Guha’s Neonatology: Principles and Practice Dipak K Guha, Arvind Saili, Swarnarekha Bhat, Arvind Shenoi
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1Guha's Neonatology Principles and Practice
2Guha's Neonatology Principles and Practice
Third Edition
Editor-in-Chief Dipak K Guha MD FIAP, FRSTM & H Chairman, Department of Pediatrics and Neonatal-Perinatal Medicine Balaji Action Medical Institute, Delhi and Vinayak Hospital, Delhi Formerly Medical Superintendent and Head Department of Pediatrics and Neonatology Kasturba Hospital, Delhi Head of the Department of Pediatrics and Neonatal-Perinatal Medicine Apollo Millennium Hospital, Delhi Editors Arvind Saili MD Professor of Neonatology Kalavati Saran Children Hospital Delhi Swarnarekha Bhat MD HOD and Professor of Pediatrics Division of Neonatology St. John Medical College and Hospital Bangalore Arvind Shenoi MD DM Fellow Neonatal Intensive Care (Aust) Head, Department of Pediatrics and Neonatology Manipal Hospital, Bangalore
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Jaypee Brothers Medical Publishers (P) Ltd
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Guha's Neonatology: Principles and Practice 3rd Edition
© 2005, Dipak K Guha
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters to be settled under Delhi jurisdiction only.
First Edition: 1995
Second Edition: 1998
Third Edition:2005
Cover Design: Abhya Panya Vij, Dr. Aditi Vij and Vineet Vij
9788180614217
Typeset at JPBMP typesetting unit
Printed atGopsons Papers Ltd., A-14, Sector 60, Noida
4Dedicated to
All students of Perinatology
5and
6Our spouses and children
7Contributors 11Foreword to the Third Edition 12
India has made tremendous progress in neonatalogy over the past two decades. The evidence is clear from this new edition of Dipak Guha's Neonatology—Principles and Practice. More than 20 new chapters have been added and the existing chapters completely revised. Three eminent neonatologists join as editors: Professor Arvind Saili, Professor Swarnarekha Bhat and Dr Arvind Shenoi. The work of international authors from the UK and USA is presented alongside chapters written by India's finest neonatologists.
This book is unique in that it has been written specifically for developing countries, providing information on essential newborn care alongside state-of-the-art research on systemic disorders of the newborn. New chapters on appropriate technology, assessment and accountability, distance learning and the role of the internet in medicine reflect the changing environment of neonatal medicine. The history of India's own neonatal movement, as described in this book, demonstrates that a community-based approach is vital, coupled with the continued development of technical expertise and knowledge.
This new edition is ambitious in scope, but succeeds in tackling the challenges of neonatal health from a variety of perspectives, with sections on health service organisation, community care of the newborn, neonatal intensive care, imaging of the newborn and systemic disorders. Such an integrated approach will be essential if India is to continue progress throughout the new millennium, and succeed in meeting the Millennium Development Goal of decreasing infant mortality by two-thirds by 2015.
‘Neonatology’ will be of great benefit to postgraduate students, budding neonatologists, teachers, practising neonatologists and doctors dealing in child health from district hospital level to smaller centres and nursing homes.
Anthony Costello
Professor of International Child Health and
Director, International Perinatal Care Unit
Institute of Child Health
University College, London
13Foreword to the First Edition
There has been an upsurge of interest in neonatology in India due to the felt need and concern of pediatricians to enhance the intact survival of newborn babies and the catalytic role played by the National Neonatology Forum of India. Neonatology: Principles and Practice is yet another eminent effort by Dr Dipak K Guha, a leading neonatologist of the country, to provide a complete guide and a comprehensive manual of practical newborn care. This is a multi-authored venture covering wide ranging aspects of newborn care spanning over 47 chapters.
