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Use and misuse of drugs in perinatology and neonatology
Seminars in Fetal & Neonatal Medicine xxx (2017) 1
Contents lists available at ScienceDirect
Seminars in Fetal & Neonatal Medicine journal homepage: www.elsevier.com/locate/siny
Editorial
Use and misuse of drugs in perinatology and neonatology This issue of Seminars evaluates the evidence that may support or refute the use of common medications; in neonataleperinatal medicine, only a few drugs have been developed and appropriately studied via large multicenter randomized controlled trials. Examples of these drugs include surfactant use to support premature infants with hyaline membrane disease, inhaled nitric oxide use in term infants to resolve persistent pulmonary hypertension, and the perinatal use of magnesium sulfate to optimize neurodevelopmental outcomes of prematurely born infants. Nonetheless, many medications are used without clear evidence to support their efficacy or used in conditions beyond their primary intended indications. The issue starts by addressing antibiotics and microbiota. The first chapter examines fetal and neonatal exposure to antibiotics and the importance of having antibiotic stewardship to control harms associated with antimicrobial usage. The following chapter provides an update on the use of prebiotics and probiotics during pregnancy and in infancy. Two chapters in the issue discuss the current evidence for corticosteroids use in premature infants. Recent evidence may support the early use of inhaled steroids to reduce the risk of developing chronic lung disease, whereas its later use after the disease ensues may not be as effective. The second chapter emphasizes the critical importance of the application method for inhaled steroids to be efficacious. Updates on the controversy around the closure of ductus arteriosus in premature infants is presented in another chapter. Also, the perinatal and neonatal use of paracetamol for analgesia is discussed. The use of opiates and benzodiazepines in delivering
women and in premature infants is discussed in a separate chapter. This is followed by a chapter on the use of barbiturates and newer antiepileptic drugs for the treatment of neonatal seizures. The misuse of albumin and sodium bicarbonate during neonatal resuscitation is discussed in two chapters. The use of caffeine for the prevention of apnea of prematurity is presented in a separate chapter; updates on its long-term impact on neurodevelopmental outcome of premature infants is reviewed. The issue concludes with two chapters that address chronic lung disease in premature infants. The use of surfactant less invasively and non-invasively is discussed along with the use of bubble continuous positive airway pressure to prevent chronic lung disease. The recent trial on the inferiority of nasal cannula when used to support premature infants with respiratory distress is also presented. The final chapter is an overview for individual and combinations of medications that could be helpful for the treatment of chronic lung disease. I thank all authors who generously contributed their expertise and time to make this issue possible. I thank Steven Donn for suggesting such an interesting theme for this issue. Finally, I praise Sean Duggan and Ann Smiley for their tireless efforts to produce this issue. I trust this issue will enrich the prospect of perinatal and neonatal management in the area it covers. Hany Aly Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA E-mail address: [email protected].
http://dx.doi.org/10.1016/j.siny.2017.08.003 1744-165X/© 2017 Published by Elsevier Ltd.
Please cite this article in press as: Aly H, Use and misuse of drugs in perinatology and neonatology, Seminars in Fetal & Neonatal Medicine (2017), http://dx.doi.org/10.1016/j.siny.2017.08.003
Contents lists available at ScienceDirect
Seminars in Fetal & Neonatal Medicine journal homepage: www.elsevier.com/locate/siny
Editorial
Use and misuse of drugs in perinatology and neonatology This issue of Seminars evaluates the evidence that may support or refute the use of common medications; in neonataleperinatal medicine, only a few drugs have been developed and appropriately studied via large multicenter randomized controlled trials. Examples of these drugs include surfactant use to support premature infants with hyaline membrane disease, inhaled nitric oxide use in term infants to resolve persistent pulmonary hypertension, and the perinatal use of magnesium sulfate to optimize neurodevelopmental outcomes of prematurely born infants. Nonetheless, many medications are used without clear evidence to support their efficacy or used in conditions beyond their primary intended indications. The issue starts by addressing antibiotics and microbiota. The first chapter examines fetal and neonatal exposure to antibiotics and the importance of having antibiotic stewardship to control harms associated with antimicrobial usage. The following chapter provides an update on the use of prebiotics and probiotics during pregnancy and in infancy. Two chapters in the issue discuss the current evidence for corticosteroids use in premature infants. Recent evidence may support the early use of inhaled steroids to reduce the risk of developing chronic lung disease, whereas its later use after the disease ensues may not be as effective. The second chapter emphasizes the critical importance of the application method for inhaled steroids to be efficacious. Updates on the controversy around the closure of ductus arteriosus in premature infants is presented in another chapter. Also, the perinatal and neonatal use of paracetamol for analgesia is discussed. The use of opiates and benzodiazepines in delivering
women and in premature infants is discussed in a separate chapter. This is followed by a chapter on the use of barbiturates and newer antiepileptic drugs for the treatment of neonatal seizures. The misuse of albumin and sodium bicarbonate during neonatal resuscitation is discussed in two chapters. The use of caffeine for the prevention of apnea of prematurity is presented in a separate chapter; updates on its long-term impact on neurodevelopmental outcome of premature infants is reviewed. The issue concludes with two chapters that address chronic lung disease in premature infants. The use of surfactant less invasively and non-invasively is discussed along with the use of bubble continuous positive airway pressure to prevent chronic lung disease. The recent trial on the inferiority of nasal cannula when used to support premature infants with respiratory distress is also presented. The final chapter is an overview for individual and combinations of medications that could be helpful for the treatment of chronic lung disease. I thank all authors who generously contributed their expertise and time to make this issue possible. I thank Steven Donn for suggesting such an interesting theme for this issue. Finally, I praise Sean Duggan and Ann Smiley for their tireless efforts to produce this issue. I trust this issue will enrich the prospect of perinatal and neonatal management in the area it covers. Hany Aly Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA E-mail address: [email protected].
http://dx.doi.org/10.1016/j.siny.2017.08.003 1744-165X/© 2017 Published by Elsevier Ltd.
Please cite this article in press as: Aly H, Use and misuse of drugs in perinatology and neonatology, Seminars in Fetal & Neonatal Medicine (2017), http://dx.doi.org/10.1016/j.siny.2017.08.003