Neo Reviews

NeoReviews current issue

  • Understanding the Limitations of Fetal Cardiac Imaging
    Congenital heart defects are among the most common fetal structural malformations, with a prevalence of 8 in 1,000 live births, and are a significant source of infant mortality. Women with low-risk pregnancies are screened for fetal cardiac disease by anatomical ultrasonographic surveys. Fetal echocardiography is typically reserved for pregnant women with a suspected fetal cardiac lesion based on fetal survey and pregnancies at high risk for fetal congenital heart defects. Prenatal diagnosis allows for collaboration and consultation with multiple services, improved recognition of associated extracardiac anomalies, and early detection of underlying genetic anomalies. Theoretically, prenatal diagnosis should offer opportunities to improve postnatal management and long-term outcomes. However, the evidence to suggest benefit to prenatal diagnosis is mixed and the benefit seems to be dependent on the specific cardiac lesion. To facilitate the appropriate utilization of fetal echocardiography, it is necessary to understand how the study is currently being performed, its cost considerations, and how clinicians and sonographers can use it effectively to ensure appropriate image acquisition and interpretation.

  • Universal Screening for Perinatal Depression
    Perinatal depression, defined as maternal depression that occurs during the antenatal period or the first 12 months after delivery, is a leading cause of maternal morbidity. Although some women may have risk factors for the development of perinatal depression, screening based on risk factors alone is insufficient. In this article, we summarize the validated screening tools that have been used clinically to assess for perinatal depression. We then review the implementation process of universal screening during the obstetric and pediatric office visits and in the setting of the NICU. We conclude that obstetricians, neonatologists, and pediatricians can influence the quality of life for mothers and their children through successful implementation of validated screening tools for perinatal depression.

  • Outcomes of Universal Perinatal Mood Screening in the Obstetric and Pediatric Setting
    Universal mood screening for pregnant women in the perinatal period has been recommended for both obstetric and pediatric settings. This review summarizes the body of evidence that supports universal mood screening in the perinatal period. Screening has been shown to increase detection of depression, especially in the inpatient setting. When implemented with immediate referral systems or brief counseling sessions, universal screening can increase rates of referral and treatment and lower rates of depression in the postpartum period. Immediate assessment systems can be used by midlevel health-care clinicians in the home visit, obstetric, and pediatric outpatient settings.

  • Selective Serotonin Reuptake Inhibitor Use in Pregnancy: Repercussions on the Oblivious Passenger
    Depression is one of the most common comorbidities in pregnancy, and use of selective serotonin reuptake inhibitors (SSRIs) has become increasingly more common during this period. For this reason it is essential to understand the implications of SSRI use on fetal development and neonatal complications. As reviewed here, the preponderance of evidence suggests that the risk of teratogenicity with SSRI use is low. Poor neonatal adaptation or withdrawal syndrome is common among neonates exposed to SSRIs in the third trimester of pregnancy. However, the risk of severe neonatal adaptation syndrome, which would require neonatal intensive care, is low. The association between SSRI exposure and persistent pulmonary hypertension of the newborn remains controversial, but the evidence suggests a weak relationship with this rare outcome. The decision to initiate an SSRI in pregnancy should be individualized. Providers caring for pregnant women using SSRIs should feel comfortable discussing possible neonatal adaptation syndrome associated with the antenatal use of SSRIs, with a primary focus on appropriate treatment of maternal depression after discussion of risks and benefits.