This issue of Clinics in Perinatology reviews Healthcare Associated Infections in the Neonatal Intensive Care Unit. Guest Editors Drs. Karen Fairchild and Richard Polin have assembled a panel of expert contributors to pen articles on Epidemiology and Risk Factors for NICU HAI: Genes and Environment; Strategies to Reduce NICU HAI: Line, Tube, and Hand Hygiene;? Candida in the NICU: Pros and Cons of Prophylaxis; MRSA in the NICU; New Concepts of Microbial Translocation in the Neonatal Intestine: Mechanisms and Prevention; Antibiotic Resistance in NICU Pathogens: Mechanisms, Clinical Impact, and Prevention; Biomarkers for LONS: Cytokines and Beyond; Heart Rate Variability: A Novel Physiomarker for Sepsis Detection in the NICU; Ventilator-Associated Pneumonia; Perinatal Infection and Prematurity; and Meningitis in Neonates: Bench to Bedside.

During the past several years, there has been an extensive reappraisal of the physiologic changes of pregnancy and their associated disorders, along with a refinement of diagnostic procedures and evaluation of the therapeutic approaches that are of primary concern to the physician. In Shoulder Dystocia and Birth Injury: Prevention and Treatment, Third Edition, noted authority James A. O'Leary, M.D., with 40 years experience as an M.D. academician, lecturer, practitioner and clinical researcher with almost 200 contributions to the OB-GYN literature and textbooks, shares his insight on treatment techniques, identification and treatment of predisposing risk factors, current statistical data, ultrasound diagnosis and the necessary steps toward prevention, along with a thorough review of the important medical-legal issues. Shoulder Dystocia and Birth Injury: Prevention and Treatment, Third Edition supplements the limits of personal experience with the accumulated experience of many talented clinicians to aid physicians, midwives, and professionals in training with the most current information in this vital field.

Early Onset Neonatal Sepsis is covered in this issue of Clinics in Perinatology, guest edited by Drs. Karen Fairchild and Richard Polin. Authorities in the field have come together to pen articles on Innate host defenses and risk for EONS, Group B streptococcus, Diagnosis and management of clinical chorioamnionitis, Molecular diagnostics of sepsis, Use of proteomics in the diagnosis of chorioamnionitis and neonatal sepsis, Adjunct laboratory tests in the diagnosis of EONS, Ureaplasma: role in diseases of prematurity, Meningitis in neonates, Adjunct immunologic therapies in neonatal sepsis, Pathophysiology and treatment of septic shock in neonates, and International perspective on EONS.

This issue of Clinics in Perinatology, guest edited by Drs. Alan Spitzer and Dan Ellsbury, examines Quality Improvement in Neonatal and Perinatal Medicine. The first part of the issue addresses Tools of Quality Improvement and includes articles on The Quality Chasm in Neonatal and Perinatal Medicine; Evaluating the Medical Evidence; The Vermont Oxford Network Database; The Pediatrix Clinical Data Warehouse; Role of Regional Collaboratives: The California Perinatal Quality Care Collaborative Model; A Primer on Quality Improvement Methodology; Using Statistical Process Control Methodology; Human Factors in Quality Improvement, Random Safety Audits, Root Cause Analysis, and Failure Mode and Effects Analysis; Collaboration Between Obstetricians and Neonatologists: Perinatal Safety Programs and Improved Clinical Outcomes; and Pay for Performance: A Business Strategy for Quality Improvement in Neonatal-Perinatal Medicine. The second part of this issue addresses Specific Applications of Documented Quality Improvement Methodology in Neonatal and Perinatal Medicine and includes articles on Delivery Room Intervention-Improving the Outcome, Reducing Retinopathy of Prematurity, Improving Breast Milk Use During and After the NICU Stay, Decreasing Catheter Related Bloodstream Infection, and Decreasing Bronchopulmonary Dysplasia.

The subject of medicalisation of childbirth in colonial India has so far been identified with three major themes: the attempt to reform or 'sanitise' the site of birthing practices, establishing lying-in hospitals and replacing traditional birth attendants with trained midwives and qualified female doctors. This book, part of the series The Social History of Health and Medicine in South Asia, looks at the interactions between childbirth and midwifery practices and colonial modernities. Taking eastern India as a case study and related research from other areas, with hard empirical data from local government bodies, municipal corporations and district boards, it goes beyond the conventional narrative to show how the late nineteenth-century initiatives to reform birthing practices were essentially a modernist response of the western-educated colonised middle class to the colonial critique of Indian sociocultural codes. It provides a perceptive historical analysis of how institutionalisation of midwifery was shaped by the debates on the women's question, nationalism and colonial public health policies, all intersecting in the interwar years. The study traces the beginning of medicalisation of childbirth, the professionalisation of obstetrics, the agency of male doctors, inclusion of midwifery as an academic subject in medical colleges and consequences of maternal care and infant welfare. This book will greatly interest scholars and researchers in history, social medicine, public policy, gender studies and South Asian studies.

