Anemia of Prematurity - Portal Neonatal

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Picture 25. Omphalocele and gastroschisis. Baby with isolated epispadias. Picture 26. Omphalocele and gastroschisis. An operative photo from the repair of a draining umbilicus. BIBLIOGRAPHY Section 10 of 10 • Cooney D: Defects of the Abdominal Wall. Pediatric Surgery 1998; 2: 1045-1070. • de Lorimier AA, Adzick NS, Harrison MR: Amnion inversion in the treatment of giant omphalocele. J Pediatr Surg 1991 Jul; 26(7): 804-7[Medline]. • Dinatti LA, Meagher DP Jr, Martinez-Frontanilla LA: "Bucket handle" avulsion of intestine in gastroschisis. J Pediatr Surg 28(6): 840[Medline]. • Duffy PG: Bladder exstrophy. Semin Pediatr Surg 1996 May; 5(2): 129-32[Medline]. • Dykes EH: Prenatal diagnosis and management of abdominal wall defects. Semin Pediatr Surg 1996 May; 5(2): 90-4[Medline]. • Fok TF, Ng PC, Wong W: High frequency oscillatory ventilation in infants with increased intra- abdominal pressure. Arch Dis Child Fetal Neonatal Ed 1997 Mar; 76(2): F123-5[Medline]. • Langer JC: Gastroschisis and omphalocele. Semin Pediatr Surg 1996 May; 5(2): 124-8 • Molenaar JC, ed.: Abdominal Wall Defects. Seminars in Pediatric Surgery 1996; 5: 81-135. • Molenaar, J.C.: Cloacal Exstrophy. Seminars in Pediatric Surgery 1996; 5: 133-135[Medline]. • Moore TC: Omphalomesenteric duct malformations. Semin Pediatr Surg 1996 May; 5(2): 116- 23[Medline]. • Salihu HM, Boos R, Schmidt W: Omphalocele and gastrochisis. J Obstet Gynaecol 2002 Sep; 22(5): 489-92[Medline]. • Sauter ER, Falterman KW, Arensman RM: Is primary repair of gastroschisis and omphalocele always the best operation? Am Surg 1991 Mar; 57(3): 142-4[Medline]. • Suita S, Okamatsu T, Yamamoto T, et al: Changing Profile of Abdominal Wall Defects in Japan: Results of a National Survey. J Pediatr Surg 2000; 35: 66-72[Medline]. • Suita S, Nagasaki A: Urachal remnants. Semin Pediatr Surg 1996 May; 5(2): 107-15[Medline]. • Tan KH, Kilby MD, Whittle MJ: Congenital anterior abdominal wall defects in England and Wales 1987- 93: retrospective analysis of OPCS data. BMJ 1996 Oct 12; 313(7062): 903-6 • Vermeij-Keers C, Hartwig NG, van der Werff JF: Embryonic development of the ventral body wall and its congenital malformations. Semin Pediatr Surg 1996 May; 5(2): 82-9[Medline]. • Wakhlu A, Wakhlu AK: The management of exomphalos. J Pediatr Surg 2000 Jan; 35(1): 73- 6[Medline]. • Wheatley JM, Stephens FD, Hutson JM: Prune-belly syndrome: ongoing controversies regarding pathogenesis and management. Semin Pediatr Surg 1996 May; 5(2): 95-106 Omphalocele and Gastroschisis excerpt © Copyright 2005, eMedicine.com, Inc.
Perinatal Drug Abuse and Neonatal Drug Withdrawal Last Updated: October 26, 2004 Synonyms and related keywords: neonatal abstinence syndrome, neonatal withdrawal syndrome, substance abuse during pregnancy, maternal drug abuse AUTHOR INFORMATION Section 1 of 10 Author: Marvin Wang, MD, Director, Newborn Nurseries, Massachusetts General Hospital, Instructor, Department of Pediatrics, Harvard Medical School Editor(s): David N Sheftel, MD, Director, Division of Neonatology, Lutheran General Children's Hospital of Park Ridge, Clinical Associate Professor, Department of Pediatrics, Chicago Medical School; Robert Konop, PharmD, Director, Clinical Account Management, Ancillary Care Management; Brian S Carter, MD, Associate Director, Associate Professor, Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center and Gateway Medical 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: The use and abuse of addictive drugs has occurred throughout many centuries. Only recently have certain drugs under question become defined as illicit. Therefore, many pregnant women have used such medications without prior consideration to the adverse effects of these substances upon their unborn children. The effects of chemicals, such as opiates, cocaine, nicotine, alcohol, and new recreational drugs, on fetal development have been seriously studied only in the last 30 years. The difficulty in evaluating research in this area is enormous. Clear methods for differentiating drug use from drug abuse are not established. The question of whether the mere presence of the chemical in maternal serum alludes to fetal damage needs to be answered. Evaluating if the mother in question has told the whole truth about her drug use is difficult. Given the stigma of substance abuse during pregnancy, lack of disclosure by the mother to her health provider is common because such damaging information ultimately could lead to the separation of mother and child. Many confounding factors, such as the probability of polysubstance use and how this affects singledrug studies, may exist. Additionally, the fact that a mother has used an illicit drug (or even a legal substance such as alcohol or tobacco) intertwines with many other factors that can affect a child. Socioeconomic status, support systems, role of the father, lack of prenatal care, and the caregiving ability of the mother all play tremendous roles in child development. Pathophysiology: Maternal alterations Almost all drugs of abuse follow a similar mechanism of action in the adult brain; this mechanism alters the pathways for reward. Through complex neurochemical interactions, various chemicals act to increase dopaminergic pathways from the midbrain ventral tegmental area (VTA) to the nucleus accumbens (NAc) in the striatum. Additionally, the NAc provides a negative feedback loop to the VTA using the inhibitory monoamine gamma-aminobutyric acid (GABA). Blocking such a pathway also attenuates the reward mechanism in the adult brain.
