There is general consensus regarding threshold levels that describe the gray zone on the limits of viability, and gestational age alone should not be used solely in making a decision. This issue will bring light to the latest thoughts and clinical recommendations for delivery during the periviable period. Top thought leaders and clinicians have submitted articles in the following areas: Consequences of Birth at Periviable Gestions on Organ Systems; Medical and Surgical Interventions Before Birth; NICU Care: Nutrition/NEC; Pulmonary Care and Circulatory Support; NICU Stay and Microbiome; and Ethical Considerations and Counseling, to name a few. Readers will come away with the most current content written on this topic and details that can be incorporated into clinical care.

Awarded Third Place in the 2016 AJN Book of the Year Awards in the Maternal-Child Health Category! Breastfeeding Management for the Clinician: Using the Evidence, Fourth Edition is an essential and practical reference guide for clinicians. Using a research-based approach, it includes literature reviews while covering incidence, etiology, risk factors, prevention, prognosis and implications, interventions, expected outcomes, care plans, and clinical algorithms. With a focus on the practical application of evidence-based knowledge, this reference offers a problem-solving approach to help busy clinicians integrate the latest research into everyday clinical practice. Completely updated and revised, the Fourth Edition includes a new discussion of the vitally important newborn gut microbiome. In addition, it features new and more effective techniques for addressing breastfeeding barriers, new research, and the latest guidelines.

Preterm birth interrupts the normal developmental progression of most organs, particularly when birth occurs at the lowest level of viability. An immediate task is to successfully transition to a post-natal life without a placental circulation. To do this demands careful management of the cardiorespiratory systems. To best help the fragile preterm infant at this demanding time, care-givers must remember two most pressing goals. These are first to maintain adequacy of gas exchange and delivery, while simultaneously minimizing any secondary injury to the fragile preterm lung. However, after these immediate priorities in the delivery room, the longer term effects of an immature lung development and its associated problems come to the forefront. These problems include the inflammation of perinatal infection, oxygen, and invasive mechanical ventilation. Both the immaturity itself, and secondary lung injury and its inflammation - collectively will often lead to the condition termed bronchopulmonary dysplasia (BPD). Although many of these infants may eventually be discharged to home without a need for oxygen supplementation or pulmonary medications, the long-term impact of interrupted lung development and secondary lung injury remain serious concerns. It is now well recognized that mechanical ventilation is pivotal to developing secondary lung injury and BPD. Consequently, a great deal of time and effort has been put into the development and application of non-invasive ventilator (NIV) approaches to supporting respiratory function in neonates. Since the landmark publication by Gregory and colleagues in 1967, nasal continuous positive airway pressure (nCPAP) has been the most commonly applied approach to NIV. This approach has been supported by the recent generation of randomized controlled trials. However, cumulatively these trials have shown only a small reduction in rates of BPD. Outside of the trial data, despite the wider application of nCPAP, rates of BPD remain relatively unchanged over recent years. This has led to investigations of other NIV approaches including nasal ventilation and high flow nasal cannula therapy. Not only have available modes increased, but so have the interfaces through which these modes may be applied. In the issue of Clinic in Perinatology, readers will find an up-to-date review of non-invasive approaches to supporting preterm respiratory function. This draws on the expertise of leading investigators in the field. This issue reviews the physiologic mechanisms by which the various approaches to NIV may support respiratory function; the evidence base supporting different NIV approaches; and adjunctive aspects of NIV therapy including their use during neonatal transport and the application of other supportive therapies such as inhaled NO.

This book provides an overview of fetal psychobiological research, focusing on brain and behavior, genetic and epigenetic factors affecting both short and long-term development, and technological breakthroughs in the field. These focal points intersect throughout the chapters, as in the challenges of evaluating the fetal central nervous system, the myriad impacts of maternal stressors and resiliencies, and the salience of animal studies. It also discusses specific monitoring and assessment methods, including cardiotocography, biomagnetometry, 4D ultrasound, in utero MRI, and the KANET test. Spanning assessment, identification, and pre- and postnatal intervention, the book weighs the merits of standardized evaluations and argues for more integrative research in the future. Included in the coverage: Effects on the fetus of maternal anxiety, depression, and stress during pregnancy. Clinical and experimental research in human fetuses and animal models. Observational research including the use of behaviors in developing tests to assess fetal health. Fetal auditory processing and implications for language development. Fetal effects of prenatal exposure to selective SRI antidepressant exposure. Structural and functional imaging of the prenatal brain. The effects of alcohol exposure on fetal development. Fetal Development: Research on Brain and Behavior, Environmental Influences, and Emerging Technologies is an essential resource for researchers, clinicians and related professionals, as well as students in a wide range of fields such as developmental psychology, pediatric and obstetrical medicine, neuroscience, nursing, social work, and early childhood education.