Fetal Neurology is covered in this issue of Clinics in Perinatology, guest edited by Dr. Adre du Plessis. The genetic basis of normal brain development and its disorders is explored, including reviews on the prosencephalon, the cerebral cortex, and the cerebellum. Next, normal and abnormal circulatory support of the fetal brain is covered, with articles on normal fetal cerebral substrate supply, disorders of placental circulation and the fetal brain, and disorders of fetal circulation and the fetal brain. Toxic-metabolic causes of disturbed brain development is reviewed, including articles on primary disorders of metabolism and disturbed fetal brain development and maternal drug abuse and impaired fetal brain development. Next, a section on infectious-inflammatory causes of disturbed brain development includes articles on fetal viral infections and impaired brain development and fetal inflammation and impaired brain development. A section on disorders of labor and delivery covers fetal hypoxia insults and patterns of brain injury, the fetal heart rate response to hypoxia, and non-asphyxial hypoxic-ischemic brain injury during prolonged labor. The issue closes with a section on advances in fetal neurodiagnostic testing, including reviews on imaging the fetal brain, quantitative fetal heart rate techniques, and fetal magnetoencephalography for assessment of fetal neurologic function.

This authoritative guide offers a vital overview including the recent fundamental changes in the care of newborn babies. As well as medical staff, key roles are now played by senior nurses, clinical nurse specialists, pharmacists, advanced neonatal nurse practitioners, nurse consultants, midwives, dieticians, physiotherapists and speech therapists. The involvement of such a diverse range of professional cultures in such a rapidly developing area often leads to competing priorities, complicated by a lack of established guidelines. There is also the added challenge of fetal medicine - an important emerging allied specialty new to many healthcare professionals. This book assists all professionals involved in the provision of neonatal care in understanding the genetic, physiological and biochemical mechanisms which have either led to or are associated with the clinical conditions affecting their patients. With comprehensive chapters on fetal medicine, genetics, inherited biochemical disorders, fundamental physiological concepts, the cardiovascular, renal and respiratory systems, bacterial and transplacental infections, pharmacokinetics, nutrition, and an overview of haemostasis, A Foundation For Neonatal Care aids understanding of the continuum of developmental physiology and pathology which is now required of neonatal care providers.

Current Controversies in Perinatology is covered in this issue of Clinics in Perinatology, guest edited by Drs. Michael Uhing and Robert Kliegman. Authorities in the field have come together to pen articles on Strategies to prevent bacterial and fungal infection in the NICU, Drugs of choice for sedation and analgesia in the NICU, Iron therapy for preterm infants, Management of fetal arrhythmias, Inhaled nitric oxide for preterm infants, Racial disparity in low birth weight and infant mortality, Evaluation and treatment of hypotension in the preterm infant, Indications for home apnea monitoring, Short bowel syndrome: how short is too short?, Anemia in the preterm infant: the role of transfusions and erythropoietin, Evaluation and management of stroke in the neonate, Screening for postpartum depression in the NICU, Treatment of gastroesophageal reflux in the preterm and term infant, Optimizing growth in the preterm infant, The role of postnatal steroids in the treatment of bronchopulmonary dysplasia, and The role of genomics in the NICU.

At one time, many children born with congenital heart disease (CHD) suffered from issues that carried fatal prognoses. But that's changing, thanks to technological advances. Interventions in Structural, Valvular, and Congenital Heart Disease, Second Edition guides you throught the interventional treatment of congenital, valvular, and structural heart disease in the children and adults. The book emphasizes the practical aspects of procedures and covers other important areas such as indications and patient selection, potential pitfalls, and complications. See What's New in the Second Edition: Contributions from new authors who are pioneers in structural interventions in adults and transcatheter aortic valve replacement Expanded emphasis on the importance of imaging alongside the technical details of equipment and its safe and effective delivery Coverage of emerging techniques at the forefront of interventional treatment such as fetal interventions, hybrid procedures, and mitral valve repair Greater understanding, technical knowhow, and wider availability of catheters, balloons, delivery systems, and devices have spread intervention into the realm of acquired valve disease, degenerative disease of the aorta, paravalve leakage, postinfarction ventricular septal defects, and closure of the left atrial appendage. The book draws together expert interventionists from throughout the world to present approaches to congenital and structural heart disease that results in better outcomes for patients.

