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Neonatology for the Obstetricians
Randhir Puri, SP Rathore
PART - I: NEONATOLOGY
CHAPTER 1:
Introduction
WHAT IS NEONATOLOGY?
Why Should an Obstetrician Know Neonatology?
CHAPTER 2:
Care of Baby at Birth
CARE OF THE BABY DURING DELIVERY
BASIC CARE OF THE BABY AT BIRTH (FIG. 2.4)
RESUSCITATION AT BIRTH
Consider Every Birth as a Medical Emergency
High Risk Factors
Resuscitation Equipments (Fig. 2.5)
Resuscitation of Baby
Overview of Resuscitation
Technique of Cardiac Massage
Apgar Score
EXAMINATION OF BABY AT BIRTH
ADVISE JUST AFTER BIRTH
CHAPTER 3:
Normal Neonate
CARE OF THE NORMAL BABY AFTER BIRTH
CARE DURING ‘ROOMING IN'
Advantage of Rooming in
Breastfeeding
Baby Massage
Care of the Skin
Care of the Umbilical Cord
Care of the Eyes
Dressing the Baby
Weight—Record
Early Detection of Serious Diseases
IMMUNIZATION
CHAPTER 4:
Normal Care of Healthy Babies Week-wise
CHAPTER 5:
Neonatal Nursery
ROOM REQUIREMENT
Room Temperature and Humidity
EQUIPMENT REQUIRED
Bag and Mask Resuscitator
Weighing Machine (Fig. 5.2)
Paediatric Laryngoscope (Fig. 5.3)
Resuscitator
Thermometers
Phototherapy Unit
Single Surface Phototherapy Unit (Fig. 5.4)
Double Surface Phototherapy Unit (Fig. 5.5)
Examining Light
Emergency Drugs
Care in the Nursery
CHAPTER 6:
Intensive Neonatal Care
CHAPTER 7:
Low Birth Weight and Premature Babies
CHAPTER 8:
Physiological Jaundice and Phototherapy
CHAPTER 9:
Feeding the Neonate
CHAPTER 10:
Common Neonatal Ailments: How to Deal?
CHAPTER 11:
Common First Aid Medicine Ready to Keep Handy
CHAPTER 12:
Problems of Neonates in the First Few Weeks
CHAPTER 13:
Your Tiny Newborn–Advise to Parents
PART- II A: MANAGEMENT PROTOCOLS FOR COMMON NEONATAL PROBLEMS
CHAPTER 14:
Apnoea
INTRODUCTION
DIFFERENTIAL DIAGNOSIS
INVESTIGATIONS
MANAGEMENT
The Acute Apnoeic Episode
Management of Specific Causes
Symptomatic Management
AREAS OF UNCERTAINTY IN CLINICAL PRACTICE
CONCLUSION
CHAPTER 15:
Cyanosed Infant
INTRODUCTION
DIFFERENTIAL DIAGNOSIS OF A CYANOSED INFANT
GENERAL APPROACH TO THE CYANOTIC INFANT
DIFFERENTIAL DIAGNOSIS
CARDIAC CAUSES
PROSTAGLANDIN E1 (PG) INFUSION
When to give?
Dose
Side Effects
Whom to Intubate?
