Anemia of Prematurity - Portal Neonatal

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MISCELLANEOUS Section 9 of 10 Medical/Legal Pitfalls: • Birth asphyxia, birth injury, and perinatal asphyxia are terms often used incorrectly to describe HIE. This must be avoided, because their improper usage has medicolegal implications. o Birth injury is a condition in which fetal or neonatal injury has occurred during the process of birth (ie, during the first and second stages of labor). Examples include brachial plexus injury; fracture of the clavicle; forceps-induced damage to the facial nerve or soft tissues; and cuts or bruises from scissors, clips, or scalp monitors. o Birth asphyxia is similar to birth injury in that asphyxia occurs during the first and second stages of labor when the fetus was otherwise normal. o Perinatal asphyxia signifies that asphyxia occurred at any time in the perinatal period, namely, from conception through the first month of life. • The AAP and ACOG recommend using HIE because this term accurately describes the clinical condition, encephalopathy from asphyxia, without implying the time of brain injury. The AAP and ACOG also advise not using the terms perinatal asphyxia or birth asphyxia because it is difficult to identify the time of brain injury and nearly impossible to ascertain that the brain had been "normal" before such injury. These terms are vague and do not reflect all components of HIE. • Avoid inappropriate designation of the diagnosis as asphyxia and ascribing asphyxia as a cause of any neurological symptom. The medical records should contain objective information on maternal and neonatal history and on clinical findings on the infant. • The findings from any brain imaging procedures that have been carried out must be included in the total assessment of the infant's clinical status. The findings of neuroimaging tests and EEG (if performed) must be documented. • No diagnostic tests conclusively prove that a given magnitude of asphyxia has led to a specific neurological injury. Acute perinatal and intrapartum events have been found in only about 20% of children diagnosed as having cerebral palsy. • Parents must be given realistic explanations about their infant's clinical status and prognosis. It should be emphasized that, except under controlled experimental conditions, cause-andeffect is nearly impossible to establish. • Good medical records are always better than poor medical records: all details about the infant's status and parental counseling must be documented carefully. BIBLIOGRAPHY Section 10 of 10 • American Academy of Pediatrics: Relation between perinatal factors and neurological outcome. In: Guidelines for Perinatal Care. 3rd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1992: 221-234. • Berger R, Garnier Y: Pathophysiology of perinatal brain damage. Brain Res Brain Res Rev 1999 Aug; 30(2): 107-34[Medline]. • de Haan HH, Hasaart TH: Neuronal death after perinatal asphyxia. Eur J Obstet Gynecol Reprod Biol 1995 Aug; 61(2): 123-7[Medline]. • Depp R: Perinatal asphyxia: assessing its causal role and timing. Semin Pediatr Neurol 1995 Mar; 2(1): 3-36[Medline]. • Gunn AJ, Gunn TR: The 'pharmacology' of neuronal rescue with cerebral hypothermia. Early Hum Dev 1998 Nov; 53(1): 19-35[Medline]. • Hall RT, Hall FK, Daily DK: High-dose phenobarbital therapy in term newborn infants with severe perinatal asphyxia: a randomized, prospective study with three-year follow-up. J Pediatr 1998 Feb; 132(2): 345-8[Medline]. • Latchaw RE, Truwit CE: Imaging of perinatal hypoxic-ischemic brain injury. Semin Pediatr Neurol 1995 Mar; 2(1): 72-89[Medline].
• Patel J, Edwards AD: Prediction of outcome after perinatal asphyxia. Curr Opin Pediatr 1997 Apr; 9(2): 128-32[Medline]. • Rivkin MJ: Hypoxic-ischemic brain injury in the term newborn. Neuropathology, clinical aspects, and neuroimaging. Clin Perinatol 1997 Sep; 24(3): 607-25[Medline]. • Roohey T, Raju TN, Moustogiannis AN: Animal models for the study of perinatal hypoxicischemic encephalopathy: a critical analysis. Early Hum Dev 1997 Jan 20; 47(2): 115- 46[Medline]. • Sarnat HB, Sarnat MS: Neonatal encephalopathy following fetal distress: A clinical and electroencphalographic study. Archives of Neurology 1976; 33: 696-705. • Simon NP: Long-term neurodevelopmental outcome of asphyxiated newborns. Clin Perinatol 1999 Sep; 26(3): 767-78[Medline]. • Thorngren-Jerneck K, Alling C, Herbst A, et al: S100 Protein in Serum as a Prognostic Marker for Cerebral Injury in Term Newborn Infants with Hypoxic Ischemic Encephalopathy. Pediatr Res 2003 Nov 19;[Medline]. • Van Bel F, Shadid M, Moison RM: Effect of allopurinol on postasphyxial free radical formation, cerebral hemodynamics, and electrical brain activity. Pediatrics 1998 Feb; 101(2): 185- 93[Medline]. • Vannucci RC: Mechanisms of perinatal hypoxic-ischemic brain damage. Semin Perinatol 1993 Oct; 17(5): 330-7[Medline]. • Vannucci RC, Perlman JM: Interventions for perinatal hypoxic-ischemic encephalopathy. Pediatrics 1997 Dec; 100(6): 1004-14[Medline]. • Vannucci RC, Yager JY, Vannucci SJ: Cerebral glucose and energy utilization during the evolution of hypoxic-ischemic brain damage in the immature rat. J Cereb Blood Flow Metab 1994 Mar; 14(2): 279-88[Medline]. Hypoxic-Ischemic Encephalopathy excerpt © Copyright 2005, eMedicine.com, Inc.
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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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o Hypernatremia is defined as a ser
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intake from protein is included in
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Energy ENTERAL NUTRITION MANAGEMENT
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growth and bone mineral content has
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Hemolytic Disease of Newborn Last U
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CLINICAL Section 3 of 11 History: W
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• Serologic tests Imaging Studies
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IVT in 1981. With ultrasonographic
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status (eg, watching for hypoglycem
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� 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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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
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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
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
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Page 223 and 224: Increased insulin levels stimulate
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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
Page 243 and 244: Lab Studies: WORKUP Section 5 of 11
Page 245 and 246: at equilibrium conditions, the isom
Page 247 and 248: • A number of guidelines for the
Page 249 and 250: Exchange transfusion Exchange trans
Page 251 and 252: FOLLOW-UP Section 8 of 11 Further I
Page 253 and 254: BIBLIOGRAPHY Section 11 of 11 • A
Page 255 and 256: Kernicterus Last Updated: November
Page 257 and 258: CLINICAL Section 3 of 11 History: A
Page 259 and 260: o Extravasated blood: Significant a
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Page 265 and 266: Diet: Depending on the degree of ne
Page 267 and 268: Transfer: The recently reported cas
Page 269 and 270: 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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Lab Studies: WORKUP Section 5 of 11
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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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Lab Studies: WORKUP Section 5 of 10
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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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FOLLOW-UP Section 8 of 10 Further I
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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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FOLLOW-UP Section 7 of 10 Further I
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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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