Books on the topic 'Premature morbidity'

General principles 38Parenteral nutrition 39Enteral feeding 40Developments in care for the premature newborn have lead to increasing survival (50% of infants born at 24 weeks gestation) and an increased awareness of the importance of nutrtional support. Many have difficulty tolerating enteral nutrition in the early weeks of life until gastrointestinal motility has matured. Some develop necrotizing enterocolitis (NEC) which carries a high risk of morbidity and mortality, and may be regarded as a failure of adaptation to postnatal life. Optimum nutrition should allow adequate growth in the short term, free of metabolic and other complications, with long-term fulfilment of both genetic growth and developmental potential....

Necrotizing enterocolitis (NEC) is a severe inflammatory bowel disease that commonly affects premature infants. The pathogenesis is multifactorial and poorly understood, although certain risk factors have been identified. This disease, more commonly detected in premature infants with accompanying cardiac and pulmonary comorbid conditions, is associated with increased morbidity and mortality. Multiorgan system homeostasis becomes critical for the pediatric anesthesiologist when approaching medical and surgical interventions for affected patients. This chapter focuses on the population at risk for developing necrotizing enterocolitis, medical and surgical management, providing anesthesia care in the neonatal intensive care unit, as well as perioperative considerations and complications.

Increased medical co-morbidity is one of the underlying causes of excess and premature mortality in bipolar disorder. This increased prevalence of medical conditions is likely to result from a range of different factors. Some attention in recent years has been devoted to intrinsic illness factors resulting in excessive allostatic load and oxidative stress potentially predisposing to physical morbidity. Some other contributors have also been identified as unhealthy lifestyle habits and unwanted effects of pharmacological treatment. Irrespective of causality, risk minimization can be obtained by systematically addressing physical needs into the management of bipolar disorder. This can be achieved with a range of interventions including regular monitoring of physical health, tailored management of unhealthy lifestyle choices, and pharmacological optimization.

Despite the advances in surgical techniques, very few ACHD patients have a truly curative procedure, with the majority being at lifelong risk of complications, including ventricular dysfunction, arrhythmias, and premature death. Ventricular dysfunction, leading to heart failure, remains a major cause of morbidity and mortality, with some studies showing that it accounts for up to 40% of deaths in adults with CHD. This chapter discusses drug therapy, transplantation, and end-of-life care in ACHD.

The UK government, in its White Paper in 1998, declared that ‘smoking is the greatest single cause of preventable illness and premature death in the UK’. Cigarette smoke is inhaled because it contains nicotine, which is highly addictive. Nicotine itself has some adverse physiological effects but it is mainly the 4000+ chemicals (including acetone, arsenic, paint stripper, pesticides, and over 60 known carcinogens), added to make the cigarette such an extremely potent nicotine delivery device, that cause so much damage.A smoker dies on average 8–10 years before a non-smoker does. The commonest causes of premature death in smokers are cardiovascular disease, lung cancer, and COPD. However, smoking also leads to much morbidity, causing or worsening many illnesses and affecting every system of the body. In addition, it is associated with a number of cancers, including lung cancer, nasopharyngeal cancer, laryngeal cancer, oesophageal cancer, stomach cancer, pancreatic cancer, colonic cancer, kidney cancer, bladder cancer, cervical cancer, and acute myeloid leukaemia. Stopping smoking at any age has been shown to improve health and increase life expectancy. Even with advanced smoking-related diseases, observational studies show clinically meaningful benefits in stopping smoking.

Necrotizing enterocolitis is a common and serous disease predominantly affecting premature newborns, with an incidence, morbidity, and mortality that has remained unchanged for several decades. Around 7% of infants between 500g and 1500g birth weight are affected, with the disease often manifesting with vomiting, bilious aspirates, distended abdomen, and blood in stools around 8–10 days of age. Medical management includes decompression of the gastrointestinal tract via a nasogastric tube, broad-spectrum antibiotics, and bowel ‘rest’ (total parenteral nutrition). Surgical intervention is required for intestinal perforation or ongoing deterioration despite medical management. The pathogenesis is multifactorial and includes genetic predisposition, gastrointestinal immaturity, imbalance in microvascular tone, abnormal intestinal microbiological colonization, and a highly immunoreactive intestinal mucosa. Breast milk feeds appear to confer some degree of protection.

