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Manual of Newborn Critical Care Medicine
Dipak K Guha, Rashmi Guha, RD Srivastava
SECTION 1: BASIC FOCUS ON NEWBORN CARE
1:
Newborn Critical Care Nursery (NCCN) or Newborn Intensive Care Unit (NICU) General Policies
ALL CONCERNED MUST FOLLOW
Summary of Policy
Personnel
Handwashing
Standard Precautions are Utilized in the Care of All Patients
Nursery Attire
Visitors
Infant Care
Care of Infants and Equipment in Isolation Nursery
Cleaning Nursery Unit and Equipment
Environmental Cleaning
Isolettes and Bassinets
Other Equipment
Outbreak Control
VISITATION
Policy
Guidelines
PROFESSIONAL CONDUCT
2:
Care of Unborn Babies and Assessment of Newborn
ASSESSMENT OF NEWBORN
Neurological Assessment
Posture
Square Window
Arm Recoil
Popliteal Angle
Scarf Sign
Heel to Ear
Physical Assessment
Plantar Length
Eyelid Separation
3:
Fetal Therapy
DEFINITION
INTRODUCTION
PATIENT SELECTION
Erythroblastosis Fetalis
Congenital Diaphragmatic Hernia (CDH)
Urinary Tract Obstruction
Fetal Tumors Causing Hydrops Fetalis
Twin-Twin Transfusion Syndrome (TTTS)
Meningomyelocele (MMC)
Other Conditions
NEONATAL CARE
4:
Recommended Minimum Standards in Neonatal Care
INTRODUCTION
Medical Records
Types of Maternity Units
Unit in a District General Hospital or Equivalent
Small Maternity Unit
Designated Regional Intensive Care Units or Territory Care Unit
DISTRIBUTION OF SPECIAL AND INTENSIVE CARE COTS
MEDICAL STAFF
District General Hospital
Small Maternity Units
Designated Regional Neonatal Care Units
NURSING AND MIDWIFERY STAFF
MEDICAL EXAMINATION
RESUSCITATION
EQUIPMENT AND LABORATORY SERVICES
FAMILY SUPPORT
5:
Admission to Newborn Care Unit
INTRODUCTION
GENERAL GUIDELINES
CRITERIA FOR ADMISSION
6:
Provision of Intensive Care Facilities
PERSPECTIVES AND MANPOWER
PHYSICAL INFRASTRUCTURE
NEONATAL TRANSFER
EQUIPMENT
LABORATORY
DOCUMENTATION
EDUCATION PROGRAMS
INFECTION CONTROL AND SURVEILLANCE
FOLLOW-UP PROGRAM
TOWARDS A GENTLE AND FRIENDLY NICU ENVIRONMENT
FAMILY BONDING
DISCHARGE PLAN
PROCEDURE FOR ADMITTING SMALL BABIES LESS THAN 1500 gm
PROCEDURE FOR ADMITTING HOSPITAL BORN BABIES
PROCEDURE FOR ADMITTING BABIES BORN OUTSIDE
MONITORING OF INTENSIVE AND HIGH DEPENDENCY CARE BABIES
LIFE-THREATENING CONDITIONS
IDENTIFICATION OF INFANTS IN NURSERIES
HOW TO MAKE INTERESTING ROUND WITH THE CONSULTANT
SAMPLE MEDICAL PROGRESS NOTE
SAMPLE BRIEF WARD ROUND SUMMARY
7:
Discharge Planning, Retinopathy of Prematurity and Hearing Screening
INTRODUCTION
SOCIAL SERVICE ROUNDS
CRITERIA FOR DISCHARGE
HELPFUL TIPS FOR PLANNING AN INFANT'S DISCHARGE
DISCHARGE CHECKLIST
TRANSFER TO ANOTHER FACILITY
Transfer Checklist
Discharge and Transfer Summaries
RETINOPATHY OF PREMATURITY
Guidelines for Eye Exams
Follow-up Eye Exams
HEARING SCREENING
SECTION 2: DELIVERY ROOM CARE OF NEWBORN
8:
Delivery Room Management
BASIC RESUSCITATION OF ALL HIGH-RISK INFANTS
Preparation of Resuscitation Room (Set-up Room)
Duties of Team Members
Member A Team
Member B Team
Member C Team
Goals of Resuscitation are to Assist Adaptation to Extrauterine Life by
