Preterm neonates remain at increased risk for adverse bilirubin-related outcomes, including acute bilirubin encephalopathy relative to term infants. Yet, most vulnerable neonates are likely to benefit from the potent anti-oxidant properties of bilirubin. Evidence-based guidelines for the management of hyperbilirubinemia in preterm infants, however, are lacking. High concentrations of unconjugated bilirubin can cause permanent neurologic damage in infants, evident through magnetic resonance imaging of chronic bilirubin encephalopathy or kernicterus. There is a growing concern that exposures to even moderate concentrations of bilirubin may lead to subtle but permanent neurodevelopmental impairment referred to as bilirubin-induced neurologic dysfunction. Our current use of phototherapy to decrease bilirubin loads and its potential photo-oxidant properties is a biological conundrum that has been questioned in the use of phototherapy for very low birth weight neonates. In this issue of Clinics in Perinatology, we provide updates on the current understanding of the biology, mechanisms of increasing bilirubin load due to hemolysis, decreased bilirubin binding capacity and glucose-6-phosphate dehydrogenase deficiency, as well as clinical strategies to operationalize the thresholds for hyperbilirubinemia interventions in preterm infants.

Dr. Mimouni and Dr. Koletzko have assembled some of the world's leaders on breast milk for preterm infants to provide a current overview of the benefits and barriers. Authors address the following topics: Preterm human milk macronutrient composition; Bed-side human milk analysis in the NICU; Human milk fortification; DHA supplements; Potential benefits of bioactive proteins in human milk for preterm infants; New insights into variations of metabolite and hormone contents in human milk; Immune properties of human milk in relation to preterm infant feeding; Human milk oligosaccharides; Treatment and quality of banked human milk; Use of donor milk: collection, storage and safety; Postnatal CMV infection through human milk in preterm infants: Transmission, clinical presentation, and prevention; NEC and human milk feeding; Neurodevelopmental outcomes of preterm infants fed human milk; Evidence-based methods that promote human milk feeding of preterm infants; and Human flavor learning: the breastfeeding experience. Lactiation consultants, NICU nurses, and neonatologists will find these clinical review articles to be very valuable.

Each year more than 4 million children are born with birth defects. This book highlights the unprecedented opportunity to improve the lives of children and families in developing countries by preventing some birth defects and reducing the consequences of others. A number of developing countries with more comprehensive health care systems are making significant progress in the prevention and care of birth defects. In many other developing countries, however, policymakers have limited knowledge of the negative impact of birth defects and are largely unaware of the affordable and effective interventions available to reduce the impact of certain conditions. Reducing Birth Defects: Meeting the Challenge in the Developing World includes descriptions of successful programs and presents a plan of action to address critical gaps in the understanding, prevention, and treatment of birth defects in developing countries. This study also recommends capacity building, priority research, and institutional and global efforts to reduce the incidence and impact of birth defects in developing countries.

The Guest Editors have assembled top experts to provide the most current and clinically relevant articles devoted to Birth Asyphyxia. Articles in this issue are devoted to: Neonatal Transition After Birth; Pathophysiology of Birth Asphyxia; Perinatal Asphyxia from the Obstetrical Standpoint: Diagnosis and Interventions; Stillbirths: U.S. and Global Perspectives; Novel Approaches to Resuscitation and the Impact on Birth Asphyxia; Multiorgan Dysfunction and its Management After Birth Asphyxia; Neonatal Encephalopathy and Update on Therapeutic Hypothermia and Other Novel Therapeutics; Biomarkers in Neonatal Encephalopathy; Imaging and Other Diagnostics in Neonatal Encephalopathy; Asphyxia in the Premature Infant; The role of the NeoNeuro Unit for Birth Asphyxia; Long-term Cognitive Outcomes of Birth Asphyxia and the Contribution of Identified Perinatal Asphyxia to Cerebral Palsy; Global Burden, Epidemiologic Trends, and Prevention of Intrapartum Related Deaths in Low-resource Settings; and Neonatal Resuscitation in Low-resource Settings.

Preterm birth interrupts the normal developmental progression of most organs, particularly when birth occurs at the lowest level of viability. An immediate task is to successfully transition to a post-natal life without a placental circulation. To do this demands careful management of the cardiorespiratory systems. To best help the fragile preterm infant at this demanding time, care-givers must remember two most pressing goals. These are first to maintain adequacy of gas exchange and delivery, while simultaneously minimizing any secondary injury to the fragile preterm lung. However, after these immediate priorities in the delivery room, the longer term effects of an immature lung development and its associated problems come to the forefront. These problems include the inflammation of perinatal infection, oxygen, and invasive mechanical ventilation. Both the immaturity itself, and secondary lung injury and its inflammation – collectively will often lead to the condition termed bronchopulmonary dysplasia (BPD). Although many of these infants may eventually be discharged to home without a need for oxygen supplementation or pulmonary medications, the long-term impact of interrupted lung development and secondary lung injury remain serious concerns. It is now well recognized that mechanical ventilation is pivotal to developing secondary lung injury and BPD. Consequently, a great deal of time and effort has been put into the development and application of non-invasive ventilator (NIV) approaches to supporting respiratory function in neonates. Since the landmark publication by Gregory and colleagues in 1967, nasal continuous positive airway pressure (nCPAP) has been the most commonly applied approach to NIV. This approach has been supported by the recent generation of randomized controlled trials. However, cumulatively these trials have shown only a small reduction in rates of BPD. Outside of the trial data, despite the wider application of nCPAP, rates of BPD remain relatively unchanged over recent years. This has led to investigations of other NIV approaches including nasal ventilation and high flow nasal cannula therapy. Not only have available modes increased, but so have the interfaces through which these modes may be applied. In the issue of Clinic in Perinatology, readers will find an up-to-date review of non-invasive approaches to supporting preterm respiratory function. This draws on the expertise of leading investigators in the field. This issue reviews the physiologic mechanisms by which the various approaches to NIV may support respiratory function; the evidence base supporting different NIV approaches; and adjunctive aspects of NIV therapy including their use during neonatal transport and the application of other supportive therapies such as inhaled NO.

