Management of patent ductus arteriosus in premature infants.

Patency of the ductus arteriosus is required for fetal survival in utero. In infants born prematurely, ductus fails to close and shunt reverses from left to right. Incidence of patent ductus arteriosus (PDA) is inversely proportional to the gestational age.

Optimizing growth in the preterm infant.

Most very low birth weight preterm infants experience postnatal growth failure in the neonatal ICU. In an attempt to minimize this phenomenon, the nutritional support of these infants has tended to become more aggressive in recent years and has become a focus of much study. Despite this attention, many questions remain unresolved.

Alcohol dehydrogenase 2*3 affects alterations in offspring facial morphology associated with maternal ethanol intake in pregnancy.

Background: Ethanol intake during pregnancy alters offspring facial morphology. However, significant variation that may be due to genetic diversity in ethanol metabolizing enzymes occurs. The alcohol dehydrogenase 1B*3 (ADH1B*3) allele is protective for offspring developmental outcome after maternal alcohol drinking in pregnancy and may explain the spectrum of facial morphology.

Low Apgar scores and the definition of birth asphyxia.

Nonreassuring fetal heart rate patterns, prolonged labor, meconium-stained fluid, a low 1-minute Apgar score, and mild to moderate acidemia have no predictive value for long-term neurologic injury without signs of encephalopathy and seizures. It is important to provide proper resuscitation, support infants, and allow time for evaluation. We have time and the tools to provide fairly predictive information to the families.

Abnormal fetal growth: intrauterine growth retardation, small for gestational age, large for gestational age.

The two extremes of abnormal fetal growth are restricted growth and excessive growth, both of which originate from alterations in the uterine metabolic milieu. The fetus must adapt to these conditions to survive. In both instances, however, the inciting insult and the subsequent adaptation of the fetus carry long-term health consequences.

Preparing the neonate for transport.

Evaluation and stabilization of a neonate while arranging for neonatal transport are often stressful undertakings marked by urgency. Available resources may be limited, which further exacerbates anxiety of parents, staff, and physician. Even with limited resources, however, staff should be trained to evaluate and assess newborn babies and notify a physician quickly of any concerns.