Anemia of Prematurity - Portal Neonatal

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MISCELLANEOUS Section 8 of 9 Medical/Legal Pitfalls: • Failure to differentiate breast milk jaundice from pathologic jaundice • Failure to appropriately treat elevated bilirubin levels • Failure to identify and treat inadequate breastfeeding, with resultant dehydration Special Concerns: • Treat preterm infants (estimated gestational age
Bronchopulmonary Dysplasia Last Updated: February 7, 2003 Synonyms and related keywords: BPD, chronic lung disease, CLD, respiratory distress syndrome, RDS AUTHOR INFORMATION Section 1 of 11 Author: William Driscoll, DO, Assistant Professor, Department of Neonatology, Winthrop University Hospital, State University of New York Stony Brook School of Medicine Coauthor(s): Jonathan Davis, MD, Director, Division of Neonatology and CardioPulmonary Research Institute, Winthrop University Hospital, Professor, Department of Pediatrics, State University of New York at Stony Brook William Driscoll, DO, is a member of the following medical societies: American Academy of Pediatrics 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; Arun Pramanik, MD, Professor, Department of Pediatrics, Division of Neonatology, Louisiana State University Health Science 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 11 Background: Bronchopulmonary dysplasia (BPD) is a chronic lung disease (CLD) that develops in preterm neonates treated with oxygen and positive pressure ventilation (PPV). Northway originally described BPD in 1967 with clinical, radiographic, and histologic lung changes in preterm infants who had respiratory distress syndrome (RDS) and were treated with oxygen and ventilator therapy. Northway's original definition has been modified. Bancalari has refined Northway's definition using ventilation criteria, oxygen requirement at 28 days to maintain arterial oxygen concentration greater than 50 mm Hg, and abnormal findings on chest radiography. In 1988, Shennan proposed that the additional need for supplemental oxygen at 36 weeks corrected age may be a more accurate indicator of pulmonary outcome; this criterion decreases the large number of healthy very preterm infants included by Bancalari and others. A recent National Institute of Heart Disease (NIHD)/National Heart, Lung, and Blood Institute (NHLBI)/Office of Rare Diseases (ORD) workshop was summarized by Jobe and Bancalari in 2001; the definition of BPD was further modified with the diagnostic criteria based on gestational age less than 32 weeks' or greater than 32 weeks' gestation and the severity of BPD. Currently, BPD is infrequent in infants with birth weight greater than 1200 g and in infants of greater than 30 weeks' gestation. Antenatal glucocorticosteroids, early surfactant therapy, and gentler modalities of ventilation have minimized the severity of lung injury, particularly in more mature infants. However, in some smaller infants who may have been exposed to chronic chorioamnionitis, its pathogenesis remains enigmatic. Pathophysiology: The pathophysiology of BPD is multifactorial. Major organ systems affected include the lungs and the heart. The alveolar stage of lung development in the human is from about 36 weeks' gestation to 18 months postnatally, with most alveolarization occurring within 5 to 6 months of term birth. Although primary septation forms saccules and secondary septal crests indicate alveolarization, some investigators think that septations are a continuous process. The intense pulmonary
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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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Page 23 and 24: Prognosis: • The natural history
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Page 27 and 28: BIBLIOGRAPHY Section 11 of 11 • B
Page 29 and 30: Tidal volume is the volume of gas i
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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
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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 and 62: Picture 4. Bowel obstruction in the
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Page 65 and 66: DIFFERENTIALS Section 4 of 9 Anemia
Page 67: Consultations: Diet: • Consider c
Page 71 and 72: CLINICAL Section 3 of 11 History: B
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Page 75 and 76: Physical: • Infants with BPD have
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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
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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:
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Page 107 and 108: This article reviews the mechanics
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Page 115 and 116: Engorgement Engorgement is a common
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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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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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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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Anemia of Prematurity - Portal Neonatal

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