What are the teachings of the major world religious traditions about the status and care of the premature or sick newborn? This question becomes important in the context of neonatal intensive care units (NICUs) committed to the ideals of family-centered care, which encourages shared decision making between parents and NICU caregivers. In cases of infants with conditions marked by high mortality, morbidity, or “great suffering,” family-centered care affirms the right of parents to assist in decisions regarding aggressive treatment for their infant. But while there is evidence that families’ religious beliefs often profoundly shape their approach to medical decision making, few studies have tried to understand what major religious traditions teach about the care of the newborn or how these teachings may bear on parents’ decisions. This volume seeks to address this need, providing information on religious teachings to the multidisciplinary teams of NICU professionals (neonatologists, advance practice nurses, social workers), parents of NICU patients, and students of bioethics. In chapters dealing with Judaism, Catholicism, Denominational Protestantism, Evangelical Protestantism, African American Protestantism, Sunni and Shi’a Islam, Hinduism, Buddhism, Navajo religion, and Seventh-day Adventism, leading scholars develop the teachings of these traditions on the status, treatment, and ritual accompaniments of care of the premature or sick newborn.

Five types of morbidity and mortality have been identified as the main health expressions of health harm associated with illicit drug use: 1) overdose; 2) other injury; 3) non-communicable physical disease; 4) mental disorders; and 5) infectious disease. Burden of disease estimates combining years of life lost due to premature mortality and disability indicate that illicit drugs ranked eighth among causes of disease, death, and disability in developed regions of the world. Opioids, cocaine, and amphetamines entail greater risks, especially when they are injected. Many harmful consequences are not completely intrinsic to the properties of the drug, but instead are associated with the physical and social environment in which drug use takes place. These epidemiological considerations need to be taken into account in the allocation of resources for prevention programmes, treatment, and social services.

Mental health is critical to personal well-being, interpersonal relationships, and successful contributions to society. Mental health conditions consequently impose a high burden not only on individuals, families and society, but also on economies. In Jamaica, mental health conditions are highly prevalent and major contributors to morbidity, disability, and premature mortality. Encouragingly, with timely and effective treatment, individuals suffering from mental health conditions can lead productive and satisfying lives. This publication, the first of its kind, provides evidence and guidance to support the development, financing, and implementation of mental health interventions in Jamaica. Specifically, it estimates the return on investment (ROI) from scaling up treatment for anxiety, depression, and psychosis. The results from this analysis show that Jamaica can significantly reduce the health and economic burden of mental health conditions by investing in cost-effective recommended interventions designed to improve mental health.

There is a bidirectional relationship between depression and type 2 diabetes (T2D). Patients with comorbid depression and T2D are at high risk of complications and premature mortality. Conventional treatments for depression do not consistently improve diabetes outcomes, despite improving depressive symptoms. Shared mechanisms may underpin both depression and T2D, providing novel pharmacological targets to treat both conditions simultaneously. There are several candidate pathways. For inflammation and vitamin D deficiency, there is good cross-sectional evidence to support an association with depression in T2D. Prospective epidemiological studies are needed to test biological pathways as predictive biomarkers of depression and T2D. Intervention studies are needed to test the modifiability of these pathways. Repurposing of established diabetes treatments may provide a ‘multiple hit’ strategy. The identification and modification of novel biological targets has the potential to treat both depression and T2D, as well as reducing longer term morbidity and mortality.

