Google+ Por Nuestros Niños....: Topicos en Pediatria y Neonatologia

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jueves, 10 de septiembre de 2009

Topicos en Pediatria y Neonatologia

1. Que es lo nuevo en alimentacion enteral del Recien Nacido prematuro
Along with most aspects of neonatal care how, when and what is given as enteral feeds has evolved considerably over the last 2 decades. Feeds are started earlier and advanced more rapidly and they are much more likely to be human milk. Steriod administration pre delivery and surfactant post delivery resulting in preterm babies needing less intensive respiratory support has in part allowed this more liberal approach.
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2. Resucitacion del pretermino con baja concentracion de oxigeno, causa menos estres oxidativo, inflamacion y enfermedad pulmonar cronica.
Rates of survival of extremely low gestational age neonates (ELGANs) (≤28 weeks of gestation) have increased steadily since the late 1990s. However, death in the delivery room (DR) still represents 32% of total ELGAN deaths at discharge, and morbidity rates are especially high at 23 to 25 weeks of gestation. Of note, the use of positive pressure ventilation with a high oxygen concentration has been associated with development of chronic lung disease. Lung-stretching and hyperoxia may act synergistically on prenatally inflamed fetal membranes and may elicit a systemic inflammatory response that contributes to the development of bronchopulmonary dysplasia (BPD). In fact, in experimental and clinical settings, hyperoxia has been associated with serious injury to the developing brain, lung, myocardium, and kidney. Therefore, excessive oxygenation contributes to the formation of reactive oxygen species (ROS). These highly reactive compounds react with nearby molecules (eg, protein, lipids, DNA, and RNA), modifying their structure and function. In addition, it was shown experimentally that ROS may act in the lung as upstream signaling molecules favoring alveolar epithelial cell apoptosis.
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3. Avances en farmacocinetica pediatrica
The past year provided a number of interesting publications in the area of pediatric pharmacokinetics. Studies were conducted that provided valuable information on drugs often used in pediatric medicine such as cyclophosphamide, ibuprofen, mycophenolate, pantoprazole, sildenafil, and voriconazole. Other papers have furthered our knowledge of the dosing and monitoring of drugs during adolescence and added to our understanding of toxicities associated with common therapies such as opioid analgesics. This issue of Pediatric Pharmacotherapy will provide an overview of these studies and case reports.

4. Evaluacion y manejo del trauma craneal moderado o severo en pediatria
Computed tomography scan is the diagnostic test of choice for the moderate to severe head-injured pediatric patient. Several unique scales to describe and prognosticate the head injury are discussed, although currently, the Glasgow Coma Scale is still the most commonly accepted one. Similar to the adult patient, avoidance of hypotension and hypoxia are key to decreasing mortality. Etomidate and succinylcholine remain the choice of medications for intubation. Hyperventilation should be avoided.

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