| 1. |
- Backes, Carl H., et al.
(författare)
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Management, treatment and ethical considerations in the care of mother-infant dyads at less than 25 weeks of gestations
- 2022
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Ingår i: Seminars in Perinatology. - : Elsevier. - 0146-0005 .- 1558-075X. ; 46:1
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Tidskriftsartikel (refereegranskat)abstract
- Infants born at less than 25 weeks of gestation represent a small fraction of all preterm births. Caring for these fragile patients is complex because of their significant risks of mortality and adverse outcomes. In the last decades, in view of decreased mortality without increased morbidity as reported from different centers, many clinicians are now more likely to consider providing intensive care treatment to infants born at less than 25 weeks of gestation. But in other settings, palliative care is still considered standard practice, particularly at 22 and 23 weeks of gestation.
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| 2. |
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| 3. |
- Bry, Kristina, 1953, et al.
(författare)
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Mechanisms of inflammatory lung injury in the neonate: lessons from a transgenic mouse model of bronchopulmonary dysplasia.
- 2010
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Ingår i: Seminars in perinatology. - : Elsevier BV. - 1558-075X .- 0146-0005. ; 34:3, s. 211-21
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Forskningsöversikt (refereegranskat)abstract
- The role of inflammation in the pathogenesis of bronchopulmonary dysplasia (BPD) is not well understood. By using a transgenic mouse expressing the inflammatory cytokine interleukin (IL)-1beta in the lung, we have shown that perinatal expression of IL-1beta causes a BPD-like illness in infant mice. We have used this model to identify mechanisms by which inflammation causes neonatal lung injury. Increased matrix metalloproteinase (MMP)-9 activity is associated with BPD. MMP-9 deficiency worsens alveolar hypoplasia in IL-1beta-expressing newborn mice, suggesting that MMP-9 has a protective role in neonatal inflammatory lung injury. The beta6 integrin subunit, an activator of transforming growth factor-beta, is involved in adult lung disease. Absence of the beta6 integrin subunit improves alveolar development in IL-1beta-expressing mice, suggesting that the beta6 integrin subunit is a pathogenetic factor in inflammatory lung disease in the newborn. The authors of clinical studies who have examined maternal inflammation as a risk factor for BPD have found variable results. We have shown that maternal IL-1beta production preceding fetal IL-1beta production prevents lung inflammation, alveolar hypoplasia, and airway remodeling in newborn IL-1beta-expressing mice. Thus, maternal inflammation may protect the newborn lung against subsequent inflammatory injury. In contrast, when maternal and fetal production of IL-1beta are induced simultaneously, the development of IL-1beta-induced lung disease in the newborn is not prevented.
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| 4. |
- Dehaene, Isabelle, et al.
(författare)
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Maintaining and repeating tocolysis : A reflection on evidence
- 2017
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Ingår i: Seminars in Perinatology. - : Elsevier BV. - 0146-0005 .- 1558-075X. ; 41:8, s. 468-476
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Forskningsöversikt (refereegranskat)abstract
- It is inherent to human logic that both doctors and patients want to suppress uterine contractions when a woman presents in threatened preterm labor. Tocolysis is widely applied in women with threatened preterm labor with a variety of drugs. According to literature, tocolysis is indicated to enable transfer to a tertiary center as well as to ensure the administration of corticosteroids for fetal maturation. There is international discrepancy in the content and the implementation of guidelines on preterm labor. Tocolysis is often maintained or repeated. Nevertheless, the benefit of prolonging pregnancy has not yet been proven, and it is not impossible that prolongation of the pregnancy in a potential hostile environment could harm the fetus. Here we reflect on the use of tocolysis, focusing on maintenance and repeated tocolysis, and compare international guidelines and practices to available evidence. Finally, We propose strategies to improve the evaluation and use of tocolytics, with potential implications for future research.
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| 5. |
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| 6. |
- Gudmundsson, Saemundur, et al.
(författare)
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Placental morphologic and functional imaging in high-risk pregnancies.
- 2009
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Ingår i: Seminars in Perinatology. - : Elsevier BV. - 1558-075X .- 0146-0005. ; 33:4, s. 270-280
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Tidskriftsartikel (refereegranskat)abstract
- The placenta is vital for fetal growth and development. Improvement in ultrasound and magnetic resonance imaging have improved our understanding of placental morphology that can be important as in the case of placental accrete/percreta. Functional imaging is presently mainly performed by the use of Doppler ultrasound and can give information on placental perfusion, which can be vital for clinical diagnosis. This review summarizes the present knowledge on placental imaging and it's clinical value in high-risk pregnancies.
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| 7. |
- Lagercrantz, H, et al.
(författare)
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Basic consciousness of the newborn
- 2010
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Ingår i: Seminars in perinatology. - : Elsevier BV. - 1558-075X .- 0146-0005. ; 34:3, s. 201-206
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Tidskriftsartikel (refereegranskat)
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| 8. |
- McKinney, R. L., et al.
