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SM ISO690:2012 CRIVCEANSCAIA, Larisa. Mai puțin inseamnă mai mult: tendințe contemporane in neonatologie. Reviul literaturii de specialitate. In: Buletin de Perinatologie, 2019, nr. 3(84), pp. 48-56. ISSN 1810-5289. |
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Buletin de Perinatologie | ||||||
Numărul 3(84) / 2019 / ISSN 1810-5289 | ||||||
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CZU: 618.3+616-053.31:614.07 | ||||||
Pag. 48-56 | ||||||
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The neonatal intensive care unit is one of the medical care facilities where iatrogenesis is more common, because the newborn babies are vulnerable and exposed to prolonged intensive medical care. It was estimated that sixty percent of extremely low-birth-weight infants are exposed to iatrogenesis, the risk factors in NICUs including prematurity, mechanical or non-invasive ventilation, central lines, and prolonged length of stay. This determined the use of the notion „less means more”. Delayed cord clamping is recommended for term and preterm infants in the delivery room, and suction for the airways in newborns with meconium-stained fluid is not performed anymore. As a symbol for a less aggressive attitude the term neonatal stabilization is recommended rather than resuscitation. Lower levels of oxygen saturations are accepted as normal during the first 10 minutes of life, and if respiratory assistance is needed, 100% oxygen is no longer used, but 0.21–0.3 FiO2, depending on the gestational age and the level of oxygen saturation. Efforts are made to avoid endotracheal ventilation by using non-invasive respiratory support and administering continuous positive airway pressure early on, starting in the delivery room. If surfactant administration is needed, non-invasive methods of surfactant administration are used. Use of central lines is shortened, and early feeding with breast milk is the routine. Permissive hypercapnia is allowed, and continuous non- invasive monitoring not only of the O2 but also of CO2 is warranted. „Kangaroo care” and an individualized newborn developmental care, together with a calm atmosphere with parental involvement are encouraged. The outcomes of the „less means more” approach still require thorough research. |
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Cuvinte-cheie non-invasive ventilation, neonatal intensive care unit, iatrogenesis, premature infants, неинвазивная вентиляция, отделение интенсивной терапии новорожденных, ятрогения, недоношенные дети |
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