatal Society has promoted, initiated and coordinated two major quality improvement programs encompassing all INN collaborators, aimed at reducing the rate of blood stream infections and the rate of severe intraventricular hemorrhage among very preterm infants.","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49070021","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}
{"title":"Clinical management of epilepsy associated with low-grade glioma and literature review","authors":"Xin-ke Xu, Fangcheng Li","doi":"10.21037/pm-21-49","DOIUrl":"https://doi.org/10.21037/pm-21-49","url":null,"abstract":"","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42459140","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}
: Assessment of systolic and diastolic function of both the left and right ventricles is an integral part of the assessment and management of children with heart disease. Despite corrective or palliative repair of congenital heart disease, dysfunction of the systemic ventricle, which may a morphologic left or a right ventricle, subpulmonary right ventricle, and the functional single ventricle may occur in the long term. Conventional echocardiographic indices of cardiac function can be regarded as parameters of indirect changes consequential to the shortening and lengthening of the myocardium in the cardiac cycle. Direct interrogation of myocardial deformation, on the other hand, may shed important lights on the understanding, diagnosis and prognosis of cardiac dysfunction in the paediatric cardiac population. In the past decade, technological advances in echocardiographic strain imaging have enabled direct interrogation of global and regional deformation of the myocardium. In this review, the concept of strain imaging, the evolution of echocardiographic strain imaging, the methods of ventricular and atrial strain quantification, and clinical applications of strain imaging in children and young adults with congenital heart disease are discussed. The gaps and challenges in the clinical translational use of echocardiographic strain imaging are also highlighted. Given the emerging data on potential prognostic values of strain measures in the prediction of occurrence of adverse cardiovascular outcomes in the congenital heart population, it is timely for paediatric cardiologists to consider the incorporation of strain imaging into the clinical management algorithm.
{"title":"Echocardiographic strain imaging: what do paediatric cardiologists need to know?","authors":"Y. Cheung","doi":"10.21037/pm-21-39","DOIUrl":"https://doi.org/10.21037/pm-21-39","url":null,"abstract":": Assessment of systolic and diastolic function of both the left and right ventricles is an integral part of the assessment and management of children with heart disease. Despite corrective or palliative repair of congenital heart disease, dysfunction of the systemic ventricle, which may a morphologic left or a right ventricle, subpulmonary right ventricle, and the functional single ventricle may occur in the long term. Conventional echocardiographic indices of cardiac function can be regarded as parameters of indirect changes consequential to the shortening and lengthening of the myocardium in the cardiac cycle. Direct interrogation of myocardial deformation, on the other hand, may shed important lights on the understanding, diagnosis and prognosis of cardiac dysfunction in the paediatric cardiac population. In the past decade, technological advances in echocardiographic strain imaging have enabled direct interrogation of global and regional deformation of the myocardium. In this review, the concept of strain imaging, the evolution of echocardiographic strain imaging, the methods of ventricular and atrial strain quantification, and clinical applications of strain imaging in children and young adults with congenital heart disease are discussed. The gaps and challenges in the clinical translational use of echocardiographic strain imaging are also highlighted. Given the emerging data on potential prognostic values of strain measures in the prediction of occurrence of adverse cardiovascular outcomes in the congenital heart population, it is timely for paediatric cardiologists to consider the incorporation of strain imaging into the clinical management algorithm.","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43711282","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}
Damilola O. Adesanya, Jessica F. Johnson, C. Galanter
: Aggression is common in children and adolescents and has serious consequences. This manuscript reviews the following aspects of aggression: (I) types and causes, (II) components of a comprehensive assessment, (III) a comprehensive approach to treatment, (IV) recent evidence based psychotherapeutic treatments, (V) the recent evidence based psychopharmacological treatments and (VI) aggression outcomes. We conducted a selective review from the last two decades using terms, “aggression”, “children”, “adolescents” using PubMed and also PsychINFO for the psychotherapy literature, and PubMed alone for the psychopharmacology review. We also included additional relevant references. We provide evidence-based recommendations for the assessment and treatment of aggression for children and adolescents. Aggression treatment requires a comprehensive assessment, treatment for the underlying conditions and behavioral interventions/psychotherapy and may also include careful pharmacological treatment and eventual recovery and/or short/long-term monitoring. A comprehensive assessment includes gathering a thorough history, considering symptoms in a developmental context, interviewing the guardian and child separately and together, ruling in and out psychopathology and potential stressors, conducting a risk assessment and using rating scales at baseline to assist in diagnosis and to track symptoms. A comprehensive approach to treatment includes providing or assisting the family in obtaining evidence-based psychotherapy appropriate for the child’s age and developmental level, engaging the child, family and school in taking an active role in implementing psychosocial strategies and implementing the appropriate supports, following evidence-based guidelines to treat the primary (underlying) disorder with evidence-based psychotherapies and medications. The manuscript provides a review of the psychotherapeutic approaches that have been shown to be effective in treating aggression as well as the evidence for efficacy of the different classes of medication including psychostimulants, alpha agonists, antidepressants, atypical antipsychotics and mood stabilizers. Evidence supports that first line medication begins with optimization of pharmacological treatment for the primary diagnosis, for example the use of stimulants for children with attention deficit hyperactivity disorder (ADHD) and co-occurring aggression, followed by risperidone, and aripiprazole with substantial evidence supporting their effectiveness in treating aggression. Finally, we review the outcomes of aggression.
