Seminars in Fetal & Neonatal Medicine RSS feed: Articles in Press. Seminars in Fetal & Neonatal Medicine (formerly Seminars in Neonatology ) is a bi-monthly journal which publishes topic-based issues, including current 'Hot Topics' on the latest advances in fetal and neonatal medicine. The change in title relates to the growing interest amongst obstetricians, midwives and fetal medicine specialists. The Journal commissions review-based content covering current clinical opinion on the care and treatment of the neonate and draws on the necessary specialist knowledge, including that of the respiratory physician, the infectious disease physician, the surgeon, as well as the paediatrician and obstetrician. Each topic-based issue is edited by an authority in their field and contains 8-10 articles. Recent Issues have included: • Newer Concepts in Neonatal Respiratory Care • Perinatal Infection: Detection and Prevention • Multiple Births • Neonatal Jaundice • Inborn Errors of Metabolism Seminars in Fetal & Neonatal Medicine provides: • coverage of major developments in neonatal care; • value to practising neonatologists, consultant and trainee paediatricians, obstetricians, midwives and fetal medicine specialists wishing to extend their knowledge in this field; • up-to-date information in an attractive and relevant format. Book Reviews Seminars in Fetal and Neonatal Medicine accepts relevant books for inclusion in the book review section. Please contact Associate Publisher, Lindsay Campbell, Elsevier, 32 Jamestown Road, London, NW1 7BY; l.campbell@elsevier.com for further information or to submit books for consideration.http://www.sfnmjournal.com//inpress?rss=yesElsevier Inc.en © 2010 Elsevier Ltd. All rights reserved. Seminars in Fetal & Neonatal Medicine1744-165X2010-07-21 © 2010 Elsevier Ltd. All rights reserved. healthpermissions@elsevier.comhttp://www.sfnmjournal.com/article/PIIS1744165X10000466/abstract?rss=yesSummary: Twin pregnancy is associated with a high risk of congenital malformations. This review covers the risk of such anomalies in both dizygotic and monozygotic twin pregnancies, and discusses current insights into the associations relating to zygosity, chorionicity and genetic factors. The pathological basis of specific malformations unique to the monochorionic twinning process, including conjoined twinning and twin reversed arterial perfusion (TRAP) sequence, is discussed in more detail, and factors contributing to the higher perinatal mortality rate in multiple pregnancies are addressed.Genetics and developmental pathology of twinning - Corrected ProofMartin A. Weber, Neil J. Sebire10.1016/j.siny.2010.06.002Seminars in Fetal & Neonatal Medicine (2010)2010-07-21Seminars in Fetal & Neonatal Medicine2010-07-21http://www.sfnmjournal.com/article/PIIS1744165X10000557/abstract?rss=yesSummary: To explore international variation in implementation of point-of-care ultrasound in the neonatal intensive care unit (NICU), contributions were invited from neonatologists and paediatric cardiologists in six countries. The contributors show variation in national implementation that ranges from almost total coverage through to a minority of NICUs having point-of-care ultrasound capability. To a varying degree in all systems the main barriers have been concerns from the consultative specialties that traditionally use ultrasound, relating to the risk of misdiagnosis but also involving different clinical needs, liability concerns and lack of outcome-based evidence. All contributors agreed that safe point-of-care ultrasound depends on close collaboration with the consultative specialties and also that there is a need to develop training and accreditation structures for neonatologists using ultrasound.Point-of-care ultrasound in the neonatal intensive care unit: international perspectives - Corrected ProofNick Evans, Veronique Gournay, Fernando Cabanas, Martin Kluckow, Tina Leone, Alan Groves, Patrick McNamara, Luc Mertens10.1016/j.siny.2010.06.005Seminars in Fetal & Neonatal Medicine (2010)2010-07-21Seminars in Fetal & Neonatal Medicine2010-07-21http://www.sfnmjournal.com/article/PIIS1744165X10000569/abstract?rss=yesSummary: The association between multiple pregnancy and preterm labour is well-established, with >50% of multiple births delivering before 37 weeks. However, there remains limited understanding of the factors predisposing to early delivery of twins. Physiological stimuli to the onset of parturition, including stretch, placental corticotrophin-releasing hormone and lung maturity factors, may be