Anemia of Prematurity - Portal Neonatal

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Picture 10. Necrotizing enterocolitis. Histologic section of bowel mucosa showing regeneration of normal cellular architecture. Department of Pathology, Cornell University Medical. BIBLIOGRAPHY Section 11 of 11 • Adderson EE, Pappin A, Pavia AT: Spontaneous intestinal perforation in premature infants: a distinct clinical entity associated with systemic candidiasis. J Pediatr Surg 1998 Oct; 33(10): 1463-7[Medline]. • Ahmed T, Ein S, Moore A: The role of peritoneal drains in treatment of perforated necrotizing enterocolitis: recommendations from recent experience. J Pediatr Surg 1998 Oct; 33(10): 1468 • Avila-Figueroa C, Goldmann DA, Richardson DK: Intravenous lipid emulsions are the major determinant of coagulase- negative staphylococcal bacteremia in very low birth weight newborns. Pediatr Infect Dis J 1998 Jan; 17(1): 10-7[Medline]. • Berseth CL, Abrams SA: Special gastrointestinal concerns. In: Taeusch W, Ballard RA, eds. Avery's Diseases of the Newborn. 7th ed. Philadelphia, Pa: WB Saunders Co; 1998: 965-970. • Berseth CL: Effect of early feeding on maturation of the preterm infant's small intestine. J Pediatr 1992 Jun; 120(6): 947-53[Medline]. • Eyal F, Sagi E, Arad I: Necrotising enterocolitis in the very low birthweight infant: expressed breast milk feeding compared with parenteral feeding. Arch Dis Child 1982 Apr; 57(4): 274-6. • Freeman J, Wilcox MH: Antibiotics and Clostridium difficile. Microbes Infect 1999 Apr; 1(5): 377 • Hartman GE, Boyajian MJ, Choi SS, et al: General surgery. In: Neonatology: Pathophysiology & Management of the Newborn. 5th ed. Philadelphia, Pa: Lippincott; 1999: 1005-1044. • Kanto WP Jr, Hunter JE, Stoll BJ: Recognition and medical management of necrotizing enterocolitis. Clin Perinatol 1994 Jun; 21(2): 335-46[Medline]. • Kennedy KA, Tyson JE, Chamnanvanakij S: Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed lowbirth-weight infants. Cochrane Database Syst Rev 2000; (2): CD001241[Medline]. • Lucas A, Cole TJ: Breast milk and neonatal necrotising enterocolitis. Lancet 1990 Dec 22-29; 336(8730): 1519-23[Medline]. • McKeown RE, Marsh TD, Amarnath U: Role of delayed feeding and of feeding increments in necrotizing enterocolitis. J Pediatr 1992 Nov; 121(5 Pt 1): 764-70[Medline]. • Meetze WH, Valentine C, McGuigan JE: Gastrointestinal priming prior to full enteral nutrition in very low birth weight infants. J Pediatr Gastroenterol Nutr 1992 Aug; 15(2): 163-70[Medline]. • Nash PL: Naloxone and its use in neonatal septic shock. Neonatal Netw 1990 Jun; 8(6): 29-34. • Rayyis SF, Ambalavanan N, Wright L: Randomized trial of "slow" versus "fast" feed advancements on the incidence of necrotizing enterocolitis in very low birth weight infants. J Pediatr 1999 Mar; 134(3): 293-7[Medline]. • Rovin JD, Rodgers BM, Burns RC: The role of peritoneal drainage for intestinal perforation in infants with and without necrotizing enterocolitis. J Pediatr Surg 1999 Jan; 34(1): 143-7. • Shorter NA, Liu JY, Mooney DP: Indomethacin-associated bowel perforations: a study of possible risk factors. J Pediatr Surg 1999 Mar; 34(3): 442-4[Medline]. • Stark AR, Carlo WA, Tyson JE: Adverse effects of early dexamethasone in extremely-low-birthweight infants. National Institute of Child Health and Human Development Neonatal Research Network. N Engl J Med 2001 Jan 11; 344(2): 95-101[Medline]. • Stoll BJ: Epidemiology of necrotizing enterocolitis. Clin Perinatol 1994 Jun; 21(2): 205-18. • Taketomo CK, Hodding JH, Kraus DM: Pediatric Dosage Handbook. 6th ed. Hudson, Ohio: Lexi-Comp, Inc; 1999
Neonatal Hypertension Last Updated: June 7, 2004 Synonyms and related keywords: high blood pressure, high BP, premature infants AUTHOR INFORMATION Section 1 of 10 Author: Joseph Flynn, MD, Director of Pediatric Hypertension Program, Division of Pediatric Nephro, Children's Hospital at Montefiore; Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine Joseph Flynn, MD, is a member of the following medical societies: American Academy of Pediatrics, American Heart Association, American Society of Hypertension, American Society of Nephrology, American Society of Pediatric Nephrology, National Kidney Foundation, and Phi Beta Kappa Editor(s): Steven M Donn, MD, Professor of Pediatrics, Director, Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan Health System; Robert Konop, PharmD, Director, Clinical Account Management, Ancillary Care Management; Arun Pramanik, MD, Professor, Department of Pediatrics, Division of Neonatology, Louisiana State University Health Science Center; 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 10 Background: Recent advances in the ability to identify, evaluate, and care for hypertensive infants, coupled with advances in the practice of neonatology in general, have led to an increased awareness of hypertension in modern neonatal intensive care units (NICUs) since its first description in the 1970s. This article discusses an overview of the differential diagnosis of hypertension in the neonate, the optimal diagnostic evaluation, and both immediate and long-term antihypertensive therapy. Pathophysiology: Hypertension in newborn infants primarily is of renal origin, although cardiac, endocrine, and pulmonary causes have been described as well. Therefore, the pathophysiology depends on the organ system involved. For example, hypertension related to renal emboli primarily is a high renin form of hypertension, whereas the hypertension associated with bronchopulmonary dysplasia (BPD) is likely related to hypoxia. Such differences in pathophysiology are very important because they can guide the clinician with respect to evaluation and treatment. Frequency: In the US: Although precise figures are difficult to obtain, available data suggest that the incidence of hypertension in newborns is low, with published figures ranging from 0.2-3%. Hypertension is so unusual in otherwise healthy term infants that routine blood pressure (BP) determination is not advocated for these patients. In 1992, Singh and colleagues found that in a group of over 3000 infants admitted to a Chicago area NICU, the overall incidence of hypertension was found to be 0.81%. Hypertension was considerably more common in infants with BPD, patent ductus arteriosus, or intraventricular hemorrhage or in those who had indwelling umbilical arterial catheters. Approximately 9% of the infants who had indwelling umbilical arterial catheters developed hypertension. Hypertension may also be detected following discharge from the NICU. In 1987, Friedman and Hustead diagnosed hypertension (defined as a systolic BP >113 mm Hg on 3 consecutive visits over 6 wk) in 2.6% of infants discharged from a teaching hospital NICU. The diagnosis of hypertension was made in these infants at a mean corrected age of approximately 2 months. Infants in this study who developed hypertension tended to have lower initial Apgar scores and slightly longer NICU stays than infants who remained normotensive, indicating that sicker babies have a somewhat greater likelihood of developing hypertension. Although the number of babies affected is likely to be relatively small, include screening for hypertension in the follow-up of NICU graduates, especially those with more complicated NICU courses.
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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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o Allopurinol: Slight improvements
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• Patel J, Edwards AD: Prediction
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Increased insulin levels stimulate
