ONCE CONSIDERED AN environmental nuisance at best and a dangerous poison at worst, nitric oxide (NO) has been discovered to be an important biologic messenger, sending a shock wave through the scientific community. This article briefly reviews the discovery of NO as a regulator of vascular muscle tone and describes important events on its road to fame. The application of inhaled NO (iNO) for the treatment of hypoxic respiratory failure in neonates is discussed.
Your search for all content returned 27 results
THE VERB PALLIATE COMES FROM the Late Latin palliatus, past participle of palliare, to cloak, conceal. Merriam-Webster Online defines palliate as “to reduce the violence of (a disease)” or “to moderate the intensity of” something.1 Understanding the features of palliative care can challenge NICU staff, whose focus is primarily promotion of the neonate’s survival and healing. Many staff members may be ill prepared to assist the family of a newborn who is dying.2
ACCORDING TO 2003 CENTERS for Disease Control and Prevention statistics, bacterial sepsis of the newborn is the eighth leading cause of death among neonates of all races and both sexes in the U.S., with a mortality rate of 18.9 per 100,000 live births, and necrotizing enterocolitis (NEC) is the thirteenth leading cause of death, with a mortality rate of 9.9 per 100,000 live births.1 Because these entities present such a significant public health challenge, researchers have been exploring various modalities, including immunomodulation, to enhance the neonatal immune system. Generally, the immunomodulators studied work through indirect stimulation or augmentation of the immune system.
CYTOMEGALOVIRUS (CMV), a member of the herpesvirus family, is the most common virus passed from the mother to the fetus. According to the Centers for Disease Control and Prevention (CDC), approximately 1 in 150 children is born with congenital CMV infection.1 Neonates may also acquire CMV during delivery, via blood transfusions, or through breast milk. Both prenatally and perinatally infected infants are at risk for developing short-term effects and long-term sequelae and are candidates for antiviral therapy.2 Each year, approximately 8,000 children suffer permanent disabilities secondary to CMV infection.1
ARTERIAL VASCULAR ACCESS IS often essential to the management of critically ill neonates. If umbilical artery access cannot be obtained or is otherwise contraindicated, peripheral vascular access becomes necessary. Clinical experience has shown that cannulized peripheral arteries may develop vasospasm, however, resulting in catheter failure. When this occurs, blood cannot be drawn or dripped from the peripheral arterial catheter, and the arterial waveform may be dampened or flat.
- Go to article: Steps 1 and 2: Asking a Compelling Clinical Question and Searching for the Best Evidence
A compelling clinical question using the PICOT format sets the stage for a successful search for relevant evidence. This column describes the PICOT format with examples for each component and uses a specific example to demonstrate, through a first-person librarian narrative, how to conduct a literature search for relevant evidence.
It stands to reason that competency in every area of practice, including the evidence-based practice process, improves through participation in the practice. But before engagement in the evidence-based practice process can occur, Melnyk and Fineout-Overholt1 assert, there must be a “spirit of inquiry.” This column describes strategies to spark and cultivate a spirit of inquiry for evidence-based practice and barriers that can dampen the spirit.
THE ANCIENTS WROTE OF THE healing properties of honey. A Sumerian tablet, possibly dated 3000 BCE, documents the treatment of an infected skin ulcer with honey. An Egyptian papyrus dated around 2000 BCE notes the use of honey to treat a gaping wound penetrating to the bone near the eyebrow. Aristotle (384–322 BCE) wrote about the use of honey to treat wounds and sore eyes. As with those of other natural substances, the healing benefits of honey were passed from generation to generation. Honey continues to be a popular medicine throughout the world, except in the U.S.1
SEPSIS CONTINUES TO BE A significant cause of neonatal morbidity and mortality. Researchers have been exploring various modalities, including immunomodulation, as adjuncts to antibiotics to enhance the neonatal immune system. Generally, the role of the immunomodulators that have been studied is indirect stimulation or augmentation of the immune system.
SEPSIS CONTINUES TO BE A significant cause of neonatal morbidity and mortality. In a recent study by the National Institute of Child Health and Human Development Neonatal Research Network, 21 percent of very low birth weight neonates older than three days of age had one or more episodes of proven bloodstream sepsis (range for the 15 network centers: 11–32 percent). The study’s authors assert that strategies to decrease the incidence of nosocomial infection and the related social and economic impact are urgently needed.1 Researchers have been exploring various modalities, including immunomodulation, as adjuncts to antibiotics to enhance the neonatal immune system. Generally, immunomodulators act to stimulate or augment the immune system indirectly.