Sequential Steps in Resuscitation
RESUSCITATION OF THE ASPHYXIATED INFANT
Definition
Asphyxia
Conditions that Place Newborn Infants at ↑ Risk for Asphyxia
Maternal Conditions
Labor and Delivery Conditions
Fetal Conditions
Phases of Resuscitation
Phase I
Clinical Assessment of Severity of Asphyxia and Treatment
Treat Persistent Bradycardia
Phase II
Evaluation after Stabilization
Re-evaluate Assisted Ventilation
Assess Circulatory Status
Sign of Hypovolemia
Treatment of Hypovolemic Shock
Conditions that can be mistaken for Hypovolemic Shock
Phase III
General Management
RESUSCITATION OF INFANT WITH MECONIUM ASPIRATION
RESUSCITATION OF THE VERY LOW BIRTH WEIGHT INFANT
Respiratory Care
Oxygenation
Insensible Water Loss and Temperature Maintenance
RESUSCITATION OF MULTIPLE BIRTHS
Complications
Special Situations
Twin-to-Twin Transfusion Syndrome (TTTS)
Stuck Twin Syndrome
RESUSCITATION OF AN INFANT WITH BIRTH TRAUMA
RESUSCITATION OF AN INFANT WITH HYDROPS FETALIS
Problems that may Complicate Resuscitation of Hydropic Infant
Delivery Room Preparation
Postnatal Management
RESUSCITATION OF INFANT WITH PULMONARY HYPOPLASIA AND CONGENITAL DIAPHRAGMATIC HERNIA
9:
Respiratory Support
ABBREVIATIONS
ASSESS ADEQUATE VENTILATION
GENERAL PRINCIPLES
Ventilation
Oxygenation
Sedation/Neuromuscular Blockade
OXYGEN (Oxygen is a drug!)
OXYGEN DELIVERY AND MEASUREMENT
OXYGEN ADMINISTRATION
Flow Rate and Oxygen Saturation
Humidification
Method of O2 Delivery
Methods of Use of Oxygen Headbox or Hood
Procedures
Nursing Principles
ALVEOLAR GAS EQUATION
ACID-BASE BALANCE
Introduction
Metabolic Acidosis
Common Causes of Metabolic Acidosis
Dilution Acidosis
Effects of Metabolic Acidosis
Management of Metabolic Acidosis
Risks of Alkali Administration
Metabolic Alkalosis
IMPORTANT TECHNIQUES
Mask and Bag Ventilation
Tracheal Intubation
Suctioning of Endotracheal Tube
Extubation of the Trachea
METHODS OF RESPIRATORY SUPPORT
General Principles
Continuous Positive Airway Pressure (CPAP)
Positive Pressure Ventilation (PPV)
START-UP SETTINGS (CONVENTIONAL VENTIALTION) (always discuss with respiratory therapist—RT)
MODES OF CONVENTIONAL VENTILATION (CV)
IMV/CMV
SIMV
Assist Control (AC)
Pressure Support Ventilation (PSV)
Volume Guarantee (VG)
Nasal CPAP
Indications
Management of the Conventional Ventilator
Extubation from Conventional Ventilator
HIGH FREQUENCY OSCILLATORY VENTILATION (HFOV)
Indications for High Frequency Oscillating Ventilation (HFOV)
Initiating HFOV
MAP (Mean Airway Pressure)
Power
Frequency
FiO2
Inspiratory Time (Ti)
HIGH FREQUENCY JET VENTILATION (HFJV)
Indications for HFJV
Initial Settings
Conventional Vent Settings
NITRIC OXIDE
EXTRACORPOREAL MEMBRANE OXYGENATION
ECMO Criteria
Preparation
10:
Newborn Health Care Maintenance and Thermoregulation
STANDARD MEASUREMENTS
TEMPERATURE AND ENVIRONMENT
Definition of Body Temperature
Metabolic Response to Cold
Prevention of Heat Loss
Trouble Shooting an Incubator
Factors Affecting Microenvironmental Temperature are the Following
Measures for Warming Infant
SECTION 3: GENERAL CARE OF NEWBORN