CONCLUSION
BIBLIOGRAPHY
CHAPTER 16:
Meconium-stained Liquor, Delivery Room Management
INTRODUCTION
MANAGEMENT
AREAS OF UNCERTAINTY IN CLINICAL PRACTICE
CHAPTER 17:
Meconium Aspiration Syndrome
INTRODUCTION
MAS PATHOGENESIS (FIG. 17.1)
CLINICAL FEATURES
COMPLICATIONS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Respiratory Care
Oxygen
Nasal CPAP
Indications
Method
Surfactant Therapy
Suctioning
General Supportive Care
CONCLUSION
CHAPTER 18:
Jaundice in First Two Weeks of Life
INTRODUCTION
Kramer's Rule (Fig. 18.1)
Risk Factors for Developing Severe Hyperbilirubinaemia
Causes
PHYSIOLOGICAL JAUNDICE (FIG. 18.2)
Pathological Jaundice (Fig. 18.3)
“Too Early” (< 48 hours of age)
“Too High” (24 hours - 10 days of age)
Infection
Breast Milk Jaundice
“Too Long” (> 10 days of age, especially > 2 weeks)
Causes of Persistent Unconjugated Hyperbilirubinaemia
Hypothyroidism
Haemolysis
Causes of Persistent Conjugated Hyperbilirubinaemia
Hepatitis
Biliary Atresia
TREATMENT OF JAUNDICE
PHOTOTHERAPY
Indications
1. Management of non-pathologic jaundice in healthy term infants
2. Guidelines for exchange transfusion in infants of 35 or more weeks' gestation
Complications
Ceasing Phototherapy
EXCHANGE TRANSFUSION
Indications
3. Guidelines for the use of phototherapy and exchange transfusion in low birthweight infants based on birth weight
4. Guidelines for the use of phototherapy and exchange transfusion in low birthweight infants based on gestational age
Prevention of Hyperbilirubinaemia
Other issues
CHAPTER 19:
Seizures
INTRODUCTION
Differential Diagnosis
Investigations
Management (Fig. 19.1)
Areas of Uncertainty in Clinical Practice
CONCLUSION
CHAPTER 20:
Sepsis
INTRODUCTION
Early Onset Sepsis (within the first 48 hours of life)
Late Onset Sepsis (after the first 48 hours)
Risk Factors for Sepsis
Early Onset Sepsis
Late Onset Sepsis
Recognition of Systemic Sepsis
Investigations
General Investigations
Infection Related Tests
Early Onset Sepsis
Late Onset Sepsis
Management
General Measures
Antibiotic Choice
Early Onset Sepsis
Late Onset Sepsis
When to Stop Antibiotics
Special Circumstances
Preterm Infants
Term Infants
Areas of Uncertainty in Clinical Practice
CONCLUSION
CHAPTER 21:
Vomiting
INTRODUCTION
VOMIT CONTAINS BLOOD
VOMITING BILE
PROJECTILE VOMITING
VOMITING IN A UNWELL BABY
VOMITING WITH FAILURE TO THRIVE
VOMITING CAUSING CHOKING AND ASPIRATION
THE BABY HAS CONCOMITANT DIARRHOEA
CHAPTER 22:
Intravenous Electrolyte Correction
INTRODUCTION
Hypocalcaemia
Hyponatraemia
Hypocalaemia
Hypomagnesaemia
Metabolic Acidosis (Sodium Bicarbonate)
CHAPTER 23:
Immediate Management of the Tiny Baby
INTRODUCTION
Antenatal Corticosteroids
Resuscitation
Nursery Management
Areas of Uncertainty in Clinical Practice
Conclusion
CHAPTER 24:
Immunisation of Preterm Infants
INTRODUCTION
Adverse Events Following Immunisation
Adverse events include
Immunisation Schedule
Observation after Vaccination
Cardiorespiratory Monitoring after Vaccination
Anaphylaxis
Signs of Anaphylaxis Include
Management of Anaphylaxis
Adrenaline
Common Minor Adverse Events
Storage of Vaccines
Areas of Uncertainty in Clinical Practice
CHAPTER 25:
Small for Gestational Age Infants
DEFINITION
Types
Aetiology
Physical Examination
Problems in SGA
Investigations
Management
Outcome
Postnatal Physical Growth
Neurodevelopmental Outcome
BIBLIOGRAPHY
CHAPTER 26:
Congenital Infection
INTRODUCTION
TOXOPLASMOSIS
Clinical Features
Investigation
Management
Outcome
Prevention
RUBELLA
Clinical Features
Investigations
Management
Prevention
Outcome
CYTOMEGALOVIRUS (CMV) INFECTION
Clinical Features
Investigations
Management
Prevention
HERPES SIMPLEX VIRUS (HSV)
Clinical Features
Investigations
Management
Prognosis
Prevention
SYPHILIS
Clinical Features
Investigations
Management
Follow up
Prevention
CONCLUSION
