Disease Knowledge Centres

  • Neonatal/Perinatal Medicine - Disease Topic Overview

    Perinatal and neonatal medicine encompasses the care of newborn babies immediately prior to and during birth, and in the following 28 days.

    Birth is a critical time for both mother and baby; however, due to the routine introduction of antenatal screening and scanning, congenital abnormalities and any potential problems that could arise during birth are usually foreseen. When there is significant benefit to the fetus pre-natal surgery is performed, but this occurs on a case by case basis as there is a high risk of premature birth. The malformations that are sometimes eligible for surgery are; congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, sacrococcygeal teratoma and urinary tract obstructions.1 Alternatively the time to plan effective post-natal treatment, and to ensure that the birth occurs in a specialist centre, can lead to the best possible outcome.2

    Premature birth occurs in 7% of pregnancies in the UK.3 These neonates often require more interventions than those who are born at term. Premature birth can be induced to provide the best outcome for mother and fetus. This decision is most controversial on the borderline of viability; at 23 weeks gestational age a fetus has the potential to live independent of its mother.4 However, premature babies often suffer from respiratory complications5 and some form of disability.6 An increase in premature births in recent years has been attributed to an increase in reproductive assistance and subsequently a higher rate of multiple births.3 There is a trend showing earlier births in pregnancies with more babies; twins are born on average at approximately 36 weeks gestation, whereas this figure is 28 weeks gestation for quintuplets.3

    1. Browne N. Nursing Care of the Pediatric Surgical Patient. Jones & Bartlett Learning. 2007 : 153-156.
    2. Dykes E. et al. Impact of Prenatal Diagnosis on Neonatal Surgery. Semin Neonatol.1996 ; 1: 177-184.
    3. Lissauer T. et al. Neonatology at a Glance. Wiley-Blackwell. 2006 : 22-23.
    4. Louis J.M. et al. Perinatal Intervention and Neonatal Outcomes Near the Limit of Viability. American Journal of Obstetrics and Gynecology. October 2004 ; 191 (4) : 1398-1402.
    5. Kotecha S. Chronic Respiratory Complications of Prematurity. Pediatric Respiratory Medicine. Elsevier Inc. Second Edition. 2008 : 387-411.
    6. Steinmacher J. et al. Neurodevelopmental Follow-up of Very Preterm Infants after Proactive Treatment at a Gestational Age of ≥23 Weeks. The Journal of Pediatrics. June 2008 ; 152 (6) : 771-776.

Latest Multi Media

An Introduction to Diagnosing Gastroschisis or Omphalocele

Neonatal/Perinatal Medicine Drug Data - A-Z English

Drug Updates

Boots Ibuprofen 6 Months Plus 100mg/5ml Suspension Strawberry Flavour
For the fast and effective reduction of fever, including post immunisation pyrexia and the fast and effective relief of mild to moderate pain, such as a sore throat, teething pain, toothache, earache, headache, minor aches and sprains.
Simple Linctus Paediatric Sugar Free
For the management of a mild non-specific cough.
WILZIN Hard Capsules
Treatment of Wilson’s disease.

Latest Social Media

Medical slangs anyone??
on doc2doc

... sure you send the right one to the cardiac surgeon.In the world of congenital anomalies TOF can  be Tracheo-Oesophageal Fistual or Tetralogy Of ...

Would CCTV cameras make you more likely to wash your hands?
on doc2doc

... compliance by heath care workers (Gould et al; 2010). Therefore multiple strategies, including installation of CCMTA Cameras would be beneficial. A ...

Will NIce refuse to approve botox for migraine?
on doc2doc

... although knowing mine are sensory has removed my fear of having a premature stroke. When I got into the BMJ a colleague had found this on the BBC news ...

Latest Journal Publications

Immunology Letters
The TCR-αβ/γδ CD8αα intraepithelial T lymphocytes (T-IEL) located in the gut mucosa of the small intestine are an abundant population believed to have a major role in ensuring the integrity of the gut wall. Here, we describe their unique characteristics and the controversies regarding the origin and differentiation of these T-IELs. We show how accumulated experimental evidence has finally arrived at a unifying concept, which demonstrates that these cells originate from early thymus precursors that have not yet undergone TCR rearrangement and TCR-αβ/γδ commitment. These precursors colonize the gut lamina propria during the perinatal period and complete rearrangements and TCR-αβ/γδ commitment while migrating to the epithelium. Therefore, the gut epithelium, which shares the same embryonic origin as the thymus epithelium, behaves as a primary lymphoid organ responsible for the differentiation of a major local T cell set.
Journal of Hospital Infection
Neonatal nosocomial infections are public health threats in the developing world, and successful interventions are rarely reported. A before-and-after study was conducted in the neonatal unit of the Hôpital Principal de Dakar, Senegal to assess the efficacy of a multi-faceted hospital infection control programme implemented from March to May 2005. The interventions included clustering of nursing care, a simple algorithm for empirical therapy of suspected early-onset sepsis, minimal invasive care and promotion of early discharge of neonates. Data on nosocomial bloodstream infections, mortality, bacterial resistance and antibiotic use were collected before and after implementation of the infection control programme. One hundred and twenty-five infants were admitted immediately before the programme (Period 1, January–February 2005) and 148 infants were admitted immediately after the programme (Period 2, June–July 2005). The two groups of infants were comparable in terms of reason for admission and birth weight. After implementation of the infection control programme, the overall rate of nosocomial bloodstream infections decreased from 8.8% to 2.0% (P = 0.01), and the rate of nosocomial bloodstream infections/patient-day decreased from 10.9 to 2.9/1000 patient-days (P = 0.03). Overall mortality rates did not differ significantly. The proportion of neonates who received antimicrobial therapy for suspected early-onset sepsis decreased significantly from 100% to 51% of at-risk infants (P < 0.001). The incidence of drug-resistant bacteria was significantly lower after implementation of the programme (79% vs 12%; P < 0.001), and remained low one year later. In this neonatal unit, simple, low-cost and sustainable interventions led to the control of a high incidence of bacterial nosocomial bloodstream infections, and the efficacy of these interventions was long-lasting. Such interventions could be extended to other low-income countries.

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Neonatal/Perinatal Medicine