Abstract:
:Fetal and neonatal infections can occur at different times during pregnancy, from conception to birth. Infections that take place near the time of conception often destroy the zygote or embryo and only rarely leave definitive evidence. The mother can transmit the infection to her fetus through several routes, but the most likely routes are through ascending infections and through the blood. The inability of most agents to infect the early embryo probably depends largely on local barriers to the infectious agent, such as the zona pellucida. Some viruses, however, because of their systems for gene regulation of expression, can infect only embryos of certain developmental stages. Certain retroviruses can infect embryos, integrate into cellular DNA, and become part of the germline. After implantation, most infectious agents reach the fetus hematogenously. Organisms circulating in the mother reach and infect the placenta. They then may breach the placenta, gain access to the fetal circulation, and disseminate through the fetal body. Agents with particular tropisms infect particular organs and cause particular symptom complexes. The damage done by the organisms depends largely on the gestational age of the fetus at the time of the infection. The ability of the agent to infect or damage the fetus at all often depends on whether the mother is experiencing a primary infection or has previously mounted an effective immune response. Agents harm the fetus through direct destruction of parenchymal cells, through destruction of blood vessels and resulting infarction, through continued replication in fetal and neonatal tissues, through altering the growth parameters of various fetal tissues, and through provoking autoimmune responses. Infections that begin in the perinatal period usually infect the fetus by direct inoculation from infected foci in the birth canal or through direct contact with large amounts of infected maternal body fluids. Direct tissue destruction of the immediate sequelae of invasive infections usually causes the fetal damage from these perinatally acquired agents. The clinical features of the disease that begin in this period provide an opportunity for effective therapeutic intervention. Understanding the routes of fetal infection and the mechanisms underlying fetal damage from infection will help in devising strategies for preventing and treating congenital infections.
journal_name
Clin Perinatoljournal_title
Clinics in perinatologyauthors
Zeichner SL,Plotkin SAsubject
Has Abstractpub_date
1988-06-01 00:00:00pages
163-88issue
2eissn
0095-5108issn
1557-9840journal_volume
15pub_type
杂志文章,评审abstract::The fetal environment is thus well suited for normal growth and development with oxygen availability exceeding oxidative needs. With impairments in blood gas exchange this excess oxygen acts as a "margin of safety," providing for the maintenance of oxidative metabolism through increases in fractional O2 extraction, al...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1989-09-01 00:00:00
abstract::Congenital heart defects (CHDs) are structural abnormalities of the heart and great vessels that are present from birth. The presence or absence of extracardiac anomalies has historically been used to identify patients with possible monogenic, chromosomal, or teratogenic CHD causes. These distinctions remain clinicall...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:10.1016/j.clp.2015.02.009
更新日期:2015-06-01 00:00:00
abstract::Insulin resistance appears to be a causative mechanism for the development of essential hypertension. Insulin resistance syndrome consists of a cluster of abnormalities that aggravate preexisting tendencies to develop hypertension, resulting in a cascade of physiologic alterations and ultimately leading to increased r...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1998-12-01 00:00:00
abstract::Normal pregnancy produces profound metabolic alterations that occur, in large part, by the conclusion of the first trimester. Although necessary to support the metabolic needs of the conceptus, the metabolic and cardiovascular changes of pregnancy are well established weeks before the metabolic needs of the fetus and ...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1993-09-01 00:00:00
abstract::The currently available interventional cardiac procedures in neonates and infants are at various stages of development. We currently dilate neonates and infants with critical valvular pulmonary and aortic stenosis and postoperative aortic obstruction. We do not routinely dilate native coarctation of the aorta because ...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1988-09-01 00:00:00
abstract::Dysphagia and aspiration are commonly encountered problems in the neonatal population. It is often multifactorial in nature and management should be tailored to the individual patient. Multiple causes should be considered, including anatomic abnormalities, neurologic/developmental delay, cardiopulmonary disease/infect...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:10.1016/j.clp.2018.07.005
更新日期:2018-12-01 00:00:00
abstract::Pharmacotherapy for gastroesophageal reflux (GER) in neonates, aimed at interfering with this physiologic process and potentially reducing the negative sequelae that providers often attribute to GER, consists primarily of drugs that increase the viscosity of feeds, reduce stomach acidity, or improve gut motility. Medi...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:10.1016/j.clp.2011.12.015
