Differences in demographics and outcomes based on method of consent for a randomised controlled trial on heat loss prevention in the delivery room.

Objective: Informed consent is standard in research. International guidelines allow for research without prior consent in emergent situations, such as neonatal resuscitation. Research without prior consent was incorporated in the Vermont Oxford Network Heat Loss Prevention Trial.

Parallel Exploratory RCT of Polyethylene Wrap for Heat Loss Prevention in Infants Born at Less than 24 Weeks' Gestation.

Background: The treatment effect of occlusive wrap applied immediately after delivery in infants born 24-28 weeks' gestation has been studied, but the effect is not known in infants born at less than 240/7 weeks' gestation.

Objectives: To determine if the use of occlusive wrap applied immediately after birth in infants born at less than 240/7 weeks' gestation results in any differences in outcomes when compared to non-wrapped infants.

Methods: Parallel exploratory randomized controlled trial with a convenience sample of 28 inborn infants born at less than 240/7 weeks' gestation enrolled during the duration of the HeLP trial.

Effect of routine probiotic, Lactobacillus reuteri DSM 17938, use on rates of necrotizing enterocolitis in neonates with birthweight < 1000 grams: a sequential analysis.

Background: Necrotizing enterocolitis (NEC) is a disease in neonates, often resulting in death or serious medical or neurodevelopmental complications. The rate of NEC is highest in the smallest babies and many efforts have been tried to reduce the rate of NEC. In neonates born below 1500 grams, the rate of NEC has been significantly reduced with the use of various probiotics.

Treatment of neonatal withdrawal with clonidine after long-term, high-dose maternal use of tramadol.

Objective: To describe a case of tramadol withdrawal in a neonate and treatment with clonidine after exposure to long-term maternal use of high-dose tramadol.

Case Summary: A 34-week gestational age neonate displayed symptoms of tramadol withdrawal within 48 hours of delivery. Due to a confusing initial clinical picture, including presumed congenital Chlamydia, questionable seizures, and an original report of maternal use of ketorolac (Toradol), diagnosis was delayed until day of life 5.

Hemophagocytic lymphohistiocytosis in the premature neonate: a case study.

Hemophagocytic lymphohistiocytosis (HLH) is a rare disease resulting from an abnormal proliferation of histiocytes within the body's tissues leading to an ineffective immune response. Typically, HLH is characterized by fever, hepatosplenomegaly, cytopenia, hypertriglyceridemia, hypofibrinogenemia, and hemophagocytosis. However, the premature infant with HLH may present differently making diagnosis of the disease cumbersome.

Successful use of dexmedetomidine for sedation in a 24-week gestational age neonate.

Objective: To describe a case of dexmedetomidine use for sedation in a 24-week gestational age premature neonate.

Case Summary: A 9-day-old, 24-week gestational age male neonate on high-frequency oscillatory mechanical ventilation was experiencing severe agitation refractory to high-dose intravenous narcotics and benzodiazepines. Since the infant's respiratory stability was reliant on adequate sedation, he was given dexmedetomidine after several days of suboptimal response to escalation of standard agents.

A growing challenge: patient education in a diverse America.

Patient education is a vital part of nursing practice, but the inability to provide consistent culturally sensitive patient care to minority populations has most certainly contributed to disparities in health and healthcare. This article explores minority populations in the United States and their characteristics in relation to health and healthcare, popular cultural competence theories, and nursing school curricula, and discusses teaching strategies for developing more culturally competent nursing professionals.

Recognition of Zellweger syndrome in infancy.

At least 29 proteins are required for assembly of the peroxisome, a single-membrane organelle responsible for many metabolic processes. A defect in any of these proteins affects the numerous biochemical functions of the cell. Many genetic disorders are associated with peroxisome defects.

Evaluation and development of potentially better practices for improving family-centered care in neonatal intensive care units.

Objective: Technological and scientific advances have progressively decreased neonatal morbidity and mortality. Less attention has been given to meeting the psychosocial needs of the infant and family than on meeting the infant's physical needs. Parents' participation in making decisions and caring for their child has often been limited.

Infasurf and curosurf: theoretical and practical considerations with new surfactants.

Type II pneumocytes, normally responsible for surfactant production and release, are insufficiently formed and differentiated in the premature infant born before 34 weeks' gestation. Without an adequate amount of pulmonary surfactant, alveolar surface tension increases, leading to collapse and decreased lung compliance. Pulmonary surfactants are naturally occurring substances made of lipids and proteins.

Lepirudin use in a neonate with heparin-induced thrombocytopenia.

Objective: To describe a case of heparin-induced thrombocytopenia (HIT) in a premature infant and the doses of danaparoid and lepirudin needed to achieve appropriate therapeutic endpoints.

Case Summary: A 30-week gestational age infant was diagnosed with HIT with heparin antibodies. Danaparoid 2.

Effect of age and birth weight on indomethacin pharmacodynamics in neonates treated for patent ductus arteriosus.

Objectives: To determine patent ductus arteriosus (PDA) closure rates, and indomethacin (INDO) toxicity rates in neonates dosed with INDO using an individualized pharmacokinetic/pharmacodynamic (PK/PD) dosing approach. In addition, develop PD curves evaluating dose-response and concentration-response relationships for closure and renal toxicity, especially in select subgroups historically known as "poor responders" (<1000 g and > or = 10 days postnatal age).

Design: Prospective, cohort study.

Use of enoxaparin in a preterm infant.

Objective: To describe the use of enoxaparin to treat suspected thrombosis in a preterm neonate.

Case Description: A 29-week-gestation white infant with a family history of protein S deficiency lost color and blood flow to the right hand several hours after removal of the umbilical artery catheter. Although normal color returned to all except the distal first, second, and third fingers after warming, Doppler flow showed a radial artery defect, indicating a lack of blood flow.

Critical congenital cardiac defects in the newborn.

Recognizing cyanotic and other critical congenital cardiac defects and providing appropriate supportive care before transport to a cardiac center or unit are crucial in promoting the survival and positive outcome of affected newborns. The article discusses basic pathophysiology, signs, symptoms, and supportive care required for the following defects: transposition of the great arteries, tetralogy of Fallot, tricuspid atresia, truncus arteriosus, total anomalous pulmonary venous return, hypoplastic left heart syndrome, critical aortic stenosis, coarctation of the aorta, and pulmonary atresia with intact ventricular septum. Also discussed are the normal transition from fetal to neonatal circulation, diagnosis, preparation for transport, and treatment of these defects.