Anemia of Prematurity - Portal Neonatal

More documents

Recommendations

Info

o Arterial blood gases (ABG): Consider measuring ABG values to assess oxygenation in the symptomatic infant. o Platelet count: This count may demonstrate thrombocytopenia if thrombosis or DIC are present. TREATMENT Section 6 of 9 Medical Care: Therapy is based on both the measured central venous Hct and the presence or absence of symptoms. Treatment of polycythemia with partial exchange transfusion remains controversial. Regarding treatment with partial exchange, the Committee of the Fetus and Newborn of the American Academy of Pediatrics states, "The accepted treatment of polycythemia is partial exchange transfusion (PET). However there is no evidence that exchange transfusion affects the long term outcome." • Treatment for asymptomatic patients o Hct 65-75%: Liberally give fluids, perform cardiorespiratory monitoring and monitoring of Hct and glucose levels every 6 hours, and observe the patient for symptoms. o Hct >75% on repeated measurements: Consider partial exchange transfusion. o If the etiology is dehydration: Rehydrate the patient over 6-8 hours. • Treatment for symptomatic patients o Hct 60-65%: Consider alternative explanations for the symptoms. Although hyperviscosity may be the etiology of the symptoms, other causes for the symptoms must be excluded. o Hct >65% with symptoms attributable to hyperviscosity: Perform partial exchange transfusion. • Partial exchange transfusion o Perform a partial exchange transfusion by using an umbilical arterial or venous catheter to reduce the central Hct to 50-55%. o The total blood volume to be exchanged is determined as follows: [blood volume(patient's Hct – desired Hct)]/(patient's Hct), where blood volume = the patient's weight in kilograms multiplied by 90 mL/kg. o Normal saline is the replacement fluid of choice for exchange transfusions because it is effective and inexpensive. As alternatives, Plasmanate, 5% albumin, or fresh frozen plasma can be used. However, none of these is more effective than normal saline. In addition, both 5% albumin and fresh frozen plasma are blood products, and certain religious beliefs prohibit their use. o Sterile technique is required. o An exchange transfusion can be performed in 3 ways, depending on the type of vascular access that is available. Regardless of the method used, aliquots should not exceed approximately 5 mL/kg delivered or removed over 2-3 minutes. � If only a single umbilical arterial or venous catheter is in place, use a push-pull technique. With this technique, the withdrawal of blood is alternated with the administration of replacement fluid through the single catheter. Do not remove more than 5% of the patient's calculated blood volume in any single withdrawal. � If both umbilical venous and arterial catheters are in place, withdraw blood from the arterial catheter while administering the replacement fluid through the venous catheter � If a venous or arterial umbilical catheter and a peripheral venous catheter are in place, the former can be used for blood withdrawal, while the latter is used to simultaneously and continuously infuse the replacement fluid.
FOLLOW-UP Section 7 of 9 Further Inpatient Care: • Carefully monitor vital signs and bilirubin, glucose, and electrolyte levels as needed • Feedings may cautiously be introduced a number of hours after completing the partial exchange transfusion. Further Outpatient Care: • Perform routine newborn follow-up care. Complications: • Apnea • Arrhythmia • Vasospasm • Vessel perforation • Air embolus • Thrombosis • Infarction • Thrombocytopenia • Hemolysis • Electrolyte abnormalitie • Hypoglycemia • Hypocalcemia • Intrahepatic hematoma • Necrotizing enterocolitis Prognosis: • Infants are at increased risk for neurological deficits including speech abnormalities, finemotor delays, and gross-motor delays. • Partial exchange transfusion has not been shown to reduce these problems. • MISCELLANEOUS Section 8 of 9 Medical/Legal Pitfalls: • Use of a blood product (eg, albumin) in an exchange transfusion may result in the transmission of infection. Infections related to blood products can be avoided by using normal saline, which is sterile and which has been shown to be as effective as albumin. • Informed consent must be obtained as exchange transfusions have multiple risks (see Partial exchange transfusion). • The question regarding the efficacy of partial exchange transfusion in improving neurologic outcomes has not been answered. However, polycythemia and neurologic abnormalities have been linked. With this in mind, a symptomatic infant who has not been treated with partial exchange transfusion and who subsequently develops neurologic abnormalities may be considered inadequately treated.
