A review of drug therapy for neonatal hypertension.

Neonatal hypertension is becoming a more common diagnosis because of higher survival rates in premature infants and the need for intravascular access and invasive blood pressure (BP) monitoring. Defining hypertension in the neonatal population has been challenging, and understanding what constitutes a normal BP is still evolving.Five general classes of antihypertensives exist for the treatment of hypertension in neonates. Few studies are available to guide clinicians in the treatment of hypertension in neonates, and limited data exist regarding outcomes of hypertension in the neonatal period.

Oral clonidine in the management of acquired opioid dependency.

Clonidine is a nonnarcotic analgesic historically used as a nasal decongestant and more recently established as an antihypertensive agent in adults. Because of its sedative properties with few adverse effects, clonidine has also been reported to be an effective pharmacologic agent for the treatment of neonatal abstinence syndrome (NAS). The use of oral clonidine as a primary or secondary agent in the treatment of NAS has been found to reduce hospitalization and duration of treatment in this population.

Levetiracetam.

The incidence of neonatal seizures varies according to gestational age, weight, and cause. Seizures occur in an estimated 1.0-3.5 per 1,000 term infants1 with an increased incidence of 10-130/1,000 in preterm infants.2 Most neonatal seizures have a specific cause.3 Hypoxic-ischemic encephalopathy has been identified as the most common etiology associated with neonatal seizures, accounting for 50-60 percent of the cases.4 Table 1 outlines common causes of neonatal seizures. Early recognition of seizures and appropriate treatment is vital in preventing multiorgan dysfunction and permanent brain damage.

Vasopressin for the treatment of neonatal hypotension.

Vasopressin (pitressin), also known as arginine vasopressin (AVP), is an antidiuretic hormone formed in the hypothalamus and secreted from the posterior pituitary gland. Various forms of exogenous vasopressin exist and have been used in neonates to treat conditions such as diabetes insipidus. Vasopressin has also been studied on a limited basis for use in the treatment of catecholamine-resistant hypotension in vasodilatory shock. Hypotension is a significant problem resulting in increased morbidity in preterm, septic, and postsurgical neonates. This article will discuss the role of vasopressin and its use as a therapeutic agent in the treatment of hypotension in the neonate.

Failure to rescue as a process measure to evaluate fetal safety during labor.

PURPOSE: To evaluate a perinatal team's clinical responses to the key components of the failure to rescue process. METHODS: This retrospective descriptive study involved a review of medical records and their accompanying fetal monitoring strips for 53 women who had a cesarean birth at term for a nonreassuring fetal heart rate pattern. The instrument was the Fetal Safety Failure to Rescue Process Tool based on the Agency for Healthcare Research and Quality's Failure to Rescue Patient Safety Indicator adapted for perinatal care processes. This tool measured four process measures: careful surveillance, timely identification of complications, appropriate interventions, and activating a team response. A mean total score was computed to determine quality of care based on all four of the process measures. RESULTS: The perinatal team's mean total score was 6.6 (SD = 1.0, range 3-8); the highest possible score was 8. The lowest score was found in the team's response with appropriate interventions (lateral positioning, intravenous fluid bolus, discontinuation of oxytocin, oxygen administration, amnioinfusion, administration of Terbutaline) based on fetal heart rate pattern. Interrater reliability of the tool was 90%. CLINICAL IMPLICATIONS: This study provided information that may be useful in evaluating processes of care to ensure quality care for mothers and babies during labor. The findings formed the basis for implementing unit-specific educational programs, including (a) certification, continuing education, and documented competence in electronic fetal monitoring education to promote consistency in language and understanding of abnormal fetal heart rate patterns; (b) review of appropriate documentation of nonreassuring fetal heart rate patterns; (c) review and revision, if necessary, of established institutional standards and guidelines for appropriate interventions for nonreassuring fetal heart rate patterns; (d) changes in standardized forms to include times for notification of team members and improved communication, and (e) mechanisms for identifying system failures.