The book covers the historical background of the neonatal movement in the country and gives highlights of current status and future perspectives of newborn care. It provides a unique blend of essential newborn care along with the current state-of-the-art information on systemic disorders of the newborn babies. The organization of neonatal intensive care within the constraints of financial resources and biomedical equipment for neonatal monitoring and management have been discussed in detail. Practical aspects of neonatal procedures have been covered in depth. In keeping with the philosophy of his previous manual, Dr Guha has laid emphasis on the practical aspects of newborn care with special focus on neonatal monitoring and optimal care by the nurses which indeed is crucial for newborn survival. I have no doubt that this text would be extremely useful and serve the needs of residents and consultants in pediatrics and obstetrics working both in the government and private sector hospitals.
Dr. Meharban Singh MD
Professor and Head, Department of Pediatrics and
Neonatal Division
All India Institute of Medical Sciences
Ansari Nagar, New Delhi
14Preface to the Third Edition
15There have been dramatic and palpable changes in the third edition of the book Neonatology—Principles and Practice. This edition of the book is not only meant for pediatricians practicing neonatology but has been upgraded to be a good reference book for postgraduates in pediatrics. The emphasis in each of the chapters dealing with neonatal problems is on pathophysiology, pathogenesis and recent advances in addition to practical approach and management. The contents are based on the American Academy of Pediatrics (AAP) recommendations for fellows in neonatology. The book has been expanded to include 20 more new chapters and has now 92 chapters. Majority of the old chapters have been rewritten keeping in mind the changed philosophy, ethos and readership of the book.
The other highlight of this edition is that there are many chapters exclusively written for the developing countries and most chapters highlight Indian data and also a feasible approach to management. Keeping in tune with the development and advances both in our own country and outside, the book has been re-organised and many new chapters have been added and many new authors have been recruited. The contributors have increased from 42 to 85 of which dozen authors are from USA and UK with practical experience in developing countries. Each one of these authors are actually practicing neonatologist and therefore have succeeded in putting across, in addition to facts, their experience and philosophy.
Some of the new chapters include Death of a baby in NICU, Distance learning, Computer and internet in neonatal services, Future financial neonatal shock, Current status and future challenges for neonatal health in developing countries, Neonatology in India - Challenges in new millennium, Free radical and neonatal diseases, Doctors-patients and law, Gene therapy, Immunology and immunization in the newborn, Inborn error of metabolism-neonatal screening, Research methodology, Innovative and Appropriate Technology in Modern day newborn care in developing countries, Neonatal intensive care services: Assessment and Accountability, Perinatal ultrasonography, and Neonatal Nursing: The Challenge.
The section on maternal-fetal-medicine has been upgraded to include Fetomaternal interaction, Evaluation of fetal lung maturity, Amniotic fluid and clinical association with abnormal amniotic fluid, Fetal conditions which jeopardise the fetus during pregnancy, Physiology and mechanism of normal and preterm labor, Complications occurring during labor which affect the fetus, PROM at term and preterm and High risk neonates. Neonatal procedures has been rewritten.
Many of the new chapters will be of immense importance for newborn care in India and developing countries and such informations are unlikely to be available in a single reference textbook anywhere. Our hope is that with these changes in the new edition the readers will get an updated and indepth knowledge of neonatology and a flavour of the status of neonatal care in India.
The foreword to first edition by Prof. Meharban Singh, ex HOD of Pediatrics, AIIMS and Doyen of Neonatology in India and to this edition by Professor Anthony Costello, Professor of International Child Health and Director, International Perinatal Care Unit, Institute of Child Health, University College, London, with enormous practical experience in India and Nepal is a testimony to the excellent quality and appropriateness of the contents of the book for the developing countries.
“Excellence can be attained if you risk more than others think is safe, care more than others think is wise, dream more than others think is practical and expect more than others think is possible”. We do hope this effort of ours will motivate pediatricians and neonatologists to achieve a high degree of excellence in caring for the normal and sick newborn.
