Congenital HIV: Prevention of Maternal to Child Transmission.

BACKGROUND: Human immunodeficiency virus (HIV) is caused by a cytopathic lentivirus. HIV without adequate treatment during pregnancy can result in maternal to child transmission (MCT) of the virus. Sequelae can include severe lifelong morbidities, shorter life expectancies, and high mortality rates without antiretroviral therapy. PURPOSE: To discuss epidemiological trends, pathophysiology, and clinical care guidelines including those for diagnosis, treatment, and management of MCT of HIV in the United States. To emphasize the importance of prompt identification, prophylaxis, and treatment of at-risk infants. METHODS: PubMed, CINAHL, MEDLINE, and Google Scholar were used to search key words-maternal to child transmission, HIV, HIV in pregnancy, and neonatal HIV-for articles that were relevant and current. The World Health Organization, Centers for Disease Control and Prevention, and UNICEF were also utilized for up-to-date information on the topic. FINDINGS: Timely identification, intervention, and treatment are necessary to prevent MCT of HIV. Membrane rupture duration is not associated with higher transmission rates with adequate viral suppression. IMPLICATIONS FOR PRACTICE: An evidence-based maternal/neonatal collaborative approach to care for the prevention and management of MCT of HIV including adherence to combined antiretroviral therapy (cART) should be emphasized. Early testing, prophylaxis, and treatment for neonates at risk, as well as education on current clinical care guidelines for caregivers. IMPLICATIONS FOR RESEARCH: Pregnancy complications of cART. MCT rates in conjunction with birthing practices and restrictions among women living with HIV with low to undetectable viral loads.

Impact of Diuretic Therapy in the Treatment of Bronchopulmonary Dysplasia and Acute Kidney Injury in the Neonatal Population.

BACKGROUND: Diuretics are among the most frequently prescribed medications in the neonatal intensive care unit (NICU), despite minimal data regarding the safety and efficacy of their use in the neonatal population. Off-label diuretic therapy is used in preterm and full-term infants to both optimize kidney function and improve respiratory status. PURPOSE: This article examines the literature specific to the impact of diuretic therapy in the NICU and compares the benefits versus risks of utilization as they pertain to the prevention and treatment of renal and pulmonary dysfunction in this population. METHODS/SEARCH STRATEGY: A comprehensive literature search of online databases was performed, utilizing: CINAHL via EBSCO, PubMed, and ProQuest. Full-text, peer-reviewed, clinical trials, and review articles published in the English language between 2005 and 2015 were searched. FINDINGS/RESULTS: Diuretics rank as the seventh most frequently prescribed medication in the NICU. More than 8% of all NICU patients and 37% of infants born at less than 32 gestational weeks and weighing less than 1500 g are exposed to diuretics. Benefits include lung fluid resorption acceleration, improved urine output, fluid retention counteraction, and augmentation of physiologic weight loss. IMPLICATIONS FOR PRACTICE: Diuretics are currently utilized in the NICU at an alarming rate, without adequate clinical trials regarding their safety and efficacy of use. IMPLICATIONS FOR RESEARCH: Updated studies are needed regarding short- and long-term outcomes of diuretic use, as well as overall general outcome data regarding the impact and evaluation of diuretic usage in the NICU population.