Anemia of Prematurity - Portal Neonatal

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BIBLIOGRAPHY Section 11 of 11 • Ashcraft KM, Murphy JP, Sharp RJ, eds: Pediatric Surgery. 3rd ed. Philadelphia, Pa: WB Saunders and Co; 2000. • Davenport M: Cystic fibrosis: surgical considerations. In: Stringer MD, Oldham KT, Howard ER, eds. Pediatric Surgery and Urology: Long Term Outcomes. Philadelphia, Pa: WB Saunders and Co; 1998: 279-288. • Ladd WE: Surgical diseases of the alimentary tract in infants. N Engl J Med 1936; 215: 705. • Louw JH, Barnard CN: Congenital intestinal atresia: observations on its origin. Lancet 1955; 2: • O'Neill JA, Rowe MI, Grosfeld JL, eds: Pediatric Surgery. 5th ed. St. Louis, Mo: Mosby-Year Book; 1998. • Oldham KT, Columbani PM, Foglia RP, eds: Surgery of infants and children: scientific principles and practice. Baltimore, Md: Williams & Wilkins; 1997. • Pena A: Anorectal malformations: experience with the posterior sagittal approach. In: Stringer MD, Oldham KT, Howard ER, eds. Pediatric Surgery and Urology: Long Term Outcomes. Philadelphia, Pa: WB Saunders and Co; 1998: 376-386.
Breast Milk Jaundice Last Updated: January 20, 2005 Synonyms and related keywords: neonatal jaundice, indirect bilirubin, bilirubin, breastfeeding, uridine diphosphoglucuronic acid, UDPGA, UDPGA GT, unconjugated bilirubin pigment, conjugated bilirubin, hyperbilirubinemia, clinical jaundice, cholestatic jaundice, bilirubin level, phototherapy, breast milk, breastfeeding-associated jaundice, breastmilk jaundice AUTHOR INFORMATION Section 1 of 9 Author: Timothy Ramer, MD, Assistant Professor, Department of Family Practice and Community Health, Fairview University Medical Center, University of Minnesota Timothy Ramer, MD, is a member of the following medical societies: A A of Family Physicians Editor(s): Oussama Itani, MD, Medical Director of Neonatology, Borgess Medical Center, Clinical Assistant Professor, Department of Pediatrics and Human Development, Michigan State University; 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: Arias first described breast milk jaundice in 1963. Breast milk jaundice is a type of neonatal jaundice associated with breastfeeding. Specifically, it is an elevation of indirect bilirubin in a breastfed newborn that develops following the first 4-7 days of life, persists beyond physiologic jaundice, and has no other identifiable cause. It should be differentiated from breastfeeding jaundice, which occurs before the first 4-7 days of life and is caused by insufficient production or intake of breast milk. Pathophysiology: The etiology of breast milk jaundice is under investigation, but this type of jaundice is thought to be caused by a substance in the breast milk that inhibits uridine diphosphoglucuronic acid (UDPGA) glucuronyl transferase resulting in a prolonged unconjugated hyperbilirubinemia. Accumulation of unconjugated bilirubin pigment in the skin causes jaundice. Physiologic jaundice results from immaturity of newborn's liver and its inability to produce enough UDPGA glucuronyl transferase, the enzyme required to conjugate bilirubin. Conjugated bilirubin is water-soluble and can be excreted. Frequency: • In the US: Jaundice occurs in 50-70% of newborns. Moderate jaundice (bilirubin level >12 mg/dL) develops in 4% of bottle-fed newborns, compared to 14% of breastfed newborns. Severe jaundice (>15 mg/dL) occurs in 0.3% of bottle-fed newborns, compared to 2% of breastfed newborns. • Internationally: International frequency is not extensively reported but is thought to be similar to that in the United States. Race: Whether racial differences exist for breast milk jaundice is unclear, although an increased prevalence of physiologic jaundice exists in babies of Chinese, Japanese, Korean, and Native American descent. Sex: No known sex predilection exists. Age: Breast milk jaundice manifests within the first 4-7 days of life and can persist for 3-12 weeks.