16Penning the preface is an exhilarating moment after the painstaking process of meeting the challenge of revising the text with enthusiasm. It is also the time to express with pleasure sincere gratitude to all our contributors whose knowledge, penmanship, clarity of thought and diligence has made our job much easier and enjoyable. The editor-in-chief expresses his very sincere and special gratitude to Professors Swarnarekha Bhat, Arvind Saili and Arvind Shenoi, the three young and bright neonatologists of the country who have joined me in co-editing this edition of the book.
Editor-in-Chief would once again like to acknowledge the incredible contribution of his wife Dr Rashmi Guha and loving daughter Dr Aditi Vij, who have been pillar of strength in many phases of the development of the book and designing the cover since the inception of the first edition. As the size of the book has increased, so has the number of outstanding individuals at Jaypee Brothers with whom we had the pleasure of interaction. We are particularly indebted and thankful to Mr JP Vij, Mr Tarun Duneja, Mr PS Ghuman, Mrs Kapoor and Mr Bharat Bhushan for excellent co-operation and in-house editorial assistance in completing this state-of-the-art book.
Dipak K Guha
Editor-in-Chief
Arvind Saili
Swarnarekha Bhat
Arvind Shenoi
Editors
17Preface to the First Edition
Neonatology has come of age during the last four decades in many countries and the last two decades in India. Recently most pediatricians have realized and quite rightly so that perinatology is the core of true pediatrics. Birth initiates the progression of independent life event that each one of us experiences. Neonatal care is distinctive and unique because of special needs due to many factors like extrauterine adaptation and anatomical, physiological and biochemical immaturity.
Neonatology is a young discipline and all of us, the practitioners of neonatal medicine, are proud of our achievements. Dramatic changes in the quality and quantity of information available to use have resulted in a significant improvement in the understanding and management of neonatal problems. There has been an upsurge of interest in neonatology in India due to the felt need and the concern of pediatricians to enhance the intact survival of newborn babies. Essential care of normal and sick newborn in India is changing at a rapid pace. We expect basic newborn care to continue to improve in the future too because of the intense interest of our pediatricians in the new knowledge on the expanding horizons of developmental biology. We are on the verge of taking off to more meaningful neonatal intensive care in India.
Neonatology: Principles and Practice, a multi-authored venture in 47 chapters, provides a complete guide and comprehensive manual of practical newborn care (some may like to call it “textbook of neonatology” because of the sheer information provided). It provides a unique blend of essential newborn care along with the current state-of-the-art information on neonatal intensive care. Several chapters like infections in the newborn, respiratory disorders, oxygen therapy, acid base and blood gas analysis, mechanical ventilation, physiotherapy, TPN, followup of high risk babies (beyond survival), procedures, drugs in pregnancy and drug therapy in newborn are so informative that it is unlikely that the reader will find the same material in any single reference book. The chapters related to tertiary care of newborn will be of immense help to the upcoming neonatologist venturing to start neonatal intensive care unit and intensive care of the newborn. In short the book is equally devoted to expanding knowledge relevant to the newborn and to training future leaders in neonatology. Our overall objectives have been to provide a sound physiological and experimental basis for practical perinatal care.
I am greatly indebted to my wife Dr Rashmi Guha and dear colleagues Drs RD Srivastava and JP Dadhich for their constructive critism, suggestions, assistance and proofreading during the preparation of the book. I am most gratified to my lovely daughter Dr Aditi Vij for designing the cover of the book. My task of completing the state-of-the-art book has been most pleasurable because of expert editorial assistance provided in-house by Dr Mona Narang and Mr YN Arjuna, excellent artwork and drawing by Mr Majumdar, and keen interest taken by Mr Jitendar Vij and Pawaninder Vij of Jaypee brothers. I am deeply indebted to all of them as well as to all the contributors—who-is-who of Indian neonatology.
I have no doubt that this book will become a guide and companion for all neonatal health care providers in India and south-east Asia.
Dipak K Guha