11:
Evaluation of Sick Newborn
COMMON DANGER MANIFESTATIONS OF SICKNESS IN A NEWBORN
SCARING COLOR DISORDERS
Blue, Blue-Purple, Cyanosis
Observe Breathing Pattern Carefully
Hyperoxia Test
Auscultate Heart Sounds
Take Chest Radiograph
Take 2D ECHO
White Pallor
Diagnostic Approach to Pallor in a Newborn
Red, Red-Purple, Plethora
Yellow/Jaundice
OTHER CONDITIONS
Lethargy
Hypothermia
Poor Feeding
Apnea
Convulsions
Motor Automatisms Following Severe Birth Asphyxia are Characterized by
Irritability
Vomiting
Abdominal Distention
Failure to Pass Meconium
Failure to Pass Urine
Failure to Move an Extremity
Sudden Deterioration (“Crash” or “Crump”)
12:
Care of Premature and LBW Infants
PREMATURE CARE
Delivery Room (DR) Management of Premature Infants:
Priorities Prepare for Delivery
Resuscitation as per NRP Temperature Control is Essential in Small Babies
Infants < 29 Weeks or < 1200 Grams
NICU Stabilization of Premature Infants: Priorities
Surfactant
Antibiotics
Central Access
Oxygenation/Blood Gases
Glucose
Blood Pressure
Temperature
Humidity
Gestational Age Assessment
Growth Parameters
Fluids and Electrolytes
Suggested Start-up Fluids [rate (ml/kg/day) and type of fluid]
Suggested Electrolyte Administration for Non-surgical Patients
Common Electrolyte and Metabolic Problems in Small Premature Infants
IVH Prophylaxis
Exogenous Surfactant Therapy
VERY LOW AND EXTREMELY LOW BIRTH WEIGHT INFANTS
Introduction and Definitions
Prevalence
Causes
Risk Factors
Neonatal Complications
Management
Outcome
INTRAUTERINE GROWTH RETARDATION
Clinical Significance
Definitions and Classification
Asymmetric vs Symmetric Growth Retardation
Causal Factors
Maternal
Uterine and Placental Factors
Fetal Causes
Pathophysiology
Assessment and Management
Outcome
CARE OF NORMAL AND NEAR NORMAL NEWBORN
Introduction
Criteria for Placing Infants on the Various Services
Well Baby Nursery (WBN)
Pedi-Med Service
Breastfeeding
Vitamin K1 Administration
Eye Prophylaxis
Hyperbilirubinemia
Hypoglycemia
Treatment of Hypoglycemia
Sepsis, HIV and Hepatitis
Toxicology Screening
Management of Drug withdrawal Syndrome
Additional Useful Tips from Residents
13:
Multiple Births
14:
Nutrition and Feeding
FEEDING OF PRETERM INFANTS
Introduction
Physiology and Pathophysiology
ENTERAL FEEDS
Nutrition Goals
Breast Milk vs Formula
Breast Milk Contraindications
Feeding Administration
Cup and Spoon Feeding
Feeding Volumes
Special Considerations for Different Birth Weight Categories
Feeding Plan
Strength of Formula
Formulas
How to Order or Prepare High Caloric Density Formula
Example
Fortifying Feedings
Vitamins and Iron
Intolerance to Feedings
Management of Feeding Intolerance
Contraindications to Feeding
Bilious Vomiting in a Newborn
TOTAL PARENTERAL NUTRITION (TPN)
General Guidelines and Nutritional Goal
Infusion Routes
Peripheral
Central
COMPONENTS OF PARENTERAL NUTRITION
Protein
Carbohydrate
Fat
Electrolyte Requirements
Minerals
Other Additives
Metabolic Monitoring
Monitoring Growth
Discontinuing Parenteral Nutrition (PN)
15:
Fluids and Electrolytes
INTRODUCTION
Body Composition
