Anemia of Prematurity - Portal Neonatal

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BIBLIOGRAPHY Section 10 of 10 • AAP: Neonatal drug withdrawal. American Academy of Pediatrics Committee on Drugs [published erratum appears in Pediatrics 1998 Sep;102(3 Pt 1):660]. Pediatrics 1998 Jun; 101(6): 1079-88[Medline]. • Bauer CR: Perinatal Effects of Prenatal Drug Exposure. Clinics in Perinatology 1999; 26(1): 87- 105[Medline]. • Bishai R: Maternal and Obstetric Effects of Prenatal Drug Exposure. Clinics in Perinatology 1999; 26(1): 75-85[Medline]. • Eyler FD: Early Development of Infants Exposed to Drugs Prenatally. Clinics in Perinatology 1999; 26(1): 107-149[Medline]. • Finnegan LP: Neonatal Abstinence Syndrome: Assessment and Pharmacotherapy. In Neonatal Therapy: An Update 1986; 122-146. • Flanagan P: Adolescent Pregnancy and Substance Abuse. Clinics in Perinatology 1999; 26(1): 185-199[Medline]. • Hans SL: Demographic and Psychosocial Characteristics of Substance-Abusing Pregnant Women. Clinics in Perinatology 1999; 26(1): 55-73[Medline]. • Hien D, Scheier J: Trauma and short-term outcome for women in detoxification. J Subst Abuse Treat 1996 May-Jun; 13(3): 227-31[Medline]. • Kosofsky BE: Cocaine-Induced Alterations in Neuro-Development. Seminars in Speech and language 1998; 19(2): 109-121[Medline]. • Lester BM: The Maternal Lifestyles Study. Ann N Y Acad Sci 1998 Jun 21; 846: 296- 305[Medline]. • Shephard R, Greenough A, Johnson K, Gerada C: Hyperphagia, weight gain and neonatal drug withdrawal. Acta Paediatr 2002; 91(9): 951-3[Medline]. • Smeriglio VL: Prenatal Drug Exposure and Child Outcome. Clinics in Perinatology 1999; 26(1): 1-15[Medline]. • Tronick EZ, Beeghly M: Prenatal cocaine exposure, child development, and the compromising effects of cumulative risk. Clin Perinatol 1999 Mar; 26(1): 151-71[Medline]. • Wilsnack SC, Beckman LJ: Drinking, sexuality, and sexual dysfunction in women. In: Alcohol Problems in Women: Antecedents, Consequences, and Intervention. New York: Guilford Press; 1984: 189. Perinatal Drug Abuse and Neonatal Drug Withdrawal excerpt © Copyright 2005, eMedicine.com, Inc.
Perioperative Pain Management in Newborns Last Updated: November 30, 2004 Synonyms and related keywords: neonatal analgesia, newborn postoperative pain control AUTHOR INFORMATION Section 1 of 10 Author: Napoleon Burt, MD, Director of Pediatric Anesthesia, Associate Professor, Assistant Program Director, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina Coauthor(s): Jeana Havidich, MD, Assistant Professor, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina Napoleon Burt, MD, is a member of the following medical societies: American Medical Association, American Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine, International Anesthesia Research Society, Ohio State Medical Association, Society for Pediatric Anesthesia, and South Carolina Medical Association Editor(s): Shelley C Springer, MD, MBA, MSc, Neonatologist, Assistant Professor of Pediatrics, Department of Pediatrics, University of Wisconsin, Madison; 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 The practice of medicine has become progressively more sophisticated. Physicians can now achieve the goal of facilitating the healing process while simultaneously minimizing or even eliminating the pain once thought necessary to achieve this goal. Adults were the first to benefit from these advances. Only within the last 2 decades has the sophisticated medical establishment realized that pediatric patients, including neonates, also feel pain and require medical intervention to alleviate unnecessary suffering. Medical intervention to alleviate unnecessary suffering is significantly affected by the beliefs of the caregiver. Before the late 1980s and early 1990s, the belief remained commonplace that neonates experienced no pain or less pain than adults, children, or infants who underwent similar surgical procedures. A health care provider who believes that neonates feel less pain tends to observe fewer clinical signs of pain in neonates. Furthermore, this group of practitioners tends to believe that narcotic administration is associated with increased risk in neonates. These practitioners may administer narcotic analgesics; however, less aggressive intervention and, frequently, subtherapeutic regimens are employed in preverbal patients as compared to adults. The fear of respiratory depression most significantly limits the administration of narcotics postoperatively, especially in nonintubated neonates or neonates undergoing minor surgical procedures. While these concerns may have some pharmacologic basis, they should not prevent the appropriate administration of narcotic analgesics to neonates who have experienced significant surgery. Furthermore, other therapeutic regimens formerly reserved for adults, adolescents, and older children may also be used safely to manage postoperative pain for the neonate. This article expressly and specifically considers the application of medical advances in pain management to the care of our youngest perioperative patients, neonatal surgical patients.
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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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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
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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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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 and 418: Picture 20.Omphalocele and gastrosc
Page 419 and 420: Perinatal Drug Abuse and Neonatal D
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: • Cognitive and developmental def
Page 433 and 434: The relative potency of each volati
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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
Page 469 and 470: Causes: umbilical artery, gastroint
Page 471 and 472: TREATMENT Section 5 of 9 Medical Ca
Page 473 and 474: Prognosis: • Polyhydramnios o If
Page 475 and 476: Pulmonary Interstitial Emphysema La
Page 477 and 478: compared to 39 of 169 among infants
Page 479 and 480: • 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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Anemia of Prematurity - Portal Neonatal

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