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Persistent pulmonary hypertension of the newborn (PPHN) is a condition caused by a failure in the systemic and pulmonary circulation to convert from the antenatal circulation pattern to the normal postnatal pattern. Due to persistent high pressure in the pulmonary vessels, less than normal blood flows to the lungs and thus less oxygen reaches the organs of the body. Milrinone may cause the pulmonary vessels to relax and allow for an increased oxygen supply for the body. However, the review found no trials of the use of milrinone for babies with persistent pulmonary hypertension. Research is needed into the effects of milrinone on PPHN.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: November 10, 2010

The blood pressure in the arteries of the lungs (pulmonary arteries) is normally much lower than the blood pressure in the rest of the body. Before a baby is born the muscle surrounding the pulmonary arteries is tightly constricted resulting in a very high pressure in these arteries. After birth the arteries dilate and the pressure drops. In persistent pulmonary hypertension of the newborn this drop in pulmonary blood pressure, for a variety of reasons, fails to occur.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 18, 2007

This clinical guideline concerns the management of hypertensive disorders in pregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancy complicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2010

This guideline contains recommendations specific to twin and triplet pregnancies and covers the following clinical areas: optimal methods to determine gestational age and chorionicity; maternal and fetal screening programmes to identify structural abnormalities, chromosomal abnormalities and feto-fetal transfusion syndrome (FFTS), and to detect intrauterine growth restriction (IUGR); the effectiveness of interventions to prevent spontaneous preterm birth; and routine (elective) antenatal corticosteroid prophylaxis for reducing perinatal morbidity. The guideline also advises how to give accurate, relevant and useful information to women with twin and triplet pregnancies and their families, and how best to support them.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: September 2011

The original antenatal care guideline was published by NICE in 2003. Since then a number of important pieces of evidence have become available, particularly concerning gestational diabetes, haemoglobinopathy and ultrasound, so that the update was initiated. This update has also provided an opportunity to look at a number of aspects of antenatal care: the development of a method to assess women for whom additional care is necessary (the ‘antenatal assessment tool’), information giving to women, lifestyle (vitamin D supplementation, alcohol consumption), screening for the baby (use of ultrasound for gestational age assessment and screening for fetal abnormalities, methods for determining normal fetal growth, placenta praevia), and screening for the mother (haemoglobinopathy screening, gestational diabetes, pre-eclampsia and preterm labour, chlamydia).

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: March 2008

The guideline is intended to cover the care of healthy women with uncomplicated pregnancies entering labour at low risk of developing intrapartum complications. In addition, recommendations are included that address the care of women who start labour as ‘low risk’ but who go on to develop complications. These include the care of women with prelabour rupture of membranes at term, care of the woman and baby when meconium is present, indications for continuous cardiotocography, interpretation of cardiotocography traces, and management of retained placenta and postpartum haemorrhage. Aspects of intrapartum care for women at risk of developing intrapartum complications are covered by a range of guidelines on specific conditions (see section 1.8) and a further guideline is planned on intrapartum care of women ‘at high risk’ of complications during pregnancy and the intrapartum period.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: December 2014

This guideline reviews the evidence for the care of women who present with signs and symptoms of preterm labour and those who are scheduled to have a preterm birth. It also reviews how preterm birth can be optimally diagnosed in symptomatic women, given that many women thought to be in preterm labour when clinically assessed will not deliver preterm. Optimal diagnosis can facilitate transfer to a place where appropriate neonatal intensive care can be provided, a strategy known to improve rates of survival for the baby. Additional areas that will be covered by the guidance (such as information needs for women who presents with signs and symptoms of preterm labour) are outlined in the guideline scope.

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: November 2015

This well-conducted review concluded that exposure to selective serotonin reuptake inhibitors in late pregnancy seemed to be associated with an increased risk of newborn persistent pulmonary hypertension, but did not find an association in early pregnancy. The authors' conclusions appear reliable and reflect the limitations of the varied studies. No conclusions could be made about other classes of antidepressants.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

BACKGROUND: An association between PPHN and antidepressant use in pregnancy has been reported.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