This first-of-its-kind volume addresses the myriad of issues relating to-and reviews the plethora of responses to--premature births in the United States, both in national context and compared with other countries. In addition to current clinical data, it examines how preterm births in the U.S. fit in with larger social concerns regarding poverty, racial disparities, reproductive rights, gender expectations, and the business of health care. Comparisons with preterm birth phenomena in Canada, the U.K., and other Western European countries illustrate cultural narratives about motherhood, women's status, differences across social welfare and abortion policies , and across health care financing and delivery sytems, and how these may affect outcomes for newborns. The book sorts out these intersecting complexities through the following critical lenses: * Clinical: causes, treatments, and outcomes of preterm birth * Population: the distribution of preterm births * Cultural: how we understand preterm birth * Health care: delivering care for high-risk pregnant women and preterm infants * Ethical: moral decision-making about preterm births Preterm Birth in the United States synthesizes a wide knowledge base for maternal and child health professionals across diverse disciplines, including public health, social work, nursing, medicine, and health policy. Social scientists with interests in reproduction and gender issues will gain access to historical, clinical and epidemiological knowledge that can support their work. There is also an audience for the book among childbirth activists such as supporters of midwifery and less medicalized childbirth.

Cardiac disease is one of the leading causes of maternal morbidity and mortality. Catastrophic outcomes typically encountered are due to gaps in knowledge and communication between health care providers. There is a great need for a standardized approach for care of this very high-risk group of pregnant women. The book encompasses detailed obstetrics and cardiology perspectives that are crucial in the management of the commonly encountered cardiac conditions in pregnancy. This text aims to provide guidance to the whole team caring for a pregnant cardiac patient consisting of obstetricians, maternal-fetal medicine, hospitalists, cardiologists, obstetric anaesthesiologists, emergency physicians, primary care providers and nurses. Features: Cardio-Obstetric team organization Preconception counselling and family planning considerations Cardiovascular disease screening and risk stratification of a pregnant cardiac patient Management of a wide spectrum of cardiovascular diagnoses through use of checklists and algorithms in a simple format Essential key points for each cardiac diagnosis

One new mother in twenty is diagnosed with traumatic stress after childbirth. In Birth Crisis Sheila Kitzinger explores the disempowerment and anxiety experienced by these women. Key topics discussed include:

• increasing intervention in pregnancy
• the shift in emphasis from relationships to technology in childbirth
• how family, friends and professional caregivers can reach out to traumatized mothers
• how women can work through stress to understand themselves more deeply and grow in emotional maturity
• how care and the medical system needs to be changed.

Birth Crisis draws on mothers' voices and real-life experiences to explore the suffering after childbirth which has, until now, been brushed under the carpet. It is a fascinating and useful resource for student and practising midwives, all health professionals, and women and their families who want to learn how to overcome a traumatic birth.

When a woman is denied all choice - feels as if she has been swallowed up by a vast machine and spat out at the other end with a baby - how can she come to terms with that ordeal? One new mother in twenty is diagnosed with traumatic stress after childbirth. In Birth Crisis Sheila Kitzinger explores the disempowerment and anxiety experienced by these women. Key topics discussed include: increasing intervention in pregnancy; the shift in emphasis from relationships to technology in childbirth; how family, friends and professional caregivers can reach out to traumatized mothers; how women can work through stress to understand themselves more deeply and grow in emotional maturity; how care and the medical system needs to be changed. Birth Crisis draws on mothers' voices and real-life experiences to explore the suffering after childbirth which has, until now, been brushed under the carpet. It is a fascinating and useful resource for student and practicing midwives, all health professionals, and women and their families who want to learn how to overcome a traumatic birth.

Containing over 10,000 citations from the literature, Chemically Induced Birth Defects, Third Edition deserves a place on the bookshelves of all toxicologists, teratologists, pediatricians, obstetricians, gynecologists, environmentalists, biochemists, oncologists, pharmacologists, endocrinologists, and upper-level undergraduate, graduate, and medical school students in these disciplines.