更新日期:2012-03-01 00:00:00
abstract::This article discusses the management of short bowel syndrome during the neonatal period. It includes information regarding etiology and pathophysiology and parenteral and enteral nutrition therapy. Finally, a discussion of the role of intestinal transplantation in the treatment of short bowel syndrome is included. ...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1996-06-01 00:00:00
abstract::When tissue oxygenation is impaired, compensatory mechanisms occur, including a redistribution of blood flow in order to maintain oxygen delivery to vital organs, resulting in a fall in peripheral blood flow. Monitoring peripheral oxygenation therefore has potential benefits as it may provide an early warning of chang...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1999-12-01 00:00:00
abstract::The signs and symptoms associated with necrotizing enterocolitis (NEC) and the common scenarios in which NEC is observed are described to help physicians appreciate the breadth of this illness and to aid in the identification and diagnosis of those affected. An outline for medical management of infants with NEC is pre...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1994-06-01 00:00:00
abstract::This article reviews the significance of hypoxic-ischemic encephalopathy and the associated patterns of cerebral injury in the context of the most probable timing of the insult and prognosis. The evolution of the clinical features of significant hypoxic-ischemic encephalopathy, and the diagnostic value of imaging and ...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1989-06-01 00:00:00
abstract::The past 15 years has seen the resurgence of an interest in biomedical ethics and an awareness of the importance of teaching this discipline in medical curricula at varying levels. Physicians and philosophers can work together to achieve an integration of clinical case material and philosophical theory, in order to te...
journal_title:Clinics in perinatology
pub_type: 杂志文章
doi:
更新日期:1987-06-01 00:00:00
abstract::Obstetric care providers and researchers have long relied on analysis of the fetal heart rate tracing for insight into the fetal neurologic status. Although a normal fetal heart rate tracing does provide reassurance of intact neurologic function, an abnormal pattern is a very poor predictor of newborn brain injury. In...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:10.1016/j.clp.2009.06.006
更新日期:2009-09-01 00:00:00
abstract::Hemoglobinopathies are frequently occurring disorders for which prenatal diagnosis is possible. Couples in which one parent has microcytic hypochromic red blood cells; is of Southeast Asian, Mediterranean, Middle Eastern, Indian, or African origin; or had one previous child with a known hemoglobinopathy or a previous ...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1990-12-01 00:00:00
abstract::Most pharmacokinetic and biologic attributes of digitalis are age dependent. They are determined in great measure by the chemical structure of the specific cardiac glycoside being used. These effects differ in the intact normal circulation and in heart failure because of the altered autonomic nervous system and hormon...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1988-09-01 00:00:00
abstract::The phenomenal developments in molecular genetics and technological refinements which have occurred over the past decade are revolutionizing the area of prenatal genetics. State-of-the-art care commences with comprehensive preconceptional counseling. Prenatal diagnosis is now feasible from the moment of conception onw...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1994-12-01 00:00:00
abstract::In understanding the various electrolyte disorders associated with respiratory failure, one has to appreciate how the otherwise healthy premature infant maintains extracellular fluid homeostasis. The same physiologic processes that regulate body fluids are affected to varying degrees in the infant with respiratory fai...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1992-03-01 00:00:00
abstract::Congenital lung lesions (CLLs) comprise a heterogeneous group of developmental and histologic entities often diagnosed on screening prenatal ultrasound. Most fetuses with CLL are asymptomatic at birth; however, the risk of malignancy and infection drives the decision to prophylactically resect these lesions. The autho...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:10.1016/j.clp.2017.08.003
更新日期:2017-12-01 00:00:00
abstract::Neurologically impaired infants have immature, damaged, or abnormally developed nervous systems that may cause abnormalities of sucking and swallowing, among other problems. Sucking abnormalities usually present as absence of the sucking response, weakness or incoordination of sucking and swallowing, or some combinati...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1987-03-01 00:00:00
abstract::The enunciation of equipment requirements has been attempted as needs appear today. Detailed and technical specifications for some of this equipment must be understood prior to major acquisitions. An awareness of current trends in clinical research can often be obtained from appropriate consultants which should forest...
