Correction: Corrigendum: An extra-uterine system to physiologically support the extreme premature lamb

Partridge, Emily A.; Davey, Mary‐Ann; Hornick, Matthew A.; McGovern, Patrick E.; Mejaddam, Ali Y.; Vrecenak, Jesse D.; Burgos, Carmen Mesas; Olive, Aliza; Caskey, Robert C.; Weiland, Theodore R.; Han, Jiancheng; Schüpper, Alexander J.; Connelly, James; Dysart, Kevin; Rychik, Jack; Hedrick, Holly L.; Peranteau, William H.; Flake, Alan W.

doi:10.1038/ncomms15794

Cited by 25 publications

(18 citation statements)

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“…The artificial womb, confirmed as beneficial for premature babies, is another possible solution for allowing the myocardium enough time to adapt to the extrauterine conditions (175). Whether this technique would also be of assistance in term neonates with severe PA, remains a question for further research.…”

Section: Discussion Of Future Directionsmentioning

confidence: 99%

Getting an Early Start in Understanding Perinatal Asphyxia Impact on the Cardiovascular System

et al. 2020

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Perinatal asphyxia (PA) is a burdening pathology with high short-term mortality and severe long-term consequences. Its incidence, reaching as high as 10 cases per 1000 live births in the less developed countries, prompts the need for better awareness and prevention of cases at risk, together with management by easily applicable protocols. PA acts first and foremost on the nervous tissue, but also on the heart, by hypoxia and subsequent ischemia-reperfusion injury. Myocardial development at birth is still incomplete and cannot adequately respond to this aggression. Cardiac dysfunction, including low ventricular output, bradycardia, and pulmonary hypertension, complicates the already compromised circulatory status of the newborn with PA. Multiorgan and especially cardiovascular failure seem to play a crucial role in the secondary phase of hypoxic-ischemic encephalopathy (HIE) and its high mortality rate. Hypothermia is an acceptable solution for HIE, but there is a fragile equilibrium between therapeutic gain and cardiovascular instability. A profound understanding of the underlying mechanisms of the nervous and cardiovascular systems and a close collaboration between the bench and bedside specialists in these domains is compulsory. More resources need to be directed toward the prevention of PA and the consecutive decrease of cardiovascular dysfunction. Not much can be done in case of an unexpected acute event that produces PA, where recognition and prompt delivery are the key factors for a positive clinical result. However, the situation is different for high-risk pregnancies or circumstances that make the fetus more vulnerable to asphyxia. Improving the outcome in these cases is possible through careful monitoring, identifying the high-risk pregnancies, and the implementation of novel prenatal strategies. Also, apart from adequately supporting the heart through the acute episode, there is a need for protocols for long-term cardiovascular follow-up. This will increase our recognition of any lasting myocardial damage and will enhance our perspective on the real impact of PA. The goal of this article is to review data on the cardiovascular consequences of PA, in the context of an immature cardiovascular system, discuss the potential contribution of cardiovascular impairment on short and long-term outcomes, and propose further directions of research in this field.

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Section: Discussion Of Future Directionsmentioning

confidence: 99%

Getting an Early Start in Understanding Perinatal Asphyxia Impact on the Cardiovascular System

et al. 2020

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“…New methods for extracorporeal life support for the premature are in development. The artificial placenta (AP) focuses on support in the extremely premature (23–28 weeks gestational age, GA) (42–44). To predict the volume of extremely prematurely born infants to be offered AP, or the spread of this life support mode and the extent of engagement by mobile ECMO teams is impossible.…”

Section: Discussionmentioning

confidence: 99%

“…In this article, the impact of stem cell/gene therapy in the neonate will not be discussed and what the future holds is yet to be seen (50). However, AP patients have been suggested as one group for gene therapy (44).…”

Section: Discussionmentioning

confidence: 99%

Interhospital Transport on Extracorporeal Membrane Oxygenation of Neonates—Perspective for the Future

Broman

2019

Front. Pediatr.

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In recent years the number of extracorporeal membrane oxygenation (ECMO) cases in neonates has been relatively constant. Future expansion lays in new indications for treatment. Regionalization to high-volume ECMO centers allows for optimal utilization of resources, reduction in costs, morbidity, and mortality. Mobile ECMO services available “24-7” are needed to provide effective logistics and reliable infrastructure for patient safety. ECMO transports are usually high-risk and complex. To reduce complications during ECMO transport communication using time-out, checklists, and ECMO A-B-C are paramount in any size mobile program. Team members' education, clinical training, and experience are important. For continuing education, regular wet-lab training, and simulation practices in teams increase performance and confidence. In the future the artificial placenta for the extremely premature infant (23–28 gestational weeks) will be introduced. This will enforce the development and adaptation of ECMO devices and materials for increased biocompatibility to manage the high-risk prem-ECMO (28–34 weeks) patients. These methods will likely first be introduced at a few high-volume neonatal ECMO centers. The ECMO team brings bedside competence for assessment, cannulation, and commencement of therapy, followed by a safe transport to an experienced ECMO center. How transport algorithms for the artificial placentae will affect mobile ECMO is unclear. ECMO transport services in the newborn should firstly be an out-reach service led and provided by ELSO member centers that continuously report transport data to an expansion of the ELSO Registry to include transport quality follow-up and research. For future development and improvement follow-up and sharing of data are important.

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“…Furthermore, as newer and more technologically innovative interventions, including the artificial placenta, appear on the horizon for management of infants with extreme prematurity, clinicians and parents will continue to make decisions in ethical "gray zones," in which reasonable people can disagree. 7 The purpose of this Commentary is to support clinicians seeking consistent strategies for counseling and SDM in the gray zone by exploring the moral and practical dimensions at the margin of gestational viability, with an emphasis on contemporary normative and empirical work. We focus on the resuscitation of infants with extreme prematurity in high-resource settings; extensive exploration of the moral landscape of decision-making for preterm infants born in low-resource settings is equally important, but beyond the scope of this brief review.…”

mentioning

confidence: 99%

Perinatal Counseling at the Margin of Gestational Viability: Where We’ve Been, Where We’re Going, and How to Navigate a Path Forward

Arnolds

Laventhal

2021

The Journal of Pediatrics

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Correction: Corrigendum: An extra-uterine system to physiologically support the extreme premature lamb

Cited by 25 publications

References 0 publications

Getting an Early Start in Understanding Perinatal Asphyxia Impact on the Cardiovascular System

Getting an Early Start in Understanding Perinatal Asphyxia Impact on the Cardiovascular System

Interhospital Transport on Extracorporeal Membrane Oxygenation of Neonates—Perspective for the Future

Perinatal Counseling at the Margin of Gestational Viability: Where We’ve Been, Where We’re Going, and How to Navigate a Path Forward

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