Page 1 and 2:
e.medecine NEONATOLOGY 2006
Page 3 and 4:
24. Neonatal Hypertension..........
Page 5 and 6:
Although EPO is not the only erythr
Page 7 and 8:
Causes: • AOP results from a comb
Page 9 and 10:
• Reducing the number of donor ex
Page 11 and 12:
FOLLOW-UP Section 8 of 10 Further O
Page 13 and 14:
Apnea of Prematurity Last Updated:
Page 15 and 16:
The primary problem for premature n
Page 17 and 18:
pressure. Bradycardia may begin wit
Page 19 and 20:
TREATMENT Section 6 of 11 Medical C
Page 21 and 22:
Drug Name Doxapram (Dopram) -- Stim
Page 23 and 24:
Prognosis: • The natural history
Page 25 and 26:
o Despite the number of premature i
Page 27 and 28:
BIBLIOGRAPHY Section 11 of 11 • B
Page 29 and 30:
Tidal volume is the volume of gas i
Page 31 and 32:
5 time constants. The resulting tim
Page 33 and 34:
Once the diagnosis of RDS is establ
Page 35 and 36:
PATHOPHYSIOLOGY-BASED VENTILATORY S
Page 37 and 38:
High-frequency ventilation:High-fre
Page 39 and 40:
Picture 2. Determinants of oxygenat
Page 41 and 42:
Birth Trauma Last Updated: August 4
Page 43 and 44:
The extent of hemorrhage may be sev
Page 45 and 46:
CRANIAL NERVE AND SPINAL CORD INJUR
Page 47 and 48:
unpredictable unavoidable complicat
Page 49 and 50:
Bowel Obstruction in the Newborn La
Page 51 and 52:
The prenatal diagnosis of a bowel o
Page 53 and 54:
demonstrate the normal fixation pat
Page 55 and 56:
Other causes of proximal bowel obst
Page 57 and 58:
Hirschsprung disease Hirschsprung d
Page 59 and 60:
POSTOPERATIVE CARE FOLLOWING SURGER
Page 61 and 62:
Picture 4. Bowel obstruction in the
Page 63 and 64:
Breast Milk Jaundice Last Updated:
Page 65 and 66:
DIFFERENTIALS Section 4 of 9 Anemia
Page 67 and 68:
Consultations: Diet: • Consider c
Page 69 and 70:
Bronchopulmonary Dysplasia Last Upd
Page 71 and 72:
CLINICAL Section 3 of 11 History: B
Page 73 and 74:
of BPD and in the need for continue
Page 75 and 76:
Physical: • Infants with BPD have
Page 77 and 78:
discomfort. Many new synchronized v
Page 79 and 80:
treat acute bronchospasm; however,
Page 81 and 82:
• Excessive glucose loads may inc
Page 83 and 84:
Interactions Beta-adrenergic blocke
Page 85 and 86:
Drug Category: Pulmonary vasodilato
Page 87 and 88:
MISCELLANEOUS Section 9 of 11 Medic
Page 89 and 90:
• Frank L, Groseclose E: Oxygen t
Page 91 and 92:
• Northway WH Jr: Bronchopulmonar
Page 93 and 94:
Congenital Diaphragmatic Hernia Las
Page 95 and 96:
DIFFERENTIALS Section 4 of 10 Aspir
Page 97 and 98:
o Inhaled nitric oxide may be used
Page 99 and 100:
Drug Name Pediatric Dose Contraindi
Page 101 and 102:
Drug Name Pediatric Dose Vecuronium
Page 103 and 104:
Prognosis: • Pulmonary recovery:
Page 105 and 106:
• O'Toole SJ, Irish MS, Holm BA:
Page 107 and 108:
This article reviews the mechanics
Page 109 and 110:
Positioning the infant Positioning
Page 111 and 112:
stress and fatigue in both parents
Page 113 and 114:
As the mother's milk supply is esta
Page 115 and 116:
Engorgement Engorgement is a common
Page 117 and 118:
Ethical Issues in Neonatal Care Las
Page 119 and 120:
GOALS OF NEONATAL INTENSIVE CARE Se
Page 121 and 122:
Other guidelines of ethical import
Page 123 and 124:
In some situations, tragic situatio
Page 125 and 126:
BIBLIOGRAPHY Section 8 of 8 • AAP
Page 127 and 128:
CLINICAL FEATURES Section 4 of 7 Th
Page 129 and 130:
Comparisons of the nutrient content
Page 131 and 132:
Indomethacin is used prophylactical
Page 133 and 134:
FOLLOW-UP CARE Section 5 of 7 Nearl
Page 135 and 136:
BIBLIOGRAPHY Section 7 of 7 • Bha
Page 137 and 138:
Fluid, Electrolyte, and Nutrition M
Page 139 and 140:
Clinical evaluation • Weight fact