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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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FOLLOW-UP Section 8 of 10 Further O
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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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MEDICATION Section 7 of 11 In addit
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Drug Category: Sedatives -- Maximiz
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Transfer: • Although stabilizatio
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BIBLIOGRAPHY Section 11 of 11 • A
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occurs even later (ie, during days
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• Delivery room management of inf
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MISCELLANEOUS Section 7 of 9 Medica
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Necrotizing Enterocolitis Last Upda
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Race: Some studies indicate higher
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o With abdominal ultrasonography, a
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o Stage IB � Diagnosis is the sam
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Pregnancy C - Safety for use during
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Drug Name Epinephrine (Adrenaline)
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Pediatric Dose Contraindications In
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• Short-gut syndrome o This is a
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Picture 5. Necrotizing enterocoliti
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Neonatal Hypertension Last Updated:
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o Although BP readings obtained usi
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Other Problems to be Considered: Re
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as nitroprusside, that may make it
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Surgical Care: Surgery is rarely in
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decrease in cardiac output; triazol
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Contraindications Documented hypers
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• 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
Page 367 and 368: MISCELLANEOUS Section 9 of 11 Medic
Page 369 and 370: Neural Tube Defects in the Neonatal
Page 371 and 372: An experienced pediatrician or surg
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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Page 383 and 384: OUTCOME AND PROGNOSIS OF CHILDREN W
Page 385 and 386: Picture 2. Neural tube defects in t
Page 387 and 388: Picture 8. Neural tube defects in t
Page 389 and 390: • Sutton LN, Adzick NS, Bilaniuk
Page 391 and 392: Pathophysiology: • The umbilical
Page 393 and 394: • Omphalitis also may be the init
Page 395 and 396: • Supportive care: In addition to
Page 397 and 398: Drug Name Clindamycin (Cleocin) --
Page 399 and 400: multiple organisms) that lead direc
Page 401 and 402: • McKenna H, Johnson D: Bacteria
Page 403 and 404: Several processes combine to form t
Page 405 and 406: Frequency: • In the US: Combined
Page 407 and 408: • Polyhydramnios suggests fetal i
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Page 411 and 412: Prognosis: without extensively unde
Page 413 and 414: Picture 3. Omphalocele and gastrosc
Page 415 and 416: Picture 11. Omphalocele and gastros
Page 417: Picture 20.Omphalocele and gastrosc
Page 421 and 422: Race: • The difficulty in assessi
Page 423 and 424: ehavioral and cognitive changes. Ma
Page 425 and 426: • All medically treated newborns
Page 427 and 428: Drug Category: Barbiturates -- Alth
Page 429 and 430: • Cognitive and developmental def
Page 431 and 432: Perioperative Pain Management in Ne
Page 433 and 434: The relative potency of each volati
Page 435 and 436: Opioid administration remains the m
Page 437 and 438: Use a short beveled needle to minim
Page 439 and 440: • Lerman J, Robinson S, Willis MM
Page 441 and 442: Pathophysiology: Site of origin The
Page 443 and 444: Pathogenesis of sequelae The major
Page 445 and 446: • Hypertension or beat-to-beat va
Page 447 and 448: Interactions suspected necrotizing
Page 449 and 450: PICTURES Section 10 of 11 Picture 1
Page 451 and 452: Picture 8. Periventricular hemorrha
Page 453 and 454: • Roberts JR: Drug therapy in inf
Page 455 and 456: Following the initial insult, wheth
Page 457 and 458: FOLLOW-UP Section 7 of 10 Further O
Page 459 and 460: Picture 6. Cranial CT scan, axial i
Page 461 and 462: Polycythemia of the Newborn Last Up
Page 463 and 464: Causes: • Increased fetal erythro
Page 465 and 466: FOLLOW-UP Section 7 of 9 Further In
Page 467 and 468: 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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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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