stronger in multiple pregnancies due to the increased fetal and placental mass. Pathological processes including infection and cervical insufficiency also have a role. Treatments that prevent preterm birth in singleton pregnancies, such as progesterone and cervical cerclage appear to be ineffective in multiple pregnancies. This article reviews aspects of preterm birth in twins and higher order multiples including epidemiology, prediction and prevention of preterm labour and potential mechanisms controlling onset of parturition. Evidence relating to the management of labour in preterm and term multiples is also discussed.Preterm and term labour in multiple pregnancies - Corrected ProofSarah Stock, Jane Norman10.1016/j.siny.2010.06.006Seminars in Fetal & Neonatal Medicine (2010)2010-07-21Seminars in Fetal & Neonatal Medicine2010-07-21http://www.sfnmjournal.com/article/PIIS1744165X1000048X/abstract?rss=yesSummary: Multiple pregnancy is one of the greatest perinatal challenges facing clinicians today. In a society of rising expectations among fertility and maternity service users, the potential for adverse outcomes associated with multiple pregnancy is a source of concern. This article examines the impact of assisted conception on the incidence of multiple pregnancies and associated complications. It explores some of the reasons for the strong association between assisted reproductive technology and multiple pregnancies and suggests possible ways of addressing this continuing problem.Epidemiology of multiple pregnancy and the effect of assisted conception - Corrected ProofMairead Black, Siladitya Bhattacharya10.1016/j.siny.2010.06.004Seminars in Fetal & Neonatal Medicine (2010)2010-07-15Seminars in Fetal & Neonatal Medicine2010-07-15http://www.sfnmjournal.com/article/PIIS1744165X10000399/abstract?rss=yesAbstract: Near infrared spectroscopy (NIRS) is a light-based technology used to monitor tissue oxygen status. Refinements to the method since it was first described have extended its applicability to different research and clinical settings due to its non-invasiveness, instrument portability and ease of use. Classic NIRS recordings, based in the Beer-Lambert law, can be used for the trend monitoring of changes in tissue perfusion-oxygenation parting from an arbitrary zero point. However, in order to derive intermittently quantitative values in absolute terms, certain manoeuvres must be performed. More recently, the evolution of the technique has led to the development of instruments that provide an absolute value of regional hemoglobin saturation in a continuous manner. This review will focus on the physical principles of tissue spectroscopy including a brief description of the different operating principles that are currently in use or under development. The theoretical details, experimental procedures and data analysis involved in the measurements of physiological variables using NIRS will be described. The future beyond the scope of NIRS and potential lines of research will also be discussed.Near-infrared spectroscopy: A methodology-focused review - Corrected ProofAdelina Pellicer, Maríadel Carmen Bravo10.1016/j.siny.2010.05.003Seminars in Fetal & Neonatal Medicine (2010)2010-06-28Seminars in Fetal & Neonatal Medicine2010-06-28http://www.sfnmjournal.com/article/PIIS1744165X10000405/abstract?rss=yesSummary: Multiple pregnancies, the majority of which are twins, are at substantially higher risk of fetal morbidity and mortality when compared with singleton pregnancies. Single fetal demise occurs in up to 6.2% of all twin pregnancies. It may cause considerable risk for the co-twin including increased risk of fetal loss, premature delivery, neurovascular injury and end-organ damage. In this review we seek to summarise the most contemporary literature on the aetiology of single twin demise, the pathophysiology of injury to the surviving twin and the evidence for current management strategies.Single twin demise: consequence for survivors - Corrected ProofS.C. Hillman, R.K. Morris, M.D. Kilby10.1016/j.siny.2010.05.004Seminars in Fetal & Neonatal Medicine (2010)2010-06-28Seminars in Fetal & Neonatal Medicine2010-06-28http://www.sfnmjournal.com/article/PIIS1744165X10000442/abstract?rss=yesSummary: For infants with perinatal hypoxia–ischaemia, the ability to give an accurate prognosis at different ages enables the clinician to make decisions on the continuation of management, and also assists in discussions regarding further treatment and prognosis with parents and families. This review suggests which outcome