Page 141 and 142:
o Hypernatremia is defined as a ser
Page 143 and 144:
intake from protein is included in
Page 145 and 146:
Energy ENTERAL NUTRITION MANAGEMENT
Page 147 and 148:
growth and bone mineral content has
Page 149 and 150:
Hemolytic Disease of Newborn Last U
Page 151 and 152:
CLINICAL Section 3 of 11 History: W
Page 153 and 154:
• Serologic tests Imaging Studies
Page 155 and 156:
IVT in 1981. With ultrasonographic
Page 157 and 158:
status (eg, watching for hypoglycem
Page 159 and 160:
� The mechanism by which unconjug
Page 161 and 162:
BIBLIOGRAPHY Section 11 of 11 • B
Page 163 and 164:
Race: No racial predilection exists
Page 165 and 166:
Drug Name Pediatric Dose Phytonadio
Page 167 and 168:
Human Milk and Lactation Last Updat
Page 169 and 170:
LACTATION Section 5 of 11 Two essen
Page 171 and 172:
IMMUNOLOGIC PROPERTIES OF HUMAN MIL
Page 173 and 174:
Picture 3. Human milk and lactation
Page 175 and 176:
• Isaacs CE, Thormar H: The role
Page 177 and 178:
Hydrops Fetalis Last Updated: June
Page 179 and 180:
Also of note is a computer simulati
Page 181 and 182:
Physical: The presence of any of th
Page 183 and 184:
o Once disorders of hemoglobin alph
Page 185 and 186:
Structural anomalies Table 2. Cardi
Page 187 and 188:
o B19V o Cytomegalovirus (CMV) o Sy
Page 189 and 190:
o Sjögren syndrome A (uncertain in
Page 191 and 192:
most commonly thrombocytopenia, is
Page 193 and 194:
Lab Studies: WORKUP Section 5 of 10
Page 195 and 196:
o Karyotyping is always indicated i
Page 197 and 198:
Page 199 and 200:
• Space-occupying masses, which i
Page 201 and 202:
of antidiabetic agents and antagoni
Page 203 and 204:
Drug Name Sotalol (Betapace) -- Rec
Page 205 and 206:
• Cowan RH, Waldo AL, Harris HB:
Page 207 and 208:
• Silverman NH, Schmidt KG: Ventr
Page 209 and 210:
At the cellular level, neuronal inj
Page 211 and 212:
o Disturbances of ocular motion, su
Page 213 and 214:
DIFFERENTIALS Section 4 of 10 Methy
Page 215 and 216:
Page 217 and 218:
Interactions Benzodiazepines, cimet
Page 219 and 220:
o Allopurinol: Slight improvements
Page 221 and 222:
• Patel J, Edwards AD: Prediction
Page 223 and 224:
Increased insulin levels stimulate
Page 225 and 226:
irth; symptoms may include jitterin
Page 227 and 228:
speculated to be secondary to incre
Page 229 and 230:
Procedures: o Clinical features of
Page 231 and 232:
• Cardiac management o If signs o
Page 233 and 234:
Pediatric Dose Contraindications In
Page 235 and 236:
FOLLOW-UP Section 8 of 10 Further O
Page 237 and 238:
Page 239 and 240:
limiting step in the process, relea
Page 241 and 242:
History: CLINICAL Section 3 of 11
Page 243 and 244:
Page 245 and 246:
at equilibrium conditions, the isom
Page 247 and 248:
• A number of guidelines for the
Page 249 and 250:
Exchange transfusion Exchange trans
Page 251 and 252:
FOLLOW-UP Section 8 of 11 Further I
Page 253 and 254:
BIBLIOGRAPHY Section 11 of 11 • A
Page 255 and 256:
Kernicterus Last Updated: November
Page 257 and 258:
CLINICAL Section 3 of 11 History: A
Page 259 and 260:
o Extravasated blood: Significant a
Page 261 and 262:
milk intake because of reduced mamm
Page 263 and 264:
department and must be heavily seda
Page 265 and 266:
Diet: Depending on the degree of ne
Page 267 and 268:
Transfer: The recently reported cas
Page 269 and 270:
Prognosis: The spectrum of neurolog
Page 271 and 272:
Picture 5. Kernicterus. Neuronal ch
Page 273 and 274:
Airway obstruction Complete obstruc
Page 275 and 276:
Page 277 and 278:
MEDICATION Section 7 of 11 In addit
Page 279 and 280:
Drug Category: Sedatives -- Maximiz
Page 281 and 282:
Transfer: • Although stabilizatio
