PubMed Health⌕ Search

Biomedical subjects

John Kattwinkel

Publications and source records attributed to John Kattwinkel.

12 recordsLinked to original sources
PubMed2006

Delivery room resuscitation past, present, and the future.

Delivery room resuscitation guidelines evolved in the late 1980s in the United States, based largely on clinical experience with some supportive experimental evidence. Subsequently over time, there has been an increasing emphasis toward the practice of evidence-based medicine. Despite difficulties in conducting research in the delivery room, several large randomized studies have been undertaken over the past two decades that have provided a scientific basis for some of the new guidelines.

Consensus Statements as Topic↗
PubMed2006

The use of octreotide to treat congenital chylothorax.

We report the use of the octreotide (a somatostatin analogue) in the treatment of idiopathic congenital chylothorax in a patient with Turner's syndrome who had previously failed conservative medical therapy. The patient improved rapidly after initiation of octreotide with complete resolution after 5 days of continuous therapy (10 microg/kg per hour).

Chylothorax↗
PubMed2006

Summary proceedings from the apnea-of-prematurity group.

Apnea of prematurity (AOP) is found in >50% of premature infants and is almost universal in infants who are <1000 g at birth. The literature clearly defines clinically significant apnea in infants (breathing pauses that last for >20 seconds or for >10 seconds if associated with bradycardia or oxygen desaturation), but there is no consensus about the duration of apnea, the degree of change in oxygen saturation, or severity of bradycardia that should be considered pathologic. Although caregivers are able to respond successfully to apnea events with drugs (as well as physical and mechanical interventions) in the NICU, it remains unproven whether such interventions have any long-term effects. One of the most effective drugs, caffeine citrate, is currently labeled for short-term use only and within a limited gestational-age population. Clinicians often use off-label drugs that have been approved for gastroesophageal reflux disease, which is common in premature infants, with the belief that such treatments also have an impact on AOP, although this link has never been demonstrated. Key treatment issues include (1) lack of standardization for definition, diagnosis, and treatment of AOP, (2) unproven benefit of intervention, (3) lack of real-time data documenting AOP events, (4) unevaluated sustained treatment improvement at 7 days or later, (5) failure to address confounding conditions, (6) unsubstantiated AOP-gastroesophageal reflux disease relationship, and (7) undetermined role of AOP affecting long-term neurodevelopmental outcomes. In addressing study-design issues, the pulmonary group identified (1) key questions about neonatal apnea, (2) methodologic requirements for study, (3) appropriate outcome measures, and (4) ethical considerations for future studies. This article describes a sample framework for the study of apnea in neonates and identifies future research needs. Plenary-session discussion points are also listed.

Apnea↗
PubMed2005

Meeting the challenge: using policy to improve children's health.

We reflect on the proceedings of a symposium at a conference of the Centers for Disease Control and Prevention National Center on Birth Defects and Developmental Disabilities. We present examples of bridging the gap between science and policy to achieve improvements in children's health through case studies in early hearing detection and intervention, folic acid fortification to prevent birth defects, sleep positioning recommendations to reduce infant mortality, and workplace lactation support programs. We discuss case studies that present different policy strategies (public health law and voluntary practices) for improving public health. These case studies demonstrate both the power of policy as a tool for improving children's health and the challenges of communicating public health research to policy decisionmakers.

Breast Feeding↗
PubMed2004

Regionalized perinatal education.

Despite changes in the organization and financing of healthcare delivery, and dramatic increases in the number and distribution of perinatal facilities and professionals over the past three decades, there remains a continuing need for effective and efficient regionalized perinatal outreach education programmes. Both the organizers and the participants should be multidisciplinary and include both inpatient and outpatient providers. Content should be restricted to issues relevant to participants' practice, and include topics ranging from preconception to postpartum and early infant care. There are various effective formats, but consideration should be given to reaching as many providers as possible simultaneously within a given facility, minimizing expense and economizing on participants' time. Evaluation strategies range from assessment of immediate outcomes, which generally examine programme process, to ultimate outcomes, which measure changes in patient care and patient health.

Education, Continuing↗
PubMed2004

Technique for intrapartum administration of surfactant without requirement for an endotracheal tube.

OBJECTIVE: To evaluate the feasibility and safety of administering surfactant into the nasopharynx during delivery, thus permitting the baby to aspirate the solution into the fluid-filled airway as an air-fluid interface is established. This process avoids the endotracheal intubation (ETI) and positive pressure ventilation (PPV) usually associated with prophylaxis, thus avoiding the pulmonary barotrauma associated with the conventional method of surfactant administration. STUDY DESIGN: In all, 23 neonates weighing 560 to 1804 g and born at 27 to 30 weeks had their nasopharyngeal airways suctioned and then 3.0-4.5 ml Infasurf instilled into the nasopharynx before delivery of the shoulders. Continuous positive airway pressure (CPAP) of 10 cmH(2)O was administered by mask as the babies initiated breathing. Nasal CPAP at 6 cmH(2)O was then continued for a minimum of 48 hours. RESULTS: In all, 13 of 15 babies delivered vaginally were weaned quickly to room air and required no further surfactant or endotracheal intubation for RDS. Five of eight babies delivered by C-section required subsequent endotracheal intubation soon after birth and two received subsequent endotracheal tube surfactant. CONCLUSION: Nasopharyngeal surfactant instillation at birth appears to be relatively safe and simple to accomplish, especially for vaginal births. A large randomized clinical trial will be required to determine the efficacy of this technique when compared to prophylaxis by endotracheal intubation and to nCPAP alone.

Biological Products↗
PubMed2003

Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery.

Cranial asymmetry may be present at birth or may develop during the first few months of life. Over the past several years, pediatricians have seen an increase in the number of children with cranial asymmetry, particularly unilateral flattening of the occiput. This increase likely is attributable to parents following the American Academy of Pediatrics "Back to Sleep" positioning recommendations aimed at decreasing the risk of sudden infant death syndrome. Although associated with some risk of deformational plagiocephaly, healthy young infants should be placed down for sleep on their backs. This practice has been associated with a dramatic decrease in the incidence of sudden infant death syndrome. Pediatricians need to be able to properly diagnose skull deformities, educate parents on methods to proactively decrease the likelihood of the development of occipital flattening, initiate appropriate management, and make referrals when necessary. This report provides guidelines for the prevention, diagnosis, and management of positional skull deformity in an otherwise normal infant without evidence of associated anomalies, syndromes, or spinal disease.

Female↗