The High Risk Newborn A Parthasarathy, MKC Nair, Naveen Jain, Srinivas Murki
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1The High Risk Newborn
2Senior Editors
Amitava Sen, Kolkata
Anand Pandit, Pune
Anil Narang, Chandigarh
Armida Fernandez, Mumbai
Arvind Saili, New Delhi
Ashok K Deodari, New Delhi
Bhatia BD, Varanasi
Dadhich JP, New Delhi
Dutta AK, New Delhi
Girish Gupta, Pune
Guha DK, New Delhi
Harish Chellani, New Delhi
Jana AK, Vellore
Jayam S, Chennai
Kumutha J, Chennai
Madhuri V Kulkarni, Mumbai
Maiya PP, Bangalore
Malik GK, Lucknow
Mathur NB, New Delhi
Nair PMC, Thiruvananthapuram
Neelam Kler, New Delhi
Nitin K Shah, Mumbai
Padma K, Thiruvananthapuram
Praveen Kumar, Chandigarh
Raj Kumar Kayal, Guwahati
Ramji S, New Delhi
Sabarinathan K, Thiruvananthapuram
Santosh K Bhargava, New Delhi
Satish Saluja, New Delhi
Shanmugha Sundaram, Chennai
Shantharam Baliga B, Mangalore
Shashi N Vani, Ahmedabad
Shikhar Jain, Indore
Snehapalan V, Thiruvananthapuram
Sourabh Dutta, Chandigarh
Sushma Nangia, New Delhi
Swarna Rekha Bhat, Bangalore
Tanmaya R Amladi, Mumbai
Uma S Nayak, Vadodara
Vinod K Paul, New Delhi
Zulfikar Ahamed, Thiruvananthapuram
3The High Risk Newborn
Editor in Chief MKC Nair Professor of Pediatrics and Clinical Epidemiology Director, Child Development Centre, Medical College Campus Thiruvananthapuram, Kerala, India Academic Editors Naveen Jain Senior Consultant, Neonatology Kerala Institute of Medical Sciences, Anayara Thiruvananthapuram, Kerala, India Srinivas Murki Consultant Neonatologist Fernandez Hospital, Hyderabad Andhra Pradesh, India Executive Editor A Parthasarathy Formerly Professor of Pediatrics Madras Medical College and Deputy Superintendent, Institute of Child Health and Hospital for Children Chennai, Tamil Nadu, India
4
Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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The High Risk Newborn
© 2008, Jaypee Brothers Medical Publishers
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.
First Edition: 2008
9788184482584
Typeset at JPBMP typesetting unit
Printed at Rajkamal
5Contributors 8Foreword
The accreditation process of Level-II care introduced by National Neonatology Forum (NNF) standardized and accelerated the growth of special care units for high risk neonates in our country. With the introduction of DM (Neonatology) training programme there has been a phenomenal growth of Neonatal Intensive Care Units (NICU) in India.
The ultimate determinant of the quality of care delivered by such units is the intact survival rates of the neonates treated by them. Survival rates alone cannot be the end point to assess NICU treatment protocols. Experiences of the western world have clearly shown the importance of simultaneously organizing early intervention programmes for high risk babies in order to reduce the potential burden of neurodevelopment disabilities. From survival to intact survival is a real challenge of modern neonatal intensive care. This book will go a long way in meeting that challenge. There has been a genuine need for an Indian book specifically focusing on the outcome of graduates of NICUs.
The major highlight of this book is the attempt to review the relationship of risk factors, the brain damage caused, and neurodevelopmental outcome and link the same to NICU management principles. This book focuses on the follow-up in the first two years of post-natal period. Details of specific neurodevelopment disabilities, available elsewhere, have been rightly omitted.
I am glad to see so many of my colleagues and former neonatology students contributing to this book. My special congratulations to Dr Naveen and Dr Srinivas for a job well done. Dr MKC Nair and Dr A Parthasarathy team has once again shown the same magic touch, as in the IAP Textbook of Pediatrics.
Dr ON Bhakoo md fiap, fams, fnnf
National President NNF (1985–89)
Formerly Professor and Head, Pediatrics and Neonatology
Postgraduate Institute of Medical Education and Research
Chandigarh, India
9Preface
In India, neonatal mortality has remained static over the last several years. Majority of mortality could be explained by infection (52%), asphyxia (20%) and low birth weight (17%), all of which are preventable. At the community level, we have made a conscious shift from “diagnosis based” approach to “illness based protocols” in the integrated management of neonatal and childhood illness (IMNCI), a concept endorsed by both National Neonatology Forum and the Indian Academy of Pediatrics. At the tertiary level health care, Neonatal Intensive Care Units (NICUs) across the country have definitely improved the survival chances of many high risk babies, who otherwise would have succumbed easily.
Now, the question asked more often is, whether we are increasing the incidence of developmental delay and disability by saving more and lower birth weight and other at-risk babies. Unfortunately we do not have hard data on this. Our understanding of risk factors for neurodevelopmental disabilities has made definite progress, yet we still cannot predict outcome in every individual case. But, we surely know that the answer probably lies in promoting “developmental friendly well baby clinic” concept and mother oriented early stimulation at home for all babies especially for preterm/ IUGR babies. Infact, it may be now considered unethical to have a level-II and level-III NICU, without having a neonatal follow-up and developmental stimulation program. The lack of a “standardprotocol” for neurodevelopmental follow-up and availability of trained personnel has been the major limiting factors. The one year Postgraduate Diploma in Developmental Neurology course for doctors and two years Master of Health Science (MHSc) in Clinical Child Development course for nurses, therapists and doctors, being conducted by Child Development Centre, in association with Institute of Distance Education, University of Kerala is a step in the right direction.
This book attempts to organize currently available knowledge on risk factors affecting neurodevelopment, best practices in modifying these risks and explains simple neurodevelopmental assessment techniques. It also discusses, in detail the early stimulation program that can be initiated in the neonatal period and management of developmental delay in the 10first two years, with the ultimate objective of minimizing child hood disability. The emphasis in this book has been in organizing current evidence into simple protocols that can be practiced at all levels of care. We do hope that you would find this book useful and pardon us for inadequacies inevitable in the first edition of any book.
Editors
11Acknowledgements