markers are still valid, which need new ‘cut-off values’ and which can no longer be used in cooled infants. The main focus is on convenient bedside technologies such as the amplitude-integrated electroencephalogram that can be easily applied in routine clinical practice.Patient selection and prognostication with hypothermia treatment - Corrected ProofMarianne Thoresen10.1016/j.siny.2010.05.008Seminars in Fetal & Neonatal Medicine (2010)2010-06-28Seminars in Fetal & Neonatal Medicine2010-06-28http://www.sfnmjournal.com/article/PIIS1744165X10000375/abstract?rss=yesSummary: The use of point-of-care functional ultrasound to assess cardiovascular function is gaining interest in the neonatal intensive care unit (NICU). The modality has been in use in adult intensive care units for some time and has often guided management. Clinical signs such as heart rate, blood pressure, and capillary refill time, which physicians traditionally have relied upon, provide limited insight into the adequacy of systemic blood flow and organ perfusion. Enhanced cardiovascular imaging and hemodynamic evaluation offers novel insights regarding the contribution of the ductus arteriosus, myocardial performance and pulmonary hemodynamics to ongoing clinical instability. In addition, it allows more accurate delineation of the nature of the underlying disease process and facilitates the evaluation of response to therapeutic intervention. This review examines the potential clinical role of ultrasound methods in the NICU; specifically, its applications in different disease states, and how the technology may be introduced safely in the NICU.Neonatologist-performed functional echocardiography in the neonatal intensive care unit - Corrected ProofAfif F. El-Khuffash, Patrick J. McNamara10.1016/j.siny.2010.05.001Seminars in Fetal & Neonatal Medicine (2010)2010-06-21Seminars in Fetal & Neonatal Medicine2010-06-21http://www.sfnmjournal.com/article/PIIS1744165X10000417/abstract?rss=yesSummary: There is now compelling clinical evidence that prolonged, moderate cerebral hypothermia initiated within a few hours after severe hypoxia–ischemia and continued until resolution of the acute phase of delayed cell death can reduce subsequent neuronal loss and improve behavioral recovery in term infants and adults after cardiac arrest. Perhaps surprisingly, the specific mechanisms of hypothermic neuroprotection remain unclear, at least in part because hypothermia suppresses a broad range of potential injurious factors. In the present review we critically examine proposed mechanisms in relation to the known window of opportunity for effective protection with hypothermia. Better knowledge of the mechanisms of hypothermia is critical to help guide the rational development of future combination treatments to augment neuroprotection with hypothermia, and to identify those most likely to benefit from it.Mechanisms of hypothermic neuroprotection - Corrected ProofPaul P. Drury, Laura Bennet, Alistair J. Gunn10.1016/j.siny.2010.05.005Seminars in Fetal & Neonatal Medicine (2010)2010-06-21Seminars in Fetal & Neonatal Medicine2010-06-21http://www.sfnmjournal.com/article/PIIS1744165X10000430/abstract?rss=yesSummary: Cerebral hypothermia reduces brain injury and improves behavioral recovery after hypoxia–ischemia (HI) at birth. However, using current enrolment criteria many infants are not helped, and conversely, a significant proportion of control infants survive without disability. In order to further improve treatment we need better biomarkers of injury. A ‘true’ biomarker for the phase of evolving, ‘treatable’ injury would allow us to identify not only whether infants are at risk of damage, but also whether they are still able to benefit from intervention. Even a less specific measure that allowed either more precise early identification of infants at risk of adverse neurodevelopmental outcome would reduce the variance of outcome of trials, improving trial power while reducing the number of infants unnecessarily treated. Finally, valid short-term surrogates for long term outcome after treatment would allow more rapid completion of preliminary evaluation and thus allow new strategies to be tested more rapidly. Experimental studies have demonstrated that there is a relatively limited ‘window of opportunity’ for effective treatment (up to about 6–8h after HI, the ‘latent phase’), before secondary cell death begins. We critically evaluate the utility of proposed biochemical, electronic monitoring, and imaging biomarkers against this framework. This review highlights