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Development, Function, and Pathology of the Placenta

Key Points The placenta is the first organ to form in mammals and is required for establishment of a maternal–fetal vascular interface capable of supplying the bioenergetic needs of the developing conceptus. Multiple placental cell types engage in highly varied functions, from attachment, invasion, and vascular remodeling to cell fusion, hormone production, and nutrient transport. Multiple mechanisms allow transport of waste and nutrients across the placenta,…

Ethics, Data, and Policy in Newborn Intensive Care

Key Points Increasingly available data in neonatal intensive care may help guide ethical decision-making about sick infants. Despite better ability to predict outcomes for sick infants, prognostic efforts are imperfect. When using data to guide decision-making in the neonatal intensive care unit, it is important to choose appropriate outcomes that match families’ values. There are policy implications to both limited data, as in predicting outcomes for…

Neonatal and Perinatal Epidemiology

Key Points Maternal and child health in the population have traditionally been assessed by monitoring two key statistics—the maternal mortality ratio and the infant mortality rate. The infant mortality rate is the sum of the neonatal mortality and post-neonatal mortality rates. Due to improvements in income, housing, birth spacing, and nutrition, along with public health interventions to produce cleaner food and water, improve maternal and infant…

Acute Frostbite

Skin and soft tissue are readily susceptible to injury at either end of the temperature spectrum. With exposure to cold, unprotected tissues can readily become frostbitten and/or hypothermic (aka frostnip); these are two distinct but often linked injuries. In the past, skin, limbs, and digits sustaining severe frostbite injury had predictable outcomes: sloughing or amputation. The only question was how long to wait to amputate. Essentially,…

Spinal Cord Injury

Introduction Spinal cord injury (SCI) is a devastating, life-altering event for patients and their families. In spite of decades of innovative research in the field, no pharmacologic “silver bullet” has been developed that can mitigate or cure the extent of neurologic impairment in SCI patients. Preservation of function by providing early stability to the injured spine followed by neurorehabilitation remains the current standard of care. Surgical…

Cervical Spine Fractures

The purpose of this chapter is to outline a stepwise approach to C-spine fractures to aid in the safe and expedient work-up for these potentially complex injuries. The inclusion of some of the specific classifications employed by spine surgeons and the stepwise progression through localization, anatomy, neurologic status, stability, and disposition allow the reader to critically evaluate the nuances of the injury in anticipation of definitive…