Anemia of Prematurity - Portal Neonatal

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• The use of other pharmacological modalities to prevent PVH-IVH has been proposed; however, this use is not widely accepted. The other pharmacological modalities include prenatal treatment with vitamin K and phenobarbital and postnatal treatment with Ethamsylate, phenobarbital, and vitamin E. Although positive reports concerning the efficacy of these agents exist, further investigation is required to prove conclusive evidence of benefit. Complications: • Obstructive hydrocephalus • Nonobstructive hydrocephalus • Developmental impairment • Cerebral palsy • Seizures Prognosis: • Grade I and grade II hemorrhage: Neurodevelopmental prognosis is excellent (ie, perhaps slightly worse than infants of similar gestational ages without PVH-IVH). • Grade III hemorrhage without white matter disease: Mortality is less than 10%. Of these patients, 30-40% have subsequent cognitive or motor disorders. • Grade IV (severe PVH-IVH) IVH with either periventricular hemorrhagic infarction and/or periventricular leukomalacia: Mortality approaches 80%. A 90% incidence of severe neurological sequelae including cognitive and motor disturbances exists. Patient Education: • Prenatal o Specific risks of gestational age o Sequelae • Postnatal o Provide postnatal education (if not provided previously) or reinforce prenatal education. o Provide results of sonography and expectations for short-term and long-term care. MISCELLANEOUS Section 9 of 11 Medical/Legal Pitfalls: Use of indomethacin o According to randomized controlled trials, the use of indomethacin appears to be effective in the prevention of PVH-IVH. However, this therapy is not accepted universally because of potential complications of treatment. Whether or not failure to use indomethacin (or the use of the drug with subsequent complications) could result in civil liability is not clear. o Additionally, in order to be effective, indomethacin must be administered within hours of birth. The number of at-risk premature patients who could conceivably receive the drug is large. Obtaining a pre-indomethacin echocardiogram to rule out an underlying cardiac condition in which patency of the ductus arteriosus is essential may be considered impractical and not cost effective. Whether or not legal risk is associated with the failure to diagnose a ductal-dependent lesion prior to administering indomethacin is not clear. Special Concerns: In patients with posthemorrhagic ventricular dilation that regresses, provide close follow-up care because hydrocephalus can recur.
PICTURES Section 10 of 11 Picture 1. Periventricular hemorrhage, intraventricular hemorrhage. Sonographic appearance of a normal neonatal brain. Image is from a coronal midline scan. Picture 2. Periventricular hemorrhage, intraventricular hemorrhage. Normal neonatal brain shown with left sagittal scan. Picture 3. Periventricular hemorrhage, intraventricular hemorrhage. Normal neonatal brain shown with midline sagittal scan.
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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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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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Page 399 and 400: multiple organisms) that lead direc
Page 401 and 402: • McKenna H, Johnson D: Bacteria
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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
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Page 421 and 422: Race: • The difficulty in assessi
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Page 427 and 428: Drug Category: Barbiturates -- Alth
Page 429 and 430: • Cognitive and developmental def
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Page 433 and 434: The relative potency of each volati
Page 435 and 436: Opioid administration remains the m
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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: Interactions suspected necrotizing
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
Page 481 and 482: • Other considerations o Avoid us
Page 483 and 484: • Gaylord MS, Quissell BJ, Lair M
Page 485 and 486: The components of pulmonary surfact
Page 487 and 488: WORKUP Section 5 of 11 Lab Studies:
Page 489 and 490: in infants who respond poorly or ar
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Page 493 and 494: Table 6. Meta-Analysis of Clinical
Page 495 and 496: Drug Name Pediatric Dose of acute a
Page 497 and 498: 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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