This innovative book for Neonatal Nurses and NICU clinicians provides evidence-based clinical guidelines proven to mitigate and reduce the often profound trauma experience and subsequent developmental challenges for vulnerable hospitalized infants and their families. Each in-depth guideline includes the latest scientific research explaining the clinical rationale for the recommended practices, associated short-term and long-term outcomes, and implementation strategies to support practice improvement. The text reflects a trend - the provision of trauma-informed care in the neonatal intensive care unit - that has recently gained increasing momentum. With endorsements by respected transdisciplinary neonatal clinicians, it provides guidelines that encompass the five core measures for age-appropriate care, including the Healing Environment, Pain and Stress, Protected Sleep, Activities for Daily Living, Age-Appropriate Infant Guided Feeding, and Family-Integrated Care. The book also features downloadable sample competencies and parent teaching guides, along with additional eLearning modules with Nursing CE. A self-assessment checklist and teaching sheets, sample competencies, and sample algorithms add to the book's utility. Key Features:Provides clinically relevant, evidence-based practice guidelines for minimising trauma in neonates.Encompasses the five core measures for age-appropriate care.Includes proven implementation strategies to facilitate practice transformation.Offers downloadable sample competencies and parent teaching guides and eLearning modules with Nursing CE.Reviewed and endorsed by transdisciplinary neonatal clinicians.

Care of the Well Newborn is a unique text that focuses on care of the term newborn for the first month of life. Written by distinguished experts in the field, it teaches students and professionals how and what to assess in the care of the nonverbal newborn, while also providing criteria for recognizing deviations from normal and strategies for managing complications that arise. The first text of its kind, it provides easily accessible information on evidence-based neonatal care that follows current guidelines, standards, and recommendations. Also explored are physiology and pathophysiology, data collection, differential diagnosis, cultural considerations, and parental education. An ideal resource for both students and professionals, each chapter includes multiple choice questions, case studies, or activities to facilitate critical thinking and learning.

This book summarises the state of cognoscibility with regard to normal new-born care that has accumulated over the past centuries, especially the 20th and now 21st century. This compendium is not an ersatz discussion of neonatology, but of the fascinating zone that involves the new-born in the normal new-born nursery. It is not a homogenous area and thus, some overlap is inevitable in such a compilation of data. The preface details historical concepts that have followed new-borns over the millennia of homo sapiens' existence, such as infanticide, breast feeding, swaddling, neonatal resuscitation, and principles of caring for new-borns. The mortality rate of new-borns has been reduced in many parts of the world in this century and we have learned much more about how to keep increasing numbers of new-borns alive, especially when health care providers and society collaborate in this important endeavour and emphasise known preventative principles. Current modern paediatric and perinatal treatments allow new-borns in the current 21st century America to have a start on an overall life expectancy of 78.5 years (up to 76 years in males and 80.9 years in females), if they receive meticulous medical care even if born into a penurious state. Such deserved care and inevitable ongoing medical discoveries will only lengthen these life trajectories.

Sixteen British specialists pool their extensive knowledge of spontaneous abortion in one source. Their discussion is directly applicable to clinical situations and helps identify areas of debate and alternative methods.

This book is a collection of state-of-the-art reviews on the various aspects of nutrition for the preterm neonate, by internationally renowned clinicians and researchers from Australia, UK, USA, Canada, and Italy. It provides the scientific basis and clinical perspective on the A to Z of enteral and parenteral nutrition for extremely preterm neonates, making it valuable for all involved in the care of this high-risk population. The topics covered range from the developmental physiology of the gastrointestinal tract, and early trophic feeds, to aggressive enteral and parenteral nutrition, and feeding under special conditions such as intrauterine growth restriction and chronic lung disease. Survival of extremely preterm neonates has improved significantly following the advances in neonatal intensive care. Extrauterine growth restriction is recognised as a serious and almost universal issue in this population. Considering the long term consequences of nutritional deficit and poor growth (e.g. neurodevelopmental impairment, short stature and metabolic disorders), optimising nutrition in the early postnatal life of the preterm neonate is crucial. However this is easier said than done considering the frequency of feed intolerance, fear of necrotising enterocolitis, and the hesitancy in adopting an aggressive approach to parenteral nutrition in this population. The simple and practical approach of this comprehensive and unique book makes it a must read for clinicians as well as researchers involved in neonatal intensive care. It is a useful resource for trainees in neonatology, paediatric gastroenterology, and neonatal nursing, and also for dieticians specialising in neonatal nutrition.