Congenital infection with human cytomegalovirus (CMV) is the most common infectious cause of developmental disability in newborns. Congenital CMV is also a leading cause of hearing loss in infants. The overall birth prevalence of congenital CMV is 0.5–1%, varying among different populations. CMV infection may be symptomatic at birth or, more commonly, asymptomatic. Both groups are at risk for sequelae. Antiviral therapy with ganciclovir (or valganciclovir) in infants with symptomatic congenital CMV infection can result in improved neurodevelopmental and hearing outcomes. CMV infections in very low birthweight premature infants, typically acquired via breast milk, can also produce substantial short-term and possibility long-term morbidity. This chapter reviews current concepts regarding the biology of CMV as well as the epidemiology, clinical presentation, diagnosis, management, and outcome of congenital and perinatal CMV infections. High-priority areas for future research, including in the arena of newborn screening for congenital CMV, are discussed.

Cystic fibrosis (CF) is a genetic disease resulting in an impaired mucociliary clearance, chronic bacterial airway infection, and inflammation. The progressive destruction of the lungs is the main cause of morbidity and premature death. Diverse other organ systems such as heart, muscles, bones, gastro-intestinal tract, and sweat glands are often also affected and interfere with exercise capacity. Hence, exercise capacity is reduced as the disease progresses mainly due to reduced functioning of the muscles, heart, and/or lungs. Although there is still growing evidence of positive effects of exercise training in CF on exercise capacity, decline of pulmonary function, and health-related quality of life, the observed effects are encouraging and exercise should be implemented in all patient care. More research is needed to understand pathophysiological mechanisms of exercise limitations and to find optimal exercise modalities to slow down disease progression, predict long-term adherence, and improve health-related quality of life.

Critical and dangerous threats imperil global health. Serious health disparities, hazardous contagions that can circle our globalized planet in hours, a bewildering confusion of health actors and systems all combine in a kaleidoscopically fragmented, incoherent, and unjust global health enterprise. While a growing body of work in global justice and international relations explores moral issues and global governance, very little of it has linked principles of global health justice to governance to create a theory of global health. But the dangers confronting the world make a theoretical framework essential, to enable analysis of the current system and to ground proposals to reform it and align it with moral values. This book presents a global justice theory—provincial globalism (PG)—and links it with the theory of shared health governance (SHG) to offer an alternative to the prevailing modus operandi, which has manifestly failed to serve global health. The PG/SHG framework advances health capability, and specifically the capability to avoid premature death and preventable morbidity, as the proper goal of health systems and policy. This framework sees human flourishing as global society’s end goal and proposes an ethical demand for health equity as the criterion for evaluating global health policy and law. It examines the current actors in global health, assessing their strengths and weaknesses, and proposes assigning responsibilities to actors at all levels according to their functions and capabilities.

Substance abuse in pregnancy is a cause of maternal and neonatal morbidity and mortality. It can lead to a wide range of health, social, and psychological problems. Many of these mothers are young, single, socially deprived, and often present late for antenatal care. The prevalence is unclear as substance abuse is often concealed, but it is most common in young adults, and may be around 4% in the United Kingdom and 6% in the United States. It is estimated that 200,000–300,000 children living in England and Wales have one or both parents with a drug problem. Patterns and prevalence of substance abuse vary between and within countries, but polysubstance abuse is common. Obstetric anaesthetists may be involved in care of mothers who have known or covert substance abuse. Common problems include poor nutrition, dentition, difficult intravenous access, immunosuppression, and altered drug metabolism. Use of some illicit drugs can cause obstetric complications, and others can mimic serious issues such as pre-eclampsia. The incidence of emergency caesarean delivery is higher. Neonates tend to be premature, small for gestational age, at risk of withdrawal, and have ongoing health issues throughout life. Healthcare workers should enquire about tobacco, alcohol, and illicit drug use early in pregnancy as advice and support may motivate women to alter their lifestyle. The impact of tobacco, caffeine, alcohol, marijuana, solvents, opioids, cocaine, and amphetamine use on the mother and fetus, and the implications for the obstetric anaesthetist, are presented.