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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
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
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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: Picture 4. Bowel obstruction in the
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
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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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TREATMENT Section 6 of 10 Medical C
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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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TREATMENT Section 6 of 10 Medical C
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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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MISCELLANEOUS Section 9 of 11 Medic
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limiting step in the process, relea
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History: CLINICAL Section 3 of 11
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at equilibrium conditions, the isom
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• A number of guidelines for the
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Exchange transfusion Exchange trans
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FOLLOW-UP Section 8 of 11 Further I
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BIBLIOGRAPHY Section 11 of 11 • A
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Kernicterus Last Updated: November
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CLINICAL Section 3 of 11 History: A
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o Extravasated blood: Significant a
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milk intake because of reduced mamm
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department and must be heavily seda
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Diet: Depending on the degree of ne
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Transfer: The recently reported cas
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Prognosis: The spectrum of neurolog
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Picture 5. Kernicterus. Neuronal ch
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Airway obstruction Complete obstruc
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MEDICATION Section 7 of 11 In addit
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Drug Category: Sedatives -- Maximiz
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Transfer: • Although stabilizatio
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BIBLIOGRAPHY Section 11 of 11 • A
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occurs even later (ie, during days
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• Delivery room management of inf
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MISCELLANEOUS Section 7 of 9 Medica
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Necrotizing Enterocolitis Last Upda
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Race: Some studies indicate higher
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o With abdominal ultrasonography, a
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o Stage IB � Diagnosis is the sam
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Pregnancy C - Safety for use during
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Drug Name Epinephrine (Adrenaline)
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Pediatric Dose Contraindications In
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• Short-gut syndrome o This is a
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Picture 5. Necrotizing enterocoliti
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Neonatal Hypertension Last Updated:
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o Although BP readings obtained usi
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Other Problems to be Considered: Re
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as nitroprusside, that may make it
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Surgical Care: Surgery is rarely in
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decrease in cardiac output; triazol
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Contraindications Documented hypers
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• Flynn JT: Neonatal hypertension
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Neonatal Resuscitation Last Updated
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Fetal pulmonary physiology The feta
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Flow studies have revealed that rel
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Table 2. Equipment for Neonatal Res
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Airway management Once the infant i
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Cardiovascular support and chest co
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Once the appropriate functional res
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Premature infants are also at high
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Because secretions or oral feedings
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The team should be led and organize
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Intubation and suctioning for mecon
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Neonatal Sepsis Last Updated: June
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The fetus has some preimmune immuno
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when chorioamnionitis accompanies t
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weeks of infection, the proportion
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cultures, clinicians may elect to c
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o The clinician may require differe
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Precautions Drug Name Pediatric Dos
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Pregnancy B - Usually safe but bene
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MISCELLANEOUS Section 9 of 11 Medic
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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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FOLLOW-UP Section 7 of 10 Further O
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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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compared to 39 of 169 among infants
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• Selective main bronchial intuba
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• Other considerations o Avoid us
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• Gaylord MS, Quissell BJ, Lair M
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The components of pulmonary surfact
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WORKUP Section 5 of 11 Lab Studies:
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in infants who respond poorly or ar
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intensive care setting, and be anxi
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Table 6. Meta-Analysis of Clinical
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Drug Name Pediatric Dose of acute a
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The postnatal use of surfactant the
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Picture 5. A schematic diagram of t
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Retinopathy of Prematurity Last Upd
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• Examination recommendations Oth
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Picture 5. Retinopathy of prematuri
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• Raju TN, Langenberg P, Bhutani
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• Contractility is a semiquantita
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• Uncompensated o During uncompen
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mL/kg of volume expansion should re
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MEDICATION Section 7 of 10 Drug Cat
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Drug Name cyanide toxicity; sodium
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Pregnancy Precautions Drug Name fur
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Transient Tachypnea of the Newborn
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DIFFERENTIALS Section 4 of 11 Pneum
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Drug Name Pediatric Dose Gentamicin
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Transport of the Critically Ill New
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Communications To initiate the tran
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Table 1. Advantages and disadvantag
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Table 2. A comparison of the advant
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Flight team personnel also are affe
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PICTURES Section 10 of 11 Picture 1
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