CHAPTER 27:
Breastfeeding Issues
INTRODUCTION
Benefits of Breast Milk (Table 27.1 and Fig. 27.1)
Storage of Breast Milk for Infant Use
Maintenance of Supply of Breast Milk
Galactagogue
Developmental Issues
Prematurity and Nutritional Adequacy of Human Milk
Human Milk Fortifier
Breast Milk Substitutes
Infections
Maternal Medications
Drugs of Addiction
Jaundice
CONCLUSION
Websites
Breastfeeding Online— Dr Jack Newman
CHAPTER 28:
Neonatal Screening
INTRODUCTION
PRINCIPLES OF NEWBORN SCREENING
CONDITIONS SCREENED (TABLE 28.1)
Phenylketonuria (PKU)
Congenital Hypothyroidism
Cystic Fibrosis (CF)
Various Inborn Errors of Metabolism
PRE-TEST PROCEDURE
CONSENT/REFUSAL
SAMPLE COLLECTION
Special Situations (These should be noted on the card)
PART - II B: PROCEDURES FOR NICU
CHAPTER 29:
Headbox Oxygen Set-up
INTRODUCTION
Equipment
Procedure
Headbox oxygen/air flow rates
Complications
Cleaning of Equipment
Areas of Uncertainty in Clinical Practice
CHAPTER 30:
Peripheral Venous Catheter Insertion
INTRODUCTION
Indications
Definition of Terms
Equipment (Fig. 30.1)
Technique
PREFERRED SITES
A. HAND
Dorsal Arch Veins
Cephalic Vein in Anatomical Snuffbox
B. WRIST
Volar Aspect
C. CUBITAL FOSSA
Median Antecubital, Cephalic and Basilic Veins
D. FOOT
Dorsal Arch
Saphenous Vein Ankle
E. LEG
Saphenous Vein Knee
F. SCALP
Superficial Temporal
Posterior Auricular
Supratrochlear Vein
Procedure
Potential Complications
CHAPTER 31:
Umbilical Artery Catheterization
INDICATIONS
EQUIPMENT
Arterial Tray
Other Equipment
PROCEDURE (FIG. 31.1)
ONGOING MANAGEMENT
COMPLICATIONS
CATHETER REMOVAL
CHAPTER 32:
Intubation
INTRODUCTION
EQUIPMENT
MONITORING
ENDOTRACHEAL TUBE SIZE AND LENGTH
PROCEDURE
Confirmation of tube position
Areas of Uncertainty in Clinical Practice
CONCLUSION
Web Links
CHAPTER 33:
Intravenous Infusion
INTRODUCTION
Fluid Infused
Investigations
Introducing Enteral Feeding
Inputs (while nil by mouth)
CHAPTER 34:
Intraosseous Needle Insertion
INTRODUCTION
SITES
EQUIPMENT REQUIRED
PROCEDURE
ABSORPTION
CONTRAINDICATIONS
Absolute
Relative
COMPLICATIONS
CHAPTER 35:
Transfusion
INTRODUCTION
WHEN TO TRANSFUSE?
COMPLICATIONS
INVESTIGATION
MANAGEMENT
ACUTE BLOOD LOSS
AREAS OF UNCERTAINTY IN CLINICAL PRACTICE
CHAPTER 36:
Surfactant Replacement Therapy
INTRODUCTION
PREPARATION
DOSAGE
PROCEDURE
POSTDOSING
COMPLICATIONS
AREAS OF UNCERTAINTY IN CLINICAL PRACTICE
CONCLUSION
CHAPTER 37:
Umbilical Cord Care
INTRODUCTION
WELL BABY CARE
NURSERY CARE
AREAS OF UNCERTAINTY
BIBLIOGRAPHY
CHAPTER 38:
Transfer Guidelines
INTRODUCTION
LEVEL 1
Newborn Problems
Nursery Equipment Requirements
Optional
LEVEL 2
Low Dependency Level 2 Newborn Problems
Equipment Requirements
Optional
LEVEL 3
Neonatal Problems
Essential Resuscitation Equipment
INTUBATION EQUIPMENT
CONCLUSION
CHAPTER 39:
Normal Laboratory Values
INTRODUCTION
Term Infants (Age of Life)
Acid-base Values*—Term and Preterm Infants (by age of life)
Electrolytes—Preterm Infants (< 37 weeks) (by day of life)
Other Biochemistry—Preterm Infants (by gestation)
Haematology—Preterm Infants (by age)
Coagulation Profile—Preterm Infants (by age)
CSF—Term and Preterm Infants (by age of life)
Urine — Term and Preterm Infants
CONCLUSION
PART - III: ESSENTIAL EQUIPMENT SUPPLIES
CHAPTER 40:
Health Care and Laboratory Facilities
BIOCHEMISTRY AND HAEMATOLOGY
MICROBIOLOGY
BLOOD BANK
NEWBORN SPECIAL CARE UNIT
Non-patient Care Areas
PATIENT CARE AREAS
EQUIPMENT
SUPPLIES
Tubes and Catheters
METHODS OF ADMINISTERING OXYGEN
IV LINE
INJECTIONS
INSTRUMENTS
TESTS
FEEDING AND BREASTFEEDING
OTHER
RECORDS
LOG BOOK
INFECTION PREVENTION FACILITIES FOR HANDWASHING
GLOVES
SKIN PREPARATION
WASTE DISPOSAL
CLEANING AND DISINFECTION
DRUGS
VACCINES
PART - IV: DRUGS
CHAPTER 41:
Drugs for Neonates
INDEX
TOC
Index
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