Abstract：
:In initiating enteral feedings for high-risk infants, clinicians struggle with three fundamental questions: When should enteral feedings be initiated? Should a period of trophic (minimal) feeding be provided? When feedings are advanced, how rapidly should the volume be increased? We present the findings of our systematic reviews of randomized trials addressing each of these questions. These reviews identified various limited short-term benefits of initiating feedings early, providing a period of trophic feedings, and increasing the volume at a relatively rapid rate when feedings are advanced. However, the safety and effectiveness of these approaches are unclear due to limitations in trial design, an inadequate sample size, and the problems inherent in evaluating the effects of initial feeding regimen on necrotizing enterocolitis (NEC) and neurodevelopmental outcome. We provide a detailed description of how a multicenter clinical trial might best be designed to adequately address these questions. In our view, it would be necessary to assess the effect of three feeding regimens on survival without neurodevelopmental impairment (primary outcome) among extremely low birth weight (ELBW) infants. The most daunting obstacle to resolving our current feeding dilemmas is the sample size required to assess all important outcomes. Even in the largest existing research network that achieves a high follow-up rate (the NICHD Neonatal Research Network), it is not feasible to meet conventional (frequentist) sample size requirements. Fortunately, this problem may be addressed using Bayesian methods. (For this reason and because Bayesian methods are likely to be increasingly used in neonatal trials, we provide a brief introduction to these methods.) We show that, with the sample size achievable in the Neonatal Network, Bayesian analyses are likely to provide clear and clinically useful assessments of the probability of benefit for all important clinical outcomes resulting from initial feeding regimens for ELBW infants.
journal_name
Semin Perinatoljournal_title
Seminars in perinatologyauthors
Tyson JE,Kennedy KA,Lucke JF,Pedroza Cdoi
10.1053/j.semperi.2007.02.008subject
Has Abstractpub_date
2007-04-01 00:00:00pages
61-73issue
2eissn
0146-0005issn
1558-075Xpii
S0146-0005(07)00030-4journal_volume
31pub_type
杂志文章,评审abstract：:Retinopathy of Prematurity (ROP) is a preventable neovascular retinal disease with a lifetime impact on vision and ocular morbidities. Retinal vessel immaturity and oxygen therapy, influenced or modulated by several risk factors including oxidative stress, intermittent hypoxia and desaturations, inflammation, infectio...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2019.05.009
更新日期：2019-10-01 00:00:00
abstract：:Neonatal erythropoiesis is limited by a relatively inadequate production of erythropoietin. This is likely the result of dependence on the hepatic production of erythropoietin and an incomplete switchover to renal production. The present model of neonatal erythropoiesis suggests that the use of exogenous erythropoieti...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1016/s0146-0005(97)80016-x
更新日期：1997-02-01 00:00:00
abstract：:Oligohydramnios is a severe and common complication of pregnancy. The finding of oligohydramnios can be associated with fetal anomalies, PROM, uteroplacental insufficiency (eg, growth retardation, postdatism, abruptio placenta, significant maternal illness), abnormalities of twinning, and idiopathic oligohydramnios. U...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1993-06-01 00:00:00
abstract：:Experience gathered over the last decade from high-risk centers provide strong evidence that mid-trimester sonographic markers are sensitive for Down syndrome prediction. More recent data indicate that combining mid trimester sonography with traditional serum markers significantly improves diagnostic accuracy over eit...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/sper.2003.50013
更新日期：2003-04-01 00:00:00
abstract：:Increased hemolysis in the presence of severe neonatal hyperbilirubinemia appears to augment the risk of bilirubin neurotoxicity. The mechanism of this intensifying effect is uncertain. In direct antiglobulin titer (DAT) positive, isoimmune hemolytic disease, the bilirubin threshold at which neurotoxicity occurs appea...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2014.08.006
更新日期：2014-11-01 00:00:00
abstract：:The Lancet Neonatal Survival Series categorized neonatal health interventions into 3 service delivery modes: "Outreach," "Family-Community Care," and "Facility-based Clinical Care." Family-Community Care services generally have a greater potential impact on neonatal health than Outreach services, with similar costs. C...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2010.09.008
更新日期：2010-12-01 00:00:00
abstract：:Thyroid hormone plays an important role in regulating cardiovascular function during the transition to extrauterine physiology. Multiple mechanisms participate, ranging from transcriptional to more immediate nongenomic modes of regulation. ...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2008.09.007
更新日期：2008-12-01 00:00:00