This is the true story of the heart-wrenching struggle for survival, devastating financial loss, and the power of hope that comes with extremely premature babies born nearly four months early. The twin babies arrived at 24 weeks gestation and each weighed a pound. Imagine that, the same as six sticks of butter It's a riveting story of despair and tragedy, joy and laughter. I couldn't put it down and I hope you find it the same way...perhaps just not so late into the wee hours of the night. Re-told from journals, the story unfolds like a medical-mystery. Will the twins survive? Will they have devastating disabilities? The breath-taking pace of life-altering decisions in a Neonatal Intensive Care setting is like witnessing an accident--one you can't bear to watch and yet so compelling you can't look away. Follow the roller-coaster ride through heroics, medical miracles, unrelenting fear, and heart-warming joy. The events of this true story will make you cry. You'll be appalled at the insensitivity of some towards this young family. You'll be angry at the gall of insurance companies that use "fine print" to deny coverage for certain medical treatments. And you'll rejoice with the miracle of life fought for and won. With less than a 20% chance of survival at birth, the doctors warned; "If the babies manage to survive, they have an 80% chance of debilitating issues--including cerebral palsy, breathing issues, and severe learning disabilities." The second edition of A Pound of Hope adds the much awaited five-year look back on this harrowing start in life. Read the unexpected outcome (I won't spoil the surprise here ) of these one-pound miracle babies. The backdrop setting for this story of survival is one of financial disaster. This family is bankrupted by the unrelenting medical costs to save their babies. They lose everything--savings and retirement accounts are emptied; belongings are sold and their house is lost as they fall into the bottomless pit of medical bankruptcy. Our leaders in health insurance, medical services, and government have failed to address a hole in the very fabric of our society. A hole so big it swallows families at a time when they are experiencing life-threatening issues. For what is the point of medical miracles if there is no way to pay for them? Our society has developed machines and techniques to preserve and extend life against all odds. But at what cost? Families stricken with the financial burden of catastrophic medical bills will see their financial stability, their future, even their very viability as a family slip away. If science can save the babies, who will save the family?

Growth Parameters of the Newborn Revisited With Review of the Standardized Placental Measurements

This book has been written to summarise the available knowledge regarding transcutaneous bilirubinometry, the first technique that allows a completely non-invasive measurement of a clinical variable. This technique led to important changes in the management of neonatal jaundice, the most common clinical condition of new-born infants world-wide. Transcutaneous bilirubinometry has its roots in the old observation that yellow skin colour is due to the deposition of bilirubin, a chromophore molecule. More recently, transcutaneous bilirubinometry has involved many disciplines; and accordingly, this book has contributions from physicists, biologists, paediatric dermatologists and neonatologists who have clinical research expertise in the field of neonatal hyperbilirubinemia. We hope that this book may prompt the advancement of research that will answer the as-yet unanswered questions, improve the reliability and usefulness of transcutaneous bilirubinometry, and respond to the clinical needs of our little patients.

A new look at how we welcome newborn babies into the world, whatever context they are born in, but particularly if they are born in a large maternity hospital. Reflections, exercises and ideas for midwives and other maternity professionals. "The deeply ingrained, rational scientific culture we live in today suppresses our innate knowledge of how things could improve. We focus on categorising through measuring, counting and documenting what we do, instead of realising deep inside that things must change with regard to our rituals around birth in hospital. It's as if we don't quite know how to engender that change..." Experienced midwife Debby Gould considers the current situation and explores how change is not just possible but also beneficial for mother, baby and healthcare professionals. Questions and exercises are provided to stimulate reflection and seminar discussion. Following a varied and distinguished career in many maternity contexts, Debby Gould is currently Head of Midwifery for University College London Hospitals and has served two full terms in office (as Deputy Chair, then Chair) on the Royal College of Midwives Council. She is also named in Debrett's People of Today as one of the top 25,000 influential and successful people in the UK. Her words are well worth reading

Perinatal Programming addresses the environment-dependent setting of fundamental life functions and dispositions for diseases in developmental periods during pregnancy and in early infancy. It provides a new view of the origins of health and diseases. To realize these associations may enable us to prevent diseases for the long term.This book reviews actual state-of-the-art knowledge in the perinatal programming field. The authors are internationally known scientists of this research area.

