Contents Chapter Topic Page Neonatology Respiratory Cardiology

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Table 1 Agents to be avoided in G6PD Deficiency Patients 1) Foods and Herbs to be avoided Fava Beans (Kacang Parang) Documented Chinese herbs/medicine Chuen Lin San Chi 13 herbs 12 herbs Other traditional herbs/medications are also not to be taken unless with medical advice 2) Other chemicals to be avoided Naphthalene (moth balls) Mosquito coils and insect repellants which contains pyrethium 3) Drugs to be avoided or contraindicated Acetanilide Doxorubicin Furazolidone Methylene Blue Nalidixic acid Niridazole Nitrofurantoin Phenazopyridine Primaquine Sulfamethoxazole Bactrim MANAGEMENT OF NNJ 4) Drugs that can be safely given in therapeutic doses Paracetamol Ascorbic Acid Aspirin Chloramphenicol Chloroquine Colchicine Diphenhydramine Isoniazid Phenacetin Phenylbutazone Phenytoin Probenecid Procainamide Pyrimethamine Quinidine Streptomycin Sulfisoxazole Trimethoprim Tripelennamine Vitamin K Mefloquine History: The following information needs to be obtained: • Age of onset and rate of progress (both clinically and also if serial serum bilirubin (SB) results are available) • Previous infants with NNJ, kernicterus, neonatal death, G6PD deficiency • Mother’s blood group (from antenatal history) • Gestation: although term gestation is taken as 37 completed weeks, infants born at 37- 38 weeks of gestation are more prone to hyperbilirubinaemia, the incidence of hyperbilirubinaemia increasing with decreasing gestational age. • Presence of abnormal symptoms such as apnoea, difficulty in feeding, feed intolerance and temperature instability.
Physical examination • General condition: ill-looking if jaundice is severe or if there is presence of some other illnesses e.g. infection. Neurological signs are present if kernicterus develops. • Pallor, presence of cephalohaematoma/subaponeurotic haematoma, petechiae, purpura, ecchymosis , and hepatosplenomegaly implicate a pathological cause of jaundice • Cephalo-caudal progression of severity of jaundice may be seen in some infants, but correlating with levels of bilirubin is often inaccurate • Intensity of yellow discoloration in skin and mucosa helps with assessment of the severity of jaundice When should a neonate be referred for hospital management? (When to worry?) The following are indications for referral. 1. Jaundice below umbilicus, corresponding to serum bilirubin of 12-15 mg/dl (200- 250 µmol/L). 2. Jaundice up to level of the sole of the feet - likely to need exchange transfusion. 3. Jaundice within 24 hours of life. 4. Rapid rise of serum bilirubin of more than 8.5 µmol/L/hour (>0.5 mg/dl/hour). 5. Prolonged jaundice of more than 14 days - other causes/conditions need to be excluded e.g. neonatal hepatitis, biliary atresia. 6. Family history of significant haemolytic disease or kernicterus 7. Clinical symptoms/signs suggestive of other diseases e.g. sepsis. Laboratory diagnosis Investigations for NNJ include: • Total serum bilirubin – sufficient in most cases • Unconjugated & conjugated fractions in specific conditions e.g. prolonged NNJ • Infant’s blood group, maternal blood group (if not already known) • Direct Coomb’s test (if blood group incompatibility is suspected) • G6PD status (if not known yet) • Full blood count • Reticulocyte count • Peripheral blood film • Blood culture, urine microscopy and culture ( if infection is suspected) Treatment PHOTOTHERAPY The aim of phototherapy is to prevent potentially dangerous indirect bilirubin levels and to decrease the need for exchange transfusion, since phototherapy changes bilirubin into more soluble forms to be excreted in the bile or urine. The effectiveness of phototherapy is affected by the intensity, or irradiance, of the phototherapy light, increased irradiance producing increased effectiveness, until the saturation dose of 40 µW/cm 2 /nm of appropriate light is reached. The minimum irradiance is 6-12 µW/cm 2 /nm. Other factors affecting the effectiveness are the spectrum of light delivered by the phototherapy unit, the surface area of the infant exposed to phototherapy, and the
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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
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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 and 90: D. Asymptomatic Hypoglycaemia Feed
Page 91: NEONATAL JAUNDICE What is jaundice?
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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