Minimally Invasive Neonatal Surgery An Issue Of Clinics In Perinatology

Experts in the field of minimally invasive surgery have come together to provide the most up-to-date clinical review of the topic. The Guest Editors have created an issue with comprehensive coverage of relevant topics in the field, with articles devoted to the following: Fetal Surgery; Robotics; NOTES; Minimally Invasive PDA Ligation; CDH/Eventration Esophageal Atresia/TEF; Thoracic lesions: Congenital Lung Lesions; Hepato-Biliary surgery Fundoplication/g-tube; Hernia; Hirschsprung's Disease; Imperforate Anus; and Minimally Invasive Urology. Readers will come away with the clinical infomration they need to help inform them as they utilize the most current technologies and minimally invasive techniques in the neonatal patient.

Experts in the field of minimally invasive surgery have come together to provide the most up-to-date clinical review of the topic. The Guest Editors have created an issue with comprehensive coverage of relevant topics in the field, with articles devoted to the following: Fetal Surgery; Robotics; NOTES; Minimally Invasive PDA Ligation; CDH/Eventration Esophageal Atresia/TEF; Thoracic lesions: Congenital Lung Lesions; Hepato-Biliary surgery Fundoplication/g-tube; Hernia; Hirschsprung's Disease; Imperforate Anus; and Minimally Invasive Urology. Readers will come away with the clinical infomration they need to help inform them as they utilize the most current technologies and minimally invasive techniques in the neonatal patient.

The Guest Editors have assembled a list of topics that provide state-of-the-art coverage on fetal surgery. Topics covered include fetal cardiac intervention, abdominal wall defects, NEC, esophageal atresia, and spinia bifida. Some articles provide the clinical basics, like general concepts of fetal surgery, while others provide a detailed look at CDH in utero, CDH post natal, ECMO/placenta, stem cell, and anorectal malformations.

In this issue of Clinics in Perinatology, guest editors KuoJen Tsao and Hanmin Lee bring their considerable expertise to the topic of Fetal and Neonatal Surgery. Provides in-depth reviews on the latest updates in Fetal and Neonatal Surgery, 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.

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.

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.

This issue is a must-read for perinatologists and neonatologists who need current advances in treastment and interventions to improve the viability of the neonate. The Guest Editors have put together a concise monograph on the topic, offering the most current clinica review articles on the following topics: Antenatal corticosteroids: Who should we be treating?; Quality improvement strategies to improve care of women in preterm labor; Delivery at term: when, how, and why?; Detection and prevention of perinatal infection; Current strategies to prevent perinatal HIV transmission; Advances in fetal monitoring and association with outcomes; Relationship between perinatal interventions, the maternal-infant microbiome and neonatal outcomes; Understanding outcomes and counseling families at a periviable gestational age; Therapeutic hypothermia - how can we optimize this therapy to further improve outcomes; Reducing CPAP failure in extremely preterm infants; Optimizing caffeine therapy in preterm infants; Improving uptake of key perinatal interventions using state-wide quality collaboratives; Oxygen therapy in the delivery room: What is the right dose?; and Perinatal white matter injury: prevention and long-term outcomes. Readers will leave with the best evidence they need to improve outcomes.

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.