(författare)
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Novel forms of ventilation in neonates : Neurally adjusted ventilatory assist and proportional assist ventilation
- 2024
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Ingår i: Seminars in Perinatology. - : Elsevier. - 0146-0005 .- 1558-075X. ; 48:2
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Forskningsöversikt (refereegranskat)abstract
- Patient-triggered modes of ventilation are currently the standard of practice in the care of term and preterm infants. Maintaining spontaneous breathing during mechanical ventilation promotes earlier weaning and possibly reduces ventilator-induced diaphragmatic dysfunction. A further development of assisted ventilation provides support in proportion to the respiratory effort and enables the patient to have full control of their ventilatory cycle. In this paper we will review the literature on two of these modes of ventilation: neurally adjusted ventilatory assist (NAVA) and proportional assist ventilation (PAV), propose future studies and suggest clinical applications of these modes.
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| 9. |
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| 10. |
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| 11. |
- Sindelar, Richard, Docent, 1964-, et al.
(författare)
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Respiratory Management for Extremely Premature Infants born at 22 to 23 weeks of Gestation in Proactive Centers in Sweden, Japan, and USA
- 2022
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Ingår i: Seminars in Perinatology. - : Elsevier. - 0146-0005 .- 1558-075X. ; 46:1, s. 151540-
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Tidskriftsartikel (refereegranskat)abstract
- Survival of preterm newborn infants have increased steadily since the introduction of surfactanttreatment and antenatal steroids. In the absence of randomized controlled trials onventilatory strategies in extremely preterm infants, we present ventilatory strategiesapplied during the initial phase and the continued ventilatory care as applied in three centerswith proactive prenatal and postnatal management and well documented good outcomesin terms of mortality and morbidity in this cohort of infants.
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| 12. |
- Thernström Blomqvist, Ylva, 1974-, et al.
(författare)
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The Swedish approach to nurturing extremely preterm infants and their families : A nursing perspective
- 2022
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Ingår i: Seminars in Perinatology. - : Elsevier. - 0146-0005 .- 1558-075X. ; 46:1
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Forskningsöversikt (refereegranskat)abstract
- Nurturing extremely premature infants is a complicated task that not only necessitates a systematic approach to the immature physiology and its medical management, but also to the needs of the family. Infants born at 22-24 weeks require many weeks of intensive care including a long duration of mechanical ventilation, numerous stressful medical interventions, and for the parents to spend a lot of time in the Neonatal Intensive Care unit (NICU). This paper aims to outline the Swedish nursing approach to nurturing these infants and their families. The nursing care is structured so the parents are the primary caregivers supported by the staff and is based on: timely expression and provision of mother's own breast milk, early and prolonged skin-to-skin contact and close collaboration with the family. While this presentation is based on a single-center's experience, it well represents the general features of nursing provided to extremely preterm infants in Swedish NICUs.
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| 13. |
- Ågren, Johan, 1966-, et al.
(författare)
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Fluid management considerations in extremely preterm infants born at 22-24 weeks of gestation
- 2022
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Ingår i: Seminars in Perinatology. - : Elsevier. - 0146-0005 .- 1558-075X. ; 46:1
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Forskningsöversikt (refereegranskat)abstract
- Emerging data regarding the encouraging outcomes of extremely preterm infants from cen-ters taking active approaches to the care of these infants have prompted dialogue regarding optimal medical management. Among the multitude of decisions providers make in caring for extremely premature infants is the prescribing of parenteral fluids. Surprisingly, there are limited data to guide evidenced-based approaches to fluid and electrolyte management in this population. Immaturity of renal function and skin barriers contribute to the impaired capacity of the preterm infant to maintain salt and water homeostasis. This per-spective paper highlights developmental physiological properties of the kidney and skin, which the provider needs to understand to provide parenteral fluid therapy. Additionally, we provide recommendations for initial fluid and electrolyte management of the preterm infant based on novel data as well as the published literature.
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| 14. |
- Ågren, Johan, 1966-
(författare)
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The proactive approach to mother-infant dyads at 22-24 weeks of gestation : Perspectives from a Swedish center
- 2022
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Ingår i: Seminars in Perinatology. - : Elsevier. - 0146-0005 .- 1558-075X. ; 46:1
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Forskningsöversikt (refereegranskat)abstract
- The care of infants born at the lowest extreme of gestation requires dedication, skill, and experience. Most centers apply a selective approach where intensive care at these gesta-tional ages is being offered to a varying proportion of infants depending on the views and experiences of the medical community, the individual physician, and the parents. Conse-quently, the outcomes differ dramatically with survival rates at 22-23 weeks ranging from 0 to greater than 50%. This paper presents the approach in a center with a long tradition of providing a comprehensive and uniformly active care to all mother-infant dyads from 22+0 weeks of gestation. Important features outlined include prenatal maternal referral and transfer, delivery room management, and initial intensive care.
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| 15. |
- Gustafsson, JA
(författare)
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An update on estrogen receptors
- 2000
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Ingår i: Seminars in perinatology. - 0146-0005. ; 24:1, s. 66-69
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Tidskriftsartikel (refereegranskat)
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| 16. |
- Andersson, Ola, et al.
