Aims: To determine the monitoring and treatment of neonatal abstinence syndrome (NAS) in neonatal intensive care units (NICUs) following opiate or polydrug exposure in utero.Methods: A pretested questionnaire was distributed via email to the chiefs of the neonatology divisions with accredited Fellowship programs in Neonatal-Perinatal Medicine in the United States.Results: Of the 102 individuals contacted, 75 participated in the survey. In all, 41 of the respondents (54.5%) have a written policy regarding the management of neonatal NAS. The method of Finnegan is the most commonly used abstinence scoring system (49 of 75, 65%), while only three respondents use the Lipsitz tool. Opioids (tincture of opium, or morphine sulfate solution) are used most commonly for management of both opioid (63% of respondents) and polydrug (52% of respondents) withdrawal, followed by phenobarbital (32 % of respondents) for polydrug withdrawal and methadone (20% of respondents) for opioid withdrawal. In all, 53 respondents (70%) use phenobarbital, and 19 (25%) use intravenous morphine to control opioid withdrawal seizures, while 61 (81%) use phenobarbital in cases of polydrug withdrawal seizures. Only 53 respondents (70%) always use an abstinence scoring system to determine when to start, titrate, or terminate pharmacologic treatment of neonatal NAS. Conclusion:The management of neonatal psychomotor behavior consistent with withdrawal varies widely, with inconsistent policies to determine its presence or treatment. Only about half of NICUs have written guidelines for the management of NAS, which may preclude effective auditing of this practice. Educational interventions may be necessary to ensure changes in clinical practice.
Imaging is playing an increasingly important role in the detection of prostate cancer (PCa). This review summarizes the key imaging modalities—multiparametric ultrasound (US), multiparametric magnetic resonance imaging (MRI), MRI–US fusion imaging, and positron emission tomography (PET) imaging—used in the diagnosis and localization of PCa. Emphasis is laid on the biological and functional characteristics of tumors that rationalize the use of a specific imaging technique. Changes to anatomical architecture of tissue can be detected by anatomical grayscale US and T2-weighted MRI. Tumors are known to progress through angiogenesis—a fact exploited by Doppler and contrast-enhanced US and dynamic contrast-enhanced MRI. The increased cellular density of tumors is targeted by elastography and diffusion-weighted MRI. PET imaging employs several different radionuclides to target the metabolic and cellular activities during tumor growth. Results from studies using these various imaging techniques are discussed and compared.
Objective: Multiorgan dysfunction in asphyxiated newborns receiving therapeutic hypothermia achieved by either selective head cooling (SHC) or whole-body cooling (WBC) has not been well characterized. The beneficial effect of SHC in organs other than the brain may potentially be limited because unlike WBC, SHC aims to achieve effective brain cooling with lesssystemic hypothermia. However, the relative effects of SHC and WBC with currently available cooling protocols on multiorgan dysfunction are unknown.The aim of this study was to compare the multiorgan dysfunction in infants receiving therapeutic hypothermia induced by either SHC or WBC.Study Design: In 59 asphyxiated newborns who received therapeutic hypothermia by either SHC (n ¼ 31) or WBC (n ¼ 28), the severity of pulmonary, hepatic and renal dysfunction and coagulopathy and electrolyte disturbances were assessed before the start of cooling (baseline), and at specific time intervals (24, 48 and 72 h) throughout cooling. Enrollment criteria, clinical monitoring and treatment during cooling, whether SHC or WBC, were similar, as reported earlier.Result: The presence of clinical respiratory distress, along with the need for ventilatory support for varying duration during cooling, was similar in both the WBC and SHC groups (100 vs 94%, P ¼ 0.49, OR 1.9, 95% CI 1.5-2.5). The use of fresh frozen plasma and platelet transfusion to treat coagulopathy and thrombocytopenia was similar (WBC 48% vs SHC 58%, P ¼ 0.59, OR 0.7, 95% CI 0.2-1.9, and WBC 41% vs SHC 32%, P ¼ 0.58, OR 1.4, 95% CI 0.5-4.2, respectively), and equivalent numbers of infants from both groups were treated with vasopressors for >24 h (WBC 59% vs SHC 55%, P ¼ 0.79, OR 1.2, 95% CI 0.4-3.4). The incidence of oliguria (urine output <0.5 ml kg -1 h -1 for >24 h after birth) and rising serum creatinine (with maximum serum creatinine >0.9 mg dl -1 ) was also similar (WBC 18% vs SHC 39%, P ¼ 0.15, OR 0.4, 95% CI 0.1-1.3, and WBC 48% vs SHC 58%, P ¼ 0.59, OR 0.7, 95% CI 0.2-1.9, respectively).Laboratory parameters to assess the differential effect of WBC versus SHC on multiorgan dysfunction during 72 h of cooling, which include serum transaminases (serum aspartate aminotransferase and alanine aminotransferase), prothrombin time, partial thromboplastin time, INR, platelet counts, serum creatinine, serum sodium, serum potassium and serum calcium, were similar between the groups at the initiation of cooling and did not differ with the method of cooling. Conclusion:Multiorgan system dysfunction in asphyxiated newborns during cooling remains similar for both cooling methods. Concerns regarding a differential effect of WBC versus SHC on multiorgan dysfunction, other than of the brain, should not be a consideration in selecting a method to produce therapeutic hypothermia.
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