Anemia of Prematurity - Portal Neonatal

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PICTURES Section 10 of 11 Picture 1. Kernicterus. Typical patterns of total serum bilirubin levels in neonates of different racial origins. Used with the permission of the Academy of Pediatrics. Picture 2. Kernicterus. Overview of bilirubin metabolism. Picture 3. Kernicterus. Hour-specific nomogram for total serum bilirubin and attendant risk of subsequent severe disease in term and preterm infants. Used with the permission of the Academy of Pediatrics. Picture 4. Magnetic resonance image of 21-month-old with kernicterus. Area of abnormality is the symmetric high-intensity signal in the area of the globus pallidus (arrows). Courtesy of M.J. Maisels.
Picture 5. Kernicterus. Neuronal changes observed in kernicterus. Courtesy of J.J. Volpe. BIBLIOGRAPHY Section 11 of 11 • AAP: Practice parameter: management of hyperbilirubinemia in the healthy term newborn. American Academy of Pediatrics. Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia [published erratum appears in Pediatrics 1995 Mar;95. Pediatrics 1994 Oct; 94(4 Pt 1): 558-65[Medline]. • Barefield ES, Dwyer MD, Cassady G: Association of patent ductus arteriosus and phototherapy in infants weighting less than 1000 grams. J Perinatol 1993 Sep-Oct; 13(5): 376- 80[Medline]. • Bhutani VK, Johnson L, Sivieri EM: Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics 1999 Jan; 103(1): 6-14[Medline]. • Cashore WJ: Bilirubin and jaundice in the micropremie. Clin Perinatol 2000 Mar; 27(1): 171-9, vii[Medline]. • Gartner LM: Neonatal jaundice. Pediatr Rev 1994 Nov; 15(11): 422-32[Medline]. • Johnson L, Brown AK: A pilot registry for acute and chronic kernicterus in term and near-term infants. Pediatrics 1999 Sep; 104:(3): 736. • MacMahon JR, Stevenson DK, Oski FA: Physiologic jaundice. In: Taeusch, Ballards, eds. Avery's Disease of the Newborn. 7th ed. Philadelphia, Pa: Saunders; 1998: 1003-1007. • Maisels MJ: Jaundic. In: Avery, Fletcher, eds. Neonatology, Pathophysiology and Management of the Newborn. 5th ed. Philadelphia, Pa: Lippincott; 1999: 765-819. • Pezzati M, Biagiotti R, Vangi V: Changes in mesenteric blood flow response to feeding: conventional versus fiber-optic phototherapy. Pediatrics 2000 Feb; 105(2): 350-3[Medline]. • Rao R: Hyperbilirubinemia. Available at: www.peds.umn.edu/divisions/neonatology. • Subcommittee on Hyperbilirubinemia: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation . Pediatrics 2004; 1 (114): 297-316. • Taketomo CK, Hodding JH, Draus DM: Pediatric Dosage Handbook. 6th ed. Cleveland, Ohio: Lexi-Comp, Inc; 1999. • Volpe JJ: Bilirubin and Brain Injury: Neurology of the Newborn. 3rd ed. Philadelphia, Pa: WB Saunders; 1995: 490-514. Kernicterus 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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LACTATION Section 5 of 11 Two essen
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IMMUNOLOGIC PROPERTIES OF HUMAN MIL
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Picture 3. Human milk and lactation
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• Isaacs CE, Thormar H: The role
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Hydrops Fetalis Last Updated: June
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Also of note is a computer simulati
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Physical: The presence of any of th
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o Once disorders of hemoglobin alph
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Structural anomalies Table 2. Cardi
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o B19V o Cytomegalovirus (CMV) o Sy
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o Sjögren syndrome A (uncertain in
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most commonly thrombocytopenia, is
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Lab Studies: WORKUP Section 5 of 10
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o Karyotyping is always indicated i
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• Space-occupying masses, which i
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of antidiabetic agents and antagoni
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Drug Name Sotalol (Betapace) -- Rec
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• Cowan RH, Waldo AL, Harris HB:
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• Silverman NH, Schmidt KG: Ventr
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At the cellular level, neuronal inj
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o Disturbances of ocular motion, su
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DIFFERENTIALS Section 4 of 10 Methy
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Interactions Benzodiazepines, cimet
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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
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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
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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: Prognosis: The spectrum of neurolog
Page 273 and 274: Airway obstruction Complete obstruc
Page 277 and 278: MEDICATION Section 7 of 11 In addit
Page 279 and 280: Drug Category: Sedatives -- Maximiz
Page 281 and 282: Transfer: • Although stabilizatio
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Page 285 and 286: occurs even later (ie, during days
Page 287 and 288: • Delivery room management of inf
Page 289 and 290: MISCELLANEOUS Section 7 of 9 Medica
Page 291 and 292: Necrotizing Enterocolitis Last Upda
Page 293 and 294: Race: Some studies indicate higher
Page 297 and 298: o With abdominal ultrasonography, a
Page 299 and 300: o Stage IB � Diagnosis is the sam
Page 301 and 302: Pregnancy C - Safety for use during
Page 303 and 304: Drug Name Epinephrine (Adrenaline)
Page 305 and 306: Pediatric Dose Contraindications In
Page 307 and 308: • Short-gut syndrome o This is a
Page 309 and 310: Picture 5. Necrotizing enterocoliti
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Page 313 and 314: o Although BP readings obtained usi
Page 315 and 316: Other Problems to be Considered: Re
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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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