In this issue of Clinics in Perinatology, Guest Editors Anup Katheria and Lisa Stellwagen bring their considerable expertise to the topic of Care for the Term Newborn. Top experts in the field cover key topics such as delivery room triage and transitions of care; early onset sepsis; congenital infections; postnatal screening & testing; and more. - Provides in-depth, clinical reviews on Care for the Term Newborn, providing actionable insights for clinical practice. - Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field; Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews. - Contains 14 relevant, practice-oriented topics including Umbilical Cord Management for vigorous and non-vigorous infants; Fetal Circulation and Critical Congenital Cardiac Disease; Alternative Birth Practices, Refusal, and Therapeutic Hesitancy; Prenatal Substance Exposure; and more.

Dr. Richard Polin's Neonatology Questions and Controversies series highlights the most challenging aspects of neonatal care, offering trustworthy guidance on up-to-date diagnostic and treatment options in the field. In each volume, renowned experts address the clinical problems of greatest concern to today's practitioners, helping you handle difficult practice issues and provide optimal, evidence-based care to every patient. - Stay fully up to date in this fast-changing field with Neurology, 3rd Edition. - The most current clinical information, including new coverage of genetics and pharmacology, early diagnosis and targeted treatment of neonatal-onset epilepsies, and the impact of congenital heart diseases on brain development. - Considerations of ongoing research regarding the basic mechanisms contributing to perinatal brain injury, which has in turn facilitated the introduction of targeted strategies in many areas. - Consistent chapter organization to help you find information quickly and easily. - The most authoritative advice available from world-class neonatologists who share their knowledge of new trends and developments in neonatal care. Purchase each volume individually, or get the entire 7-volume set!Gastroenterology and NutritionHematology, Immunology and GeneticsHemodynamics and CardiologyInfectious Disease and Pharmacology New Volume!Nephrology and Fluid/Electrolyte PhysiologyNeurologyThe Newborn Lung

Hyperbilirubinemia of the neonate and the related risk of brain damage with conseguent important alterations in motor development, particularly in sick preterm babies, remains a major problem in nurseries throughout the world. Since its introduction in the 1950's phototherapy has been used for reducing serum bilirubin concentrations in the newborn with hyperbilirubinemia; however, only recently the photoprocesses invoked by light on various substrates including bilirubin have been clari fied in sufficient detail. Light treatment actually exemplifies the intimate relationship between the clinical and basic sciences: the better understanding of the mechanism of phototherapy as a result of investigations initiated in the laboratory has been extended to the bedside as new types of lamps or new schedules of treatment. As a consequence, phototherapy of hyperbilirubinemia has emerged as a well-established branch of photomedicine, based on molecular photo biology, scientific method, and creative use of physics and sophis ticated electrooptical capabilities. The collaboration and exchange of information between workers in different basic and clinical di sciplines is likely to stimulate a further optimization of photo therapy. The purpose of this monograph is to discuss some of the new aspects of bilirubin metabolism and phototherapeutic treatment. Bilirubin conjugation in the fetal and early neonatal life, the mechanism of bilirubin entry into the brain, the measurements of bilirubin concentration in the skin and serum bilirubin binding capacity are discussed by a number of prominent neonatologists.

There are many books on the care of the sick infant and some are excellent. Most, however, are written with medicine in mind. This book is written mainly by experienced neonatal nurses, although some chapters have been written by the appropriate specialists. lt is intended primarily for nurses who Iook after sick infants and is not intended to be an exhaustive reference but to address some of the issues and concepts of neonatal care in the 1990s. Nursing models are an important part of neonatal care in the 1990s but this book has not been written within this framework. There are several reasons for this: arguably no current model is ideally suited to neonates and the favouring of one particular model might restriet the book's applicability. Also, as contributors from other disciplines were invited to contribute we were anxious that these chapters did not stand out as oddities. Additionally, much neonatal care overlaps and were a framework to be used in its entirety for each nursing care chapter we feit that there could be some repeti tion; conversely, if a framework was fragmented in some chap ters to cover specific areas of care, we were concemed that the overall effect would have been 'bitty'. We feit that such treat ment of nursing models would have been unjustifiable. In this book, the terms 'infant' and 'baby' are used inter changeably and where the term 'he' is used, the term 'she' is equally appropriate.