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Medical care & clinical practice


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Preterm and ill infants, treated in the neonatal intensive care unit have multiple medical clinical conditions, resulting in an extremely vulnerable patient group. (1–4) Enormous improvements in neonatal care during the last years have also made care increasingly complex.

The most important neonatal event is the postnatal adaptation to extrauterine life during which air breathing is established and circulatory changes take place. Difficulties may occur with transition in situations such as preterm birth and following perinatal asphyxia, accounting for much of the associated neonatal mortality and morbidity. (5–8) Other conditions that are of great relevance for preterm and other ill infants are bronchopulmonary dysplasia, respiratory distress syndrome, suspected early onset neonatal sepsis, hypoglycaemia, hypoxic ischaemic encephalopathy, persistant pulmonary hypertension of the newborn infant, neonatal jaundice, Retinopathy of Prematurity, and vitamin K deficiency bleeding.

Additionally, infants requiring neonatal intensive care constitute a high-risk population for developing brain injury, particularly full term and preterm infants exposed to hypoxia-ischaemia, CNS infections, or with congenital anomalies. Therefore, early recognition of disturbed brain function or structural brain injury is important in the institution of preventive or treatment strategies, and appropriate follow-up. Early identification of impaired function will improve clinical management and long-term functional outcomes. (9–14)

The Topic Expert Group on Medical care and clinical practice develops standards on the prevention, diagnosis and management of the main medical conditions and challenges affecting preterm or ill babies. Additionally, standards on specific clinical procedures and techniques are developed.

  1. Clarke P. Vitamin K prophylaxis for preterm infants. Early Hum Dev. 2010 Jul;86 Suppl 1:17–20.
  2. Glass HC, Ferriero DM. Treatment of hypoxic-ischemic encephalopathy in newborns. Curr Treat Options Neurol. 2007 Nov;9(6):414–23.
  3. Gilbert C. Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control. Early Hum Dev. 2008 Feb;84(2):77–82.
  4. Holmström GE, Hellström A, Jakobsson PG, Lundgren P, Tornqvist K, Wallin A. Swedish national register for retinopathy of prematurity (SWEDROP) and the evaluation of screening in Sweden. Arch Ophthalmol Chic Ill 1960. 2012 Nov;130(11):1418–24.
  5. World Health Organization. Causes of child mortality [Internet]. WHO. 2016. Available from: http://www.who.int/gho/child_health/mortality/causes/en/
  6. World Health Organization. World Health Statistics data visualizations dashboard. Neonatal mortality [Internet]. WHO. 2016 [cited 2018 May 29]. Available from: https://apps.who.int/gho/data/node.sdg.3-2-viz-3?lang=en.
  7. Lehtonen L, Gimeno A, Parra-Llorca A, Vento M. Early neonatal death: A challenge worldwide. Semin Fetal Neonatal Med. 2017;22(3):153–60.
  8. Murphy SL, Mathews TJ, Martin JA, Minkovitz CS, Strobino DM. Annual Summary of Vital Statistics: 2013-2014. Pediatrics. 2017 Jun;139(6).
  9. Dubowitz L, Mercuri E, Dubowitz V. An optimality score for the neurologic examination of the term newborn. J Pediatr. 1998 Sep;133(3):406–16.
  10. Amiel-Tison C. Update of the Amiel-Tison neurologic assessment for the term neonate or at 40 weeks corrected age. Pediatr Neurol. 2002 Sep;27(3):196–212.
  11. Romeo DM, Ricci D, van Haastert IC, de Vries LS, Haataja L, Brogna C, et al. Neurologic assessment tool for screening preterm infants at term age. J Pediatr. 2012 Dec;161(6):1166–8.
  12. Spittle AJ, Doyle LW, Boyd RN. A systematic review of the clinimetric properties of neuromotor assessments for preterm infants during the first year of life. Dev Med Child Neurol. 2008 Apr;50(4):254–66.
  13. Noble Y, Boyd R. Neonatal assessments for the preterm infant up to 4 months corrected age: a systematic review: Review. Dev Med Child Neurol. 2012 Feb;54(2):129–39.
  14. Spittle A, Orton J, Anderson PJ, Boyd R, Doyle LW. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev. 2015 Nov 24;(11):CD005495.

Standards at a glance