Using a highly effective, case-based approach, Workbook in Practical Neonatology puts neonatal evaluation, diagnosis, and treatment in a clinical context and tests your knowledge with questions and answers for each topic. You'll find authoritative guidance on the problems you're most likely to see in practice, including issues regarding resuscitation, mechanical ventilation, anemia, fluid therapy, and bronchopulmonary dysplasia. The 6th Edition has been extensively revised, with new authors, rewritten content, improved figures and tables, and many new cases throughout. Organizes chapters around case studies, followed by questions and answers that require you to make diagnostic decisions and help you understand how scientific concepts apply to each clinical problem. Guides you step-by-step through patient care with abundant diagnostic algorithms, illustrations, and decision trees. Features eleven chapters rewritten by new authors, new tables and algorithms, new cases, and updated discussions of existing cases. Provides online access to echocardiograph and fluoroscopic video clips that show you what to expect and how to proceed. An excellent learning tool and everyday reference for practicing neonatologists, as well as students, trainees, nurses, and other clinicians. Expert ConsultT eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices.

This text analyses the pathophysiology, diagnosis, treatment and control of respiratory disorders in the newborn infant. It explores the mechanisms, patterns and factors influencing respiratory activity and dysfunction, as well as the aetiology, management and evaluation of conditions such as respiratory distress syndrome, bronchopulmonary dysplasia, airway disorders, and congenital hypoventilation syndromes.

This is the ninth edition of a well-established, introductory text providing in-depth information on the care of the newborn, both normal and abnormal, full-term and pre-term, from minor to major abnormalities and illnesses. It provides an introduction to neonatology, concentrating on common conditions,for all health professionals concerned with care of the newborn.The concise, readable text facilitates the comprehension of content. The content is firmly evidence-based to ensure best practices. Key points listed throughout the text assist in learning and comprehension. Color photos illustrate important clinical conditions. Fully referenced to provide a current evidence base. Updated content reflects recent guidelines, developments in intensive care, pharmacology, and hepatitis C. A discussion of current issues includes vitamin K administration. Additional information is provided on the care of normal babies, including the parents' perspective. It provides an increased emphasis on the nursing/midwifery aspects.

Much has been written about twins. Very, little, however, is about their everyday lives, not even postnatal let alone prenatal. In this fascinating new study Alessandra Piontelli follows the development and behaviour of thirty pairs of twins from their early life in the womb through to their third year as members of the human community. Drawing on detailed ultrasound observations and work with mothers and families in clinical and natural settings to trace the subtle ways in which various types of twins live, behave and interact with their unequally shared and unique pre- and postnatal environments.
Piontelli shows how from a very early on distinctive and personal traits can be seen in the behaviour of each member of a twin couple and how these traits continue and strengthen well beyond birth. At the same time, the 'couple effect' has an impact on their behaviour even after the birth when social interactions begin. The book describes not only the behaviour of the twins, but the impact they have on the lives of their family and carers - what family members say, how they react and how the family changes.
Scientifically based, but warmly human in content, this unique longitudinal study offers new insights to professionals working with mothers and families of twins and to researchers in human development across a range of disciplines.

This Clinic in Developmental Medicine describes a meticulous survey of germinal matrix/intraventricular hemorrhage in preterm infants, which took place in three New Jersey counties between 1984 and 1987. The babies under study weighed 501-2000g at their birth. They were studied prospectively with cranial ultrasound; the findings were correlated with very detailed pathological examination of the brains of those who died, and with later outcome in the survivors. The numbers studied in this population-based sample were large enough both to test and to generate hypotheses about the causes and consequences of hemorrhage.

Many children spend their first days, weeks, and sometimes months in a neonatal intensive care unit as a consequence of prematurity, congenital anomalies, or birth complications. Their medical needs are thoughtfully appraised and attended to, yet some questions are rarely asked: What experiences do these newborns have? What experiences are we giving them? How can we and do we understand what their lives are like? What are the interventions and actions of medical care actually like for them? Michael van Manen explores the experiential life of newborn infants with particular consideration for those newborns who require medical care. Drawing on contemporary research findings from physiology, psychology, biology, and other disciplines, he offers phenomenological insights and raises thought-provoking questions as to how we ought to understand and care for such young children. In our contemporary world, it is often the experiences of inception, of first contact, with those who seem most distant, foreign, or even alien that we need to try to apprehend and understand. The inceptual lives of newborn infants challenges us to explore those experiences phenomenologically - to investigate the originary meanings of early life experiences. Phenomenology of the Newborn is an essential text for researchers seeking to employ phenomenology for the study of neonatal life and related concerns that may seem inaccessible to other more traditional qualitative and quantitative methods.