abstract：:The onset of preeclampsia at or near to term is associated with low maternal and neonatal morbidity and mortality. In contrast, those patients (1%) who suffer early onset preeclampsia engender significant maternal and perinatal morbidity and mortality. Therefore, because of the lack of proven prophylaxis for preeclamp...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1016/s0146-0005(99)80059-7
更新日期：1999-02-01 00:00:00
abstract：:Nitric oxide (NO) is intimately involved in vascular homeostasis through its antiplatelet, antiproliferative, and vasodilating actions. Because of these beneficial properties, methods of harnessing NO for the prevention of vascular injury responses, such as intimal hyperplasia, are being explored. One such method invo...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1016/s0146-0005(00)80056-7
更新日期：2000-02-01 00:00:00
abstract：:The studies described above collectively suggest that, whenever there is a decrease in fluid balance in the fetus, both fetal urine flow and tracheal secretion into the amniotic space are decreased. Conversely, when fetal hydration is increased, both urine and tracheal flows into the amniotic fluid may be increased. T...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1986-04-01 00:00:00
abstract：:The primary methods currently in use for imaging the infant brain are cranial ultrasound (CUS), computed tomography (CT) and magnetic resonance imaging (MRI). This review outlines the relative strengths and weaknesses of these modalities in relation to the premature infant, with specific focus on the correlations betw...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2004.10.004
更新日期：2004-12-01 00:00:00
abstract：:Diagnostic errors remain understudied in neonatology. The limited available evidence, however, suggests that diagnostic errors in the neonatal intensive care unit (NICU) result in significant and long-term consequences. In this narrative review, we discuss how the concept of diagnostic errors framed as missed opportun...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2019.08.004
更新日期：2019-12-01 00:00:00
abstract：:Neonatal hyperinsulinism (HI) is a clinical syndrome of pancreatic beta-cell dysfunction characterized by failure to suppress insulin secretion in the presence of hypoglycemia. Although rare, it is the most common cause for persistent hypoglycemia in the newborn period. Treatment can be extremely difficult, and partia...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/sp.2000.6365
更新日期：2000-04-01 00:00:00
abstract：:Surviving extremely low-birth-weight infants are at risk of severe neurodevelopmental disability. Transfusion with packed red cells is almost universal in the care of these infants, but the hemoglobin threshold at which these transfusions should be given is unclear. Different clinical trials of restrictive (low hemogl...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2012.04.010
更新日期：2012-08-01 00:00:00
abstract：:The American Heart Association (AHA) categorizes pulmonary embolism (PE) into three main categories based on the presence or absence of hemodynamic changes and evidence of right ventricular dysfunction. The AHA characterizes massive PE as occurring in the setting of persistent hypotension, profound bradycardia, or pul...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2019.03.005
更新日期：2019-06-01 00:00:00
abstract：:Medical and psychological indications for lactation suppression are discussed, and methods for lactation suppression are evaluated. Medical indications for lactation suppression include 1) maternal anatomical abnormalities, such as inadequate secretory tissue and inverted nipples; 2) maternal breast infections and tu...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：
更新日期：1979-07-01 00:00:00
abstract：:A large body of research indicates that children born very preterm are at increased risk for neurobehavioral impairments; however, research examining outcome for extremely preterm (EP) children is limited. This chapter will review the literature focusing on early development delay, general intellectual functioning, sp...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2007.12.009
更新日期：2008-02-01 00:00:00
abstract：:Sleep-disordered breathing occurs in 0.6-15% of reproductive age women. This condition is associated with an increased lifetime risk of cardiovascular disease, cardiovascular mortality, and all-cause mortality. A substantial body of evidence demonstrated increased perinatal morbidity among pregnancies affected by SDB ...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2015.05.010
更新日期：2015-06-01 00:00:00
abstract：:While the cesarean delivery (CD) rates have increased worldwide, operative vaginal delivery (OVD) rates continue to decline, with the United States having some of the lower rates amongst developed countries. It is clear that the use of forceps or vacuum can safely assist in accomplishing a vaginal delivery and prevent...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2012.04.021
更新日期：2012-10-01 00:00:00
abstract：:The neurodevelopmental outcome of very low birth weight infants experiencing early-onset intraventricular hemorrhage (IVH) occurring within the first 6 postnatal hours was compared with that of their peers without early-onset IVH at 3 years corrected age. The 440 surviving preterm infants (birth weight 600 to 1,250 g)...
