Contents Chapter Topic Page Neonatology Respiratory Cardiology

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Key points: A. Serial blood glucose should be routinely monitored in infants who have risk factors for hypoglycaemia B Bolus injections of large volumes of hypertonic glucose solutions should be avoided - dangerous to neurological function and may be followed by a rebound hypoglycaemia, cerebral oedema and is caustic to neonatal veins. C Milk formula provide more energy/ml than 10% dextrose and supply important nonglucose fuels, which have a glucose sparing role in neurological function. (Energy content of formula milk is 2750 kJ/l while that of 10% D is 1600 kJ/l). It promotes ketogenesis and gut maturation. Breast-feeding should be encouraged as it is more ketogenic. D. Milk feeds must not be discontinued or reduced when intravenous fluids are given unless the child develops NEC or other causes of feeding intolerance. The recommended practice is to feed the baby with as much milk as is tolerated and to infuse glucose at a rate sufficient to prevent hypoglycaemia. The IV glucose is then reduced slowly while milk feeds is maintained or increased. May need to continue over a few days. E. Ensure volume of intravenous fluid is appropriate for patient, taking into consideration concomitant problems like cardiac failure, cerebral oedema and renal failure. If unable to increase volume further, concentration of dextrose to be increased. Glucose requirement (mg/kg/min) = % of dextrose x rate (ml/hr) x 0.167 ------------------------------------------------------wt (kg) F. Plasma glucose is 13-18% higher than whole blood glucose. Arterial blood has higher glucose concentration than venous blood. Capillary sampling can be unreliable in the presence of poor peripheral circulation. G. Requirement of >9mg/kg/min suggests hyperinsulinism. Truly hyperinsulinaemic babies may require 15-20 mg/kg/min References Koh G Aynsley-Green A 1988a Neonatal hypoglycaemia- the controversy definition. Arch Dis Childhood;63:1386-1398 Koh G Aynsley-Green A Tarbit A Etre J 1988b Neural dysfunction during hypoglycaemia. Arch Dis Childhood;63:1353-1358 DK Pal et al 2000 Neonatal hypoglycaemia in Nepal. Prevalence and risk factors Arch Dis Childhood;82:F46-52 AA M Moris et al 1996 Evaluation of fast for investigating hypoglycaemia or suspected metabolic disease Arch Dis Childhood;75:115-119 Gomella, Cunningham ,Eyal and Zenk: Neonatalogy 4 th edition Lange
NEONATAL JAUNDICE What is jaundice? Jaundice is apparent clinically when the level of bilirubin in the serum rises above 85µmol/l (5mg/dl). Physiological jaundice is a reflection of the bilirubin load to the liver, rate of hepatic excretion (liver maturity) and ability of the serum binding protein to retain the bilirubin within the plasma. What can go wrong in jaundice? Elevated serum bilirubin can result in kernicterus, when unconjugated bilirubin is deposited in the cell wall of neurons in basal ganglia, brain stem and cerebellum resulting in cell death. Kernicterus is associated with a high mortality, and survivors usually suffer sequelae like athetoid cerebral palsy, high frequency hearing loss, paralysis of upward gaze and dental dysplasia. The factors influencing bilirubin toxicity in the brain cells of the neonate are complex and incompletely understood. There is no specific level of total serum bilirubin above which kernicterus can be predicted to happen. Causes of neonatal jaundice (NNJ) The following are the recognised causes of NNJ: • Haemolysis due to ABO or Rh isoimmunisation, G6PD deficiency, microspherocytosis, drugs • Physiological jaundice & idiopathic jaundice • Polycythaemia • Sepsis e.g. septicaemia, meningitis, urinary tract infection and intra-uterine infection • Breastfeeding and breastmilk jaundice Factors affecting severity of NNJ The following factors are said to affect the severity of jaundice • Dehydration • Large weight loss after birth • Extravasation of blood, cephalohaematoma, contusion • Swallowed maternal blood • Infant of diabetic mother • Acidosis • Asphyxia • Gastrointestinal tract obstruction: increase in enterohepatic circulation G6PD deficiency G6PD deficiency is an inherited disorder of the red blood cell, inherited in an x-linked recessive manner – males are affected while the females are carriers. G6PD is an enzyme essential in keeping glutathione in the reduced state that in turn is vital to maintain the integrity of the red cell membrane. In G6PD deficiency the red blood cells are prone to haemolysis when exposed to oxidants or when certain foods or herbs are ingested. A list of drugs and herbs that can precipitate haemolysis is provided in Table 1 .
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Contents Chapter Topic Page 1 Norma
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Dermatology 67 Atopic Dermatitis…
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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
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B. Anthropometric Measurements a) H
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Immunisation 1. Immunisation schedu
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2 General Notes 2.1 Many vaccines (
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3.5.6 Rubella - Contraindicated in
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4.8 Rubella May have rash, fever,
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5.5 Close contacts of immuno-defici
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Developmental Assessment Developmen
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Hearing Assessment Warning signs fo
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Global Developmental Delay History
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Developmental Milestones Table AGE
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AGE Gross Motor Vision & Fine Motor
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Principles of Transport of the Sick
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3.1 Airway Management Establish a p
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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 and 62: Clearance is usually monitored by m
Page 63 and 64: Daily weight Meticulous care of th
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: D. Asymptomatic Hypoglycaemia Feed
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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