This is the premiere clinical textbook on neonatal ultrasound diagnosis. Profusely illustrated, including Doppler sonographs in color, it contains eleven original new chapters by prominent clinician-teachers from America s foremost medical schools and teaching hospitals. The entire text focuses on definitive, clinically relevant, how-to information on normal neonatal head ultrasound, congenital malformations of the brain, sonography in periventricular leukomalacia and intraventricular hemorrhage, ultrasound of the neonatal gastrointestinal tract, sonographic evaluation of the neonatal biliary system, the neonatal adrenal gland, kidney abnormalities including embryogenesis and imaging appearance, neonatal hydronephrosis, sonography of the neonatal ovary, developmental displacement of the neonatal hip, and sonography of the neonatal spinal canal.

Preterm infants grow poorly after birth and very commonly develop ex utero growth restriction (EUGR). However, the risks and benefits of catch-up growth in preterm infants must be weighed, and evidence addressing this warrants examination. Perinatal Growth and Nutrition explores the reasons for EUGR and the long-term effects on developmental outcome and on metabolic risks. It provides clear information on the risks and benefits of faster post-natal growth and catch-up growth in preterm infants and offers tools for better assessment of growth and earlier identification of faltering growth. This book is divided into three sections. The first section covers advances in preterm infant growth standards, diagnosis and causes of EUGR, and assessments of preterm infant diets. The second section considers the extensive human literature on the effects of in utero and ex utero growth restriction and catch-up growth on long-term metabolic outcomes-such as obesity, insulin resistance, type 2 diabetes, and cardiac disease-and long-term neurodevelopmental outcomes including cognition. It also examines evidence for the effect of growth on these outcomes in term and preterm infants. The final section of the book considers ways to reduce the incidence of EUGR in preterm infants and when EUGR does occur, to optimize catch-up growth. Topics include assessment of dietary requirements of the diverse population of preterm infants, examination of tools for prescribing nutrition to neonatal intensive care unit patients, consideration of whether to customize or generalize nutrient intake, and fortification of human milk. In addition, the last chapter proposes using a Z-score growth chart for improved interpretation of growth data.

There is a rapidly growing international literature on very early infant relationships. Many authors have addressed the psychological aspects of neonatal intensive care and indicated a need for greater understanding and research into the links between caregiving interventions and the baby's physical and emotional development. This book looks specifically at the experiences of the premature baby in hospital and how the way professionals and parents interact with it and between themselves affects its future development. The author draws from psychoanalysis, developmental psychology, and ethnology, but takes a systemic perspective throughout. Observational material graphically illustrates the theoretical points and makes the book particularly useful for the practitioner and student.

Birth is a sudden, traumatic transition of environments. Once the placental oxygen supply ceases, the foetus has only minutes to establish pulmonary oxygen transport, which requires not only inflation of the lungs, but also sudden and sustained changes in the lung circulation. Not long ago, research in this field was largely restricted to morphology and physiology. Now the powerful new tools of cellular and molecular biology have begun to
shed light on the physiological processes in the developing lung and its supporting vasculature.

In 22 chapters, three main sections explore lung growth and development, vascular cell growth and differentiation, and the mechanisms of hemodynamic control in the neonate; extensive illustrations give a comprehensive picture of pulmonary circulatory development. Factors controlling vasculogenesis and angiogenesis are described by the scientists who pioneered the field. Similarly, the intracellular signaling cascades that determine proliferation or growth inhibition of fibroblasts, smooth muscle cells, and endothelial cells are also presented in an understandable manner. Finally, the role of
substances, such as nitric oxide and endothelin, that control the hemodynamics of the fetal and neonatal circulations are discussed in detail, particularly in relation to the changes occurring at birth.

This book will inform basic scientists as well as the clinician and student, and should be of particular interest to pediatric cardiologists, pulmonary medicine physicians, and vascular biologists.

Introducing the Social Sciences for Midwifery Practice makes clear the links between social, anthropological and psychological concepts, midwifery practice and women's experience of birth. Demonstrating how empathising with women and understanding the context in which they live can affect childbirth outcomes and experiences, this evidence-based text emphasises the importance of compassionate and humane care in midwifery practice. Exploring midwifery as an art, as well as a science, the authors collected here make the case for midwives as professionals working 'with women' rather than as birth technicians, taking a purely competency-based approach to practice. The book incorporates a range of pedagogical features to enhance student learning, including overall chapter aims and learning outcomes, 'recommendations for practice', 'learning triggers' to encourage the reader to delve deeper and reflect on practice, 'application to practice' case studies which ensure that the theory is related to contemporary practice, and a glossary of terms. The chapters cover perspectives on birth from sociology; psychology; anthropology; law; social policy and politics. Other chapters address important issues such as disability, politics and sexuality. Outlining relevant theory from the social sciences and clearly applying it to practice, this text is an essential read for all student midwives, registered midwives and doulas.