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Richard A. Polin

Bio: Richard A. Polin is an academic researcher from University of Pennsylvania. The author has contributed to research in topics: Neonatal sepsis & Sepsis. The author has an hindex of 40, co-authored 108 publications receiving 7548 citations. Previous affiliations of Richard A. Polin include Pennsylvania Hospital & Boston University.


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Book
01 Feb 1992
TL;DR: Genetics embryology the placenta developmental pharmacology and pharmacokinetics intrauterine growth postnatal growth and nutrition lipid metabolism in the foetus and newborn carbohydrate metabolism protein metabolism thermo regulation skin foetal and neonatal cardiovascular physiology.
Abstract: Section I - Genetics and Embryology Basic Genetic Principles Prenatal Diagnosis Basic Embryology Regulation of Embryogenesis The Extracellular Matrix in Development Stem Cell Biology Apoptotic Cell Death Angiogenesis Epigenetics Section II - Placenta and Intrauterine Environment Placental Development Regulation of the Placental Circulation Mechanisms of Transfer Across the Human Placenta Endocrine and Paracrine Function of the Human Placenta Fetal and Maternal Responses to Intrauterine Infection Fetal Origins of Adult Disease: A Classic Hypothesis with New Relevance Physiologic Effects of Multiple Pregnancy on Mother and Fetus Placental function in intrauterine growth restriction Section III - Developmental Pharmacology and Pharmacokinetics Basic Pharmacologic Principles Principles of Pharmacokinetics Physicochemical and Structural Properties Regulating Placental Drug Transfer Pharmacogenetics Drug Distribution in Fetal Life Drug Transfer During Breastfeeding Section IV - Intrauterine and Postnatal Growth Circulatory and Metabolic Changes Accompanying Fetal Growth Restriction Endocrine Factors Affecting Neonatal Growth Human Milk Composition and Function in the Infant Physiology of Lactation Section V - Perinatal Iron, Mineral, and Vitamin Metabolism Fetal and Neonatal Iron Metabolism Neonatal Calcium, Phosphorus, and Magnesium Homeostasis Zinc in the Fetus and Neonate Vitamin A Metabolism in the Fetus and Neonate Vitamin E Metabolism in the Fetus and Newborn Infant Vitamin K Metabolism in the Fetus and Neonate Section VI - Lipid Metabolism Maternal-Fetal Transfer of Lipid Metabolites Brown Adipose Tissue: Development and Function Lipids as an Energy Source for the Premature and Full-Term Neonate Ketone Body Production and Metabolism in the Fetus and Neonate Long-Chain Fatty Acids in the Developing Retina and Brain Section VII - Carbohydrate Metabolism Metabolism of Glucose and Methods of Investigation in the Fetus and Newborn Carbohydrate Metabolism During Pregnancy Oxygen Consumption and General Carbohydrate Metabolism of the Fetus Role of Glucoregulatory Hormones in Hepatic Glucose Metabolism During the Perinatal Period Cell Glucose Transport and Glucose Handling During Fetal and Neonatal Development Section VIII - Protein Metabolism General Concepts of Protein Metabolism Fetal Requirements and Placental Transfer of Nitrogenous Compounds Section IX - Thermoregulation Temperature Control in Newborn Infants Responses of the Fetus and Neonate to Hypothermia Section X - Skin Structure and Development of Skin and Cutaneous Appendages Physiologic Development of the Skin Section XI - Fetal and Neonatal Cardiovascular Physiology Cardiovascular Development Developmental Electrophysiology in the Fetus and Neonate Developmental Biology of the Pulmonary Vasculature Development of the Gastrointestinal Circulation in the Fetus and Newborn Physiology of Congenital Heart Disease in the Neonate Neural Regulation of Blood Pressure During Fetal and Newborn Life Developmental Effects on Fetal Circulation Mechanisms Regulating Closure of the Ductus Arteriosus Umbilical Circulation Fetal and Placental Circulation During Labor Physiology of Resuscitation Section XII - The Lung Normal and Abnormal Structural Development of the Lung Regulation of Alveolarization Physiologic Mechanisms of Normal and Altered Lung Growth Before and After Birth Molecular Mechanisms of Lung Development and Lung Branching Morphogenesis Regulation of Liquid Secretion and Absorption by the Fetal and Neonatal Lung Upper Airway Structure: Function, Regulation, and Development Regulation of Lower Airway Function Functional Development of Respiratory Muscles Mechanics of Breathing Pulmonary Gas Exchange in the Developing Lung Oxygen Transport and Delivery Control of Breathing in Fetal Life and Onset and Control of Breathing in the Neonate Basic Mechanisms of Oxygen Sensing and Response to Hypoxia Evaluation of Pulmonary Function in the Neonate Mechanisms of Neonatal Lung Injury Impaired Lung Growth After Injury in Premature Lung Antenatal Factors That Influence Postnatal Lung Development and Injury Regulation of Pulmonary Circulation Section XIII - Surfactant Historical