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Controversies and conundrums in perinatal care
Seminars in Fetal & Neonatal Medicine (2008) 13, 1
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/siny
EDITORIAL
Controversies and conundrums in perinatal care The care of the fetus and neonate is in a constant state of flux and remains as much an art as a science. Clinical research has not been able to keep pace with the infusion of new technology, devices, and pharmaceuticals, creating a situation where practices evolve before evidence is amassed. Equipoise may be short-lived, sowing the seeds of controversy. This issue of Seminars in Fetal & Neonatal Medicine examines several controversial issues that are of great importance. It has been more than 30 years since the advent of electronic fetal monitoring. Has the great promise been fulfilled? Professor Philip Steer reviews the experience and excellently summarizes the evidence in the opening chapter. The management of the infant born at the limit of viability raises vexing ethical issues. Professor Malcolm Chiswick offers a thought-provoking piece on this subject and suggests an analytical path to decision-making. Blood pressure in the very preterm newborn remains a difficult topic and Professor Keith Barrington sums this up nicely by positing whether the treatment might actually be worse than the disease. In the next chapter, we evaluate the early management of Respiratory Distress Syndrome and compare the use of surfactant and mechanical ventilation to continuous positive airway pressure. Dr. John Barks then reviews the timely subject of hypothermic neuroprotection following intrapartum asphyxia. To cool or not to cool? Selective brain cooling or total body cooling? Is one better than the other? Doctors Embleton and Yates examine yet another critical problem in the neonatal intensive care
unit, necrotising enterocolitis. Can this serious disease entity be prevented by the use of probiotic agents or other techniques? Finally, what do we do for the infant with chronic lung disease? Apparently, we do a lot, but does it make a difference? Dr. Win Tin and Prof. Tom Wiswell critically review the evidence related to pharmacologic adjuncts, and their findings will surprise many. We hope that the readership will not only enjoy this issue but that it will be stimulated to begin researching some of these areas, as well as others. We are grateful to our contributors for sharing their collective insights and expertise and to the staff of Seminars in Fetal & Neonatal Medicine, especially the managing editor, Mr. Sean Duggan, and Ann Smiley for their support and guidance in the preparation of this volume. Sunil K. Sinha* Department of Paediatrics and Neonatal Medicine, University of Durham, The James Cook University Hospital, Middlesbrough, Cleveland TS4 3BW, UK *Corresponding author. E-mail address: [email protected]
1744-165X/$ - see front matter ª 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.siny.2007.09.009
Steven M. Donn Division of NeonatalePerinatal Medicine, Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, MI, USA
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/siny
EDITORIAL
Controversies and conundrums in perinatal care The care of the fetus and neonate is in a constant state of flux and remains as much an art as a science. Clinical research has not been able to keep pace with the infusion of new technology, devices, and pharmaceuticals, creating a situation where practices evolve before evidence is amassed. Equipoise may be short-lived, sowing the seeds of controversy. This issue of Seminars in Fetal & Neonatal Medicine examines several controversial issues that are of great importance. It has been more than 30 years since the advent of electronic fetal monitoring. Has the great promise been fulfilled? Professor Philip Steer reviews the experience and excellently summarizes the evidence in the opening chapter. The management of the infant born at the limit of viability raises vexing ethical issues. Professor Malcolm Chiswick offers a thought-provoking piece on this subject and suggests an analytical path to decision-making. Blood pressure in the very preterm newborn remains a difficult topic and Professor Keith Barrington sums this up nicely by positing whether the treatment might actually be worse than the disease. In the next chapter, we evaluate the early management of Respiratory Distress Syndrome and compare the use of surfactant and mechanical ventilation to continuous positive airway pressure. Dr. John Barks then reviews the timely subject of hypothermic neuroprotection following intrapartum asphyxia. To cool or not to cool? Selective brain cooling or total body cooling? Is one better than the other? Doctors Embleton and Yates examine yet another critical problem in the neonatal intensive care
unit, necrotising enterocolitis. Can this serious disease entity be prevented by the use of probiotic agents or other techniques? Finally, what do we do for the infant with chronic lung disease? Apparently, we do a lot, but does it make a difference? Dr. Win Tin and Prof. Tom Wiswell critically review the evidence related to pharmacologic adjuncts, and their findings will surprise many. We hope that the readership will not only enjoy this issue but that it will be stimulated to begin researching some of these areas, as well as others. We are grateful to our contributors for sharing their collective insights and expertise and to the staff of Seminars in Fetal & Neonatal Medicine, especially the managing editor, Mr. Sean Duggan, and Ann Smiley for their support and guidance in the preparation of this volume. Sunil K. Sinha* Department of Paediatrics and Neonatal Medicine, University of Durham, The James Cook University Hospital, Middlesbrough, Cleveland TS4 3BW, UK *Corresponding author. E-mail address: [email protected]
1744-165X/$ - see front matter ª 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.siny.2007.09.009
Steven M. Donn Division of NeonatalePerinatal Medicine, Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, MI, USA