Anemia of Prematurity - Portal Neonatal

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Deterrence/Prevention: • The multifactorial etiology of BPD compounds its prevention. • Prenatal steroid therapy and postnatal surfactant use has improved survival and perhaps redirected severity of BPD. • Postnatal corticosteroid use may facilitate ventilator weaning but is fraught with many adverse effects. Reconsider standard of care therapy with postnatal dexamethasone, weighing the risk-to-benefit ratio in each case. • Use of exogenous surfactant has improved neonatal survival but may increase the prevalence of BPD in preterm infants. • Meticulous attention to oxygen and PPV may modify BPD. • Maximizing nutritional support, careful monitoring of fluid intake, and judicious diuretic use helps promote lung healing. • Conclusive evidence of HFV use to prevent BPD is not currently available. • Inhaled NO may improve oxygenation in some infants with BPD, but synergistic toxicity of hyperoxia and NO on pulmonary and surfactant systems has been demonstrated in vitro. • Davis in 2000 and Rosenfeld et al in 1986 completed human studies of recombinant SOD supplementation to prevent BPD in preterm infants. In preliminary studies, prophylactic use of recombinant SOD revealed that it is safe and may modify disease severity. Results of the most recent phase III efficacy trial are soon to be forthcoming. Effective prevention of BPD has yet to be found. Complications: • Chorioamnionitis, PVL, severe intraventricular hemorrhage, ventriculomegaly, sepsis, and severe retinopathy of prematurity all are important confounding variables that can greatly affect infant outcome. Prognosis: • Most neonates with BPD ultimately survive; however, these infants are at increased risk for serious infections, airway hyperreactivity, cardiac dysfunction, and neurologic impairments. o Since the routine use of surfactant replacement has begun, survival of the most immature infants has improved. Along with other advances in technology and improved understanding of neonatal physiology, infants with BPD today appear to have less disease severity as compared to infants in years past. Infants with severe BPD remain at high risk for pulmonary morbidity and mortality during the first 2 years of life. o Fortunately, pulmonary function slowly improves in most survivors with BPD, likely secondary to continued lung and airway growth and healing. Northway followed the cases of patients with BPD to adulthood. Northway reported in 1992, that these patients had airway hyperreactivity, abnormal pulmonary function, and hyperinflation noted on chest radiography. Rehospitalization for impaired pulmonary function is most common during the first 2 years of life. In 1990, Hakulinen et al found a gradual decrease in symptom frequency in children aged 6-9 years as compared to the first 2 years of life. Bader in 1987 and Blayney et al in 1991 found persistence of respiratory symptoms and abnormal PFT results in children aged 7 and 10 years, respectively. High-resolution chest CT scanning or MRI studies in children and adults with a history of BPD reveal lung abnormalities that correlate directly with the degree of pulmonary function abnormality. Postsurfactant studies of infants with BPD have yielded similar results of improved pulmonary function with time. Northway reported cor pulmonale in 36% of survivors. Oxygen supplementation at home is not infrequently required, and failure to relieve pulmonary hypertension with oxygen may be associated with a poor prognosis. o Persistent right ventricular hypertrophy or fixed pulmonary hypertension unresponsive to oxygen supplementation on cardiac catheterization portends a poor prognosis.
MISCELLANEOUS Section 9 of 11 Medical/Legal Pitfalls: • Misdiagnosis of other confounding problems in infants with BPD can be catastrophic. For example, if an infant with BPD and superimposed fungal sepsis is treated with dexamethasone, the infant may experience serious complications or death. PICTURES Section 10 of 11 Picture 1. Bronchopulmonary dysplasia. BIBLIOGRAPHY Section 11 of 11 • AAP: Prevention of respiratory syncytial virus infections: indications for the use of palivizumab and update on the use of RSV-IGIV. American Academy of Pediatrics Committee on Infectious Diseases and Committee of Fetus and Newborn. Pediatrics 1998 Nov; 102(5): 1211-6[Medline]. • Abman SH, Wolfe RR, Accurso FJ: Pulmonary vascular response to oxygen in infants with severe bronchopulmonary dysplasia. Pediatrics 1985 Jan; 75(1): 80-4[Medline]. • Ackerman NB Jr, Coalson JJ, Kuehl TJ: Pulmonary interstitial emphysema in the premature baboon with hyaline membrane disease. Crit Care Med 1984 Jun; 12(6): 512-6[Medline]. • Aliakbar S, Brown PR, Bidwell D: Human erythrocyte superoxide dismutase in adults, neonates, and normal, hypoxaemic, anaemic, and chromosomally abnormal fetuses. Clin Biochem 1993 Apr; 26(2): 109-15[Medline]. • Alverson DC, Isken VH, Cohen RS: Effect of booster blood transfusions on oxygen utilization in infants with bronchopulmonary dysplasia. J Pediatr 1988 Oct; 113(4): 722-6[Medline]. • Aquino SL, Schechter MS, Chiles C: High-resolution inspiratory and expiratory CT in older children and adults with bronchopulmonary dysplasia. AJR Am J Roentgenol 1999 Oct; 173(4): 963-7[Medline]. • Aranda JV, Turmen T: Methylxanthines in apnea of prematurity. Clin Perinatol 1979 Mar; 6(1): 87-108[Medline]. • Bader D, Ramos AD, Lew CD: Childhood sequelae of infant lung disease: exercise and pulmonary function abnormalities after bronchopulmonary dysplasia. J Pediatr 1987 May; 110(5): 693-9[Medline]. • Bagchi A, Viscardi RM, Taciak V: Increased activity of interleukin-6 but not tumor necrosis factor-alpha in lung lavage of premature infants is associated with the development of bronchopulmonary dysplasia. Pediatr Res 1994 Aug; 36(2): 244-52[Medline]. • Bancalari E, Abdenour GE, Feller R: Bronchopulmonary dysplasia: clinical presentation. J Pediatr 1979 Nov; 95(5 Pt 2): 819-23[Medline]. • Bancalari E, Sosenko I: Pathogenesis and prevention of neonatal chronic lung disease: recent developments. Pediatr Pulmonol 1990; 8(2): 109-16[Medline]. • Banks BA, Seri I, Ischiropoulos H: Changes in oxygenation with inhaled nitric oxide in severe bronchopulmonary dysplasia. Pediatrics 1999 Mar; 103(3): 610-8[Medline]. • Batsakis JG, Aronsohn RS, Walker WA: Serum albumin. A CAP survey. Am J Clin Pathol 1976 Jul; 66(1): 238-43[Medline].
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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
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 and 82: • Excessive glucose loads may inc
Page 83 and 84: Interactions Beta-adrenergic blocke
Page 85: Drug Category: Pulmonary vasodilato
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
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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
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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
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Page 133 and 134: FOLLOW-UP CARE Section 5 of 7 Nearl
Page 135 and 136: 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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