Perspective Composition of Pulmonary Surfactant Lipids and Proteins Structure And Development of Alveolar Epithelial Cells Regulation of Surfactant-Associated Phospholipid Synthesis and Secretion Hormonal Therapy for Prevention of Respiratory Distress Syndrome Surfactant Treatment Genetics and Physiology of Surfactant Protein Deficiencies Section XIV - Physiology of Gastrointestinal Tract in the Fetus and Neonate Trophic Factors and Regulation of Gastrointestinal Tract and Liver Development Organogenesis of the Gastrointestinal Tract Development of the Enteric Nervous System Development of Gastric Secretory Function Development of Gastrointestinal Motility Development of the Exocrine Pancreas Digestive-Absorption Functions in Fetuses, Infants, and Children Development of the Intestinal Microbiome Section XV - Liver and Bilirubin Metabolism Organogenesis and Histologic Development of the Liver Bile Acid Metabolism During Development Neonatal Bilirubin Metabolism Hereditary Contribution to Neonatal Hyperbilirubinemia Mechanisms of Action of Phototherapy for Neonatal Hyperbilirubinemia Section XVI - The Kidney Embryogenesis and Anatomic Development of the Kidney Functional Development of the Kidney in Utero Development and Regulation of Renal Blood flow in the Neonate Development of the Renin-Angiotensin System Postnatal Development of Glomerular Filtration Rate in Neonates Renal Transport of Sodium During Early Development Potassium Homeostasis in the Fetus and Neonate Role of the Kidney in Calcium and Phosphorus Homeostasis Transport of Amino Acids in the Fetus and Neonate Developmental Aspects of Organic Acid Transport Concentration and Dilution of the Urine Development of Acidification Mechanisms in the Fetus and Neonate Response to Nephron Loss in Early Development Section XVII - Fluid and Electrolyte Metabolism Fluid Distribution in the Fetus and Neonate Regulation of Acid-Base Balance in the Fetus and Neonate Section XVIII - Developmental Hematopoiesis Developmental Biology of Stem Cells: From the Embryo to the Adult Developmental Granulocytopoiesis Developmental Erythropoiesis Developmental Megakaryocytopoiesis Section XIX - Hemostasis Developmental Hemostasis Platelet-Vessel Wall Interactions Section XX - Developmental Immunobiology Host Defense Mechanisms Against Bacteria Host-Fungi Interactions Relevant to the Newborn Infant Host Defense Mechanisms Against Viruses T-Cell Development B-Cell Development Mononuclear Phagocyte System Normal and Abnormal Neutrophil Physiology in the Newborn The Complement System of the Fetus and Newborn Cytokines and Inflammatory Response in the Fetus and Neonate Immunology of Human Milk and Host Immunity Neonatal Pulmonary Host Defense Section XXI - Neurology Development of the Nervous System Development of the Blood-Brain Barrier Trophic Factor and Nutritional and Hormonal Regulation of Brain Development Intraventricular Hemorrhage in the Neonate Cerebellar Development - an Impact of Preterm Birth and Co-Morbidities Electroencephalography in the Premature and Full-Term Infant Developmental Aspects of Pain Section XXII - Special Sensory Systems in the Fetus and Neonate Early Development of the Human Auditory System Development of Taste and Smell in the Neonate Section XXIII - Orthopedics The Growth Plate: Embryologic Origin, Structure, and Function Ontogenesis of Striated Muscle Section XXIV - Endocrine Function Hypothalamus: Neuroendometabolic Center Growth Factor Regulation of Fetal Growth Growth Hormone in the Fetus and Newborn Luteinizing Hormone and Follicle-Stimulating Hormone Secretion in the Fetus and Newborn Development of the Corticotropin-Releasing Hormone-Corticotropin System in the Mammalian Fetus Fetal and Neonatal Adrenocortical Physiology Fetal and Neonatal Thyroid Physiology Section XXV - Ovary and Testis Genetics of Sex Determination and Differentiation Differentiation of the Ovary Testicular Development and Descent Section XXVI - Pathophysiology of Neonatal Diseases Pathophysiology of Neonatal sepsis Pathophysiology of Hypoglycemia in the Neonate Pathophysiology of Cardiomyopathies Pathophysiology of Persistent pulmonary hypertension of the newborn Pathophysiology of Shock in the Fetus and Neonate Pathophysiology of Apnea of Prematurity Pathophysiology of Respiratory Distress Syndrome Pathophysiology of Meconium Aspiration Syndrome Pathophysiology of Bronchopulmonary Dysplasia Pathophysiology of Ventilator Dependent Infants Pathophysiology of Gastroesophageal Reflux Pathophysiology of Neonatal Necrotizing Enterocolitis Pathophysiology of Kernicterus Pathophysiology of neonatal acute kidney injury Pathophysiology of Edema Pathophysiology of Retinopathy of Prematurity Pathophysiology of Hypoxic-ischemic Brain Injury Pathophysiology of Neonatal White Matter Injury Pathophysiology of Meningitis Pathophysiology of Neural Tube Defects Pathophysiology of Preeclampsia Pathophysiology of Preterm Birth Pathophysiology of Chorioamnionitis

