Kangaroo mother care improves cardiorespiratory physiology in preterm infants: an observational study.

Objectives: To evaluate whether kangaroo mother care (KMC) in preterm infants on non-invasive respiratory support improves indices of cardiorespiratory wellbeing.

Study Design: Prospective quasi-experimental observational study.

Setting: Tertiary perinatal neonatal unit.

Successful pregnancy with left ventricular assist device failure in the setting of peripartum cardiomyopathy.

Pregnancy is contraindicated for women with left ventricular dysfunction due to high maternal and fetal mortality. We present a case of a pregnant 31-year-old woman with a history of heart failure due to peripartum cardiomyopathy from a previous pregnancy. She had a left ventricular assist device (LVAD) and was on warfarin due to recurrent thrombosis of her device.

Prone sleeping affects cardiovascular control in preterm infants in NICU.

Background: Prone sleeping is used in preterm infants undergoing intensive care to improve respiratory function, but evidence suggests that this position may compromise autonomic cardiovascular control. To test this hypothesis, this study assessed the effects of the prone sleeping position on cardiovascular control in preterm infants undergoing intensive care treatment during early postnatal life.

Methods: Fifty-six preterm infants, divided into extremely preterm (gestational age (GA) 24-28 weeks, n = 23) and very preterm (GA 29-34 weeks, n = 33) groups, were studied weekly for 3 weeks in prone and supine positions, during quiet and active sleep.

When does prone sleeping improve cardiorespiratory status in preterm infants in the NICU?

Study Objectives: Preterm infants undergoing intensive care are often placed prone to improve respiratory function. Current clinical guidelines recommend preterm infants are slept supine from 32 weeks' postmenstrual age, regardless of gestational age at birth. However, respiratory function is also related to gestational and chronological ages and is affected by sleep state.

Effects of Prone Sleeping on Cerebral Oxygenation in Preterm Infants.

Objective: To determine the effect of prone sleeping on cerebral oxygenation in preterm infants in the neonatal intensive care unit.

Study Design: Preterm infants, divided into extremely preterm (gestational age 24-28 weeks; n = 23) and very preterm (gestational age 29-34 weeks; n = 33) groups, were studied weekly until discharge in prone and supine positions during active and quiet sleep. Cerebral tissue oxygenation index (TOI) and arterial oxygen saturation (SaO) were recorded.

A randomised crossover trial of clinical algorithm for oxygen saturation targeting in preterm infants with frequent desaturation episodes.

Objectives: Strategies for oxygen therapy for preterm infants, such as the Vermont-Oxford's 'Breathsavers' guidelines, seek to strike a balance between the potential risks of the extremes of hyperoxia and hypoxia in preterm infants. Using an algorithm based on those guidelines, we aimed to compare the proportion of time spent within the SpO2 target range during algorithm-based management of oxygen delivery compared with routine nursing care.

Study Design: In a randomised crossover trial, maintenance of SpO2 over a 4-hour period during routine care was compared with algorithm-based control (administered by a dedicated research nurse).

An incremental approach to improving scholarly activity.

Background: The Accreditation Council for Graduate Medical Education requires scholarly activity for both faculty and residents in obstetrics and gynecology (Ob-Gyn). There is little evidence on the most effective method to train, recruit, and retain research faculty who can mentor resident researchers at small programs.

Innovation: To address this problem, we created the "Baby Steps" program for a small university-based Ob-Gyn program.

Theoretic considerations regarding slow cooling and vitrification during cryopreservation.

This review presents the methodology of using theoretic models for development of cryopreservation protocols by designing specific cooling profiles and selecting appropriate external conditions to optimize cryopreservation survival. Biophysical events during the processes of cryopreservation were examined and corresponding theoretic equations were used to simulate cryopreservation procedures under various slow cooling conditions for rat zygotes in the presence of DMSO, using a 0.25-mL plastic straw as the container.

Operative vaginal delivery.

Operative vaginal delivery remains a valid option when problems arise in the second stage of labor. The most common indications are fetal compromise and failure to deliver spontaneously with maximum maternal effort. There is a clear trend to choose vacuum extraction over forceps to assist delivery, but the evidence supporting that trend is unconvincing.

Age-dependent susceptibility to manganese-induced neurological dysfunction.

Chronic exposure to manganese (Mn) produces a spectrum of cognitive and behavioral deficits associated with a neurodegenerative disorder resembling Parkinson's disease. The effects of high-dose exposure to Mn in occupational cohorts and in adult rodent models of the disease are well described but much less is known about the behavioral and neurochemical effects of Mn in the developing brain. We therefore exposed C57Bl/6 mice to Mn by intragastric gavage as juveniles, adults, or both, postulating that mice exposed as juveniles and then again as adults would exhibit greater neurological and neurochemical dysfunction than mice not preexposed as juveniles.

