Anemia of Prematurity - Portal Neonatal

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• Observe the position of the infant's lips on the areola. Typically, the lips should be 1-1.5 inches (2.5-3.8 cm) beyond the base of the nipple. • Observe the lower lip. If folded in, suckling does not occur. The lips should be flanged. • Observe the presentation of breast to the infant and the mother's assisting the infant to latchon. • Observe the response of the infant to lower lip stimulus. The infant should open his or her mouth wide to allow the insertion of the nipple and areola. • Observe the motion of the masseter muscle during suckling, and listen for sounds of swallowing. • Observe the mother's comfort level, and ensure that she is not having breast pain. One should reinforce a mother's own physiologic cues during breastfeeding. A mother's letdown is the interplay of her physiologic response to suckling and her emotional state. Prolactin, the hormone responsible for letdown, is inhibited by stress (mediated by dopamine, norepinephrine, and epinephrine). The mother's relaxation ensures adequate letdown and the continued adequacy of breastfeeding. Putting the infant to breast 8-12 times a day during the first 4-5 days after birth ensures the creation of an adequate milk supply, which the infant's use later regulates. A mother who responds to her infant's cry with letdown and who breastfeeds her infant on demand (ie, unrestricted breastfeeding) is more successful with continued lactation than the mother who breastfeeds according to the clock. The recommendation for mothers to use systematic or controlled timed feedings to help regulate the baby's cycles is fraught with misinformation. A mother should be empowered to follow the internal schedule that is appropriate for her and her baby. FACTORS AFFECTING THE MATERNAL MILK SUPPLY Section 5 of 11 True difficulties in the supplying of milk are most commonly related to the irregular or incomplete removal of milk. In the human mammary gland, lactation is under autocrine control in which the frequency and degree of milk removal appears to regulate an inhibitory peptide present in the milk. In other words, if the milk is not removed, this inhibitory peptide accumulates and subsequently decreases the synthesis of milk. If the milk is removed frequently, this inhibitory peptide does not accumulate, and milk synthesis increases. Although most women are capable of producing more milk than their infants require, more than half of breastfeeding mothers perceive that their milk supply as inadequate. A mother may state that her milk is not in and that her infant is not getting enough milk. This misperception is most common during the immediate postpartum period. The neonate's requirements for fluid gradually increase over the first few days; ideally, the neonate frequently ingests milk in small volumes. As the baby's GI tract becomes more regulated and functional and as the stomach volume increases, the baby's milk intake increases. The composition changes of the milk from colostrum to mature milk, which has a higher energy density (ie, caloric density) because of its higher fat content. Mothers should be encouraged to breastfeed at least 8-12 times during the immediate postpartum period to increase their milk supply. If a mother breastfeeds only 4-5 times during those early days, her milk production is delayed. Infrequent breastfeeding is associated with neonatal jaundice (referred to as breastfeeding jaundice or dehydration jaundice) and the early cessation of breastfeeding. Another perception of inadequate milk supply is related to the infant's growth spurts. During periods of enhanced growth, the infant may be more irritable and may seek the breast more often. These growth spurts usually resolve in about 1 week. Growth spurts should be explained to the mother to prevent undue stress or interruptions in breastfeeding. Because the milk supply is directly related to its removal and ongoing synthesis, factors that hinder milk removal affect milk production. Factors that could disrupt the complete removal of milk are numerous (see Recognition and Management of Common Breastfeeding Problems). For example,
stress and fatigue in both parents may have an impact on the mother's milk production. Evaluating for these risk factors in the mother-infant dyad is essential to ensure that the milk supply is sufficient and that breastfeeding difficulties are not perpetuated. If an infant is ill, a mother typically uses a breast pump to remove and store her milk. Premature infants who are first learning to breastfeed may be ineffective at milk removal. Some infants have neurologic disabilities or suck-swallow incoordination (common among premature infants born at
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e.medecine NEONATOLOGY 2006
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24. Neonatal Hypertension..........