Insensible Water Loss (IWL)
INITIAL FLUID ADMINISTRATION
INITIAL ELECTROLYTE MANAGEMENT
General Guidelines
Sodium
Potassium (K+)
Calcium (Ca++)
ELECTROLYTE ABNORMALITIES
Hyponatremia
Dilutional Hyponatremia
Sodium Deficiency
Asymptomatic Hyponatremia
Hypernatremia
Hypokalemia
Hyperkalemia
Causes of Hyperkalemia
Treatment of Hyperkalemia
Hypocalcemia
Early Onset
Late Onset
Treatment of Hypocalcemia
Hypercalcemia
Causes of Hypercalcemia
Treatment of Hypercalcemia
Hypomagnesemia
Hypermagnesemia
16:
Metabolic and Endocrine Disorders
NEONATAL HYPOGLYCEMIA
Background and Pathophysiology
Definition
Etiology
Signs and Symptoms
Diagnostic Work-up
Screening of at Risk Infants
Management of Hypoglycemia
Glucometer reading > 40 mg/dL and infant is feeding normally
Glucometer reading 20–40 mg/dL, infant is term and is able to feed:
INFANTS OF DIABETIC MOTHER (IDM)
Background and Pathophysiology
Clinical Problems in IDMs
Congenital Anomalies
Unexplained Fetal Demise
Management of IDMs
NEONATAL HYPOCALCEMIA AND HYPERCALCEMIA
NEONATAL HYPOTHYROIDISM
Clinical Signs
Investigation and Diagnosis
Treatment
CONGENITAL HYPERTHYROIDISM
Pathology
Clinical Signs and Symptoms
Management
Treatment
CONGENITAL ADRENAL HYPERPLASIA
Investigation and Diagnosis
Treatment
AMBIGUOUS GENITALIA
Differential Diagnosis
Incompletely masculinized XY infant
Assessment
Management
17:
Inborn Errors of Metabolism
18:
Infections in Neonates
SUSPECTED SEPSIS
Risk Factors for Sepsis
Pathogenesis and Causative Organisms
Early Onset Sepsis
Late Onset Sepsis
Clinical Signs of Sepsis
Work-up
Specific Therapy
General Length of Therapy
Supportive Therapy
NECROTIZING ENTEROCOLITIS (NEC)
Introduction
Etiology
Risk Factors
Presentation
Clinical Findings
Radiographic Findings (in order of severity)
Laboratory Findings
Diagnosis
Staging of NEC by Bell's Criteria
Stage 1 Suspected NEC
Stage 2 Definite NEC
Stage 3 Advanced NEC
Management
Suspected NEC
Definite/Advanced NEC
Surgical Considerations
Outcome
Preventive Measures
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
General Guidelines
Management
Infant Monitoring
UNTREATED MATERNAL GONOCOCCAL INFECTION
Treatment
HEPATITIS B VIRUS (HBV) INFECTION: IMMUNOPROPHYLAXIS
HEPATITIS C VIRUS (HCV) INFECTION IN THE MOTHER
UNTREATED MATERNAL CHLAMYDIA INFECTION
Treatment
HERPES SIMPLEX VIRUS INFECTION
Treatment
RSV Prophylaxis
AAP Guidelines for Administrations
OTHER CONGENITAL AND PERINATAL INFECTIONS
Congenital Infections
Background and Pathophysiology
Signs and Symptoms
Diagnostic Work-up
Maternal
Neonatal
Specific Treatment
GROUP B STREP EXPOSURE
CANDIDIASIS PROPHYLAXIS
Dosing Schedule Varies by Postnatal Age
CONGENITAL SYPHILLIS
SECTION 4: SYSTEMIC DISORDERS
19:
Respiratory Disorders
RESPIRATORY DISTRESS SYNDROME (RDS)
Introduction
Epidemiology
Pathophysiology
Clinical Features
Management
Antenatal Glucocorticoids
Exogenous Surfactant
Oxygen
Respiratory Management
Ventilation Guidelines for RDS
Suggested Initial Ventilator
Evaluation
Recent Trends
Antibiotic Therapy
Thermoregulation
TRANSIENT TACHYPNEA OF NEWBORN (TTNB)