936 citations

Journal ArticleDOI
TL;DR: This statement updates information about the clinical presentation of infants exposed to intrauterine drugs and the therapeutic options for treatment of withdrawal and is expanded to include evidence-based approaches to the management of the hospitalized infant who requires weaning from analgesics or sedatives.
Abstract: Maternal use of certain drugs during pregnancy can result in transient neonatal signs consistent with withdrawal or acute toxicity or cause sustained signs consistent with a lasting drug effect. In addition, hospitalized infants who are treated with opioids or benzodiazepines to provide analgesia or sedation may be at risk for manifesting signs of withdrawal. This statement updates information about the clinical presentation of infants exposed to intrauterine drugs and the therapeutic options for treatment of withdrawal and is expanded to include evidence-based approaches to the management of the hospitalized infant who requires weaning from analgesics or sedatives.

748 citations

Journal ArticleDOI
TL;DR: This updated policy statement provides a review of data supporting evidence for a tiered provision of care and reaffirms the need for uniform, nationally applicable definitions and consistent standards of service for public health to improve neonatal outcomes.
Abstract: The concept of designations for hospital facilities that care for newborn infants according to the level of complexity of care provided was first proposed in 1976. Subsequent diversity in the definitions and application of levels of care has complicated facility-based evaluation of clinical outcomes, resource allocation and utilization, and service delivery. We review data supporting the need for uniform nationally applicable definitions and the clinical basis for a proposed classification based on complexity of care. Facilities that provide hospital care for newborn infants should be classified on the basis of functional capabilities, and these facilities should be organized within a regionalized system of perinatal care.