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Although EPO is not the only erythr
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Causes: • AOP results from a comb
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• Reducing the number of donor ex
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FOLLOW-UP Section 8 of 10 Further O
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Apnea of Prematurity Last Updated:
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The primary problem for premature n
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pressure. Bradycardia may begin wit
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TREATMENT Section 6 of 11 Medical C
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Drug Name Doxapram (Dopram) -- Stim
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Prognosis: • The natural history
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o Despite the number of premature i
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BIBLIOGRAPHY Section 11 of 11 • B
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Tidal volume is the volume of gas i
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5 time constants. The resulting tim
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Once the diagnosis of RDS is establ
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PATHOPHYSIOLOGY-BASED VENTILATORY S
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High-frequency ventilation:High-fre
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Picture 2. Determinants of oxygenat
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Birth Trauma Last Updated: August 4
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The extent of hemorrhage may be sev
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CRANIAL NERVE AND SPINAL CORD INJUR
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unpredictable unavoidable complicat
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Bowel Obstruction in the Newborn La
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The prenatal diagnosis of a bowel o
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demonstrate the normal fixation pat
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Other causes of proximal bowel obst
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Hirschsprung disease Hirschsprung d
Page 59 and 60: POSTOPERATIVE CARE FOLLOWING SURGER
Page 61 and 62: Picture 4. Bowel obstruction in the
Page 63 and 64: Breast Milk Jaundice Last Updated:
Page 65 and 66: DIFFERENTIALS Section 4 of 9 Anemia
Page 67 and 68: Consultations: Diet: • Consider c
Page 69 and 70: Bronchopulmonary Dysplasia Last Upd
Page 71 and 72: CLINICAL Section 3 of 11 History: B
Page 73 and 74: of BPD and in the need for continue
Page 75 and 76: Physical: • Infants with BPD have
Page 77 and 78: discomfort. Many new synchronized v
Page 79 and 80: treat acute bronchospasm; however,
Page 81 and 82: • Excessive glucose loads may inc
Page 83 and 84: Interactions Beta-adrenergic blocke
Page 85 and 86: Drug Category: Pulmonary vasodilato
Page 87 and 88: MISCELLANEOUS Section 9 of 11 Medic
Page 89 and 90: • Frank L, Groseclose E: Oxygen t
Page 91 and 92: • Northway WH Jr: Bronchopulmonar
Page 93 and 94: Congenital Diaphragmatic Hernia Las
Page 95 and 96: DIFFERENTIALS Section 4 of 10 Aspir
Page 97 and 98: o Inhaled nitric oxide may be used
Page 99 and 100: Drug Name Pediatric Dose Contraindi
Page 101 and 102: Drug Name Pediatric Dose Vecuronium
Page 103 and 104: Prognosis: • Pulmonary recovery:
Page 105 and 106: • O'Toole SJ, Irish MS, Holm BA:
Page 107 and 108: This article reviews the mechanics
Page 109: Positioning the infant Positioning
Page 113 and 114: As the mother's milk supply is esta
Page 115 and 116: Engorgement Engorgement is a common
Page 117 and 118: Ethical Issues in Neonatal Care Las
Page 119 and 120: GOALS OF NEONATAL INTENSIVE CARE Se
Page 121 and 122: Other guidelines of ethical import
Page 123 and 124: In some situations, tragic situatio
Page 125 and 126: BIBLIOGRAPHY Section 8 of 8 • AAP
Page 127 and 128: CLINICAL FEATURES Section 4 of 7 Th
Page 129 and 130: Comparisons of the nutrient content
Page 131 and 132: Indomethacin is used prophylactical
Page 133 and 134: FOLLOW-UP CARE Section 5 of 7 Nearl
Page 135 and 136: BIBLIOGRAPHY Section 7 of 7 • Bha
Page 137 and 138: Fluid, Electrolyte, and Nutrition M
Page 139 and 140: Clinical evaluation • Weight fact
Page 141 and 142: o Hypernatremia is defined as a ser
Page 143 and 144: intake from protein is included in
Page 145 and 146: Energy ENTERAL NUTRITION MANAGEMENT
Page 147 and 148: growth and bone mineral content has
Page 149 and 150: Hemolytic Disease of Newborn Last U
Page 151 and 152: CLINICAL Section 3 of 11 History: W
Page 153 and 154: • Serologic tests Imaging Studies
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Page 159 and 160: � The mechanism by which unconjug
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BIBLIOGRAPHY Section 11 of 11 • B
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Race: No racial predilection exists
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Drug Name Pediatric Dose Phytonadio
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Human Milk and Lactation Last Updat
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LACTATION Section 5 of 11 Two essen
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IMMUNOLOGIC PROPERTIES OF HUMAN MIL
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Picture 3. Human milk and lactation
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• Isaacs CE, Thormar H: The role
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Hydrops Fetalis Last Updated: June
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Also of note is a computer simulati
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Physical: The presence of any of th
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o Once disorders of hemoglobin alph
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Structural anomalies Table 2. Cardi
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o B19V o Cytomegalovirus (CMV) o Sy
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o Sjögren syndrome A (uncertain in
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most commonly thrombocytopenia, is
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Lab Studies: WORKUP Section 5 of 10
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o Karyotyping is always indicated i
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• Space-occupying masses, which i
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of antidiabetic agents and antagoni
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Drug Name Sotalol (Betapace) -- Rec
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• Cowan RH, Waldo AL, Harris HB:
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• Silverman NH, Schmidt KG: Ventr
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At the cellular level, neuronal inj