PULMONARY HYPOPLASIA AND CONGENITAL DIAPHRAGMATIC HERNIA
Introduction
Etiology and Pathogenesis
Clinical Features
Diagnosis
Management
Management of Infant with Known or Suspected CDH
Outcome
APNEA OF PREMATURITY
Types of Apnea
Evaluation
Treatment
Nasal Cannula
Nasal CPAP
Intubation
Caffeine Citrate
Doxopram
Steroids
PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN (PPHN)
Definition
Etiologies
Evaluation
Diagnosis
Management
INHALED NITRIC OXIDE (iNO)
Physiology
Dose of iNO
Weaning of iNO
Rebound Pulmonary Hypertension
MANAGEMENT OF INFANTS BORN THROUGH MECONIUM STAINED AMNIOTIC FLUID
Background
For Infants Born with any Particulate Meconium in the Amniotic Fluid
If Respiratory Distress Develops in an Infant Born through Meconium
PULMONARY HEMORRHAGE
Definition
Etiology and Pathogenesis
Clinical Features
Treatment and Outcome
PNEUMOTHORAX (TENSION AND NON-TENSION)
Tension Pneumothorax
Needle Decompression
Angiocath Decompression
Chest Tube Placement
Rough Guide to Chest Tube Size
Pleurevac (Box hooked to Chest Tube)
CHRONIC LUNG DISEASE (BRONCHOPULMONARY DYSPLASIA)
Definition
Incidence
Pathology
Etiological Factors
Risk Factors
Clinical Features
Preventive Measures
Treatment of Established CLD
Outcome
20:
Neonatal Jaundice
PHYSIOLOGIC JAUNDICE
Term Infants
Preterm Infants
DEFINITION OF NON-PHYSIOLOGIC JAUNDICE
Bilirubin Metabolism
Bilirubin Encephalopathy
CAUSES OF UNCONJUGATED (Indirect) HYPERBILIRUBINEMIA
EVALUATION OF JAUNDICE (Unconjugated)
Initial Evaluation
Later Evaluation (as indicated)
MANAGEMENT OF UNCONJUGATED HYPERBILIRUBINEMIA
Phototherapy
Healthy Term Newborn
Sick Term Newborns
Preterm Infants
Increase Bilirubin Excretion
Albumin
IVIG
CAUSES OF CONJUGATED (Direct) HYPERBILIRUBINEMIA (Cholestasis)
Hepatocellular Disease
Biliary Tree Abnormalities
EVALUATION AND MANAGEMENT OF CHOLESTASIS
Initial Evaluation
Later Evaluation (as indicated)
Management
HEMOLYTIC DISEASE OF THE NEWBORN
Introduction and Definition
Differential Diagnosis
ISOIMMUNIZATION
Rh Disease (Rh = Rhesus Factor)
Genetics
Clinical Presentation
Laboratory Findings
Intrauterine Transfusion (IUT)
Minor Blood Group Incompatibility
ABO Incompatibility
Genetics
Clinical Presentation
Laboratory Findings
Management
HYDROPS FETALIS
Introduction
Etiology
Investigation of Non-Immune Hydrops
Management
Antenatal Management
Postnatal Treatment
Outcome
JAUNDICE IN THE FIRST 24 HOURS
JAUNDICE BEGINNING ON DAY 2–5
JAUNDICE COMMENCING AFTER 5–7 DAYS
PROLONGED JAUNDICE (Jaundice Persisting beyond 14 Days in a Term Infant or 21 Days in a Preterm Infant)
21:
Hematology
NEONATAL ANEMIA
Background and Pathophysiology
Causes of Neonatal Anemia
Blood Loss
Increased RBC Destruction
Decreased RBC Production
Clinical Findings
Diagnostic Evaluation
History
Laboratory Evaluation
Management
Prenatal
Postnatal
Transfusion in Preterm Infants
Indication of PRBCs Transfusion
Transfusion Volume
Blood Products
GUIDELINES FOR USE OF ERYTHROPOIETIN
Introduction
Criteria
Exclusions
Dose and Duration
Iron
Monitoring of R-Hu-EPO Therapy
Posttherapy Follow-up
POLYCYTHEMIA
