Anemia of Prematurity - Portal Neonatal

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• BP in newborns depends on a variety of factors, including gestational age, postnatal age, and birth weight. Hypertension can be observed in a variety of situations in the modern NICU and is especially common in infants who have undergone umbilical arterial catheterization. A careful diagnostic evaluation should lead to determination of the underlying cause of hypertension in most infants. Tailor treatment decisions, which may include intravenous therapy, oral therapy, or both, to the severity of the hypertension. Hypertension resolves in most infants over time, although a small number of infants may have persistent BP elevation throughout childhood. Patient Education: Educate the parents of infants who develop hypertension requiring drug therapy about the expected effects and side effects of their infant's antihypertensive medications. In addition, arrange home BP monitoring equipment and educate the parents in its use prior to the infant's discharge from the NICU. Parents must monitor the BP of all infants discharged on antihypertensive medications on a regular basis (ie, usually daily); parents should call the physician if the infant's BP exceeds or falls below the target range. MISCELLANEOUS Section 9 of 10 Medical/Legal Pitfalls: Failure to diagnose or treat neonatal hypertension; major concern would be missing an underlying cause of hypertension such as renal disease that might require specific therapy. BIBLIOGRAPHY Section 10 of 10 • Abman SH, Warady BA, Lum GM: Systemic hypertension in infants with bronchopulmonary dysplasia. J Pediatr 1984 Jun; 104(6): 928-31[Medline]. • Adelman RD: Long-term follow-up of neonatal renovascular hypertension. Pediatr Nephrol 1987 Jan; 1(1): 35-41[Medline]. • Alagappan A, Malloy MH: Systemic hypertension in very low-birth weight infants with bronchopulmonary dysplasia: incidence and risk factors. Am J Perinatol 1998 Jan; 15(1): 3- 8[Medline]. • Boedy RF, Goldberg AK, Howell CG Jr: Incidence of hypertension in infants on extracorporeal membrane oxygenation. J Pediatr Surg 1990 Feb; 25(2): 258-61[Medline]. • Chandar JJ, Sfakianakis GN, Zilleruelo GE: ACE inhibition scintigraphy in the management of hypertension in children. Pediatric Nephrology 1999; 13: 493-500[Medline]. • Crapanzano MS, Strong WB, Newman IR: Calf blood pressure: clinical implications and correlations with arm blood pressure in infants and young children. Pediatrics 1996 Feb; 97(2): 220-4[Medline]. • de Swiet M, Fayers P, Shinebourne EA: Systolic blood pressure in a population of infants in the first year of life: the Brompton study. Pediatrics 1980 May; 65(5): 1028-35[Medline]. • Duley L: Pre-eclampsia and the hypertensive disorders of pregnancy. Br Med Bull 2003; 67(1): 161-76[Medline]. • Elliot SJ, Hansen TN: Neonatal hypertension. In: Long WA, ed. Fetal and Neonatal Cardiology. Philadelphia, Pa: WB Saunders Co; 1990:492-498.
• Flynn JT: Neonatal hypertension: diagnosis and management. Pediatr Nephrol 2000 Apr; 14(4): 332-41[Medline]. • Flynn JT, Smoyer WE, Bunchman TE: Treatment of hypertensive children with amlodipine. Am J Hypertens 2000 Oct; 13(10): 1061-6[Medline]. • Flynn JT, Warnick SJ: Isradipine treatment of hypertension in children: a single-center experience. Pediatric Nephrology 2002; 17: 748-53[Medline]. • Friedman AL, Hustead VA: Hypertension in babies following discharge from a neonatal intensive care unit. A 3-year follow-up. Pediatr Nephrol 1987 Jan; 1(1): 30-4[Medline]. • Gouyon JB, Geneste B, Semama DS: Intravenous nicardipine in hypertensive preterm infants. Arch Dis Child Fetal Neonatal Ed 1997 Mar; 76(2): F126-7[Medline]. • Inglefinger JR: Hypertension in the first year of life. In: Inglefinger JR. Pediatric Hypertension. Philadelphia, Pa: WB Saunders Co; 1982:229-240. • Low JA, Panagiotopoulos C, Smith JT: Validity of newborn oscillometric blood pressure. Clin Invest Med 1995 Jun; 18(3): 163-7[Medline]. • Markham LA, Stevens DL: A case report of neonatal thyrotoxicosis due to maternal autoimmune hyperthyroidism. Adv Neonatal Care 2003 Dec; 3(6): 272-85[Medline]. • Merten DF, Vogel JM, Adelman RD: Renovascular hypertension as a complication of umbilical arterial catheterization. Radiology 1978 Mar; 126(3): 751-7[Medline]. • Mocan H, Beattie TJ, Murphy AV: Renal venous thrombosis in infancy: long-term follow-up. Pediatr Nephrol 1991 Jan; 5(1): 45-9[Medline]. • Neal WA, Reynolds JW, Jarvis CW: Umbilical artery catheterization: demonstration of arterial thrombosis by aortography. Pediatrics 1972 Jul; 50(1): 6-13[Medline]. • Nwankwo MU, Lorenz JM, Gardiner JC: A standard protocol for blood pressure measurement in the newborn. Pediatrics 1997 Jun; 99(6): E10[Medline][Full Text]. • Roy S, Dillon MJ, Trompeter RS: Autosomal recessive polycystic kidney disease: long-term outcome of neonatal survivors [published erratum appears in Pediatr Nephrol 1997 Oct;11(5):664]. Pediatr Nephrol 1997 Jun; 11(3): 302-6[Medline]. • Sheftel DN, Hustead V, Friedman A: Hypertension screening in the follow-up of premature infants. Pediatrics 1983 May; 71(5): 763-6[Medline]. • Singh HP, Hurley RM, Myers TF: Neonatal hypertension. Incidence and risk factors. Am J Hypertens 1992 Feb; 5(2): 51-5[Medline]. • Skalina ME, Kliegman RM, Fanaroff AA: Epidemiology and management of severe symptomatic neonatal hypertension. Am J Perinatol 1986 Jul; 3(3): 235-9[Medline]. • Smets K, Vanhaesebrouck P: Dexamethasone associated systemic hypertension in low birth weight babies with chronic lung disease. Eur J Pediatr 1996 Jul; 155(7): 573- 5[Medline].
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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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MISCELLANEOUS Section 9 of 11 Medic
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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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o Extravasated blood: Significant a
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milk intake because of reduced mamm
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department and must be heavily seda
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Diet: Depending on the degree of ne
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Transfer: The recently reported cas
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Prognosis: The spectrum of neurolog
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Picture 5. Kernicterus. Neuronal ch
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Airway obstruction Complete obstruc
Page 275 and 276: Lab Studies: WORKUP Section 5 of 11
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
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Page 293 and 294: Race: Some studies indicate higher
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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
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Page 317 and 318: as nitroprusside, that may make it
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Page 329 and 330: Neonatal Resuscitation Last Updated
Page 331 and 332: Fetal pulmonary physiology The feta
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Page 335 and 336: Table 2. Equipment for Neonatal Res
Page 337 and 338: Airway management Once the infant i
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Page 351 and 352: Neonatal Sepsis Last Updated: June
Page 353 and 354: The fetus has some preimmune immuno
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Page 357 and 358: weeks of infection, the proportion
Page 359 and 360: cultures, clinicians may elect to c
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Page 363 and 364: Precautions Drug Name Pediatric Dos
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Page 369 and 370: Neural Tube Defects in the Neonatal
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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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