Contents Chapter Topic Page Neonatology Respiratory Cardiology

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Breastfeeding and Breastmilk Jaundice Two types of NNJ are associated with breastfeeding, the first known as breastfeeding jaundice is related to inadequate nursing on the breast resulting in dehydration and otherwise physiological jaundice becoming more intense; and the second is breastmilk jaundice which is associated with prolonged jaundice extending beyond the first two weeks of life. One or more substances in breastmilk e.g. beta glucuronidase may be responsible for breastmilk jaundice. PREVENTIVE MEASURES for SEVERE NNJ Evaluation 1. Maternal prenatal testing should include ABO and Rh(D) typing. When the mother is Rh-negative, a direct Coombs’ test, ABO blood type, and an Rh(D) type on the infant’s (cord) blood are recommended 2. All infants must have a glucose-6-phosphate dehydrogenase (G6PD) screening done on cord blood. The results of G6PD screening must be known before discharge. Babies with G6PD deficiency must be observed in hospital for at least 5 days, the period of highest risk for severe jaundice. During this period parents should be educated on the disorder (e.g. avoidance of certain oxidising drugs and foods) and monitoring of jaundice can be closely observed and monitored. Breastfeeding must be encouraged and supported but mothers must avoid taking herbs that have not been found to be safe and certain foods (e.g. fava beans) 3. Infants whose mothers are of O blood group and infants with a strong family history of severe neonatal jaundice should be observed for at least 24 hours in the ward. If earlier discharge is necessary, arrangements must be made for these infants to be reviewed the next day. 4. Mothers must be assisted and provided support to manage breastfeeding successfully before discharge. 5. Parents must be alerted to the significance of early onset (within 24 hours) and severe jaundice and advised that in these situations medical attention is necessary. 6. Follow-up should be provided to all neonates discharged less than 48 hours after birth by a health care professional in an ambulatory setting, or at home within 2-3 days of discharge 7. Approximately one third of healthy breast-fed infants have persistent jaundice after 2 weeks of age. A measurement of total and direct serum bilirubin should be obtained and a history of dark urine or light stools should be sought. If the history, physical examination and direct bilirubin results are normal, continued observation is appropriate. Treatment of Jaundice Associated with Breast-feeding in the Healthy Term Newborn 1. Interruption of breastfeeding in healthy term newborns is discouraged and frequent breast-feeding (at least 8-10 times every 24 hours) should be continued. 2. Supplementation of breast-feeding with formula with or without phototherapy can be considered. Supplementing with water or dextrose water does not lower bilirubin level in jaundiced, healthy, breast-feeding infants.
Reference: extracted from MOH publications 1. CPG on Management of Jaundice in Healthy Term Newborns 2. Guideline on Screening and Management of NNJ with Special Emphasis on G6PD Deficiency
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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
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• Ventilation - Most of the babie
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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 and 92: NEONATAL JAUNDICE What is jaundice?
Page 93 and 94: Physical examination • General co
Page 95: Once the baby is on phototherapy, v
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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