Anemia of Prematurity - Portal Neonatal

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BIBLIOGRAPHY Section 10 of 10 • Bass WT, Jones MA, White LE: Ultrasonographic differential diagnosis and neurodevelopmental outcome of cerebral white matter lesions in premature infants. J Perinatol 1999 Jul-Aug; 19(5): 330-6[Medline]. • Baud O, d'Allest AM, Lacaze-Masmonteil T: The early diagnosis of periventricular leukomalacia in premature infants with positive rolandic sharp waves on serial electroencephalography. J Pediatr 1998 May; 132(5): 813-7[Medline]. • Baud O, Foix-L'Helias L, Kaminski M: Antenatal glucocorticoid treatment and cystic periventricular leukomalacia in very premature infants. N Engl J Med 1999 Oct 14; 341(16): 1190-6[Medline]. • Canterino JC, Verma U, Visintainer PF: Antenatal steroids and neonatal periventricular leukomalacia. Obstet Gynecol 2001 Jan; 97(1): 135-9[Medline]. • Dammann O, Leviton A: Brain damage in preterm newborns: might enhancement of developmentally regulated endogenous protection open a door for prevention? Pediatrics 1999 Sep; 104(3 Pt 1): 541-50[Medline]. • Dammann O, Hagberg H, Leviton A: Is periventricular leukomalacia an axonopathy as well as an oligopathy? Pediatr Res 2001 Apr; 49(4): 453-7[Medline]. • de Vries LS, Regev R, Dubowitz LM: Perinatal risk factors for the development of extensive cystic leukomalacia. Am J Dis Child 1988 Jul; 142(7): 732-5[Medline]. • Enzmann DR: Imaging of neonatal hypoxic-ischemic cerebral damage. In: Stevenson DK, Sunshine P, eds. Fetal and Neonatal Brain Injury: Mechanisms, Management, and the Risk of Practice. 2nd ed. Oxford, England: Oxford University Press; 1997: 302-355. • Hahn JS, Novotony EJ Jr: Hypoxic-ischemic encephalopathy. In: Stevenson DK, Sunshine P, eds. Fetal and Neonatal Brain Injury: Mechanisms, Management, and the Risk of Practice. 2nd ed. Oxford, England: Oxford University Press; 1997: 277-286. • Hayakawa F, Okumura A, Kato T: Determination of timing of brain injury in preterm infants with periventricular leukomalacia with serial neonatal electroencephalography. Pediatrics 1999 Nov; 104(5 Pt 1): 1077-81[Medline]. • Kuban K, Sanocka U, Leviton A: White matter disorders of prematurity: association with intraventricular hemorrhage and ventriculomegaly. The Developmental Epidemiology Network. J Pediatr 1999 May; 134(5): 539-46[Medline]. • Leviton A, Paneth N, Reuss ML: Maternal infection, fetal inflammatory response, and brain damage in very low birth weight infants. Developmental Epidemiology Network Investigators. Pediatr Res 1999 Nov; 46(5): 566-75[Medline]. • Liao SL, Lai SH, Chou YH: Effect of hypocapnia in the first three days of life on the subsequent development of periventricular leukomalacia in premature infants. Acta Paediatr Taiwan 2001 Mar-Apr; 42(2): 90-3[Medline]. • Okumura A, Hayakawa F, Kato T: Hypocarbia in preterm infants with periventricular leukomalacia: the relation between hypocarbia and mechanical ventilation. Pediatrics 2001 Mar; 107(3): 469-75[Medline]. • Paul DA, Pearlman SA, Finkelstein MS: Cranial sonography in very-low-birth-weight infants: do all infants need to be screened? Clin Pediatr (Phila) 1999 Sep; 38(9): 503-9[Medline]. • Shankaran S: Hemorrhagic lesions of the central nervous system. In: Stevenson DK, Sunshine P, eds. Fetal and Neonatal Brain Injury: Mechanisms, Management, and the Risk of Practice. 2nd ed. Oxford, England: Oxford University Press; 1997: 151-164. • Volpe JJ: Brain injury in the premature infant: overview of clinical aspects, neuropathology, and pathogenesis. Semin Pediatr Neurol 1998 Sep; 5(3): 135-51[Medline]. • Wiswell TE, Graziani LJ, Kornhauser MS: Effects of hypocarbia on the development of cystic periventricular leukomalacia in premature infants treated with high-frequency jet ventilation. Pediatrics 1996 Nov; 98(5): 918-24[Medline]. Periventricular Leukomalacia excerpt © Copyright 2005, eMedicine.com, Inc.
Polycythemia of the Newborn Last Updated: June 3, 2005 Synonyms and related keywords: neonatal polycythemia, erythrocythemia, hematocrit, Hct, hyperviscosity, sludged blood, microthrombi, microthrombus AUTHOR INFORMATION Section 1 of 9 Author: Karen J Lessaris, MD, Attending Staff, Department of Neonatology, Carolinas Medical Center Karen J Lessaris, MD, is a member of the following medical societies: American Academy of Pediatrics Editor(s): Scott MacGilvray, MD, Associate Professor, Department of Pediatrics, Pitt County Memorial Hospital; 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 9 Background: Polycythemia, defined as a venous hematocrit (Hct) of greater than 65%, is a relatively common disorder. The primary concern with polycythemia is related to hyperviscosity and its associated complications. Blood viscosity increases exponentially as the Hct rises above 42%. This associated hyperviscosity is thought to contribute to the symptom complex observed in approximately one half of infants with polycythemia. However, only 47% of infants with polycythemia have hyperviscosity, and only 24% of infants with hyperviscosity have a diagnosis of polycythemia. Pathophysiology: As the central Hct increases, viscosity increases, resulting in abnormal blood flow kinetics. This condition manifests as poor flow or sludging of blood, which predisposes the infant to microthrombi and decreased tissue oxygenation. Many factors determine blood viscosity. As previously mentioned, viscosity increases as Hct rises. Plasma volume, plasma proteins, platelets, and endothelial factors also contribute to viscosity. Factors unique to the neonate (eg, increased RBC volume, decreased deformability of the fetal erythrocyte) also contribute to increased viscosity. Frequency: In the US: Polycythemia occurs in 0.4-12% of neonates. It is more common in infants who are small for their gestational age (SGA) and in infants who are large for their gestational age (LGA). However, most infants with polycythemia are of appropriate size or weight for their gestational age (AGA). Infants of mothers with diabetes have an incidence of >40%, and those born to mothers with gestational diabetes have an incidence of >30%. Hyperviscosity occurs in 6.7% of infants. Mortality/Morbidity: Age: • The central nervous, cardiopulmonary, gastrointestinal, and renal systems are at risk. • Metabolic derangements are common. • Coagulation also can be affected. • The Hct peaks 2 hours after birth and then declines until the infant is aged 6 hours, at which time it equals the Hct in cord blood. • Fewer than 40% of infants with a Hct greater than 64% at 2 hours still have a high value at 12 hours or later.
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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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FOLLOW-UP Section 8 of 10 Further I
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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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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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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 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: Picture 6. Cranial CT scan, axial i
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
Page 491 and 492: intensive care setting, and be anxi
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
Page 499 and 500: Picture 5. A schematic diagram of t
Page 501 and 502: Retinopathy of Prematurity Last Upd
Page 503 and 504: • Examination recommendations Oth
Page 505 and 506: FOLLOW-UP Section 7 of 10 Further I
Page 507 and 508: Picture 5. Retinopathy of prematuri
Page 509 and 510: • 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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