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o Disturbances of ocular motion, su
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DIFFERENTIALS Section 4 of 10 Methy
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Interactions Benzodiazepines, cimet
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o Allopurinol: Slight improvements
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• Patel J, Edwards AD: Prediction
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Increased insulin levels stimulate
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irth; symptoms may include jitterin
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speculated to be secondary to incre
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Procedures: o Clinical features of
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• Cardiac management o If signs o
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Pediatric Dose Contraindications In
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MISCELLANEOUS Section 9 of 11 Medic
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limiting step in the process, relea
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History: CLINICAL Section 3 of 11
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at equilibrium conditions, the isom
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• A number of guidelines for the
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Exchange transfusion Exchange trans
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FOLLOW-UP Section 8 of 11 Further I
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BIBLIOGRAPHY Section 11 of 11 • A
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Kernicterus Last Updated: November
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CLINICAL Section 3 of 11 History: A
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o Extravasated blood: Significant a
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milk intake because of reduced mamm
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department and must be heavily seda
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Diet: Depending on the degree of ne
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Transfer: The recently reported cas
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Prognosis: The spectrum of neurolog
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Picture 5. Kernicterus. Neuronal ch
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Airway obstruction Complete obstruc
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MEDICATION Section 7 of 11 In addit
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Drug Category: Sedatives -- Maximiz
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Transfer: • Although stabilizatio
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BIBLIOGRAPHY Section 11 of 11 • A
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occurs even later (ie, during days
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• Delivery room management of inf
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MISCELLANEOUS Section 7 of 9 Medica
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Necrotizing Enterocolitis Last Upda
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Race: Some studies indicate higher
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o With abdominal ultrasonography, a
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o Stage IB � Diagnosis is the sam
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Pregnancy C - Safety for use during
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Drug Name Epinephrine (Adrenaline)
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Pediatric Dose Contraindications In
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• Short-gut syndrome o This is a
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Picture 5. Necrotizing enterocoliti
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Neonatal Hypertension Last Updated:
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o Although BP readings obtained usi
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Other Problems to be Considered: Re
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as nitroprusside, that may make it
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Surgical Care: Surgery is rarely in
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decrease in cardiac output; triazol
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Contraindications Documented hypers
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• Flynn JT: Neonatal hypertension
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Neonatal Resuscitation Last Updated
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Fetal pulmonary physiology The feta
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Flow studies have revealed that rel
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Table 2. Equipment for Neonatal Res
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Airway management Once the infant i
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Cardiovascular support and chest co
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Once the appropriate functional res
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Premature infants are also at high
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Because secretions or oral feedings
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The team should be led and organize
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Intubation and suctioning for mecon
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Neonatal Sepsis Last Updated: June
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The fetus has some preimmune immuno
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when chorioamnionitis accompanies t
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weeks of infection, the proportion
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cultures, clinicians may elect to c
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o The clinician may require differe
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Precautions Drug Name Pediatric Dos
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Pregnancy B - Usually safe but bene
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MISCELLANEOUS Section 9 of 11 Medic
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Neural Tube Defects in the Neonatal
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An experienced pediatrician or surg
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EPIDEMIOLOGY Section 3 of 11 Severa
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ETIOLOGY Section 5 of 11 Over the l
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AFP concentration in the maternal s
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separated his patients into 3 diffe
