Anemia of Prematurity - Portal Neonatal

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MISCELLANEOUS Section 9 of 11 Medical/Legal Pitfalls: The major pitfall is assuming that respiratory distress is solely TTN and not a more serious disorder, such as sepsis/pneumonia, persistent pulmonary hypertension, or cyanotic congenital heart disease. PICTURES Section 10 of 11 Picture 1. A supine anteroposterior chest radiograph of an infant with transient tachypnea of the newborn (TTN). Note the reticular appearance of the film with mild cardiomegaly and obvious interstitial fluid. BIBLIOGRAPHY Section 11 of 11 • Chernick V, Boat T, Kendig E: Kendig's Disorders of the Respiratory Tract in Children. 1998; 6th ed: 337-38. • Demissie K, Marcella SW, Breckenridge MB: Maternal asthma and transient tachypnea of the newborn. Pediatrics 1998 Jul; 102(1 Pt 1): 84-90[Medline]. • Fanaroff AA, Martin RJ: Neonatal-Perinatal Medicine. 1997; 2nd ed: 1046. • Gross TL, Sokol RJ, Kwong MS: Transient tachypnea of the newborn: the relationship to preterm delivery and significant neonatal morbidity. Am J Obstet Gynecol 1983 Jun 1; 146(HD 11089/HD/NICHD): 236-41[Medline]. • Lewis V, Whitelaw A: Furosemide for transient tachypnea of the newborn. Cochrane Database Syst Rev 2002; (1): CD003064[Medline]. • Milner AD, Saunders RA, Hopkin IE: Effects of delivery by caesarean section on lung mechanics and lung volume in the human neonate. Arch Dis Child 1978; 53(7): 545-8[Medline]. • O'Brodovich HM: Immature epithelial Na+ channel expression is one of the pathogenetic mechanisms leading to human neonatal respiratory distress syndrome. Proc Assoc Am Physicians 1996; 108 (5): 345-355[Medline]. • Rawlings JS, Smith FR: Transient tachypnea of the newborn. An analysis of neonatal and obstetric risk factors. Am J Dis Child 1984 Sep; 138(9): 869-71[Medline]. • Schatz M, Zeiger RS, Hoffman CP: Increased transient tachypnea of the newborn in infants of asthmatic mothers. Am J Dis Child 1991 Feb; 145(2): 156-8[Medline]. • Schaubel D, Johansen H, Dutta M: Neonatal characteristics as risk factors for preschool asthma. J Asthma 1996; 33(4): 255-64[Medline]. • Wiswell TE, Rawlings JS, Smith FR: Effect of furosemide on the clinical course of transient tachypnea of the newborn. Pediatrics 1985 May; 75(5): 908-10[Medline]. • Young T, Mangum O: Neofax: A Manual of Drugs Used in Neonatal Care. 1999; 12th ed. Transient Tachypnea of the Newborn excerpt © Copyright 2005, eMedicine.com, Inc.
Transport of the Critically Ill Newborn Last Updated: May 20, 2003 Synonyms and related keywords: emergent transfer, interfacility transport, medical transport, neonatal intensive care unit, NICU AUTHOR INFORMATION Section 1 of 11 Author: Bryan L Ohning, MD, PhD, Medical Director, NICU and Neonatal Transport Team, Clinical Associate Professor, Department of Neonatology, Greenville Children's Hospital Coauthor(s): Karen P Driggers, RNC, BSN, CEN, CMTE, Program Director of MEDUCARE Medical Transport Services, Departments of Critical Care and Emergency Services, Medical University of South Carolina Bryan L Ohning, MD, PhD, is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, National Perinatal Association Editor(s): Shelley C Springer, MD, MBA, MSc, Neonatologist, Assistant Professor of Pediatrics, Department of Pediatrics, University of Wisconsin, Madison; Robert Konop, PharmD, Director, Clinical Account Management, Ancillary Care Management; 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 AND HISTORICAL PERSPECTIVE Section 2 of 11 Critically ill neonates are often born in specialized centers either because of prenatal detection of a problem or because the referral center routinely delivers care to at-risk perinatal populations. These babies are called inborn. A large number of outborn neonates, however, require emergent transfer to a tertiary care center, often because of medical, surgical, or rapidly emerging postpartum problems. Studies show that shortened interfacility transport time leads to improved outcomes for the smallest and most critically ill neonates. Medical transport of this high-risk and fragile population requires skilled personnel and specialized equipment. Ideally, neonatal transport teams form a single component associated with a larger system of perinatal care composed of a tertiary care neonatal intensive care unit (NICU), the perinatal care unit, the cadres of medical and surgical pediatric subspecialists, and the neonatal outreach program. This chapter reviews the issues related to transport of this specialized population, including personnel, medical control, equipment, policy development, and transport administration. Discussion of the medical and surgical problems of the newborn are discussed in other articles. Because the outcome of an outborn neonate with major medical or surgical problems (including extreme prematurity) remains worse than for an inborn infant, primary emphasis should always remain on prenatal diagnosis and subsequent maternal transfer whenever possible. Despite advanced training and technology, mothers usually make the best transport incubators. Development of neonatal transport, perinatal regionalization, and neonatal intensive care unit referral centers The emergence of skills to care for ill or premature newborns often is traced to exhibits of premature infant care at public expositions, such as the 1933 World's Fair in Chicago. These exhibits preceded the emergence of neonatal intensive care units and the transport of ill infants.
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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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TREATMENT Section 5 of 9 Medical Ca
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Prognosis: • Polyhydramnios o If
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Pulmonary Interstitial Emphysema La
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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 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: Drug Name Pediatric Dose Gentamicin
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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