745 citations

Journal ArticleDOI
TL;DR: Inhaled nitric oxide improves systemic oxygenation in infants with persistent pulmonary hypertension and may reduce the need for more invasive treatments.
Abstract: Background Persistent pulmonary hypertension of the newborn causes systemic arterial hypoxemia because of increased pulmonary vascular resistance and right-to-left shunting of deoxygenated blood. Inhaled nitric oxide decreases pulmonary vascular resistance in newborns. We studied whether inhaled nitric oxide decreases severe hypoxemia in infants with persistent pulmonary hypertension. Methods In a prospective, multicenter study, 58 full-term infants with severe hypoxemia and persistent pulmonary hypertension were randomly assigned to breathe either a control gas (nitrogen) or nitric oxide (80 parts per million), mixed with oxygen from a ventilator. If oxygenation increased after 20 minutes and systemic blood pressure did not decrease, the treatment was considered successful and was continued at lower concentrations. Otherwise, it was discontinued and alternative therapies, including extracorporeal membrane oxygenation, were used. Results Inhaled nitric oxide successfully doubled systemic oxygenation in 16 of 30 infants (53 percent), whereas conventional therapy without inhaled nitric oxide increased oxygenation in only 2 of 28 infants (7 percent). Long-term therapy with inhaled nitric oxide sustained systemic oxygenation in 75 percent of the infants who had initial improvement. Extracorporeal membrane oxygenation was required in 71 percent of the control group and 40 percent of the nitric oxide group (P=0.02). The number of deaths was similar in the two groups. Inhaled nitric oxide did not cause systemic hypotension or increase methemoglobin levels. Conclusions Inhaled nitric oxide improves systemic oxygenation in infants with persistent pulmonary hypertension and may reduce the need for more invasive treatments.

735 citations

Journal ArticleDOI
TL;DR: The purpose of this clinical report is to provide a practical and, when possible, evidence-based approach to the management of infants with suspected or proven early-onset sepsis.
Abstract: With improved obstetrical management and evidence-based use of intrapartum antimicrobial therapy, early-onset neonatal sepsis is becoming less frequent. However, early-onset sepsis remains one of the most common causes of neonatal morbidity and mortality in the preterm population. The identification of neonates at risk for early-onset sepsis is frequently based on a constellation of perinatal risk factors that are neither sensitive nor specific. Furthermore, diagnostic tests for neonatal sepsis have a poor positive predictive accuracy. As a result, clinicians often treat well-appearing infants for extended periods of time, even when bacterial cultures are negative. The optimal treatment of infants with suspected early-onset sepsis is broad-spectrum antimicrobial agents (ampicillin and an aminoglycoside). Once a pathogen is identified, antimicrobial therapy should be narrowed (unless synergism is needed). Recent data suggest an association between prolonged empirical treatment of preterm infants (≥5 days) with broad-spectrum antibiotics and higher risks of late onset sepsis, necrotizing enterocolitis, and mortality. To reduce these risks, antimicrobial therapy should be discontinued at 48 hours in clinical situations in which the probability of sepsis is low. The purpose of this clinical report is to provide a practical and, when possible, evidence-based approach to the management of infants with suspected or proven early-onset sepsis.

675 citations


Cited by
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Journal ArticleDOI
TL;DR: Evidence-based recommendations can be made regarding many aspects of the acute management of sepsis and septic shock that will hopefully translate into improved outcomes for the critically ill patient.
Abstract: To develop management guidelines for severe sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis. The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations built upon a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along 5 levels to create recommendation grades from A–E, with A being the highest grade. Pediatric considerations were provided to contrast adult and pediatric management. Participants included 44 critical care and infectious disease experts representing 11 international organizations. A total of 46 recommendations plus pediatric management considerations. Evidence-based recommendations can be made regarding many aspects of the acute management of sepsis and septic shock that will hopefully translate into improved outcomes for the critically ill patient. The impact of these guidelines will be formally tested and guidelines updated annually, and even more rapidly when some important new knowledge becomes available.

3,703 citations

01 Sep 2008
TL;DR: The Methodology used to Prepare the Guideline Epidemiology Incidence Etiology and Recommendations for Assessing Response to Therapy Suggested Performance Indicators is summarized.
Abstract: Executive Summary Introduction Methodology Used to Prepare the Guideline Epidemiology Incidence Etiology Major Epidemiologic Points Pathogenesis Major Points for Pathogenesis Modifiable Risk Factors Intubation and Mechanical Ventilation Aspiration, Body Position, and Enteral Feeding Modulation of Colonization: Oral Antiseptics and Antibiotics Stress Bleeding Prophylaxis, Transfusion, and Glucose Control Major Points and Recommendations for Modifiable Risk Factors Diagnostic Testing Major Points and Recommendations for Diagnosis Diagnostic Strategies and Approaches Clinical Strategy Bacteriologic Strategy Recommended Diagnostic Strategy Major Points and Recommendations for Comparing Diagnostic Strategies Antibiotic Treatment of Hospital-acquired Pneumonia General Approach Initial Empiric Antibiotic Therapy Appropriate Antibiotic Selection and Adequate Dosing Local Instillation and Aerosolized Antibiotics Combination versus Monotherapy Duration of Therapy Major Points and Recommendations for Optimal Antibiotic Therapy Specific Antibiotic Regimens Antibiotic Heterogeneity and Antibiotic Cycling Response to Therapy Modification of Empiric Antibiotic Regimens Defining the Normal Pattern of Resolution Reasons for Deterioration or Nonresolution Evaluation of the Nonresponding Patient Major Points and Recommendations for Assessing Response to Therapy Suggested Performance Indicators