(författare)
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Cord clamping - 'hold on a minute' is not enough, and sample your blood gases while waiting
- 2023
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Ingår i: Seminars in Perinatology. - : Elsevier BV. - 0146-0005. ; 47:4
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Tidskriftsartikel (refereegranskat)abstract
- There is confusion regarding the dynamics of the umbilical cord circulation and the concomitant placental transfusion. How long does it continue, and at what rate? These questions remain an enigma for many. In this article we will address some common misconceptions about the management of cord circulation, try to explain why there is a lack of clarity, and call in to question the conclusions from an influential meta-analysis and a recently published guideline on cord clamping. We will do that partly by reviewing the rather extensive literature published on the subject over the past 50 to 70 years, which is easily forgotten, but worth considering. In this review, we will also address the important subject of why and how to sample cord blood correctly and to interpret umbilical gases with a sustained cord circulation, which is a crucial part of our ongoing multicenter study 'Sustained cord circulation And Ventilation', the SAVE-study.
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| 17. |
- Bry, Kristina, 1953, et al.
(författare)
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Pathogenesis of bronchopulmonary dysplasia: the role of interleukin 1beta in the regulation of inflammation-mediated pulmonary retinoic acid pathways in transgenic mice.
- 2006
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Ingår i: Seminars in perinatology. - : Elsevier BV. - 0146-0005. ; 30:3, s. 121-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Pulmonary inflammation, increased production of the inflammatory cytokine interleukin-1beta (IL-1beta), and vitamin A deficiency are risk factors for the development of bronchopulmonary dysplasia (BPD) in premature infants. To determine the mechanisms by which IL-1beta influences lung development, we have generated transgenic mice in which human IL-1beta is expressed in the lung epithelium with a doxycycline-inducible system controlled by the Clara cell secretory protein promoter. Perinatal IL-1beta production in these mice causes a phenotype that is strikingly similar to BPD. Pulmonary pathology in the mice shows inflammation, lack of alveolar septation, and impaired vascular development of the lung, similar to the histological characteristics of BPD. Retinoic acid (RA), one of the most biologically active derivatives of vitamin A, increases septation. Proteins involved in mediating the cellular responses to RA include the cellular retinoic acid binding proteins CRABP-I and CRABP-II and the nuclear retinoic acid receptors RAR-alpha, RAR-beta, and RAR-gamma. OBJECTIVE: To test the hypothesis that IL-1beta inhibits the expression of proteins involved in mediating the cellular response to RA. METHODS: The mRNA expression of CRABP-I, CRABP-II, RAR-alpha1, RAR-beta2, RAR-beta4, and RAR-gamma2 was studied with real-time RT-PCR on gestational day 18, and postnatal days 0, 1, 5, and 7 in IL-1beta-expressing mice and their control littermates. In addition, immunohistochemistry for CRABP-I was performed. RESULTS: IL-1beta decreased the mRNA expression and protein production of CRABP-I as well as the mRNA expression of RAR-gamma2. In contrast, no differences between IL-1beta-expressing and control mice were detected in the expression of CRABP-II, RAR-alpha1, RAR-beta2, or RAR-beta4. CONCLUSION: The present study demonstrates for the first time a link between inflammation and the retinoic acid pathway. Inhibition of CRABP-I and RAR-gamma2 expression may be one mechanism by which inflammation prevents alveolar septation. The therapeutic potential of RA in promoting septation in the setting of perinatal lung inflammation deserves further investigation.
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| 18. |
- Cnattingius, S, et al.
(författare)
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The epidemiology of stillbirth
- 2002
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Ingår i: Seminars in perinatology. - : Elsevier BV. - 0146-0005. ; 26:1, s. 25-30
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Tidskriftsartikel (refereegranskat)
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| 19. |
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| 20. |
- Hagberg, Henrik, 1955, et al.
(författare)
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Preconditioning and the developing brain
- 2004
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Ingår i: Semin Perinatol. - : Elsevier BV. - 0146-0005. ; 28:6, s. 389-95
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Forskningsöversikt (refereegranskat)abstract
- Preconditioning occurs when a subinjurious exposure renders the brain less vulnerable to a subsequent damaging exposure. In this essay, various models of preconditioning in the immature brain are discussed. Adenosine, excitatory amino acids, nitric oxide, hypoxia-inducible factor, ATP-sensitive K+ channels, caspases, heat shock proteins, inflammatory mediators and gene expression all seem to be involved in sensing, transducing and executing preconditioning resistance. Also reviewed in this essay is evidence that some subinjurious exposures render the brain more vulnerable to a subsequent damaging exposure. We believe that unraveling the mechanisms of how the developing brain becomes inherently resilient or vulnerable will offer important insights into the pathogenesis of injury. Preconditioning of the brain or induction of tolerance of the immune system might be utilized in the future to decrease CNS vulnerability and the occurrence of perinatal brain injury.
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| 21. |
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