THROMBOCYTOPENIA
NEONATAL COAGULATION DISORDERS
Background and Pathophysiology
Causes of Neonatal Bleeding
Platelet Disorders
Coagulation Protein Disorders
Combined Platelet and Coagulation Factor Disorders
Disorders of Vascular Integrity
Signs and Symptoms
DIAGNOSTIC EVALUATION OF ABNORMAL BLEEDING
History
Neonatal Physical Examination
Laboratory Investigation
Initial Screen
Neonatal Allo-Immune Thrombocytopenia (NAIT)
Subsequent Evaluation
Management
PRODUCTS FOR TREATMENT OF COAGULOPATHIES
22:
Cardiovascular Disorders
CONGENITAL HEART DISEASE (CHD)
Introduction
Some General Guidelines
Evaluation of an Infant with Suspected CHD
Algorithm for Diagnosing Cyanotic CHD
Suspected PDA (with L–>R Shunt)
Clinical Signs and Symptoms
Treatment
BLOOD PRESSURE NORMS BY GESTATIONAL AGE IN THE FIRST 24 HRS
NEONATAL HYPERTENSION
Definition
Epidemiology
Signs and Consequences
Differential Diagnosis
Evaluation
Treatment
HYPOTENSION/SHOCK
Hypovolemic
Causes
Management
Cardiogenic
Causes
Management
Septic
Adrenal Insufficiency
Asphyxial Shock
Useful Drugs for Resuscitation of Infants in Severe Shock
NEONATAL CARDIAC ARRHYTHMIAS
Introduction
Methods of Diagnosis and Therapy
Diagnostic Methods
Treatment
Immediate Management of Arrhythmias
A. Tachyarrhythmias with Narrow QRS
I. Reentry tachycardias
B. Tachyarrhythmias with wide QRS
C. Bradyarrhythmias
23:
Renal Disorders in the Newborn
EPIDEMIOLOGY
PRENATAL DIAGNOSIS OF RENAL DISEASE
Clinical Manifestations
Acute Renal Failure (ARF)
Findings in ARF
Causes of ARF
A PALPABLE RENAL MASS IN THE NEWBORN PERIOD
Causes of Palpable Renal Mass
Hematuria
Glycosuria
Proteinuria
INVESTIGATION OF THE GU TRACT
Collection of Urine Samples
Urinalysis
Color
Concentration (Table 23.5)
pH
Microscopy
Red Cells
White Cells
Epithelial cells
Organism
Crystals
Ultrasound Scan
Micturating Cystourethrography (MCUG)
DMSA Scan
DTPA Scan
MAG-3 Scan
Intravenous Urography (IVU)
INVESTIGATION OF ANTENATALLY DIAGNOSED URINARY TRACT PROBLEMS
Timing of Investigation
INVESTIGATION OF A RENAL MASS (see Table 23.1)
URINARY TRACT INFECTION
Background
Diagnosis
Acute Treatment
Investigation of a UTI
Prevention
Prognosis
OTHER NEONATAL RENAL DISORDERS
Renal Tubular Acidosis (RTA)
Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH)
Renal Cystic Disease
Congenital Nephrotic Syndrome
SYSTEMIC HYPERTENSION IN THE NEWBORN
24:
Central Nervous System Disorders
INTRACRANIAL HEMORRHAGE
Incidence
Grading
Clinical Presentation
Prevention and Prophylaxis
Recommendations and Ultrasound Screening
Infants < 32 Weeks Gestation
Infants > 32 Weeks Gestation
Management
NEONATAL SEIZURES
Presentation
Etiologies
Evaluation
Differentiation of Seizures from Nonconvulsive Movements
Treatment
Phenobarbital
Phosphenytoin
Benzodiazepines
NEONATAL ENCEPHALOPATHY/HYPOXIC-ISCHEMIC ENCEPHALOPATHY
Warning Signs of Fetal Hypoxia
Management at Delivery (See Chapter on Management at Delivery)
Post-resuscitation Care of the Infant with Suspected Perinatal Hypoxia
Initial Assessment
Basic Management Plan
Fluid Management
Respiratory Support
