Anemia of Prematurity - Portal Neonatal

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DIFFERENTIALS Section 4 of 10 Gaucher Disease Heart Failure, Congestive Hemochromatosis, Neonatal Hepatitis B Hepatoblastoma Hepatocellular Carcinoma Herpes Simplex Virus Infection Hypercalcemia Hypernatremia Hypoplastic Left Heart Syndrome Hypoprothrombinemia Hypospadias Hypothyroidism Hypoxic-Ischemic Encephalopathy Infant of Diabetic Mother Interrupted Aortic Arch Intussusception Kasabach-Merritt Syndrome Klippel-Trenaunay-Weber Syndrome Listeria Infection Methemoglobinemia Mitral Valve Insufficiency Mucopolysaccharidosis Type IV Mucopolysaccharidosis Type VI Mucopolysaccharidosis Type VII Multicystic Renal Dysplasia Myelodysplasia Myocarditis, Nonviral Myocarditis, Viral Neonatal Resuscitation Neonatal Sepsis Noonan Syndrome Oliguria Omphalocele and Gastroschisis Osteogenesis Imperfecta Pacemaker Therapy Parvovirus B19 Infection Patent Ductus Arteriosus Pericardial Effusion, Malignant Pericarditis, Constrictive Pericarditis, Viral Pleural Effusion Polycystic Kidney Disease Polycythemia Polycythemia of the Newborn Polyhydramnios and Oligohydramnios Posterior Urethral Valves Progressive Familial Intrahepatic Cholestasis Pulmonary Hypertension, Persistent-Newborn Pulmonary Hypoplasia Pulmonary Sequestration Pulmonary Stenosis, Infundibular Pulmonary Stenosis, Valvar Pyruvate Kinase Deficiency Rhabdomyosarcoma Shock Shock and Hypotension in the Newborn Single Ventricle Sinus Node Dysfunction Smith-Lemli-Opitz Syndrome Splenomegaly Supraventricular Tachycardia, Atrial Ectopic Tachycardia Supraventricular Tachycardia, Atrioventricular NodeReentry Supraventricular Tachycardia, Junctional Ectopic Tachycardia Supraventricular Tachycardia, Wolff-Parkinson-White Syndrome Syphilis Systemic Lupus Erythematosus Tetralogy of Fallot With Absent Pulmonary Valve Tetralogy of Fallot With Pulmonary Atresia Thalassemia Thyroid Storm Toxoplasmosis Turner Syndrome Ureteropelvic Junction Obstruction Urethral Anomalies and Urethral Prolapse Ventricular Septal Defect, General Concepts Ventricular Septal Defect, Muscular Ventricular Septal Defect, Perimembranous Ventricular Septal Defect, Supracristal Ventricular Tachycardia Williams Syndrome Other Problems to be Considered: Hypoxic-ischemic brain injury in newborn Laryngeal stenosis Pulmonary hypertension, congenital heart disease Prune-belly syndrome Uncommon Coagulopathies
Lab Studies: WORKUP Section 5 of 10 • Diagnostic studies may be considered best by temporal grouping (ie, fetal, maternal, placental, neonatal, postmortem). Assessments generally proceed from low-risk noninvasive tests to higher-risk invasive techniques as required for precise and complete diagnosis to properly manage the individual pregnancy. • Obtain several maternal laboratory studies concurrent with the initial fetal imaging assessment. o Assessment of maternal blood type (red cells) and antibody screen (identification, and quantitation when indicated, of maternal plasma antibodies) are standard screening tests recommended in most guidelines for prenatal care. Over the past few years, the introduction of new molecular genetic techniques (PCR) has demonstrated considerable promise; however, definitive comparisons with standard methods are not yet available. More than 85% of Rh-sensitized women whose anti-D titers were 1:512 or higher were found to be HLA type DQBI allele*0201. Although this single study suggests that HLA typing may be of value in the prospective management of isoimmunization, this observation requires confirmation and further study. o Qualitative and quantitative estimates of the proportion of red cells containing fetal hemoglobin in the maternal circulation are of particular value. � The Betke-Kleihauer technique depends on the different vulnerability of cells containing fetal hemoglobin from those with adult hemoglobin when subjected to acidelution. � A newer method using flow cytometry has also been found to be useful. � Results using either method must be interpreted with considerable caution, since poor sensitivity and specificity of these diagnostic tests has been demonstrated in several studies. o The search for maternal-fetal infection must be intensive. Syphilis serology was a standard prenatal screening test for decades. More recently, the test has been used more selectively, despite the absence of any good evidence for this change. If fetal hydrops is suspected, syphilis serology is mandatory with repeat serial testing and, very importantly, with dilution of maternal serum. The prozone effect has been demonstrated repeatedly with fetal hydrops due to syphilis, thus dilution of maternal serum to avoid false-negative results is required. o Antibody screens for common fetal infections (toxoplasmosis, other infections, rubella, CMV infection, and herpes simplex [TORCH]) and more sensitive and specific enzymelinked immunosorbent assay (ELISA) studies for individual infectious agents have been used for many years. More recently, the PCR technique generally is accepted as the criterion standard and should be employed whenever possible. o