Page 283 and 284:
BIBLIOGRAPHY Section 11 of 11 • A
Page 285 and 286:
occurs even later (ie, during days
Page 287 and 288:
• Delivery room management of inf
Page 289 and 290:
MISCELLANEOUS Section 7 of 9 Medica
Page 291 and 292:
Necrotizing Enterocolitis Last Upda
Page 293 and 294:
Race: Some studies indicate higher
Page 295 and 296:
Page 297 and 298:
o With abdominal ultrasonography, a
Page 299 and 300:
o Stage IB � Diagnosis is the sam
Page 301 and 302:
Pregnancy C - Safety for use during
Page 303 and 304:
Drug Name Epinephrine (Adrenaline)
Page 305 and 306:
Pediatric Dose Contraindications In
Page 307 and 308:
• Short-gut syndrome o This is a
Page 309 and 310:
Picture 5. Necrotizing enterocoliti
Page 311 and 312:
Neonatal Hypertension Last Updated:
Page 313 and 314:
o Although BP readings obtained usi
Page 315 and 316:
Other Problems to be Considered: Re
Page 317 and 318:
as nitroprusside, that may make it
Page 319 and 320:
Surgical Care: Surgery is rarely in
Page 321 and 322:
decrease in cardiac output; triazol
Page 323 and 324:
Contraindications Documented hypers
Page 325 and 326:
FOLLOW-UP Section 8 of 10 Further I
Page 327 and 328:
• Flynn JT: Neonatal hypertension
Page 329 and 330:
Neonatal Resuscitation Last Updated
Page 331 and 332:
Fetal pulmonary physiology The feta
Page 333 and 334:
Flow studies have revealed that rel
Page 335 and 336:
Table 2. Equipment for Neonatal Res
Page 337 and 338:
Airway management Once the infant i
Page 339 and 340:
Cardiovascular support and chest co
Page 341 and 342:
Once the appropriate functional res
Page 343 and 344:
Premature infants are also at high
Page 345 and 346:
Because secretions or oral feedings
Page 347 and 348:
The team should be led and organize
Page 349 and 350:
Intubation and suctioning for mecon
Page 351 and 352:
Neonatal Sepsis Last Updated: June
Page 353 and 354:
The fetus has some preimmune immuno
Page 355 and 356:
when chorioamnionitis accompanies t
Page 357 and 358:
weeks of infection, the proportion
Page 359 and 360:
cultures, clinicians may elect to c
Page 361 and 362:
o The clinician may require differe
Page 363 and 364:
Precautions Drug Name Pediatric Dos
Page 365 and 366:
Pregnancy B - Usually safe but bene
Page 367 and 368:
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
Page 379 and 380:
separated his patients into 3 diffe
Page 381 and 382:
Head ultrasound can be performed du
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
Page 409 and 410:
aby with a giant omphalocele or in
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 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: Causes: • Increased fetal erythro
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
Page 511 and 512: • Contractility is a semiquantita
Page 513 and 514: • Uncompensated o During uncompen
Page 515 and 516:
mL/kg of volume expansion should re
Page 517 and 518:
MEDICATION Section 7 of 10 Drug Cat
Page 519 and 520:
Drug Name cyanide toxicity; sodium
Page 521 and 522:
Pregnancy Precautions Drug Name fur
Page 523 and 524:
Transient Tachypnea of the Newborn
Page 525 and 526:
DIFFERENTIALS Section 4 of 11 Pneum
Page 527 and 528:
Drug Name Pediatric Dose Gentamicin
Page 529 and 530:
Transport of the Critically Ill New
Page 531 and 532:
Communications To initiate the tran
Page 533 and 534:
Table 1. Advantages and disadvantag
Page 535 and 536:
Table 2. A comparison of the advant
Page 537 and 538:
Flight team personnel also are affe
Page 539 and 540:
PICTURES Section 10 of 11 Picture 1
show all

Anemia of Prematurity - Portal Neonatal

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?