Neonatal Hematology And Transfusion Medicine An Issue Of Clinics In Perinatology

Recent advances in neonatal hematology, largely made by the authors of these chapters, are likely to generate wide spread and long-term improvements in outcomes, as well as reductions in costs of care. Publication of these advances in a single volume will facilitate dissemination of these techniques and practices. The advances include neuroprotection from erythropoietic stimulators, improved guidelines for platelet transfusions, evidence-based guidelines for FFP administration, improved diagnostic methods for genetic causes of severe neonatal jaundice, more accurate definitions of hematological perturbations in necrotizing enterocolitis and sepsis, and reduction in transfusions and in IVH rates by cord milking/delayed clamping.

In this issue of Clinics in Perinatology, guest editors Drs. Ravi Mangal Patel and Amy Keir bring their considerable expertise to the topic of Neonatal Transfusion Medicine. Transfusions to neonates convey both benefits and risks, and evidence-based data for possible adverse effects, preterm morbidities, mortality, and neuro-developmental problems associated with transfusions is needed to make decisions for proper care. This issue fills the gap of evidence-based knowledge in order to improve outcomes in patients. Contains 9 practice-oriented topics including potential mechanisms mediating harm from platelet transfusions in neonates; plasma transfusion in the neonate; neonatal blood banking practices; transfusion in neonatal ECMO; allogenic cord blood transfusion in infants; and more. Provides in-depth clinical reviews on neonatal transfusion medicine, 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.

In this issue of Clinics in Perinatology, guest editors Drs. Ravi Mangal Patel and Amy Keir bring their considerable expertise to the topic of Neonatal Transfusion Medicine. Transfusions to neonates convey both benefits and risks, and evidence-based data for possible adverse effects, preterm morbidities, mortality, and neuro-developmental problems associated with transfusions is needed to make decisions for proper care. This issue fills the gap of evidence-based knowledge in order to improve outcomes in patients. Contains 9 practice-oriented topics including potential mechanisms mediating harm from platelet transfusions in neonates; plasma transfusion in the neonate; neonatal blood banking practices; transfusion in neonatal ECMO; allogenic cord blood transfusion in infants; and more. Provides in-depth clinical reviews on neonatal transfusion medicine, 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.

Recent advances in neonatal hematology, largely made by the authors of these chapters, are likely to generate wide spread and long-term improvements in outcomes, as well as reductions in costs of care. Publication of these advances in a single volume will facilitate dissemination of these techniques and practices. The advances include neuroprotection from erythropoietic stimulators, improved guidelines for platelet transfusions, evidence-based guidelines for FFP administration, improved diagnostic methods for genetic causes of severe neonatal jaundice, more accurate definitions of hematological perturbations in necrotizing enterocolitis and sepsis, and reduction in transfusions and in IVH rates by cord milking/delayed clamping.

Blood transfusions are an important part of hematologic care. This issue of Hematology/Oncology Clinics will focus on transfusion medicine and will include articles on: RBC Transfusions: Conclusions from Clinical Trials and the Establishment of Evidence-based Guidelines for Adults, Platelet Transfusions: Conclusions from Clinical Trials and the Establishment of Evidence- and/or Experience-based Guidelines for Adults, Use and Overuse of Plasma Products: Establishment of Evidence- and/or Experience-based Guidelines for Plasma Transfusion in Adults, Stem Cell Mobilization/Collection: Coordination Between Hem/Onc, Transplant, and Transfusion Services, Management of Patients with Sickle Cell Disease Using Transfusion Therapy: Guidelines and Complications, and many more exciting articles.

In this issue the Guest Editors provide a contemporary look at the epidemiology, clinical manifestations, treatment and outcomes for neonatal-perinatal infections. Contributors include neonatologists, infectious disease, and critical care specialists with a wide variety of research interests in this arena. Readers will be exposed to the latest information on dosing of antibiotics, antivirals, and antifungals. This information is critical in the infant population given the rapid changes in physiology, metabolic pathways and renal elimination that occur over the first months of life. There is an extensive examination of infectious processes that commonly present in infants including meningitis, bloodstream infections, and urinary tract infections. Additional topics include infectious processes affecting the newborn (chorioamnionitis and TORCH infections) and premature infants (necrotizing enterocolitis). Specific pathogens are highlighted in articles on HSV, CMV/VZV, staphylococcal species, and Candida. Finally, the rationale for the most recent changes to guidelines for initiating therapy for early-onset neonatal sepsis are reviewed.

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.

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.