Many challenges facing premature babies are insurmountable despite the recent advancements of Neonatal medicine. Often providers need to decide which patients are the best candidates of the specialized care. Ideally, families are integral parts of the decision-making process. This two part story follows the distressing yet sometimes satisfying journey of a young doctor in two very different situations challenging his own ego, ethics, and motivations as he struggles with tough decisions, tough situations, and sometimes circumstances where his intentions are met with resistance by his colleagues.

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What makes us the "w"ay "w"e are? "Some say it's the genes we inherit at conception. Others are sure it's the environment we experience in childhood. But could it be that many of our individual characteristics--our health, our intelligence, our temperaments--are influenced by the conditions we encountered before birth?
That's the claim of an exciting and provocative field known as fetal origins. Over the past twenty years, scientists have been developing a radically new understanding of our very earliest experiences and how they exert lasting effects on us from infancy well into adulthood. Their research offers a bold new view of pregnancy as a crucial staging ground for our health, ability, and well-being throughout life.
Author and journalist Annie Murphy Paul ventures into the laboratories of fetal researchers, interviews experts from around the world, and delves into the rich history of ideas about how we're shaped before birth. She discovers dramatic stories: how individuals gestated during the Nazi siege of Holland in World War II are still feeling its consequences decades later; how pregnant women who experienced the 9/11 attacks passed their trauma on to their offspring in the womb; how a lab accident led to the discovery of a common household chemical that can harm the developing fetus; how the study of a century-old flu pandemic reveals the high personal and societal costs of poor prenatal experience.
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Origins "also brings to light astonishing scientific findings: how a single exposure to an environmental toxin may produce damage that is passed on to multiple generations; how conditions as varied as diabetes, heart disease, and mental illness may get their start in utero; why the womb is medicine's latest target for the promotion of lifelong health, from preventing cancer to reducing obesity. The fetus is not an inert being, but an active and dynamic creature, responding and adapting as it readies itself for life in the particular world it will enter. The pregnant woman is not merely a source of potential harm to her fetus, as she is so often reminded, but a source of influence on her future child that is far more powerful and positive than we ever knew. And pregnancy is not a nine-month wait for the big event of birth, but a momentous period unto itself, a cradle of individual strength and wellness and a crucible of public health and social equality.
With the intimacy of a personal memoir and the sweep of a scientific revolution, "Origins "presents a stunning new vision of our beginnings that will change the way you think about yourself, your children, and human nature itself.

This issue of Pediatric Clinics offers an update on Advances in Neonatology. Guest Editors Drs. Lucky Jain and David Carlton have assembled a panel of world-class experts who offer reviews on topics including Trends in birthing, gestational age, birth weight and mortality in newborns; Late Prematurity; Advances in newborn resuscitation; Approaches to infants with congenital anomalies; Advances in neonatal surgery; Respiratory failure in the term and near term infant; Mechanical ventilation of the newborn; Pulmonary hypertension in the newborn; Bronchopulmonary dysplasia; Extracorporeal membrane oxygenation; Necrotising enterocolitis; Hyperbilirubinemia; Retinopathy of Prematurity; Surgical approaches to an infant with congenital heart disease; Hypoxic ischemic encephalopathy; Neonatal sepsis; and Quality improvement in neonatology.

The award-wining Birth Emergency Skills Training is the interface between the world of midwifery and the world of medicine. BEST is designed to improve the midwife's ability to act decisively in an emergency and to see it though until resolved or until mother and baby are under physician management. Topics covered include pain and bleeding in pregnancy, hypertension, preterm labor, malpresentations, undiagnosed twins, abnormal fetal heart rate, neonatal resuscitation, shock, trauma, syncope and cardiac arrest.Richly illustrated with drawings and photographs by the author.

