Neo Reviews

NeoReviews current issue

  • Corneal Opacities in the Neonate
    A congenital corneal opacity is a rare occurrence but can cause significant visual compromise to the affected infant. Corneal opacities can arise from infectious, metabolic, genetic, developmental, and idiopathic causes. Early diagnosis is imperative so that an appropriate treatment plan can be initiated as soon as possible to obtain the best visual potential. An early diagnosis can facilitate the recognition of an underlying systemic disorder that may also be affecting the infant. Management strategies include amblyopia treatments, refractive error correction, and surgery. Despite aggressive treatment, visual potential may still be limited in many cases.

  • Mandibular Distraction for Micrognathia in Neonates
    Pierre Robin sequence (PRS) comprises the clinical triad of micrognathia, glossoptosis, and upper airway obstruction, with a reported incidence of 0.5 to 2.1 per 10,000 live births. The mainstay of management involves prompt diagnosis of airway obstruction and airway management. The gold standard surgical intervention for management of symptomatic micrognathia is mandibular lengthening by distraction osteogenesis (MDO) to anteriorly reposition a retroflexed tongue and relieve obstruction. Although MDO is often successful in the short-term in relieving upper airway obstruction and/or avoiding the need for permanent tracheostomy, the long-term effects of MDO are not yet elucidated.

  • Videolaryngoscopy for Intubation Training
    Intubation in the neonate can present unique challenges to an inexperienced clinician. The videolaryngoscope provides more easy visualization of the airway, as well as more reliable access to the airway. Since its inception, the videolaryngoscope has been modified from its original adult design for use in the pediatric patient population. Following its production, one of its main uses has been in the training of inexperienced operators, gaining widespread use in training hospitals. Before its introduction, instructors at these institutions relied solely on feedback from the trainee during intubation, rather than visual confirmation. Use of the videolaryngoscope to instruct trainees on the technique of intubation improves feedback given to the trainee as well as the first-attempt success rates, while lowering esophageal intubation rates. The available literature suggests that the use of videolaryngoscopy improves visualization of the glottis while sacrificing time to pass the endotracheal tube. Both methods (direct and videolaryngoscopy) proved to have similar times for intubation as well as intubation success rates for experienced practitioners. In the neonatal and pediatric populations specifically, another crucial use of videolaryngoscopy is its superiority in treating patients with a difficult airway. It enhances the operator’s ability to visualize the glottis in cases with no direct line of sight to the glottis.