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Head ultrasound can be performed du
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OUTCOME AND PROGNOSIS OF CHILDREN W
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Picture 2. Neural tube defects in t
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Picture 8. Neural tube defects in t
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• Sutton LN, Adzick NS, Bilaniuk
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Pathophysiology: • The umbilical
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• Omphalitis also may be the init
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• Supportive care: In addition to
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Drug Name Clindamycin (Cleocin) --
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multiple organisms) that lead direc
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• McKenna H, Johnson D: Bacteria
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Several processes combine to form t
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Frequency: • In the US: Combined
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• Polyhydramnios suggests fetal i
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aby with a giant omphalocele or in
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Prognosis: without extensively unde
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Picture 3. Omphalocele and gastrosc
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Picture 11. Omphalocele and gastros
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Picture 20.Omphalocele and gastrosc
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Perinatal Drug Abuse and Neonatal D
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Race: • The difficulty in assessi
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ehavioral and cognitive changes. Ma
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• All medically treated newborns
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Drug Category: Barbiturates -- Alth
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• Cognitive and developmental def
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Perioperative Pain Management in Ne
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The relative potency of each volati
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Opioid administration remains the m
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Use a short beveled needle to minim
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• Lerman J, Robinson S, Willis MM
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Pathophysiology: Site of origin The
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Pathogenesis of sequelae The major
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• Hypertension or beat-to-beat va
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Interactions suspected necrotizing
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PICTURES Section 10 of 11 Picture 1
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Picture 8. Periventricular hemorrha
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• Roberts JR: Drug therapy in inf
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Following the initial insult, wheth
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Picture 6. Cranial CT scan, axial i
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Polycythemia of the Newborn Last Up
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Causes: • Increased fetal erythro
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FOLLOW-UP Section 7 of 9 Further In
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Polyhydramnios and Oligohydramnios
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Causes: umbilical artery, gastroint
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TREATMENT Section 5 of 9 Medical Ca
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Prognosis: • Polyhydramnios o If
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Pulmonary Interstitial Emphysema La
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compared to 39 of 169 among infants
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• Selective main bronchial intuba
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• Other considerations o Avoid us
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• Gaylord MS, Quissell BJ, Lair M
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The components of pulmonary surfact
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WORKUP Section 5 of 11 Lab Studies:
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in infants who respond poorly or ar
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intensive care setting, and be anxi
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Table 6. Meta-Analysis of Clinical
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Drug Name Pediatric Dose of acute a
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The postnatal use of surfactant the
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Picture 5. A schematic diagram of t
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Retinopathy of Prematurity Last Upd
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• Examination recommendations Oth
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Picture 5. Retinopathy of prematuri
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• Raju TN, Langenberg P, Bhutani
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• Contractility is a semiquantita
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• Uncompensated o During uncompen
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mL/kg of volume expansion should re
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MEDICATION Section 7 of 10 Drug Cat
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Drug Name cyanide toxicity; sodium
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Pregnancy Precautions Drug Name fur
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Transient Tachypnea of the Newborn
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DIFFERENTIALS Section 4 of 11 Pneum
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Drug Name Pediatric Dose Gentamicin
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Transport of the Critically Ill New
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Communications To initiate the tran
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Table 1. Advantages and disadvantag
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Table 2. A comparison of the advant
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Flight team personnel also are affe
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PICTURES Section 10 of 11 Picture 1
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Anemia of Prematurity - Portal Neonatal

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