Hemoglobin electrophoresis for alpha-thalassemia heterozygosity has been useful in ethnically at-risk populations. In regions where ethnic diversity is high, routine screening may be preferable to selection based on ethnicity. More recently, PCR screens and colorimetric monoclonal antizeta antibody tests for heterozygote alpha-thalassemia have been demonstrated as economically feasible screening procedures. o Maternal serum screening tests (multiple-marker, triple-screen, triple-marker), commonly used if fetal anomaly is suspected, are of uncertain value with fetal hydrops. � In one study, positive screening tests (any of the 3 used) with a sensitivity of only 60% in 19 cases of Turner syndrome distinguished some fetuses with cystic hygroma and/or hydrops from those without. Individual components of these tests were examined separately in several other studies. � Elevated AFP levels have been reported in hydrops associated with fetomaternal hemorrhage, umbilical cord hemangioma, polycystic kidneys, CMV, and Parvovirus;
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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
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o Inhaled nitric oxide may be used
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Drug Name Pediatric Dose Contraindi
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Drug Name Pediatric Dose Vecuronium
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Prognosis: • Pulmonary recovery:
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• O'Toole SJ, Irish MS, Holm BA:
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This article reviews the mechanics
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Positioning the infant Positioning
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stress and fatigue in both parents
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As the mother's milk supply is esta
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Engorgement Engorgement is a common
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Ethical Issues in Neonatal Care Las
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GOALS OF NEONATAL INTENSIVE CARE Se
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Other guidelines of ethical import
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In some situations, tragic situatio
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BIBLIOGRAPHY Section 8 of 8 • AAP
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CLINICAL FEATURES Section 4 of 7 Th
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Comparisons of the nutrient content
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Indomethacin is used prophylactical
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FOLLOW-UP CARE Section 5 of 7 Nearl
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BIBLIOGRAPHY Section 7 of 7 • Bha
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Fluid, Electrolyte, and Nutrition M
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Clinical evaluation • Weight fact
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Page 145 and 146: Energy ENTERAL NUTRITION MANAGEMENT
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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
Page 155 and 156: IVT in 1981. With ultrasonographic
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
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Page 191: most commonly thrombocytopenia, is
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Page 197 and 198: TREATMENT Section 6 of 10 Medical C
Page 199 and 200: • Space-occupying masses, which i
Page 201 and 202: of antidiabetic agents and antagoni
Page 203 and 204: Drug Name Sotalol (Betapace) -- Rec
Page 205 and 206: • Cowan RH, Waldo AL, Harris HB:
Page 207 and 208: • Silverman NH, Schmidt KG: Ventr
Page 209 and 210: At the cellular level, neuronal inj
Page 211 and 212: o Disturbances of ocular motion, su
Page 213 and 214: DIFFERENTIALS Section 4 of 10 Methy
Page 215 and 216: TREATMENT Section 6 of 10 Medical C
Page 217 and 218: Interactions Benzodiazepines, cimet
Page 219 and 220: o Allopurinol: Slight improvements
Page 221 and 222: • Patel J, Edwards AD: Prediction
Page 223 and 224: Increased insulin levels stimulate
Page 225 and 226: irth; symptoms may include jitterin
Page 227 and 228: speculated to be secondary to incre
Page 229 and 230: Procedures: o Clinical features of
Page 231 and 232: • Cardiac management o If signs o
Page 233 and 234: Pediatric Dose Contraindications In
Page 235 and 236: FOLLOW-UP Section 8 of 10 Further O
Page 237 and 238: MISCELLANEOUS Section 9 of 11 Medic
Page 239 and 240: limiting step in the process, relea
Page 241 and 242: 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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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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FOLLOW-UP Section 7 of 10 Further O
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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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