Anemia of Prematurity - Portal Neonatal

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Kernicterus Last Updated: November 6, 2004 Synonyms and related keywords: acute bilirubin encephalopathy, chronic postkernicteric bilirubin encephalopathy, chronic bilirubin encephalopathy, profound pathologic hyperbilirubinemia AUTHOR INFORMATION Section 1 of 11 Author: Shelley C Springer, MD, MBA, MSc, Neonatologist, Assistant Professor of Pediatrics, Department of Pediatrics, University of Wisconsin, Madison Coauthor(s): David J Annibale, MD, Director of Fellowship Training Program in Neonatal- Perinatal Medicine, Associate Professor, Department of Pediatrics, Medical University of South Carolina Shelley C Springer, MD, MBA, MSc, is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, Minnesota Medical Association, National Perinatal Association, and South Carolina 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: Traditionally, the term kernicterus (literally yellow kern, with kern indicating the most commonly afflicted region of the brain, ie, the nuclear region) refers to an anatomic diagnosis made at autopsy based on a characteristic pattern of staining found in babies who had marked hyperbilirubinemia before they died. Regions most commonly affected include the basal ganglia; hippocampus; geniculate bodies; and cranial nerve nuclei, such as the oculomotor, vestibular, and cochlear. The cerebellum can also be affected. Acute bilirubin encephalopathy, which refers to the clinical signs associated with bilirubin toxicity, ie, hypotonia followed by hypertonia, opisthotonus or retrocollis, or both, is usually synonymous with kernicterus. Prevalent in the 1950s and 1960s, kernicterus had virtually disappeared from the clinical scene, only to reappear during the 1990s. Early discharge of term infants (before their bilirubin peaks) may be a factor in the reemergence of this devastating neurologic affliction. Much of the traditional teaching regarding hyperbilirubinemia is now being questioned as more is learned about bilirubin metabolism and neurologic injury. Kernicterus is now recognized to occur in the premature infant and very rarely in the term infant in the absence of profound hyperbilirubinemia. Conversely, physiologic jaundice (sometimes to levels previously thought to be universally dangerous) has been recognized to be within the reference range in the first week of life in healthy term babies, particularly those who are breastfed. Jaundice of this type resolves spontaneously, without sequelae. Despite the lack of a clear-cut cause-and-effect relationship between kernicterus and hyperbilirubinemia, laboratory investigations have demonstrated that bilirubin is neurotoxic at a cellular level. Other in vitro studies have shown bilirubin to have more antioxidant capability than vitamin E, which is commonly assumed to be the most potent antioxidant in the human system. This possible role of bilirubin in early protection against oxidative injury, coupled with identification of multiple neonatal mechanisms to preserve and potentiate bilirubin production, has led to speculation about an as-yet-unrecognized beneficial role for bilirubin in the human neonate.
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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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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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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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Page 209 and 210: At the cellular level, neuronal inj
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Page 217 and 218: Interactions Benzodiazepines, cimet
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Page 245 and 246: at equilibrium conditions, the isom
Page 247 and 248: • A number of guidelines for the
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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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