Anemia of Prematurity - Portal Neonatal

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potassium balance in extremely low birth weight neonates. Pediatrics 2000 Sep; 106(3): 561-7[Medline]. • Price PT, Kalhan SC: Nutrition for the high-risk infant. In: Klaus MH, Fanaroff AA, eds. Care of the High-Risk Neonate. 4th ed. Philadelphia: WB Saunders Co; 1997:130-75. • Sankaran K, Berscheid B, Verma V, et al: An evaluation of total parenteral nutrition using Vamin and Aminosyn as protein base in critically ill preterm infants. JPEN J Parenter Enteral Nutr 1985 Jul-Aug; 9(4): 439-42[Medline]. • Simmons CF Jr: Fluid and electrolyte management. In: Cloherty JP, Stark AR, eds. Manual of Neonatal Care. 4th ed. New York: Lippincott Raven; 1997:87-100. • Spear ML, Stahl GE, Paul MH, et al: The effect of 15-hour fat infusions of varying dosage on bilirubin binding to albumin. JPEN J Parenter Enteral Nutr 1985 Mar-Apr; 9(2): 144- 7[Medline]. • Sun Y, Awnetwant EL, Collier SB: Nutrition. In: Cloherty JP, Stark AR, eds. Manual of Neonatal Care. 4th ed. New York: Lippincott Raven; 1997:101-34. • Yip YY, Lim AK, R J, Tan KL: A multivariate analysis of factors predictive of parenteral nutrition- related cholestasis (TPN cholestasis) in VLBW infants. J Singapore Paediatr Soc 1990; 32(3-4): 144-8[Medline]. Fluid, Electrolyte, and Nutrition Management of the Newborn excerpt © Copyright 2005, eMedicine.com, Inc.
Hemolytic Disease of Newborn Last Updated: March 14, 2003 Synonyms and related keywords: HDN, erythroblastosis fetalis, transplacental hemorrhage, fetomaternal hemorrhage, alloimmunization, hemolysis, hyperbilirubinemia, jaundice, kernicterus, nonimmune hydrops fetalis AUTHOR INFORMATION Section 1 of 11 Author: Sameer Wagle, MD, Consulting Staff, Division of Neonatology, Northwest Medical Center of Washington County Coauthor(s): Prashant G Deshpande, MD, Consulting Staff, Department of Pediatrics, Hope Children's Hospital Sameer Wagle, MD, is a member of the following medical societies: Mississippi State Medical Association Editor(s): Oussama Itani, MD, Medical Director of Neonatology, Borgess Medical Center, Clinical Assistant Professor, Department of Pediatrics and Human Development, Michigan State University; Robert Konop, PharmD, Director, Clinical Account Management, Ancillary Care Management; David A Clark, MD, Chairman, Professor, Department of Pediatrics, Albany Medical College; 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 INTRODUCTION Section 2 of 11 Background: A French midwife was the first to report hemolytic disease of the newborn (HDN) in a set of twins in 1609. In 1932, Diamond and colleagues described the relationship of fetal hydrops, jaundice, anemia, and erythroblasts in the circulation, a condition later called erythroblastosis fetalis. Levine later determined the cause after Landsteiner and Weiner discovered the Rh blood group system in 1940. In 1953, Chown subsequently confirmed the pathogenesis of Rh alloimmunization to be the result of passage of Rh-positive fetal red blood cells after transplacental hemorrhage into maternal circulation that lacked this antigen. Pathophysiology: Although the Rh antibody was and still is the most common cause of severe HDN, other alloimmune antibodies belonging to Kell (K and k), Duffy (Fya), Kidd (Jka and Jkb), and MNSs (M, N, S, and s) systems do cause severe HDN. Rh blood group antigens are determined by at least 2 homologous but distinct membrane-associated proteins. Two separate genes located on chromosome 1 encode Rh proteins. Rh-negative phenotype represents absence of D protein on RBCs and results from deletion of the RHD gene on both chromosomes. Rh antigens exist in 3 loci: Cc, Dd, and Ee. Expression is limited to RBCs, with an increasing density during their maturation, unlike the ABH system, which exists in a wide variety of tissues. Rh antigen is not expressed on RBC progenitors. Of individuals who are Rh positive, 45% are homozygous and 55% are heterozygous. Frequency of Rh negativity is higher in whites (15%) than in blacks (5%), and it is rare in Asians. The paternal heterozygosity determines the likelihood of an Rh-positive child being born to an Rhnegative mother. The Kleihauer-Betke acid elution technique that determines the proportion of fetal RBCs in maternal circulation has shown the incidence of fetomaternal hemorrhage to be 75% of all pregnancies. Incidence and degree of such hemorrhage appears to increase with gestation. Risk is also increased in pregnancies complicated by placental abruption, spontaneous or therapeutic abortion, and toxemia, as well as after cesarean delivery and ectopic pregnancy.
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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:
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DIFFERENTIALS Section 4 of 9 Anemia
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Consultations: Diet: • Consider c
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Bronchopulmonary Dysplasia Last Upd
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CLINICAL Section 3 of 11 History: B
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of BPD and in the need for continue
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Physical: • Infants with BPD have
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discomfort. Many new synchronized v
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treat acute bronchospasm; however,
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• Excessive glucose loads may inc
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Interactions Beta-adrenergic blocke
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Drug Category: Pulmonary vasodilato
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MISCELLANEOUS Section 9 of 11 Medic
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• Frank L, Groseclose E: Oxygen t
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• Northway WH Jr: Bronchopulmonar
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Congenital Diaphragmatic Hernia Las
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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 and 110: Positioning the infant Positioning
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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
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Page 145 and 146: Energy ENTERAL NUTRITION MANAGEMENT
Page 147: growth and bone mineral content has
Page 151 and 152: CLINICAL Section 3 of 11 History: W
Page 153 and 154: • Serologic tests Imaging Studies
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Page 157 and 158: status (eg, watching for hypoglycem
Page 159 and 160: � The mechanism by which unconjug
Page 161 and 162: BIBLIOGRAPHY Section 11 of 11 • B
Page 163 and 164: Race: No racial predilection exists
Page 165 and 166: Drug Name Pediatric Dose Phytonadio
Page 167 and 168: Human Milk and Lactation Last Updat
Page 169 and 170: LACTATION Section 5 of 11 Two essen
Page 171 and 172: IMMUNOLOGIC PROPERTIES OF HUMAN MIL
Page 173 and 174: Picture 3. Human milk and lactation
Page 175 and 176: • Isaacs CE, Thormar H: The role
Page 177 and 178: Hydrops Fetalis Last Updated: June
Page 179 and 180: Also of note is a computer simulati
Page 181 and 182: Physical: The presence of any of th
Page 183 and 184: o Once disorders of hemoglobin alph
Page 185 and 186: Structural anomalies Table 2. Cardi
Page 187 and 188: o B19V o Cytomegalovirus (CMV) o Sy
Page 189 and 190: o Sjögren syndrome A (uncertain in
Page 191 and 192: most commonly thrombocytopenia, is
Page 193 and 194: Lab Studies: WORKUP Section 5 of 10
Page 195 and 196: o Karyotyping is always indicated i
Page 197 and 198: TREATMENT Section 6 of 10 Medical C
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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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TREATMENT Section 6 of 10 Medical C
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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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limiting step in the process, relea
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History: CLINICAL Section 3 of 11
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Lab Studies: WORKUP Section 5 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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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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