Anemia of Prematurity - Portal Neonatal

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PICTURES Section 10 of 11 Picture 1. When breastfeeding begins, the nipple, surrounding areola, and underlying breast tissue are brought deeply into the mouth of the infant, whose lips and cheeks form a seal. BIBLIOGRAPHY Section 11 of 11 • AAP: Breastfeeding and the use of human milk. American Academy of Pediatrics. Work Group on Breastfeeding. Pediatrics 1997 Dec; 100(6): 1035-9[Medline]. • Alexander JM, Grant AM, Campbell MJ: Randomised controlled trial of breast shells and Hoffman's exercises for inverted and non-protractile nipples. BMJ 1992 Apr 18; 304(6833): 1030-2[Medline]. • Cooper WO, Atherton HD, Kahana M, Kotagal UR: Increased incidence of severe breastfeeding malnutrition and hypernatremia in a metropolitan area. Pediatrics 1995 Nov; 96(5 Pt 1): 957-60[Medline]. • Huggins K: The Nursing Mother's Companion. 3rd ed. Boston, Ma: The Harvard Common Press; 1995. • La Leche League: The Womanly Art of Breastfeeding. Schaumburg, Il: La Leche League International, Inc; 1996. • Lawrence RA, Lawrence RM: Breastfeeding. A Guide for the Medical Profession. 5th ed. St. Louis, Mo: Mosby, Inc; 1999. • Marshall DR, Callan PP, Nicholson W: Breastfeeding after reduction mammaplasty. Br J Plast Surg 1994 Apr; 47(3): 167-9[Medline]. • Neifert M: Breast-feeding on trial. BabyTalk 1999 Nov; 42-44. • Neifert M: Breastfeeding after breast surgical procedure or breast cancer. NAACOGS Clin Issu Perinat Womens Health Nurs 1992; 3(4): 673-82[Medline]. • Neifert M, DeMarzo S, Seacat J, et al: The influence of breast surgery, breast appearance, and pregnancy- induced breast changes on lactation sufficiency as measured by infant weight gain. Birth 1990 Mar; 17(1): 31-8[Medline]. • Neifert M: Dr. Mom's Guide to Breastfeeding. New York, NY: Penguin Putnam, Inc; 1998. • Neifert MR: Clinical aspects of lactation. Promoting breastfeeding success. Clin Perinatol 1999 Jun; 26(2): 281-306, v-vi[Medline]. • Neville MC: Physiology of lactation. Clin Perinatol 1999 Jun; 26(2): 251-79, v[Medline]. • Powers NG: Slow weight gain and low milk supply in the breastfeeding dyad. Clin Perinatol 1999 Jun; 26(2): 399-430[Medline]. • Soskolne EI, Schumacher R, Fyock C, et al: The effect of early discharge and other factors on readmission rates of newborns. Arch Pediatr Adolesc Med 1996 Apr; 150(4): 373-9[Medline]. • Wagner CL, Anderson DM, Pittard WB 3rd: Special properties of human milk. Clin Pediatr (Phila) 1996 Jun; 35(6): 283-93[Medline]. • Wagner CL, Wagner MT: The breast or the bottle? Determinants of infant feeding behaviors. Clin Perinatol 1999 Jun; 26(2): 505-25[Medline]. Counseling the Breastfeeding Mother excerpt © Copyright 2005, eMedicine.com, Inc.
Ethical Issues in Neonatal Care Last Updated: November 2, 2003 Synonyms and related keywords: clinical ethics, bioethics, medical ethics, healthcare ethics AUTHOR INFORMATION Section 1 of 8 Author: Brian S Carter, MD, Associate Director, Associate Professor, Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center and Gateway Medical Center Brian S Carter, MD, is a member of the following medical societies: American Academy of Pediatrics, American Society for Bioethics and Humanities, National Perinatal Association, and Southern Society for Pediatric Research Editor(s): Scott MacGilvray, MD, Associate Professor, Department of Pediatrics, Pitt County Memorial Hospital; Robert Konop, PharmD, Director, Clinical Account Management, Ancillary Care Management; Brian S Carter, MD, Associate Director, Associate Professor, Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center and Gateway Medical Center; Carol L Wagner, MD, Associate Professor, Department of Pediatrics, Division of Neonatology, Medical University of South Carolina; and Neil N Finer, MD, Director, Division of Neonatology, Professor, Department of Pediatrics, University of California at San Diego Background INTRODUCTION Section 2 of 8 As neonatal medicine has developed in the United States, clinical ethics (ie, bioethics, medical ethics, healthcare ethics) also have become increasingly present in the healthcare environment. For more than 30 years, neonatal medicine has been practiced to provide specialized and intensive care measures aimed at improving the health and survival of premature and critically ill newborns. Throughout this period, great strides have been made in improving the technical capabilities that allow more rapid and precise diagnoses, effective monitoring, and specific therapy. The availability of special-care nursery beds has increased dramatically. The number of trained professionals and specialists also has risen. The results of these progresses are mixed. A substantial reduction in the mortality of premature infants has occurred. Furthermore, the rate of handicap or significant morbidity appears to have remained steady or declined in survivors of the neonatal intensive care unit (NICU) of nearly all gestational ages and weights. Despite these facts, the rate of prematurity has not declined in the United States, nor has the rate of low birth weights. Also, the rate of birth defects remains relatively constant, and infant mortality, though diminished over the past decade, remains higher in the United States than in many developed nations. Finally, the discrepancy between black and Caucasian infant mortality remains a concern. ETHICAL QUESTIONS Section 3 of 8 Questions about the current state of practice in neonatal medicine are as follows: • "Who deserves access to prenatal and neonatal specialty care?" • "Who pays for this care?" • "How can this care be assured and equitably distributed?" • "Are some babies too sick or too premature for newborn intensive care?" • "Who decides whether an infant receives care?" • "How are these decisions made?"
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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
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POSTOPERATIVE CARE FOLLOWING SURGER
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Picture 4. Bowel obstruction in the
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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:
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Page 107 and 108: This article reviews the mechanics
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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
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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
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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
Page 161 and 162: BIBLIOGRAPHY Section 11 of 11 • B
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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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