|THE SYMPOSIUM THAT I ATTENDED
|Year : 1995 | Volume
| Issue : 1 | Page : 67-68
"Hot Topics in Neonatology; December 12-14, 1993, Washington DC, USA"
King Fahd Hospital of the University, King Faisal University, AIKhobar, Saudi Arabia
|Date of Web Publication||31-Jul-2012|
P.O. Box 2208, Al-Khobar
Source of Support: None, Conflict of Interest: None
| Abstract|| |
As a guest discussant, I had the pleasure and privilege of being invited to this important meeting which is held yearly. As the name implies, this meeting has its focus on subjects in which there was tremendous changes in the field of Neonatal Medicine, also on subjects where there is unanswered questions and controversial issues. The meeting was organized and chaired by Prof. J.F. Lucey, a well-known celebrity from the Pediatric World and the editor of the highly reputed journal, Pediatrics.
The topics that were chosen for this year included five subjects based on the criteria mentioned above.
Keywords: Neonatology, Premature, Anaemia.
|How to cite this article:|
AI-Umran K. "Hot Topics in Neonatology; December 12-14, 1993, Washington DC, USA". J Fam Community Med 1995;2:67-8
1. Thyrotropin Releasing Hormone (TRH) for Prevention of Hyaline Membrane Disease in Premature Infants
In the late 70's, Liggens and Howie from Auckland, New Zealand, demonstrated that giving antenatal steroids to mothers who are expected to deliver a premature baby, will reduce both the incidence and severity of hyaline membrane disease. The same authors were enrolled in a large randomized study in which mothers undergoing premature labor were given Thyrotropin releasing, hormone in addition to steroids, and were compared with another group who received only steroids. This study took 2 years to complete. The results were presented in this meeting. The question about the beneficial effects of this intervention is not yet clearly answered. Another group from Australia presented conflicting results from those of Liggens and Howie from New Zealand. I am sure more about the subject will appear soon in the Pediatric literature.
2. Surfactant Replacement Therapy
Hyaline membrane disease is known to be caused by deficiency of surfactant, and giving rise to this illness which is responsible for a large number of neonatal mortality. In the mid 80's synthetic and natural surfactants were available and used in controlled studies. However, in the early 90's it became available for clinical practice in most modern Neonatal units around the world. These allowed investigators to look into a multicenter randomized control trial. The results obtained through the data base of the Vermont Oxford Network were presented. The efficacy of both natural and synthetic surfactants is beyond any doubt. However, some logistic issues need to be addressed and some questions about long term follow up results need some answers.
3. Nitric Oxide Therapy for Primary Pulmonary Hypertension
Persistent pulmonary circulation caused by pulmonary hypertension is a difficult clinical problem that affects an important group of babies who may suffer from significant morbidity. Unfortunately, this disease affects large babies and can cause death. Many solutions are available at the moment including hyperventilation using conventional ventilators, oscillatory ventilators, high frequency jet ventilators, and the use of pulmonary vasodilators such as tolazoline and magnesium sulfate. Each modality has its own limitations and risks. A new modality has emerged which is the use of Nitric oxide. It has been used in many centers in United States and its preliminary results are very encouraging.
However, technical questions are not answered yet, but there is clear evidence that there is some hope for a successful intervention of this difficult problem in the near future.
4. Retinopathy of Prematurity
As a consequence to 02 therapy in premature infants, damage to the retina might be very hazardous and traumatic to premature infants and their families. More information is needed to know the risk factors, ways of prevention and early interventions. Data were presented from different centers around the world focusing on the above issues. New diagnostic tools were presented and results of cryotherapy were discussed. Unfortunately, the results were not promising as one had hoped.
This meeting was unique in the sense that the detailed discussion of each subject mentioned above was held by experts carefully selected to present their experience and new data. The audience enjoyed the rich and high standard of scientific discussions and deliberations. The striking feature of the meeting was the well organized network of multicenter trials. In this rapidly growing field of medicine which was an acceptable practice few years ago may no longer be so now. The only way to live up to that is to attend such meetings. However, the problem is one of high cost of registration, air fare and accommodation which is often beyond the means of most average faculty members. The meeting was attended by 750 Pediatricians and Neonatologists but unfortunately not many Pediatricians from this part of the world were able to attend.
5. Erythropoietin for the Prevention of Anemia of Prematurity
After delivery there is a sudden rise in 02 saturation, leading to sudden drop in Erythropoitin production. This will lead to a negative feedback on the bone marrow production of red blood cells. This might cause a condition called anemia of prematurity or, in full term babies, physiologic anemia. In case of premature babies the worry about volume load and other problems related to anemia may force clinicians to use blood transfusions in a repeated manner to prevent that. There is increasing awareness about the dangers neonates might be exposed to by blood transfusions especially with regard to donor-related conditions. It is hoped that this medication, which is produced by DNA recumbinant technology, will help in minimizing the need for frequent transfusions.