Anemia of Prematurity - Portal Neonatal

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MISCELLANEOUS Section 9 of 10 Medical/Legal Pitfalls: • The major medicolegal pitfall is delayed diagnosis and treatment, leading to permanent neurologic sequelae such as cerebral palsy, epilepsy, and mental retardation. • Another potential pitfall is the misclassification of shock and subsequent inappropriate treatment. • Failure to transfer an affected infant to a level III neonatal intensive care unit in a timely manner is another pitfall. BIBLIOGRAPHY Section 10 of 10 • Faix RG, Pryce CJ: Shock and hypotension. In: Neonatal Emergencies. Mount Kisco, NY: Futura Publishing Company Inc; 1991: 371-386. • Keeley SR, Bohn DJ: The use of inotropic and afterload-reducing agents in neonates. Clin Perinatol 1988 Sep; 15(3): 467-89[Medline]. • Northern Neonatal Nursing Initiative: Systolic blood pressure in babies of less than 32 weeks gestation in the first year of life. Northern Neonatal Nursing Initiative. Arch Dis Child Fetal Neonatal Ed 1999 Jan; 80(1): F38-42[Medline]. • Nuntnarumit P, Yang W, Bada-Ellzey HS: Blood pressure measurements in the newborn. Clin Perinatol 1999 Dec; 26(4): 981-96, x[Medline]. • Sasidharan P: Role of corticosteroids in neonatal blood pressure homeostasis. Clin Perinatol 1998; 25: 723[Medline]. • Seri I, Tan R, Evans J: Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension. Pediatrics 2001 May; 107(5): 1070-4[Medline]. • Seri I, Evans J: Controversies in the diagnosis and management of hypotension in the newborn infant. Curr Opin Pediatr 2001 Apr; 13(2): 116-23[Medline]. • Skinner JR, Milligan DW, Hunter S, et al: Central venous pressure in the ventilated neonate. Arch Dis Child 1992 Apr; 67(4 Spec No): 374-7[Medline]. • Zubrow AB, Hulman S, Kushner H, et al: Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective study. J Pediatr 1995; 16: 470[Medline]. Shock and Hypotension in the Newborn excerpt © Copyright 2005, eMedicine.com, Inc.
Transient Tachypnea of the Newborn Last Updated: May 14, 2003 Synonyms and related keywords: RDS type II, retained lung fluid syndrome, wet lung, TTN AUTHOR INFORMATION Section 1 of 11 Author: Stephen D Kicklighter, MD, Clinical Assistant Professor, Department of Pediatrics, Division of Neonatology, University of North Carolina,Stephen D Kicklighter, MD, is a member of the following medical societies:AAP, National Perinatal Association Editor(s): Steven M Donn, MD, Professor of Pediatrics, Director, Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan Health System; 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 INTRODUCTION Section 2 of 11 Background: Transient tachypnea of the newborn (TTN) is a disease common in infants throughout the world and has been encountered by all physicians who care for newborn infants. Infants with TNN present within the first few hours of birth with tachypnea, increased oxygen requirement, and occasional hypoxia noted on arterial blood gases without concomitant carbon dioxide retention. When managing an infant with TTN, it is important to observe for signs of clinical deterioration that may suggest other diagnoses and to observe closely for the development of fatigue. Pathophysiology: Noninfectious acute respiratory disease develops in approximately 1% of all newborn infants and results in admission to a critical care unit. TTN is the result of a delay in clearance of fetal lung liquid. Respiratory distress typically was thought to be a problem of relative surfactant deficiency, but it is now characterized by an airspace-fluid burden secondary to the inability to absorb fetal lung liquid. In vivo experiments have demonstrated that lung epithelium secretes Cl - and fluid throughout gestation but only develops the ability to actively reabsorb Na + during late gestation. At birth, the mature lung switches from active Cl - (fluid) secretion to active Na + (fluid) absorption in response to circulating catecholamines. Changes in oxygen tension augment the Na + -transporting capacity of the epithelium and increase gene expression for the epithelial Na + channel (ENaC). The inability of the immature fetal lung to switch from fluid secretion to fluid absorption results, at least in large part, from an immaturity in the expression of ENaC, which can be upregulated by glucocorticoids. Both pharmacologic blockade of the lung's EnaC channel and genetic knockout experiments using mice deficient in the ENaC pore-forming subunit have demonstrated the critical physiologic importance of lung Na + transport at birth. When Na + transport is ineffective, newborn animals develop respiratory distress; hypoxemia; fetal lung liquid retention; and, in the case of the ENaC knockout mice, death. Bioelectrical studies of human infants' nasal epithelia demonstrate that both TTN and respiratory distress syndrome (RDS) have defective amiloride-sensitive Na + transp These results suggest that infants with neonatal RDS have, in addition to a relative deficiency of surfactant, defective Na + transport, which plays a mechanistic role in the development of the disease. An infant born by cesarean delivery is at risk of having excessive pulmonary fluid as a result of having not experienced all of the stages of labor and subsequent low release of counterregulatory hormones at the time of delivery. Frequency: In the US: Frequency is equivalent universally. Approximately 1% of infants have some form of respiratory distress that is not associated with infection. Respiratory distress
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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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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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aby with a giant omphalocele or in
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Prognosis: without extensively unde
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Picture 3. Omphalocele and gastrosc
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Picture 11. Omphalocele and gastros
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Picture 20.Omphalocele and gastrosc
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Perinatal Drug Abuse and Neonatal D
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Race: • The difficulty in assessi
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ehavioral and cognitive changes. Ma
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• All medically treated newborns
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Drug Category: Barbiturates -- Alth
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• Cognitive and developmental def
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Perioperative Pain Management in Ne
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The relative potency of each volati
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Opioid administration remains the m
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Use a short beveled needle to minim
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• Lerman J, Robinson S, Willis MM
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Pathophysiology: Site of origin The
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Pathogenesis of sequelae The major
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• Hypertension or beat-to-beat va
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Interactions suspected necrotizing
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PICTURES Section 10 of 11 Picture 1
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Picture 8. Periventricular hemorrha
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• Roberts JR: Drug therapy in inf
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Following the initial insult, wheth
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Picture 6. Cranial CT scan, axial i
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Polycythemia of the Newborn Last Up
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Causes: • Increased fetal erythro
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FOLLOW-UP Section 7 of 9 Further In
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Polyhydramnios and Oligohydramnios
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Causes: umbilical artery, gastroint
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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:
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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
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: Pregnancy Precautions Drug Name fur
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
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Anemia of Prematurity - Portal Neonatal

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