This review concluded that inhaled nitric oxide may decrease the incidence of chronic lung disease and combined mortality plus chronic lung disease in premature infants with hypoxemic respiratory failure, but that caution is required in infants at risk of intracranial haemorrhage. Multiple shortcomings in the review process and poor reporting make the reliability of these conclusions difficult to determine.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Sickle cell disease (SCD) is a recessive genetic blood disorder, caused by a mutation in the β-globin gene. For children with SCD, the risk of stroke is estimated to be up to 250 times higher than in the general childhood population. Transcranial Doppler (TCD) ultrasonography is a non-invasive technique which measures local blood velocity in the proximal portions of large intracranial arteries. Screening with TCD ultrasonography identifies individuals with high cerebral blood velocity; these children are at the highest risk of stroke. A number of primary stroke prevention strategies are currently used in clinical practice in the UK including blood transfusion, treatment with hydroxycarbamide and bone marrow transplantation (BMT). No reviews have yet assessed the clinical effectiveness and cost effectiveness of primary stroke prevention strategies in children with SCD identified to be at high risk of stroke using TCD ultrasonography.

Health Technology Assessment - NIHR Journals Library.

Version: November 2012

The renin-angiotensin system is a complex biologic system between the heart, brain, blood vessels, and kidneys that leads to the production of biologically active agents, including angiotensin I and II and aldosterone, which act together to impact a variety of bodily functions including blood vessel tone, sodium balance, and glomerular filtration pressure. The multiple and varied effects of these agents allows the renin-angiotensin system to play a wide role in the pathology of hypertension, cardiovascular health, and renal function. Our ability to begin to intervene upon the complex cycle of hormone and other biochemical agent production within the renin-angiotensin system began with the advent of the first orally active ACE-I (angiotensin converting enzyme inhibitor), captopril, in 1981. AIIRAs (angiotensin II receptor blockers) were developed as an alternative to ACE-I, and block the interaction between angiotensin II and the angiotensin receptor. Losartan, the first commercially available AIIRA, was approved for clinical use in 1995. The goal of this report is to compare the effectiveness and harms between aliskiren and placebo and between AIIRAs and ACEIs in the treatment of diagnosed coronary heart disease, hypertension, left ventricular dysfunction, heart failure, nondiabetic chronic kidney disease, or diabetic nephropathy.

Drug Class Reviews - Oregon Health & Science University.

Version: January 2010

Early-onset neonatal bacterial infection (infection with onset within 72 hours of birth) is a significant cause of mortality and morbidity in newborn babies. Parent organisations and the scientific literature report that there can be unnecessary delays in recognising and treating sick babies. In addition, concern about the possibility of early-onset neonatal infection is common. This concern is an important influence on the care given to pregnant women and newborn babies. There is wide variation in how the risk of early-onset neonatal infection is managed in healthy babies. The approach taken by the NHS needs to: prioritise the treatment of sick babies, minimise the impact of management pathways on healthy women and babies, use antibiotics wisely to avoid the development of resistance to antibiotics. These drivers have not always been addressed consistently in the NHS, and this guideline was commissioned to ensure they would be addressed in future.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2012

Clinical guidelines have been defined as ‘systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions’. This clinical guideline concerns the management of diabetes and its complications from preconception to the postnatal period. It has been developed with the aim of providing guidance on:

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: February 2015

The purpose of this guideline is to review all aspects of the methodology of induction of labour and the appropriateness of different approaches in the various clinical circumstances that may call for such an intervention.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: July 2008

The guideline makes recommendations for the use of pharmacological, psychological and service-level interventions. It aims to:

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: December 2014

This guidance is a partial update of NICE clinical guideline 13 (published April 2004) and will replace it.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: November 2011

This guideline offers best practice advice on assisting people of reproductive age who have problems conceiving.

NICE Clinical Guidelines - National Collaborating Centre for Women’s and Children’s Health (UK).

Version: February 2013

For women with favourable cervix, the study found that misoprostol and oxytocin with amniotomy are more likely to be successful than other agents in achieving vaginal delivery within 24 hours. Cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution and buccal/sublingual misoprostol were most likely to represent value for money, although there was a lot of uncertainty in the cost-effectiveness estimates.

Health Technology Assessment - NIHR Journals Library.

Version: August 2016

This guideline is a partial update of ‘The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care’ (NICE clinical guideline 20, 2004). It updates the pharmacological management sections of the 2004 guideline and also includes the use of the ketogenic diet.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: January 2012

Systematic Reviews in PubMed

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