Contents Chapter Topic Page Neonatology Respiratory Cardiology

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Cautions Hyperkalaemia. Addition of potassium is rarely required in first three days of life unless the serum potassium is < 4.00 mmol/l. Also use caution when prescribing in renal impairment. A minimal amount is inevitable in TPN because of the type of amino acid formulation used. Hypocalcaemia. May result from inadvertent use of excess phosphate. Corrects with reduction of phosphate. NEVER add bicarbonate, it will precipitate calcium carbonate out. NEVER add extra calcium to the burette, it will precipitate out the phosphate. 4. Complications 4.1. Delivery The line delivering the TPN may be compromised by; Sepsis, minimized by maintaining strict sterility of the line during and after insertion. Malposition, x-ray mandatory before infusion commences. Thrombophlebitis, with peripheral lines, requiring close observation of infusion sites. Extravasation into the soft tissue, with resulting tissue necrosis. 4.2. Metabolic complications Hyperglycaemia Hyperlipidaemia Cholestasis 5. Monitoring TPN administration requires careful clinical and laboratory monitoring Before starting an infant on parenteral nutrition, investigation required: full blood count /haematocrit, renal profile liver function test random blood sugar/dextrostix serum bilirubin While on TPN, monitoring required : 5.1. Laboratory Full blood count, renal profile. Required daily for 1 week then 3 times a week Plasma calcium, magnesium, and phosphate. Twice a week until stable then weekly Lipid levels. Twice a week first week then weekly unless complication arises (sepsis etc) Long term TPN (> 2 weeks duration) requires, liver function tests. 5.2 Clinical Blood sugar / dextrostix, 4-6 hrly first 3 days, twice a day once stable.
Daily weight Meticulous care of the catheter site and monitoring of infection. This protocol is adapted from : 1 .Feeding in the Neonatal Unit Dato Dr.Lim Nyok Ling, Consultant Neonatologist, Hospital Selayang. 2. Total Parenteral Nutrition for Neonates. Department of Neonatal Medicine Protocol Book Royal Prince Alfred Hospital. 3. Total Parenteral Nutrition for Premature Infants Elizabeth Brine, MMSc, RD; Judith A. Ernst, DMSc, RD 4. <strong>Neonatology</strong> on the Web Teaching Files: Parenteral Nutrition (PN) for Neonate Ray Duncan, MD, Staff Neonatologist, Cedars-Sinai Medical Center, Los Angeles, California.
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Contents Chapter Topic Page 1 Norma
Page 3 and 4:
Dermatology 67 Atopic Dermatitis…
Page 5 and 6:
Dato’ Dr. Lim Nyok Ling Consultan
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ISSN 1823-3856 Printed by: Perniaga
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Foreword One of the maxims of scien
Page 11 and 12: B. Anthropometric Measurements a) H
Page 13 and 14: Immunisation 1. Immunisation schedu
Page 15 and 16: 2 General Notes 2.1 Many vaccines (
Page 17 and 18: 3.5.6 Rubella - Contraindicated in
Page 19 and 20: 4.8 Rubella May have rash, fever,
Page 21 and 22: 5.5 Close contacts of immuno-defici
Page 23 and 24: Developmental Assessment Developmen
Page 25 and 26: Hearing Assessment Warning signs fo
Page 27 and 28: Global Developmental Delay History
Page 29 and 30: Developmental Milestones Table AGE
Page 31 and 32: AGE Gross Motor Vision & Fine Motor
Page 33 and 34: Principles of Transport of the Sick
Page 35 and 36: 3.1 Airway Management Establish a p
Page 37 and 38: 3.7 Environment Neutral Thermal Env
Page 39 and 40: 7. Special Surgical Conditions 7.1
Page 41 and 42: • Ventilation - Most of the babie
Page 43 and 44: Neonatal Resuscitation High Risk De
Page 45 and 46: • Drugs are available (and prepar
Page 47 and 48: Meconium stained liquor: Meconium i
Page 49 and 50: Summary: Use of medications during
Page 51 and 52: Definition Premature infant: < 37 w
Page 53 and 54: 8. Supplements: a. At birth : Vitam
Page 55 and 56: Enteral Feeding in Neonates 1. Intr
Page 57 and 58: 32 weeks Well babies Start milk imm
Page 59 and 60: Total Parenteral Nutrition for Neon
Page 61: Clearance is usually monitored by m
Page 65 and 66: Monitor BUSE and correct any imbala
Page 67 and 68: C. UAC and UVC care UAC position Le
Page 69 and 70: HIGH FREQUENCY OSCILLATORY VENTILAT
Page 71 and 72: 6. Infants must be monitored closel
Page 73 and 74: pH , PaCO2, PaO2, HCO3 - , Bases Ex
Page 75 and 76: Q. Name a likely diagnosis A. RDS 3
Page 77 and 78: A. Definition Birth Asphyxia There
Page 79 and 80: E. Management I. Good intrapartum c
Page 81 and 82: c. All doctors managing such infant
Page 83 and 84: Etiology Determination of etiology
Page 85 and 86: FLOW CHART: MANAGEMENT OF NEONATAL
Page 87 and 88: 2. Klauss & Fanaroff: Care of The H
Page 89 and 90: D. Asymptomatic Hypoglycaemia Feed
Page 91 and 92: NEONATAL JAUNDICE What is jaundice?
Page 93 and 94: Physical examination • General co
Page 95 and 96: Once the baby is on phototherapy, v
Page 97 and 98: Reference: extracted from MOH publi
Page 99 and 100: - 1ml of 4.2% NaHCO3 given for ever
Page 101 and 102: a. If unconjugated hyperbilirubinae
Page 103 and 104: APNOEA IN THE NEWBORN Definition :
Page 105 and 106: History NEONATAL SEPSIS Septic Neon
Page 107: Antibiotic choice will depend on pr
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Contents Chapter Topic Page Neonatology Respiratory Cardiology

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