the two central limitations of most presently available biomarkers: that they are most precise for infants with severe injury who are already easily identified, and that their correlation is strongest at times well after the latent phase, when injury is no longer ‘treatable’. This is an important area for further research.Potential biomarkers for hypoxic–ischemic encephalopathy - Corrected ProofL. Bennet, L. Booth, A.J. Gunn10.1016/j.siny.2010.05.007Seminars in Fetal & Neonatal Medicine (2010)2010-06-21Seminars in Fetal & Neonatal Medicine2010-06-21http://www.sfnmjournal.com/article/PIIS1744165X10000387/abstract?rss=yesBrain injury around the time of birth remains one of the great tragedies of life. Nearly all affected newborns were normal before birth, and the majority of those with moderate to severe encephalopathy will either die or go on to develop neurodevelopmental disabilities. Even amongst survivors who are not disabled in infancy, at least half will show learning problems at school. Despite major advances in obstetric and neonatal care, the incidence of acute encephalopathy has remained discouragingly unchanged in the developed world for decades, at around 1 to 3/1000 live births.Preface: Therapeutic hypothermia translates to the NICU - Corrected ProofAlistair Jan Gunn, Laura Bennet10.1016/j.siny.2010.05.002Seminars in Fetal & Neonatal Medicine (2010)2010-06-17Seminars in Fetal & Neonatal Medicine2010-06-17EDITORIALhttp://www.sfnmjournal.com/article/PIIS1744165X1000020X/abstract?rss=yesSummary: Over the past 10 years, several randomised clinical trials of therapeutic hypothermia for perinatal asphyxial encephalopathy have demonstrated both safety and efficacy of therapeutic hypothermia in improving neurological outcome. Today cooling is increasingly used in tertiary level units throughout the developed world. Therapeutic hypothermia (cooling to a rectal or core temperature of 33–34°C for 72h) is easier to achieve in newborn infants than in adults. There is a natural tendency for the core temperature of infants who suffered birth asphyxia to fall and remain lower than non-asphyxiated infants for up to 16h after birth. A variety of high- and low-tech surface cooling methods have been used in neonates – newer systems are servo-controlled and provide very stable temperature control. It is well accepted that to be most effective, cooling needs to be initiated as soon as possible after birth and, thus, needs to be commenced prior to the transfer of infants to cooling centres. We describe our experience of passive cooling before and during the transfer of infants with encephalopathy to cooling centres in a major city in the UK.Techniques for therapeutic hypothermia during transport and in hospital for perinatal asphyxial encephalopathy - Corrected ProofNicola J. Robertson, Giles S. Kendall, Sudhin Thayyil10.1016/j.siny.2010.03.006Seminars in Fetal & Neonatal Medicine (2010)2010-04-20Seminars in Fetal & Neonatal Medicine2010-04-20http://www.sfnmjournal.com/article/PIIS1744165X10000168/abstract?rss=yesSummary: Hypothermia is the first effective neuroprotective intervention for newborns who are critically ill following a life-threatening asphyxial insult. It is not surprising that it has raised complex and controversial ethical dilemmas for investigators and clinicians. Given the history of iatrogenic disasters in neonatology, there has been an understandable reluctance to incorporate hypothermia into routine clinical practice until there is persuasive evidence from high quality randomised trials. This article reviews ethical issues that arose during the design of the original clinical trials, the implications of accumulating evidence of safety and efficacy, and the problems of ensuring informed parental participation in treatment decisions.Ethics and hypothermia treatment - Corrected ProofJohn S. Wyatt10.1016/j.siny.2010.03.002Seminars in Fetal & Neonatal Medicine (2010)2010-04-12Seminars in Fetal & Neonatal Medicine2010-04-12http://www.sfnmjournal.com/article/PIIS1744165X10000156/abstract?rss=yesSummary: Evaluation of infants with hypoxic ischemic encephalopathy by magnetic resonance spectroscopy and imaging is useful to direct clinical care, and may assist the evaluation of candidate neuroprotective therapies. Cerebral metabolites measured by magnetic resonance spectroscopy, and visual analysis of magnetic resonance images during the first 30 days after birth accurately predict later neurological outcome and are valid biomarkers of the key physiological processes underlying brain injury