journal_title：Seminars in perinatology
pub_type： 临床试验,杂志文章,多中心研究,随机对照试验
doi：10.1016/s0146-0005(99)80065-2
更新日期：1999-06-01 00:00:00
abstract：:Advances in genetic engineering have allowed the creation of animals with additional or deleted genes. New genes may be inserted in mice, specific genes inactivated or "knocked out," and more complex animals created in which genes can be turned on or off at different times in development or in different tissues. These...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2006.09.001
更新日期：2006-12-01 00:00:00
abstract：:Inhaled nitric oxide (iNO), a selective pulmonary vasodilator, is available for treatment of persistent pulmonary hypertension of the newborn in term and near-term neonates. iNO decreases pulmonary vascular resistance leading to diminished extrapulmonary shunt and also has a microselective effect which improves ventil...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/sper.2000.20085
更新日期：2000-12-01 00:00:00
abstract：:Twin birth rates have increased dramatically over the past three decades, and twins currently account for 3% of all pregnancies. Twin pregnancies of any type are at risk for prematurity. In addition, monochorionic twin pregnancies (25-30% of all twin pregnancies) are predisposed to a specific set of complications, inc...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2014.10.005
更新日期：2015-02-01 00:00:00
abstract：OBJECTIVE:To describe inpatient management strategies and considerations for pregnant patients with severe acute respiratory syndrome coronavirus 2 infection. FINDINGS:The novel coronavirus has posed challenges to both obstetric patients and the staff caring for them, due to its variable presentation and current limit...
journal_title：Seminars in perinatology
pub_type： 杂志文章
doi：10.1016/j.semperi.2020.151280
更新日期：2020-11-01 00:00:00
abstract：:Neuroblastoma is the most common malignant neoplasm occurring in the neonate and arguably the most variable in its presentation. This review examines differences in the tumor's clinical course in the context of known biologic determinants of behavior. Tumors that would go undetected except for prenatal ultrasonography...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1016/s0146-0005(99)80035-4
更新日期：1999-08-01 00:00:00
abstract：:Early pregnancy loss is the most common complication in pregnancy. Management options for miscarriage include expectant management, medical intervention, or surgical aspiration. Non-surgical and surgical management are all safe and acceptable options for medically uncomplicated patients. Patient and provider preferenc...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2018.12.005
更新日期：2019-03-01 00:00:00
abstract：OBJECTIVE:Cardiovascular disease is the major cause of pregnancy-related maternal mortality in the United States, and congenital heart disease (CHD) is the most common form of structural heart disease affecting women of childbearing age. Most females born with CHD will reach childbearing age and consider pregnancy. Adu...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2017.11.008
更新日期：2018-02-01 00:00:00
abstract：:Obesity is a major risk factor for many obstetrical complications, including pre-eclampsia, gestational diabetes, indicated preterm birth, macrosomia, and stillbirth. Clinicians should be aware of the unique obstetrical management considerations related to obesity, including recommendations for alterations in prenatal...
journal_title：Seminars in perinatology
pub_type： 杂志文章
doi：10.1053/j.semperi.2011.05.015
更新日期：2011-12-01 00:00:00
abstract：:The many physiological and hormonal changes occurring during pregnancy have the potential to affect a woman's cardiovascular responses to aerobic exercise. For example, it seems that increased mass and dilation of the left ventricle allow maintenance of wall stress, ensuring adequate pumping function throughout gestat...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1016/s0146-0005(96)80017-6
更新日期：1996-08-01 00:00:00
abstract：:Bronchopulmonary dysplasia (BPD) is a chronic lung disease which develops as a result of neonatal/perinatal lung injury. It is the commonest cause of chronic lung disease in infancy and the most frequent morbidity associated with prematurity. The incidence of BPD has continued to rise despite many advances in neonatal...
journal_title：Seminars in perinatology
pub_type： 杂志文章,评审
doi：10.1053/j.semperi.2018.09.011
更新日期：2018-11-01 00:00:00
