Anemia of Prematurity - Portal Neonatal

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Cromolyn sodium inhibits release of inflammatory mediators from mast cells. Some studies have shown a decrease in inflammatory mediators in tracheobronchial aspirates of infants with BPD who were treated with this drug. Drug Category: Diuretics -- Promote excretion of water and electrolytes by the kidneys. Used to treat heart failure or hepatic, renal, or pulmonary disease when sodium and water retention has resulted in edema or ascites. Drug Name Pediatric Dose Contraindications Interactions Furosemide (Lasix) -- DOC for fluid overload in infants with BPD. A loop diuretic demonstrated to decrease PIE and pulmonary VR, while improving pulmonary function. Daily or alternate day furosemide therapy improves respiratory function and may facilitate weaning from PPV, oxygen, or both. Increases excretion of water by interfering with chloride-binding cotransport system, which in turn inhibits sodium and chloride reabsorption in ascending loop of Henle and distal renal tubule. 0.5-2 mg/kg/dose PO/IV bid-qod (qd in infants
Interactions Beta-adrenergic blockers antagonize effects; inhaled ipratropium may increase duration of bronchodilatation by albuterol; cardiovascular effects may increase with MAOIs, inhaled anesthetics, tricyclic antidepressants, or sympathomimetic agents Pregnancy C - Safety for use during pregnancy has not been established. Precautions Drug Name Pediatric Dose May cause tachycardia or reflex bronchospasm; changes in pulmonary mechanics may last as long as 4-6 h; adverse effects include increases in BP and heart rate Caffeine citrate (Cafcit) -- A CNS stimulant used to treat infants with apnea of prematurity and infants with BPD. Caffeine may facilitate ventilator weaning. Loading dose: 20 mg/kg PO/IV Maintenance dose: 5 mg/kg/d PO/IV Contraindications Documented hypersensitivity Interactions Caution with cardiovascular, renal, or hepatic dysfunction; may act synergistically with diuretics; decrease dose if coadministered with theophylline; additive positive inotropic and chronotropic effects with beta-adrenergic agonists; cimetidine and fluconazole decrease clearance Pregnancy C - Safety for use during pregnancy has not been established. Precautions Drug Name Pediatric Dose Contraindications Interactions Monitor levels at least once per wk; long half-life (100 h); therapeutic levels range from 10-20 mcg/mL; seizure threshold may be altered with very high levels; may worsen gastroesophageal reflux Theophylline (Elixophyllin, Theo-Dur) -- A systemic bronchodilator. Used to treat apnea of prematurity. May decrease diaphragmatic fatigue in infants with BPD. May improve skeletal muscle contractility. Some studies have suggested that theophylline may help facilitate weaning an infant with BPD from continuous mechanical ventilation. Monitor serum levels and adjust levels based on infant's response; generally, the therapeutic levels of theophylline are considered to be in the range of 5-12 mcg/mL. IV dose is based on theophylline equivalent. Loading dose: 3-5 mg/kg PO/IV Maintenance dose: 1-3 mg/kg/d PO/IV divided q8-12h Documented hypersensitivity; uncontrolled arrhythmias; hyperthyroidism; uncontrolled seizure disorders Theophylline levels are affected by drugs that may induce or inhibit the CYP450 enzyme system in the liver; aminoglutethimide, barbiturates, carbamazepine, ketoconazole, loop diuretics, charcoal, hydantoins, phenobarbital, phenytoin, rifampin, isoniazid, and sympathomimetics may decrease effects of theophylline; theophylline effects may increase with allopurinol, beta-blockers, corticosteroids, thyroid hormones, ephedrine, carbamazepine, cimetidine, erythromycin, macrolides, propranolol, and interferon Pregnancy C - Safety for use during pregnancy has not been established. Precautions Caution in hypertension, tachyarrhythmias, hyperthyroidism, and compromised cardiac function; do not inject IV solution faster than 25 mg/min; patients diagnosed with pulmonary edema or liver dysfunction are at greater risk of toxicity because of reduced drug clearance; may worsen gastroesophageal reflux; may lower seizure threshold at high levels
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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
Page 31 and 32: 5 time constants. The resulting tim
Page 33 and 34: Once the diagnosis of RDS is establ
Page 35 and 36: PATHOPHYSIOLOGY-BASED VENTILATORY S
Page 37 and 38: High-frequency ventilation:High-fre
Page 39 and 40: Picture 2. Determinants of oxygenat
Page 41 and 42: Birth Trauma Last Updated: August 4
Page 43 and 44: The extent of hemorrhage may be sev
Page 45 and 46: CRANIAL NERVE AND SPINAL CORD INJUR
Page 47 and 48: unpredictable unavoidable complicat
Page 49 and 50: Bowel Obstruction in the Newborn La
Page 51 and 52: The prenatal diagnosis of a bowel o
Page 53 and 54: demonstrate the normal fixation pat
Page 55 and 56: Other causes of proximal bowel obst
Page 57 and 58: Hirschsprung disease Hirschsprung d
Page 59 and 60: POSTOPERATIVE CARE FOLLOWING SURGER
Page 61 and 62: Picture 4. Bowel obstruction in the
Page 63 and 64: Breast Milk Jaundice Last Updated:
Page 65 and 66: DIFFERENTIALS Section 4 of 9 Anemia
Page 67 and 68: Consultations: Diet: • Consider c
Page 69 and 70: Bronchopulmonary Dysplasia Last Upd
Page 71 and 72: CLINICAL Section 3 of 11 History: B
Page 73 and 74: of BPD and in the need for continue
Page 75 and 76: Physical: • Infants with BPD have
Page 77 and 78: discomfort. Many new synchronized v
Page 79 and 80: treat acute bronchospasm; however,
Page 81: • Excessive glucose loads may inc
Page 85 and 86: Drug Category: Pulmonary vasodilato
Page 87 and 88: MISCELLANEOUS Section 9 of 11 Medic
Page 89 and 90: • Frank L, Groseclose E: Oxygen t
Page 91 and 92: • Northway WH Jr: Bronchopulmonar
Page 93 and 94: Congenital Diaphragmatic Hernia Las
Page 95 and 96: DIFFERENTIALS Section 4 of 10 Aspir
Page 97 and 98: o Inhaled nitric oxide may be used
Page 99 and 100: Drug Name Pediatric Dose Contraindi
Page 101 and 102: Drug Name Pediatric Dose Vecuronium
Page 103 and 104: Prognosis: • Pulmonary recovery:
Page 105 and 106: • O'Toole SJ, Irish MS, Holm BA:
Page 107 and 108: This article reviews the mechanics
Page 109 and 110: Positioning the infant Positioning
Page 111 and 112: stress and fatigue in both parents
Page 113 and 114: As the mother's milk supply is esta
Page 115 and 116: Engorgement Engorgement is a common
Page 117 and 118: Ethical Issues in Neonatal Care Las
Page 119 and 120: GOALS OF NEONATAL INTENSIVE CARE Se
Page 121 and 122: Other guidelines of ethical import
Page 123 and 124: In some situations, tragic situatio
Page 125 and 126: BIBLIOGRAPHY Section 8 of 8 • AAP
Page 127 and 128: CLINICAL FEATURES Section 4 of 7 Th
Page 129 and 130: Comparisons of the nutrient content
Page 131 and 132: Indomethacin is used prophylactical
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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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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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