{"title":"Assessing and treating aggression in children and adolescents","authors":"Damilola O. Adesanya, Jessica F. Johnson, C. Galanter","doi":"10.21037/PM-20-109","DOIUrl":"https://doi.org/10.21037/PM-20-109","url":null,"abstract":": Aggression is common in children and adolescents and has serious consequences. This manuscript reviews the following aspects of aggression: (I) types and causes, (II) components of a comprehensive assessment, (III) a comprehensive approach to treatment, (IV) recent evidence based psychotherapeutic treatments, (V) the recent evidence based psychopharmacological treatments and (VI) aggression outcomes. We conducted a selective review from the last two decades using terms, “aggression”, “children”, “adolescents” using PubMed and also PsychINFO for the psychotherapy literature, and PubMed alone for the psychopharmacology review. We also included additional relevant references. We provide evidence-based recommendations for the assessment and treatment of aggression for children and adolescents. Aggression treatment requires a comprehensive assessment, treatment for the underlying conditions and behavioral interventions/psychotherapy and may also include careful pharmacological treatment and eventual recovery and/or short/long-term monitoring. A comprehensive assessment includes gathering a thorough history, considering symptoms in a developmental context, interviewing the guardian and child separately and together, ruling in and out psychopathology and potential stressors, conducting a risk assessment and using rating scales at baseline to assist in diagnosis and to track symptoms. A comprehensive approach to treatment includes providing or assisting the family in obtaining evidence-based psychotherapy appropriate for the child’s age and developmental level, engaging the child, family and school in taking an active role in implementing psychosocial strategies and implementing the appropriate supports, following evidence-based guidelines to treat the primary (underlying) disorder with evidence-based psychotherapies and medications. The manuscript provides a review of the psychotherapeutic approaches that have been shown to be effective in treating aggression as well as the evidence for efficacy of the different classes of medication including psychostimulants, alpha agonists, antidepressants, atypical antipsychotics and mood stabilizers. Evidence supports that first line medication begins with optimization of pharmacological treatment for the primary diagnosis, for example the use of stimulants for children with attention deficit hyperactivity disorder (ADHD) and co-occurring aggression, followed by risperidone, and aripiprazole with substantial evidence supporting their effectiveness in treating aggression. Finally, we review the outcomes of aggression.","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41976530","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}
{"title":"A narrative review of pitfall and progress in management of inflammatory bowel disease in children","authors":"Z. Grover","doi":"10.21037/pm-21-11","DOIUrl":"https://doi.org/10.21037/pm-21-11","url":null,"abstract":"","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44703705","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}
A database registration system for high-risk infants in Japan started in 2003. This project was carried out with a research grant from the Japanese Ministry of Health, Labour and Welfare. Because registration in the database is voluntary, only some of the perinatal centers nationwide participated initially. However, once the benefits of database registration were recognized, more centers decided to participate, and currently, about 65% of infants with very low birth weights or gestational ages less than 32 weeks born in Japan are enrolled in the database. Currently, about 5,000 new cases are registered every year. A unique feature of the database is that, from its inception, it included outcome data at 1.5 and 3 years of age after discharge from the NICU. Since then, this follow-up data has been expanded to follow-ups at 6 years of age. At present, both the development of this database and the progress in neonatal medicine in Japan have gained the worldwide recognition with analysis results from the database being published in many international journals. In addition, international joint research through the International Network for Evaluating Outcomes (iNeo) has also progressed. However, for the further development of the database, an automated registration system of patient data through electric medical charts and the systematization of follow-up results for high-risk infants after discharge should be considered.