Randomized trial of preinduction cervical ripening: misoprostol vs oxytocin.

Objective: The purpose of this study was to compare the vaginal delivery rate in women who undergo labor induction with preinduction misoprostol or oxytocin alone.

Study Design: Women with singleton pregnancies and Bishop scores <5 with labor induction at > or = 24 weeks of gestation were eligible; they were assigned randomly to oxytocin alone or preinduction cervical ripening with misoprostol. Labor characteristics, maternal complications, and neonatal outcomes were analyzed.

Pregnancy in women with renal disease. Part I: general principles.

The purpose of this review is to improve the basis upon which advice on pregnancy is given to women with renal disease and to address issues of obstetric management by drawing upon the accumulated world experience. To ensure the proper rapport between the respect for patient's autonomy and the ethical principle of beneficence, the review attempts to impart up-to-date, evidence-based information on the predictable outcomes and hazards of pregnancy in women with chronic renal disease. The physiology of pregnancy from the perspective of the affected kidney will be discussed as well as the principal predictors of maternal and fetal outcomes and general recommendations of management.

Pregnancy in women with renal disease. Part II: specific underlying renal conditions.

The obstetric outcome in women with kidney disease has improved in recent years due to continuous progress in obstetrics and neonatology, as well as better medical management of hypertension and renal disease. However, every pregnancy in these women remains a high-risk pregnancy. When considering the interaction between renal disease and pregnancy, maternal outcomes are related to the initial level of renal dysfunction more than to the specific underlying disease.

Corticosteroids for the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP): what evidence?

The fundamental premise that has governed the proposal relative to the use of corticosteroids for the purpose of disease modification in Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) syndrome was that pre-eclampsia is a condition characterized by an inappropriate maternal systemic inflammatory response and possibly immune-mediated impairment in maternal-fetal communication, while corticosteroids have the capacity to exercise anti-inflammatory and immunosuppressive effects. The present article reviews the evidence behind this proposal, concluding that corticosteroids administration, either antepartum or postpartum, does not improve the outcome of pregnancies affected by HELLP syndrome. The risks associated with such an approach, especially in fetuses manifesting growth restriction and absent end-diastolic flow, are also discussed.

Chronic renal disease in pregnancy.

The purpose of this review was to examine the impact of varying degrees of renal insufficiency on pregnancy outcome in women with chronic renal disease. Our search of the literature did not reveal any randomized clinical trials or meta-analyses. The available information is derived from opinion, reviews, retrospective series, and limited observational series.

Diabetic ketoacidosis in pregnancy.

Objective: The development of diabetic ketoacidosis in pregnancy is a medical emergency, requiring treatment in an intensive care setting. Both the mother and the fetus are at risk for significant morbidity and mortality. Physiologic changes unique to pregnancy provide a background for the development of diabetic ketoacidosis.

Physiologic changes in pregnancy and their impact on critical care.

Objectives: To describe the major pregnancy-induced physiologic changes that affect the care of patients who are critically ill.

Methods: We reviewed relevant textbooks and articles pertaining to physiologic alterations produced by pregnancy. Those changes that have a bearing on patients admitted to an intensive care unit were abstracted, summarized, and organized by organ system.

Effects of nuchal cord on birthweight and immediate neonatal outcomes.

Our objective was to ascertain if nuchal cord is associated with adverse neonatal outcomes. Using a retrospective database of term neonates, outcomes were compared among infants with 0, 1, and 2 or more loops of cord encircling the neck. Of 4426 neonates, 3651 served as controls, 691 had one loop, and 84 had two or more loops.

Gestational diabetes: a field of controversy.

Unlabelled: Many clinicians in the United States routinely screen all pregnant women in their practices for gestational diabetes. Recently, the US Preventive Services Task Force re-emphasized that such screening is not supported by rigorous scientific evidence. Recommendations for diagnosis and management are based on an even scantier scientific foundation.

Teaching the Laufe-Piper forceps technique at cesarean delivery.

Objective: To present a method of teaching forceps technique during cesarean delivery of breech-presenting infants using Laufe-Piper forceps and to evaluate its usefulness.

Study Design: For several years, residents at the University of Texas Medical Branch, Galveston, have learned and practiced Piper forceps technique during cesarean delivery. To assess their experience with this method, we mailed questionnaires to third- and fourth-year residents and recent graduates of the Galveston program.