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irth; symptoms may include jitterin
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speculated to be secondary to incre
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Procedures: o Clinical features of
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• Cardiac management o If signs o
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Pediatric Dose Contraindications In
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limiting step in the process, relea
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History: CLINICAL Section 3 of 11
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Lab Studies: WORKUP Section 5 of 11
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at equilibrium conditions, the isom
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• A number of guidelines for the
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Exchange transfusion Exchange trans
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FOLLOW-UP Section 8 of 11 Further I
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BIBLIOGRAPHY Section 11 of 11 • A
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Kernicterus Last Updated: November
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CLINICAL Section 3 of 11 History: A
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Page 297 and 298: o With abdominal ultrasonography, a
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o The clinician may require differe
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Precautions Drug Name Pediatric Dos
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Pregnancy B - Usually safe but bene
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Neural Tube Defects in the Neonatal
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An experienced pediatrician or surg
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EPIDEMIOLOGY Section 3 of 11 Severa
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ETIOLOGY Section 5 of 11 Over the l
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AFP concentration in the maternal s
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separated his patients into 3 diffe
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Head ultrasound can be performed du
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OUTCOME AND PROGNOSIS OF CHILDREN W
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Picture 2. Neural tube defects in t
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Picture 8. Neural tube defects in t
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• Sutton LN, Adzick NS, Bilaniuk
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Pathophysiology: • The umbilical
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• Omphalitis also may be the init
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• Supportive care: In addition to
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Drug Name Clindamycin (Cleocin) --
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multiple organisms) that lead direc
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• McKenna H, Johnson D: Bacteria
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Several processes combine to form t
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Frequency: • In the US: Combined
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• Polyhydramnios suggests fetal i
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aby with a giant omphalocele or in
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Prognosis: without extensively unde
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Picture 3. Omphalocele and gastrosc
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Picture 11. Omphalocele and gastros
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Picture 20.Omphalocele and gastrosc
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Perinatal Drug Abuse and Neonatal D
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Race: • The difficulty in assessi
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ehavioral and cognitive changes. Ma
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• All medically treated newborns
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Drug Category: Barbiturates -- Alth
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• Cognitive and developmental def
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Perioperative Pain Management in Ne
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The relative potency of each volati
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Opioid administration remains the m
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Use a short beveled needle to minim
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• Lerman J, Robinson S, Willis MM
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Pathophysiology: Site of origin The
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Pathogenesis of sequelae The major
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• Hypertension or beat-to-beat va
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Interactions suspected necrotizing
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PICTURES Section 10 of 11 Picture 1
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Picture 8. Periventricular hemorrha
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• Roberts JR: Drug therapy in inf
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Following the initial insult, wheth
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Picture 6. Cranial CT scan, axial i
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Polycythemia of the Newborn Last Up
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Causes: • Increased fetal erythro
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FOLLOW-UP Section 7 of 9 Further In
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Polyhydramnios and Oligohydramnios
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Causes: umbilical artery, gastroint
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TREATMENT Section 5 of 9 Medical Ca
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Prognosis: • Polyhydramnios o If
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Pulmonary Interstitial Emphysema La
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compared to 39 of 169 among infants
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• Selective main bronchial intuba
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• Other considerations o Avoid us
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• Gaylord MS, Quissell BJ, Lair M
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The components of pulmonary surfact
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WORKUP Section 5 of 11 Lab Studies:
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in infants who respond poorly or ar
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intensive care setting, and be anxi
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Table 6. Meta-Analysis of Clinical
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Drug Name Pediatric Dose of acute a
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The postnatal use of surfactant the
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Picture 5. A schematic diagram of t
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Retinopathy of Prematurity Last Upd
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• Examination recommendations Oth
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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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