journal_title:Clinics in perinatology
pub_type: 杂志文章
doi:
更新日期:1976-09-01 00:00:00
abstract::Preterm birth is a major complication of pregnancy and remains a leading cause of neonatal morbidity and mortality worldwide. Improvements in the authors' understanding of the pathophysiology of preterm labor have led to the development of novel diagnostic tools of use to identify women at greatest risk for preterm bi...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:10.1016/s0095-5108(03)00109-x
更新日期:2003-12-01 00:00:00
abstract::The increasing numbers of children born to HIV-infected women poses formidable problems for maternal and child health programs throughout the world. Between 20% and 40% of these children will be infected with HIV and most are expected to die by the age of 5 years as a result. The vast majority of the uninfected childr...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1994-03-01 00:00:00
abstract::The epitome of FAS and ARBD has been documented substantially in the medical literature. There appears to be little question that alcohol is a teratogen. The precise nature for the mechanism of causing congenital defects, whether it be direct or indirect, is still unknown. There is no unequivocal information that can ...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1991-03-01 00:00:00
abstract::Although continuous positive airway pressure (CPAP) is an effective strategy to prevent invasive ventilation, failure rates are high and many babies require endotracheal intubation. Prolonged exposure to mechanical ventilation is linked with bronchopulmonary dysplasia and other morbidities. Different techniques of nas...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:10.1016/j.clp.2016.07.013
更新日期:2016-12-01 00:00:00
abstract::This article explains the mechanisms underlying choices of pharmacotherapy for hypoxic-ischemic insults of both preterm and term babies. Some preclinical data are strong enough that clinical trials are now underway. Challenges remain in deciding the best combination therapies for each age and insult. ...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:10.1016/j.clp.2013.09.004
更新日期:2014-03-01 00:00:00
abstract::Expertise in neonatal resuscitation is essential for all hospital personnel involved in the care of newborn infants. The guidelines to resuscitation reviewed here have been established by the American Academy of Pediatrics and the American Heart Association and have resulted in significantly improved training and expe...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1999-09-01 00:00:00
abstract::Although therapies in addition to whole-body cooling are being developed to treat the neonate at risk for hypoxic-ischemic encephalopathy, we have no quickly measured serum inflammatory or neuronal biomarkers to acutely and accurately identify brain injury or to follow the efficacy of therapy. This review covers infla...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:10.1016/j.clp.2016.04.008
更新日期:2016-09-01 00:00:00
abstract::The nature of perinatal education has been transformed, reflecting the changes in health care and health care consumers. Because of short maternity stays, the venue of most perinatal education, especially postpartum education, has moved from hospitals to other areas, including the home. In light of conflicting finding...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:
更新日期:1998-06-01 00:00:00
abstract::There were approximately 2 million deaths worldwide from tuberculosis in 1997, 98% of them in developing countries. Factors implicated in the resurgence of tuberculosis in the United States in the late 80s and early 90s included increased immigration from countries with high prevalence, HIV infection, emergence of res...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:10.1016/j.clp.2005.04.010
更新日期:2005-09-01 00:00:00
abstract::Oxygen saturation targeting is widely used in neonatal intensive care, but the optimal target range in very preterm infants has been uncertain and is the subject of recent debate and research. This review briefly discusses the technology of oxygen monitoring and the role of oxygen toxicity in preterm infants. The back...
journal_title:Clinics in perinatology
pub_type: 杂志文章,评审
doi:10.1016/j.clp.2015.08.008
更新日期:2015-12-01 00:00:00