Blood Pressure and Perfusion
Metabolic
Hematology
Liver Function
Neurological Assessment
Cerebral Edema
Convulsions
Neurolmaglng
EEG
Outcome
Good Prognostic Features
Poor Prognostic Features (i.e. risk of severe disability or death)
PAIN CONTROL
Pain Assessment
Guidelines for Pain Management
Pharmacologic Management of Pain
HYPOTONIA—THE FLOPPY INFANTS
25:
Perinatal Substance Abuse and Neonatal Abstinence Syndrome (NAS)
BREASTFEEDING AND DRUG EXPOSURE
26:
Gastrointestinal Disorders
STOMACH DISORDERS
Gastric Duplication
Pyloric Stenosis
Signs/Symptoms
Investigations
Treatment
Pylorospasm
Treatment
Gastro-Esophageal Reflux (GER)
Follow-on Treatments
INTESTINAL DISORDERS
FUNCTIONAL OBSTRUCTIONS
Hirschsprung's Disease
Etiopathogenesis
Clinical Signs and Symptoms
Investigations
Treatment
Meconium Plug Syndrome
Pseudo-Obstruction Syndrome
MECHANICAL OBSTRUCTION
Atresias
Jejunal Atresias
Jejunoileal Atresia
Meconium Ileus
Clinical Features
Investigation
Treatment
Anorectal Malformations
Incidence
Imperforate Anal Membrane
Treatment
Anal Agenesis
INFECTION
27:
Neonatal Dermatology
NEONATAL SKIN DISORDERS
VESICULOPUSTULAR RASHES IN NEONATES
GROUP 1: NONINFECTIOUS BENIGN DISEASE
Neonatal Acne
Acropustulosis of Infancy
Allergic Contact Dermatitis
Eosinophilic Pustular Folliculitis (EPF)
Transient Neonatal Pustular Melanosis (TNPM)
GROUP 2: NONINFECTIOUS BUT POTENTIALLY SERIOUS DISORDERS
GROUP 3: MILD INFECTIONS
Candidiasis
Differential Diagnosis
Diagnosis
Therapy
Prognosis
Impetigo Neonatorum
Diagnosis
Differential Diagnosis
Therapy
Scabies
Diagnosis
Differential Diagnosis
Therapy
GROUP 4: POTENTIALLY SERIOUS INFECTIONS
28:
Common Neonatal Surgical Conditions
INTRODUCTION
GENERAL GUIDELINES
ESOPHAGEAL ATRESIA WITH OR WITHOUT TRACHEO-ESOPHAGEAL FISTULA (TEF)
Diagnosis and Preoperative Management
Postoperative Management
INTESTINAL OBSTRUCTION
Diagnosis and Preoperative Management
Postoperative Management
OMPHALOCELE AND GASTROSCHISIS
Diagnosis and Preoperative Management
Surgical Management
Postoperative Management
MENINGOMYELOCELE (MMC)
Introduction
Diagnosis and Preoperative Management
Postoperative Management
29:
Orthopedic Problems of the Newborn
INTRODUCTION
FLATFOOT
CLUBFOOT (TALIPES)
Pathological Anatomy
Clinical Features
Diagnosis
Treatment
Conservative Treatment
Operative Treatment
TALIPES CALCANEOVALGUS
METATARSUS ADDUCTUS
Congenital Constriction Bands
DEVELOPMENTAL DYSPLASIA OF HIP
Clinical Features
Investigation
Treatment
CONGENITALGENU RECURVATUMOR HYPEREXTENSION OF THE KNEE
OSTEOCHONDRODYSPLASIAS
Achondroplasia
Osteogenesis Imperfecta
Marian's Syndrome
BIRTH INJURIES
Brachial Plexus Injury
Bone Injuries
Fracture of the Clavicle
Fractures of the Long Bones
Epiphyseal Displacement
OSTEOMYELITIS
SEPTIC ARTHRITIS
Etiopathogenesis
Clinical Features
Diagnosis
Roentgenographic Picture
Treatment
SECTION 5: NEONATAL DRUG THERAPY
30:
Drug Therapy in Newborn
DRUG ADMINISTRATION
Intramuscular Injections
Administration of IV Drugs
Precautions
Commonly used Neonatal Drugs
INDEX
TOC
Index
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