Bronchopulmonary Dysplasia An Update An Issue Of Clinics In Perinatology

Bronchopulmonary dysplasia (BPD) as a chronic lung disease affecting preterm infants has been recognized for more than 45 years. However, little progress has been made in the prevention and treatment of the disease. BPD continues to be a major morbidity affecting preterm infants. Studies in pre-adolescent children demonstrate that the abnormal lung function from BPD persists well into childhood. Infants with BPD also have an increased risk for adverse neurodevelopmental outcome. Thus BPD imposes a significant burden of adverse health outcomes in preterm infants. The major risk factors for BPD are prematurity, mechanical ventilation, exposure to noxious insults such as oxygen, infections. New research data both in basic science and clinical studies have shed light on the pathogenesis, and possible new treatment or management strategies for the future. In the proposed issue of the Clinics in Perinatology, we would like to comprehensively cover BPD both from a basic science and clinical perspective. Our attempt is to balance new information along with classic topics. The proposed authors for the issue are recognized experts in the topic area/s. We hope that the issue will be of interest to a broad array of readership.

In this issue of Clinics in Perinatology, guest editors Drs. Heather C. Kaplan and Munish Gupta bring their considerable expertise to the topic of Quality Improvement. In recent years, the growing use of quality improvement (QI) methods to apply evidence-based practices to clinical care has resulted in a greater penetration of QI methods in neonatal intensive care units across the world and a more sophisticated appreciation of how best to use them. This issue provides important updates in these areas as well as looks at the future of QI in perinatology. Contains 15 practice-oriented topics including frameworks for quality improvement: Lean Six Sigma and the model for improvement in perinatology; sustaining improvement in perinatology; recent progress in global health quality improvement in perinatology; measuring equity for quality improvement in perinatology; pursuing equity for all mothers and newborns through population health: the role of perinatal quality collaboratives; and more. Provides in-depth clinical reviews on quality improvement in perinatology, offering 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 clinically significant, topic-based reviews.

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.

The impact of cardiovascular disease on an infant extends from the fetal period to well beyond childhood. Perinatalogists and neonatologists can impact maternal and fetal health through wide range of diagnostic modalities and interventional techniques. For our edition focused on cardiovascular health, we sought to encompass the breadth of knowledge that would be the most relevant for the bed side clinician. Our goal was to assemble contents that would allow a clinician to quickly peruse the journal, and then be prepared to make a medical decision. The interaction between cardiology and perinatology/neonatology includes genetics, diagnostics, interventions, counseling, routine stabilization and day to day care. Ultimately, the goal is to establish the foundation for a healthy adult. For this reason, we have even included chapters on topics that are significant on a day to day basis (such as the proper environment for a newborn) and a long term basis (like the overall neurodevelopmental impact of our interventions). Hopefully, whether in the middle of the night as an emergency reference or during the day as a reliable guide, this edition of Clinics in perinatology will be an important bedside tool for anyone that participates in the care of a patient with perinatal heart disease.

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 editor Manuel Sanchez Luna brings his considerable expertise to the topic of Respiratory Management. 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.

The Guest Editors have collaborated on a state-of-the-art presentation of current clinical reviews on Quality in Neonatal Care. Top experts have prepared articles in the following areas: Standardizing Practices: How and why to standardize, using checklists, measuring variation; Health Informatics and Patient Safety; Using Statistical Process Control to Drive Improvement in Neonatal Care; Improving Value in Neonatal Intensive Care; Culture and Context in Quality of Care: Improving Teamwork and Resilience; Has Quality Improvement Improved Neonatal Outcomes; National Quality Measures in Perinatal Care; Perinatal and Obstetric Quality Initiatives; Family Involvement in Quality Improvement; Perinatal Quality Improvement: A Global Perspective; Delivery Room Care / Golden Hour; Respiratory Care and Bronchopulmonary Dysplasia; Reducing Incidence of Necrotizing Enterocolitis; Alarm Safety and Alarm Fatigue; and Patient Safety: Reducing Unplanned Extubations. Readers will come away with the clinical information they need improve quality in the NICU.

Dr. Spitzer has created an issue devoted to the evidence-based pharmacologic care of the neonate. The issue opens with an important article on A Quality Improvement Approach to Modifying Medication Use in the NICU. The expert authors he has secured have contributed articles in the areas of therapeutic drug monitoring, off-label use of medications in the NICU, antenatal and post-natal corticosteroids, antibiotics, antifungals, and antivirals, as well as bronchodilators and nitric oxide. Other articles also present evidence-based use of oxygen, dopamine, anesthetics and analgesics, and erythropoetin.