2,961 citations

Journal ArticleDOI
TL;DR: These guidelines provide a framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation and recommend that clinicians promote and support successful breastfeeding and treat newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbil Kirubin encephalopathy.
Abstract: Jaundice occurs in most newborn infants. Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus. The focus of this guideline is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy while minimizing the risks of unintended harm such as maternal anxiety, decreased breastfeeding, and unnecessary costs or treatment. Although kernicterus should almost always be preventable, cases continue to occur. These guidelines provide a framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. In every infant, we recommend that clinicians 1) promote and support successful breastfeeding; 2) perform a systematic assessment before discharge for the risk of severe hyperbilirubinemia; 3) provide early and focused follow-up based on the risk assessment; and 4) when indicated, treat newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia and, possibly, bilirubin encephalopathy (kernicterus).

2,383 citations

Journal Article
TL;DR: This revision of the General Recommendations on Immunization updates the 1989 statement and changes in the immunization schedule for infants and children include recommendations that the third dose of oral polio vaccine be administered routinely at 6 months of age rather than at age 15 months.
Abstract: This report is a revision of General Recommendations on Immunization and updates the 2002 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices and the American Academy of Family Physicians. MMWR 2002;51[No. RR-2]). This report is intended to serve as a general reference on vaccines and immunization. The principal changes include 1) expansion of the discussion of vaccination spacing and timing; 2) an increased emphasis on the importance of injection technique/age/body mass in determining appropriate needle length; 3) expansion of the discussion of storage and handling of vaccines, with a table defining the appropriate storage temperature range for inactivated and live vaccines; 4) expansion of the discussion of altered immunocompetence, including new recommendations about use of live-attenuated vaccines with therapeutic monoclonal antibodies; and 5) minor changes to the recommendations about vaccination during pregnancy and vaccination of internationally adopted children, in accordance with new ACIP vaccine-specific recommendations for use of inactivated influenza vaccine and hepatitis B vaccine. The most recent ACIP recommendations for each specific vaccine should be consulted for comprehensive discussion. This report, ACIP recommendations for each vaccine, and other information about vaccination can be accessed at CDC's National Center for Immunization and Respiratory Diseases (proposed) (formerly known as the National Immunization Program) website at http//:www.cdc.gov/nip.

1,687 citations

Journal ArticleDOI
TL;DR: The Joint Committee on Infant Hearing (JCIH) endorses early detection of and intervention for infants with hearing loss and EHDI systems should guarantee seamless transitions for infants and their families through this process.
Abstract: THE POSITION STATEMENT The Joint Committee on Infant Hearing (JCIH) endorses early detection of and intervention for infants with hearing loss. The goal of early hearing detection and intervention (EHDI) is to maximize linguistic competence and literacy development for children who are deaf or hard of hearing. Without appropriate opportunities to learn language, these children will fall behind their hearing peers in communication, cognition, reading, and social-emotional development. Such delays may result in lower educational and employment levels in adulthood.1 To maximize the outcome for infants who are deaf or hard of hearing, the hearing of all infants should be screened at no later than 1 month of age. Those who do not pass screening should have a comprehensive audiological evaluation at no later than 3 months of age. Infants with confirmed hearing loss should receive appropriate intervention at no later than 6 months of age from health care and education professionals with expertise in hearing loss and deafness in infants and young children. Regardless of previous hearing-screening outcomes, all infants with or without risk factors should receive ongoing surveillance of communicative development beginning at 2 months of age during well-child visits in the medical home.2 EHDI systems should guarantee seamless transitions for infants and their families through this process.

1,622 citations