Management of the surgical newborn: Physiological foundations and practical considerations

Nakayama, Don K.

doi:10.1016/j.jpurol.2010.03.009

Cited by 5 publications

(3 citation statements)

References 24 publications

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“…Preterms are characterized by thinner skin compared to full-term neonates, and, similarly, the subcutaneous fat layer is not adequately developed to prevent evaporative heat loss [ 31 ]. Since shivering is a physiological process gradually acquired after the first year of life [ 32 ], newborns adopt a non-shivering thermogenesis based on brown-fat deposition and oxygen consumption.…”

Section: Physiological Aspects Of Preterm Neonatesmentioning

confidence: 99%

Use of Antibiotics in Preterm Newborns

et al. 2022

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Due to complex maturational and physiological changes that characterize neonates and affect their response to pharmacological treatments, neonatal pharmacology is different from children and adults and deserves particular attention. Although preterms are usually considered part of the neonatal population, they have physiological and pharmacological hallmarks different from full-terms and, therefore, need specific considerations. Antibiotics are widely used among preterms. In fact, during their stay in neonatal intensive care units (NICUs), invasive procedures, including central catheters for parental nutrition and ventilators for respiratory support, are often sources of microbes and require antimicrobial treatments. Unfortunately, the majority of drugs administered to neonates are off-label due to the lack of clinical studies conducted on this special population. In fact, physiological and ethical concerns represent a huge limit in performing pharmacokinetic (PK) studies on these subjects, since they limit the number and volume of blood sampling. Therapeutic drug monitoring (TDM) is a useful tool that allows dose adjustments aiming to fit plasma concentrations within the therapeutic range and to reach specific drug target attainment. In this review of the last ten years’ literature, we performed Pubmed research aiming to summarize the PK aspects for the most used antibiotics in preterms.

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Section: Physiological Aspects Of Preterm Neonatesmentioning

confidence: 99%

Use of Antibiotics in Preterm Newborns

et al. 2022

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“…The infant responds with non-shivering thermogenesis, a process that involves brown fat metabolism and significant oxygen consumption (up to 25% of total oxygen consumption). Shivering, which is the major means of heat generation in adults, is gradually acquired over the first year of life 7 .…”

Section: Thermal Regulationmentioning

confidence: 99%

Premature birth: topics in physiology and pharmacological characteristics

Machado

Ferreira

Lima

et al. 2021

Rev. Assoc. Med. Bras.

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OBJECTIVE: To review the main physiological and pharmacological changes related to prematurity, to promote the evidence-based clinical practice.METHODS: This is a narrative review whose research was carried out in the ScienceDirect and Medline databases via PubMed, searching for articles in any language from January 2000 to February 2020.RESULTS: Premature newborns are born before completing the maturation process that prepares them for extrauterine life, which occurs especially in the last weeks of pregnancy. Therefore, they have their own characteristics in development. Several physiological peculiarities stand out, such as disturbances in glucose regulation, adrenal function, thermoregulation, immunity, in addition to changes in liver, renal and respiratory functions. Pharmacological aspects were also highlighted, involving pharmacokinetics and pharmacodynamics.CONCLUSIONS: Despite the recent advances in prematurity, it is still an area with many uncertainties, since several changes occur quickly and there are ethical issues that make studies difficult. Thus, it is clear that the therapeutic management of premature infants is still very much based on clinical practice.

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“…Special precautions are needed in surgery involving infants. Differing surgery in the newborn for a few days could allow diuresis and spontaneous closure of ductus arteriosus to occur, and therefore improve respiratory function and outcome of surgery [23] .…”

Section: Introductionmentioning

confidence: 99%

Untitled

2023

Int. J. Paediatrics Geriatrics

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Background: Patient-related barriers to accessing surgical interventions including patient education issues, stigma, traditional beliefs, and absence of social support, negatively impact surgical outcomes. This study aimed at evaluating the awareness, attitude, and reasons for the disposition of patients and their relatives towards the offer of surgical intervention for infants and the old in Port Harcourt in the year 2022/2023. Materials and Methods: A cross-sectional descriptive study was conducted in Port Harcourt Nigeria, among patients and relatives of patients at extremes of age (infants and the old) using an intervieweradministered questionnaire. Data were analysed using SPSS version 23.0. Results: Of 575 respondents recruited with a mean age of 50.81±17.77, 395 (68.9%) were females. While 351 (61.5%) respondents were aware of the possibility of carrying out surgical operations on infants, 189 (32.9%) were aware of consent decline for surgery for their infants and, 66 (11.5%) stated the child died as a consequence of such a decision. Whereas, 493 (86.0%) of respondents were aware that surgery could be carried out on old persons, 196 (34.5%) were aware of consent decline for surgery for the old, for which some died. Yet, 444 (77.2%) and 459 (80.8%) of respondents had a positive attitude to surgery in infants and old persons, respectively. Aversion to surgery were mainly due to fear of losing child (72.3%) and fragility of old person (46.0%). Conclusion:This study documented the awareness and attitude to surgery at extremes of age, and uncovered the reasons for such dispositions.

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Management of the surgical newborn: Physiological foundations and practical considerations

Cited by 5 publications

References 24 publications

Use of Antibiotics in Preterm Newborns

Use of Antibiotics in Preterm Newborns

Premature birth: topics in physiology and pharmacological characteristics

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