{"title":"Neonatal network database operated by the Neonatal Research Network of Japan","authors":"S. Kusuda, M. Fujimura","doi":"10.21037/pm-21-71","DOIUrl":"https://doi.org/10.21037/pm-21-71","url":null,"abstract":"A database registration system for high-risk infants in Japan started in 2003. This project was carried out with a research grant from the Japanese Ministry of Health, Labour and Welfare. Because registration in the database is voluntary, only some of the perinatal centers nationwide participated initially. However, once the benefits of database registration were recognized, more centers decided to participate, and currently, about 65% of infants with very low birth weights or gestational ages less than 32 weeks born in Japan are enrolled in the database. Currently, about 5,000 new cases are registered every year. A unique feature of the database is that, from its inception, it included outcome data at 1.5 and 3 years of age after discharge from the NICU. Since then, this follow-up data has been expanded to follow-ups at 6 years of age. At present, both the development of this database and the progress in neonatal medicine in Japan have gained the worldwide recognition with analysis results from the database being published in many international journals. In addition, international joint research through the International Network for Evaluating Outcomes (iNeo) has also progressed. However, for the further development of the database, an automated registration system of patient data through electric medical charts and the systematization of follow-up results for high-risk infants after discharge should be considered.","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43323714","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}
K. Bortolin, Sarah A. Jones, A. Mujoomdar, A. Zizzo
{"title":"A sinister source of gastrointestinal bleeding treated by transhepatic splenic varix embolization in a paediatric patient: a case report","authors":"K. Bortolin, Sarah A. Jones, A. Mujoomdar, A. Zizzo","doi":"10.21037/pm-21-30","DOIUrl":"https://doi.org/10.21037/pm-21-30","url":null,"abstract":"","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46530417","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}
W. Tang, Ting-zhao Gao, Yun Cao, Wenhao Zhou, Dongli Song, Laishuan Wang
Objective: To review the current evidence for management strategies applied during perinatal period to improve the short- and long- term outcomes in extremely preterm infants (EPIs). Background: EPIs are defined as infants born before 28 completed weeks of gestation. Due to extreme prematurity, a large number of EPIs are at increased risk for both mortality and morbidity. Although significant advances have been made in neonatal and perinatal medicine, the management of EPIs remains a great challenge to families, physicians, and the entire health care system. Methods: Literature searches were conducted in PubMed, Cochrane Library, OVID, Embase, and Web of Science to identify studies regarding perinatal management of EPIs from 2000 to 2021. Observational studies, randomized controlled trials (RCTs), systematic reviews and meta-analyses were included. The title and abstract of each article were screened for the selection of relevant articles. Conclusions: Numerous proactive interventions need to be implemented during this critical perinatal period so that the mortality and impairment rates of these vulnerable infants can be minimized. The effectiveness and safety of some interventions have been widely studied in large meta-analyses or RCTs. Meanwhile, a lot of novel management strategies are under investigation and many already have promising early results. However, the long-term effects of some intervention efforts remain limited. The answers of some important questions in the care practice of EPIs remain unsatisfying. 21
目的:回顾目前的证据，围生期管理策略的应用，以改善极早产儿(EPIs)的短期和长期结局。背景:EPIs被定义为妊娠28周前出生的婴儿。由于极度早产，大量计划生育儿童的死亡率和发病率都有增加的风险。尽管在新生儿和围产期医学方面取得了重大进展，但EPIs的管理仍然是家庭、医生和整个卫生保健系统面临的巨大挑战。方法:在PubMed、Cochrane Library、OVID、Embase和Web of Science中检索2000 - 2021年EPIs围产期管理的相关文献。包括观察性研究、随机对照试验(rct)、系统评价和荟萃分析。筛选每篇文章的标题和摘要，选择相关文章。结论:在这个关键的围产期，需要实施许多积极的干预措施，以尽量减少这些易感婴儿的死亡率和损伤率。一些干预措施的有效性和安全性已在大型荟萃分析或随机对照试验中得到广泛研究。与此同时，许多新的管理策略正在研究中，其中许多已经取得了可喜的初步成果。然而，一些干预措施的长期效果仍然有限。在EPIs的护理实践中，一些重要问题的答案仍不令人满意。21
{"title":"Narrative review of perinatal management of extremely preterm infants: what’s the evidence?","authors":"W. Tang, Ting-zhao Gao, Yun Cao, Wenhao Zhou, Dongli Song, Laishuan Wang","doi":"10.21037/pm-21-51","DOIUrl":"https://doi.org/10.21037/pm-21-51","url":null,"abstract":"Objective: To review the current evidence for management strategies applied during perinatal period to improve the short- and long- term outcomes in extremely preterm infants (EPIs). Background: EPIs are defined as infants born before 28 completed weeks of gestation. Due to extreme prematurity, a large number of EPIs are at increased risk for both mortality and morbidity. Although significant advances have been made in neonatal and perinatal medicine, the management of EPIs remains a great challenge to families, physicians, and the entire health care system. Methods: Literature searches were conducted in PubMed, Cochrane Library, OVID, Embase, and Web of Science to identify studies regarding perinatal management of EPIs from 2000 to 2021. Observational studies, randomized controlled trials (RCTs), systematic reviews and meta-analyses were included. The title and abstract of each article were screened for the selection of relevant articles. Conclusions: Numerous proactive interventions need to be implemented during this critical perinatal period so that the mortality and impairment rates of these vulnerable infants can be minimized. The effectiveness and safety of some interventions have been widely studied in large meta-analyses or RCTs. Meanwhile, a lot of novel management strategies are under investigation and many already have promising early results. However, the long-term effects of some intervention efforts remain limited. The answers of some important questions in the care practice of EPIs remain unsatisfying. 21","PeriodicalId":74411,"journal":{"name":"Pediatric medicine (Hong Kong, China)","volume":"1 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41269045","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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