in neonatal hypoxic ischemic encephalopathy. Visual assessment of magnetic resonance images may also be a suitable surrogate outcome in studies of neuroprotective therapies but current magnetic resonance methods are relatively inefficient for use in early phase, first in human infant studies of novel neuroprotective therapies. However, diffusion tensor imaging and analysis of fractional anisotropy with tract-based spatial statistics promises to be a highly efficient biomarker and surrogate outcome for rapid preliminary evaluation of promising therapies for neonatal hypoxic ischemic injury. Standardisation of scanning protocols and data analysis between different scanners is essential.Magnetic resonance biomarkers of neuroprotective effects in infants with hypoxic ischemic encephalopathy - Corrected ProofDenis Azzopardi, A. David Edwards10.1016/j.siny.2010.03.001Seminars in Fetal & Neonatal Medicine (2010)2010-04-02Seminars in Fetal & Neonatal Medicine2010-04-02http://www.sfnmjournal.com/article/PIIS1744165X10000120/abstract?rss=yesSummary: Cooling for neonatal hypoxic–ischemic encephalopathy is a novel and promising neuroprotective therapy that requires significant understanding of how cooling affects all organ systems and interventions used to treat systemic complications of cooling in an intensive care setting. As cooling is used more widely and has been newly introduced in neonatal units, continued surveillance of its use in clinical practice is mandatory. Units offering cooling should strongly consider joining a registry (e.g. the Vermont–Oxford Neonatal Encephalopathy Registry in the USA or the TOBY Register in the UK) that facilitates benchmarking of short-term adverse effects and long-term outcomes of cooling and that supports local quality improvement efforts.Systemic complications and hypothermia - Corrected ProofSubrata Sarkar, John D. Barks10.1016/j.siny.2010.02.001Seminars in Fetal & Neonatal Medicine (2010)2010-03-15Seminars in Fetal & Neonatal Medicine2010-03-15http://www.sfnmjournal.com/article/PIIS1744165X10000132/abstract?rss=yesSummary: Neuroprotection is a major health care priority, given the enormous burden of human suffering and financial cost caused by perinatal brain damage. With the advent of hypothermia as therapy for term hypoxic–ischemic encephalopathy, there is hope for repair and protection of the brain after a profound neonatal insult. However, it is clear from the published clinical trials and animal studies that hypothermia alone will not provide complete protection or stimulate the repair that is necessary for normal neurodevelopmental outcome. This review critically discusses drugs used to treat seizures after hypoxia–ischemia in the neonate with attention to evidence of possible synergies for therapy. In addition, other agents such as xenon, N-acetylcysteine, erythropoietin, melatonin and cannabinoids are discussed as future potential therapeutic agents that might augment protection from hypothermia. Finally, compounds that might damage the developing brain or counteract the neuroprotective effects of hypothermia are discussed.Synergistic neuroprotective therapies with hypothermia - Corrected ProofMaria Roberta Cilio, Donna M. Ferriero10.1016/j.siny.2010.02.002Seminars in Fetal & Neonatal Medicine (2010)2010-03-08Seminars in Fetal & Neonatal Medicine2010-03-08http://www.sfnmjournal.com/article/PIIS1744165X10000144/abstract?rss=yesSummary: Hypothermia is a potential neuroprotective intervention to treat neonatal post-asphyxial (hypoxic–ischemic) encephalopathy (HIE). In this meta-analysis of 13 clinical trials published to date, therapeutic hypothermia was associated with a highly reproducible reduction in the risk of the combined outcome of mortality or moderate-to-severe neurodevelopmental disability in childhood. This improvement was internally consistent, as shown by significant reductions in the individual risk for death, moderate-to-severe neurodevelopmental disability, severe cerebral palsy, cognitive delay, and psychomotor delay. Patients in the hypothermia group had higher incidences of arrhythmia and thrombocytopenia; however, these were not clinically important. This analysis supports the use of hypothermia in reducing the risk of the mortality or moderate-to-severe neurodevelopmental disability in infants with moderate HIE.Hypothermia: a systematic review and meta-analysis of clinical trials - Corrected ProofPrakesh S. Shah10.1016/j.siny.2010.02.003Seminars in Fetal & Neonatal Medicine (2010)2010-03-08Seminars in Fetal & Neonatal Medicine2010-03-08