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The practice of medicine is filled with controversies as to the best care practices for its patients. These patients vary from field to field, as do their conditions and the methods best suited to treat them. Neonatology struggles with several controversial issues as well as with the additional struggle of the boundaries of ethics when treating infants.
These controversial issues have encourage research and discussion. I will present the leading issues in neonatal care are present research questions so as to further investigate myself.
The Use of Steroids In Premature Infants
Steroids have proven to be very effective in the treatment of newborn infants with bronchopulmonary dysplasia (BPD), a lung disease common in infants born severely premature. Symptoms include inflammation and scarring in the lungs. The initial steroid used for BPD was known as Dexamethasone. However, prolonged use at younger ages and higher doses resulted in neurological impairments and cerebral palsy, prompting the American Academy of Pediatrics to discontinue its use in infants.
Another steroid (hydrocortisone) has since been proposed as the best effective treatment of BPD. It has been tested in very small doses, and as such has not exhibited any results. The controversy then is the possibility of increasing dosage in order to attain the desired results.
The Question
1. Are increased doses of hydrocortisone safe and effective for the prevention/treatment of BPD in premature infants?
Related Questions:
- Are higher does of hydrocortisone associated with neurological impairment and/or cerebral palsey?
- What is the optimal length of treatment and dose of hydrocortisone?
Another steroid (hydrocortisone) has since been proposed as the best effective treatment of BPD. It has been tested in very small doses, and as such has not exhibited any results. The controversy then is the possibility of increasing dosage in order to attain the desired results.
The Question
1. Are increased doses of hydrocortisone safe and effective for the prevention/treatment of BPD in premature infants?
Related Questions:
- Are higher does of hydrocortisone associated with neurological impairment and/or cerebral palsey?
- What is the optimal length of treatment and dose of hydrocortisone?
Treatment of Hypoxic Ischemic Encephalopathy
Hypoxic Ischemic Encephalopathy (HIE) is a condition in neonatal care, commonly associated with increased morbidity. The survival rate is very low and those that do survive are faced with long-term effects such as cerebral palsy, blindness, deafness, autism, epilepsy, and developmental delay. This condition is a result of decreased oxygenation and blood supply.
Several neuroprotective agents are being researched in the treatment of HIE, including Epogen, Magnesium Sulfate, stem cell therapy, hypothermia, and allopurinol. Though all have proven helpful in some preventative method, neither alone has proven significantly helpful.
The Question
2. Can a combination of several or all the treatments be considered safe and effective to provide to the mother pre and postnatally for the prevention of HIE?
Related Question:
-Can any or all of the individual treatments be used routinely as a prevention method?
Probiotics in the Prevention of Necrotizing Enterocolitis
Necrotizing Enterocolitis (NEC) is a condition in seen in premature infants where portions of an infant's bowel will undergo necrosis, or tissue death. Probiotics are nonpathogenic bacteria that are deliberately introduced to the body in order to produce positive effects. This method in treating NEC is relatively new to the neonatal health field and is receiving a lot of criticism on its benefits.
As such a new science, doses and long-term effects are considerably vague and unknown. Though many doctors emphatically support its increased use, others claim it is too unknown.
The Question
3. What are the long-term effects of the use of probiotics to treat NEC?
Related Questions:
- Are probiotics safe? And in what dosage?
-What strain (what probiotic specifically) is optimal?
I am interested in these questions as, not only are they scientifically interesting in general, they are also very important research questions in my field right now. Having a former knowledge of these issues could benefit me in my future, high-level education classes and, eventually, in my career. Even performing the basic research of finding these questions has greatly increased my knowledge of exactly what it is I will be trying to accomplish in my field.
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