The revised and updated second edition covers practical approaches to caring for healthy and high-risk infants. The book covers maternal and fetal health, care of the newborn after delivery, breastfeeding, follow-up care, common congenital anomalies, the newborn with a heart murmur or cyanosis, neurologic findings, primary care issues relating to infants requiring intensive care, and health and developmental outcomes. More than 40 chapters cover step-by-step recommendations on what to do, when to admit, and when to refer. Recommendations and lists detailed references within each chapter. New in the second edition: 8 new chapters added including: Prenatal Diagnosis Fetal Interventions Optimizing Nutrition for the Preterm, Very Low-Birth-Weight Infant After Discharge From Neonatal Intensive Care Newborn Immunizations and Immune Prophylaxis Balancing Safe Sleep and Other Newborn Recommendations Vascular Anomalies Endocrine Disorders Presenting in the Newborn Period Shared Decision Making Around Home Technologies

Prominent scientists from perinatal medicine, paediatrics, psychology and sociology will meet in Modena, Italy to explore birth as a complex psychological experience for mother, father and child. The proceedings of this interdisciplinary congress are here published in English to reach the broadest possible scientific audience. The goal is to create a dialogue between humanistic and medical perspectives with regard to conception, pregnancy and birth in an era of rapid biotechnological progress, taking different social and cultural contexts into account.

A concise clinical reference that facilitates the diagnosis of intrauterine and perinatally acquired infections was the goal in creating the Congenital and Perinatal Infections: A Concise Guide to Diagnosis. Information about the natural history, m- agement, and outcome of these infections is well detailed in many other sources and so has not been included. Rather, the focus of the book is diagnosis. The initial chapters provide general information about serological and nonserological assays that are used for the diagnosis of infections, and a chapter about the placenta includes details about histopathological findings that can be helpful with the diagnosis of congenital inf- tions. The remainder of the book is devoted to the diagnosis of specific congenital and/ or perinatal infections. As illustrated in the chapters about specific infections, the approach to diagnosis of a congenital or perinatally acquired infection in the neonate begins, when possible, with consideration and diagnosis of infection in the pregnant woman, knowledge of how the infection is transmitted, and the risk of that infection for the woman and her fetus or neonate. The possibility of congenital or perinatal infection in neonates is usually considered because of the diagnosis of, or concern about a s- cific infection in, a mother during pregnancy that can be transmitted to the neonate or because of clinical findings in the neonate at birth that suggest an infectious cause.

A critical review of the classic, as wells as most recent-and quite seminal-findings concerning the phenotypic and molecular characteristics of both fetal and neonatal B and T cells, the cells that mediate antibody and cellular immune responses in newborns and infants. Dr. Bona shows how the antibody response of neonates is modulated by maternal antibodies and how, in certain cases, this can cause transient or life-threatening neonatal autoimmune disease. He also describes the characteristics of neonatal tolerance induced by foreign allo- and self-antigens, which are the basis for understanding impaired infant immune response and which provide a rationale for the development of efficient neonatal vaccines. By making clear the characteristics and differences between the immune system and the immune responses of both newborns and infants, compared to those of adults, Dr. Bona offers insights and challenging hypotheses that promise to help overcome the poor responses of neonates to various antigens.

Mientras que mas de catorce millones de norteamericanos sufren de diabetes, la proporcion se incrementa de manera considerable entre la poblacion hispana, ya que los hispanos tienen dos veces mayor propension de desarrollar esta enfermedad que otros grupos. Las estadisticas senalan que al llegar a los cuarenta y cinco anos de edad, uno de cada diez hispanos estara enfermo de diabetes. Despues de los cuarenta y cinco anos, uno de cada cuatro hispanos habra sido diagnosticado con este padecimiento.

La diabetes es un padecimiento complicado que amenaza la vida misma, pero hoy en dia los diabeticos pueden reducir sus riesgos y llegar a tener una vida mas duradera, feliz, y productiva si cuentan con un plan para el manejo y control de su tratamiento. El "Manual Joslin para la Diabetes, " elaborado por el famoso Centro Joslin para la Diabetes, es el libro mas adecuado para la atencion personal, indispensable para todos aquellos que padecen esta enfermedad.

El Centro Joslin para la Diabetes es considerado como el instituto de investigacion y clinica mas importante del mundo en el estudio y el tratamiento de este mal, lo que hace al "Manual Joslin para la Diabetes" el libro mas actual en la materia. Escrito bajo la direccion del doctor Richard Beaser, en colaboracion con Joan Hill y un equipo de expertos, en este libro se presentan todos los aspectos esenciales para que los propios pacientes sean quienes controlen su enfermedad. Se trata de un libro practico, actualizado, y accesible, escrito en un lenguaje claro y sencillo. Se apoya en graficas y cuadros sobre que, como y cuando comer; como verificar el contenido de los azucares en la sangre; como administrar insulina y medicamentos por via oral; como controlar las alzas y bajas de azucar; y como y cuando hacer ejercicio.