Anemia of Prematurity - Portal Neonatal

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• Susskind MR, Kim KS, King LR: Hypertension and multicystic kidney. Urology 1989 Dec; 34(6): 362-6[Medline]. • Task Force on Blood Pressure Control in Children: Report of the Second Task Force on Blood Pressure Control in Children--1987. Task Force on Blood Pressure Control in Children. National Heart, Lung, and Blood Institute, Bethesda, Maryland. Pediatrics 1987 Jan; 79(1): 1-25[Medline]. • Wells TG, Bunchman TE, Kearns GL: Treatment of neonatal hypertension with enalaprilat. J Pediatr 1990 Oct; 117(4): 664-7[Medline]. • Yau V, Chow E, Davis L: Pain management in cancer patients with bone metastases remains a challenge. J Pain Symptom Manage 2004 Jan; 27(1): 1-3[Medline]. • Zubrow AB, Hulman S, Kushner H: Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group. J Perinatol 1995 Nov-Dec; 15(6): 470-9[Medline]. Neonatal Hypertension excerpt © Copyright 2005, eMedicine.com, Inc.
Neonatal Resuscitation Last Updated: September 15, 2004 AUTHOR INFORMATION Section 1 of 10 Author: Robin L Bissinger, MSN, RNC, NNP, Neonatal Nurse Practitioner Coordinator, Assistant Professor, Nursing, Medical University of South Carolina College of Nursing Coauthor(s): Bryan L Ohning, MD, PhD, Medical Director, NICU and Neonatal Transport Team, Clinical Associate Professor, Department of Neonatology, Greenville Children's Hospital and Medical University of South Carolina Editor(s): Ted Rosenkrantz, MD, Head, Division of Neonatal Perinatal Medicine, Professor, Department of Pediatrics, University of Connecticut Health Center; 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 10 Neonatal resuscitation skills are essential for all health care providers who are involved in the delivery of newborns. The transition from fetus to newborn requires intervention by a skilled individual or team in approximately 10% of all deliveries. This figure is concerning because 81% of all babies in the United States are born in nonteaching nonaffiliated level I or II hospitals. In such hospitals, the volume of delivery service may not be perceived to economically justify the continuous in-hospital presence of personnel with high-risk delivery room experience as recommended by the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) in Guidelines for Perinatal Care. Perinatal asphyxia and extreme prematurity are the 2 complications of pregnancy that most frequently require a complex resuscitation by skilled personnel. However, only 60% of asphyxiated newborns can be predicted antepartum. The remaining newborns are not identified until the time of birth. Additionally, approximately 80% of low birth weight infants require resuscitation and stabilization at delivery. Nearly one half of newborn deaths (many of which are extremely premature infants) occur during the first 24 hours following birth. A number of these early deaths also have a component of asphyxia and/or respiratory depression as an etiology. For the surviving infants, effective management of asphyxia in the first few minutes of life may influence long-term outcome. Even though prenatal care is able to identify many potential fetal difficulties antepartum, allowing maternal transfer of care to the referral center, many women who experience preterm labor are not identified prospectively, therefore not allowing the appropriate maternal transfer to a tertiary perinatal center. Consequently, many deliveries of extremely premature infants occur in smaller hospitals. For this reason, all personnel involved in delivery room care of the newborn should be trained adequately in all aspects of neonatal resuscitation. This chapter reviews the adaptation to extrauterine life and the steps necessary to optimally resuscitate neonates. Along with the necessary skills, the practitioner should approach any resuscitation with a good comprehension of transitional physiology and adaptation, as well as an understanding of the infant's response to resuscitation. Resuscitation involves knowing much more than an ordered list of skills and having a resuscitation team; it requires excellent assessment skills and a grounded understanding of physiology.
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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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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
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Page 277 and 278: MEDICATION Section 7 of 11 In addit
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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
Page 295 and 296: Lab Studies: WORKUP Section 5 of 10
Page 297 and 298: o With abdominal ultrasonography, a
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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 325 and 326: FOLLOW-UP Section 8 of 10 Further I
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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 353 and 354: The fetus has some preimmune immuno
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Page 357 and 358: weeks of infection, the proportion
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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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Page 373 and 374: EPIDEMIOLOGY Section 3 of 11 Severa
Page 375 and 376: ETIOLOGY Section 5 of 11 Over the l
Page 377 and 378: 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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