Any public debate about air pollution starts with the premise that air pollution cannot be good for you, so we should have less of it. However, it is much more difficult to determine how much is dangerous, and even more difficult to decide how much we are willing to pay for improvements in measured air pollution. Recent UK estimates suggest that fine particulate pollution causes about 6500 deaths per year, although it is not clear how many years of life are lost as a result. Some deaths may just be brought forward by a few days or weeks, while others may be truly premature. Globally, household pollution from cooking fuels may cause up to two million premature deaths per year in the developing world. The hazards of black smoke air pollution have been known since antiquity. The first descriptions of deaths caused by air pollution are those recorded after the eruption of Vesuvius in ad 79. In modern times, the infamous smogs of the early twentieth century in Belgium and London were clearly shown to trigger deaths in people with chronic bronchitis and heart disease. In mechanistic terms, black smoke and sulphur dioxide generated from industrial processes and domestic coal burning cause airway inflammation, exacerbation of chronic bronchitis, and consequent heart failure. Epidemiological analysis has confirmed that the deaths included both those who were likely to have died soon anyway and those who might well have survived for months or years if the pollution event had not occurred. Clean air legislation has dramatically reduced the levels of these traditional pollutants in the West, although these pollutants are still important in China, and smoke from solid cooking fuel continues to take a heavy toll amongst women in less developed parts of the world. New forms of air pollution have emerged, principally due to the increase in motor vehicle traffic since the 1950s. The combination of fine particulates and ground-level ozone causes ‘summer smogs’ which intensify over cities during summer periods of high barometric pressure. In Los Angeles and Mexico City, ozone concentrations commonly reach levels which are associated with adverse respiratory effects in normal and asthmatic subjects. Ozone directly affects the airways, causing reduced inspiratory capacity. This effect is more marked in patients with asthma and is clinically important, since epidemiological studies have found linear associations between ozone concentrations and admission rates for asthma and related respiratory diseases. Ozone induces an acute neutrophilic inflammatory response in both human and animal airways, together with release of chemokines (e.g. interleukin 8 and growth-related oncogene-alpha). Nitrogen oxides have less direct effect on human airways, but they increase the response to allergen challenge in patients with atopic asthma. Nitrogen oxide exposure also increases the risk of becoming ill after exposure to influenza. Alveolar macrophages are less able to inactivate influenza viruses and this leads to an increased probability of infection after experimental exposure to influenza. In the last two decades, major concerns have been raised about the effects of fine particulates. An association between fine particulate levels and cardiovascular and respiratory mortality and morbidity was first reported in 1993 and has since been confirmed in several other countries. Globally, about 90% of airborne particles are formed naturally, from sea spray, dust storms, volcanoes, and burning grass and forests. Human activity accounts for about 10% of aerosols (in terms of mass). This comes from transport, power stations, and various industrial processes. Diesel exhaust is the principal source of fine particulate pollution in Europe, while sea spray is the principal source in California, and agricultural activity is a major contributor in inland areas of the US. Dust storms are important sources in the Sahara, the Middle East, and parts of China. The mechanism of adverse health effects remains unclear but, unlike the case for ozone and nitrogen oxides, there is no safe threshold for the health effects of particulates. Since the 1990s, tax measures aimed at reducing greenhouse gas emissions have led to a rapid rise in the proportion of new cars with diesel engines. In the UK, this rose from 4% in 1990 to one-third of new cars in 2004 while, in France, over half of new vehicles have diesel engines. Diesel exhaust particles may increase the risk of sensitization to airborne allergens and cause airways inflammation both in vitro and in vivo. Extensive epidemiological work has confirmed that there is an association between increased exposure to environmental fine particulates and death from cardiovascular causes. Various mechanisms have been proposed: cardiac rhythm disturbance seems the most likely at present. It has also been proposed that high numbers of ultrafine particles may cause alveolar inflammation which then exacerbates preexisting cardiac and pulmonary disease. In support of this hypothesis, the metal content of ultrafine particles induces oxidative stress when alveolar macrophages are exposed to particles in vitro. While this is a plausible mechanism, in epidemiological studies it is difficult to separate the effects of ultrafine particles from those of other traffic-related pollutants.