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Protocols in Neonatology Srinivas Murki, Rhishikesh Thakre

SECTION 1: CLINICAL APPROACH TO SICK NEWBORN
CHAPTER 1:Identification of ‘At Risk’ Newborn and Admission to SCNU/NICU
- CONCEPT OF TRIAGE
  - Concept of TABC
- EMERGENCY SIGNS
- PRIORITY SIGNS
- NON-URGENT SIGNS
- CRITERIA FOR ADMISSION TO SCNU/LEVEL II NICU
CHAPTER 2:Hypothermia
- DEFINITION
  - Factors Interfering with Thermoregulation in Neonates
- NEUTRAL THERMAL ENVIRONMENT
- TEMPERATURE MONITORING IN NEONATES
- CLINICAL MANIFESTATIONS OF HYPOTHERMIA
- CONSEQUENCES OF HYPOTHERMIA
- MANAGEMENT OF HYPOTHERMIA IN DELIVERY ROOM
- MANAGEMENT OF HYPOTHERMIA IN LOW- RESOURCE SETTINGS
- TREATMENT OF HYPOTHERMIA
- CONCLUSION
CHAPTER 3:Approach to Respiratory Distress
- DEFINITION
- IDENTIFY SEVERITY
- ETIOLOGY
  - History/Risk Factors/Focused Examination
- INVESTIGATIONS (FOR ALL NEWBORNS WITH RESPIRATORY DISTRESS)
- MANAGEMENT OF RESPIRATORY DISTRESS
- SUGGESTED READING
- APPENDIX 1 QUANTIFY RESPIRATORY DISTRESS
  - Preterm with RD
CHAPTER 4:Neonatal Shock
- DEFINITION
- PHASES OF SHOCK
- ROLE OF BLOOD PRESSURE IN SHOCK
- TYPES OF SHOCK
- EVALUATION OF A NEWBORN WITH SHOCK
- DIAGNOSIS
- INVESTIGATIONS AND MONITORING
- TREATMENT APPROACH
- OUTCOMES
- FUTURE CONSIDERATIONS
CHAPTER 5:Neonate with Suspected Infection
- INTRODUCTION
- WHEN TO SUSPECT NEONATAL SEPSIS
- CLASSIFICATION OF NEONATAL SEPSIS
- INVESTIGATIONS
- MANAGEMENT
  - Supportive Care
  - Specific Treatment
- ADJUNCTIVE THERAPIES
- SUMMARY
CHAPTER 6:Neonatal Seizures
- DEFINITION
- SEIZURE MIMICS
- EVALUATION OF SEIZURE
  - Clinical Seizure Types
- IMPORTANT ETIOLOGIES OF NEONATAL SEIZURES
- HISTORY AND EXAMINATION
  - Take Detailed History
  - Examination
- INVESTIGATIONS
  - First line Investigations
  - Second line Investigations
- IMAGING
- ELECTROENCEPHALOGRAPHY
- PROGNOSIS (TABLE 2)
- MANAGEMENT AND DRUG THERAPY OF NEONATAL SIEZURES (FLOWCHARTS 1 AND 2)
CHAPTER 7:Approach to Jaundice
- DEFINITION
- ASSESSING SEVERITY OF JAUNDICE
CHAPTER 8:Approach to a Newborn with Congenital Heart Disease
- INTRODUCTION
- APPROACH TO ETIOLOGY
- CLINICAL EVALUATION
CHAPTER 9:Fluid and Electrolyte Therapy in Neonates
- INTRODUCTION
- PRINCIPLES OF FLUID AND ELECTROLYTE
- BODY COMPOSITION
CHAPTER 10:Neonatal Hypoglycemia
- INTRODUCTION
- DEFINITION
- CLINICAL MANIFESTATIONS
- EVALUATION
- MANAGEMENT OF HYPOGLYCEMIA
  - Parenteral Glucose Infusion is Indicated in the Following Conditions
- TREATMENT OF HYPERINSULINEMIC HYPOGLYCEMIA
- COMPLICATIONS
- SUMMARY
  - Steps
CHAPTER 11:Hypocalcemia in the Newborn
- DEFINITION
- CLINICAL SUSPICION
- ETIOLOGY
CHAPTER 12:Approach to Neonatal Polycythemia
- DEFINITION
- ASSESSING SEVERITY OF POLYCYTHEMIA
CHAPTER 13:Feed Intolerance: Gastric Residues
- DEFINITION
- CLINICAL MARKERS OF FEED INTOLERANCE
  - Best Preventive Practices
- COUNSELING
CHAPTER 14:Approach to a Bleeding Newborn
- DEFINITION
- TYPES OF DISORDERS
- ETIOLOGY
  - Special lab Tests
  - Management
    - General Measures
- PREVENTION OF BLEEDING
CHAPTER 15:Thrombocytopenia
- NEONATAL THROMBOCYTOPENIA
- APPROACH TO ETIOLOGY
- INVESTIGATATIONS
- CBC
CHAPTER 16:Approach to Neonatal Anemia
- INTRODUCTION
- IDENTIFY THE SEVERITY
- IDENTIFY THE CAUSE (FLOWCHART 1)
- PHYSIOLOGIC ANEMIA OF INFANCY
- SUGGESTED READING
- APPENDIX 1
CHAPTER 17:Neonatal Encephalopathy: An Approach
- DEFINITION
- SEVERITY OF ENCEPHALOPATHY
- ETIOLOGY OF ENCEPHALOPATHY
CHAPTER 18:Approach to the Floppy Infant
- DEFINITION AND ASSESSMENT
- IDENTIFY THE PROBLEM
  - Identify the Severity/Red Flag Sign
  - Etiology (Tables 1 and 2)
    - Conditions where Central and Peripheral Hypotonia may Coexist
- INVESTIGATIONS
  - Investigation for Suspected Lower Motor Neuron Disease
  - Principles of Management (Supportive)(Flowchart 1)
CHAPTER 19:Suspected Inborn Errors of Metabolism
- INTRODUCTION
- ENCEPHALOPATHY
- PERSISTENT HYPOGLYCEMIA
- LIVER DISEASE
- CARDIOMYOPATHY AND ARRHYTHMIAS
- FEW UNUSUAL PRESENTATIONS
- INVESTIGATIONS
- MANAGEMENT
CHAPTER 20:Approach to a Neonate with Disorder of Sex Development
- DEFINITION
CHAPTER 21:Neonatal Transport
- INDICATIONS FOR TRANSPORT
- SUGGESTED READING
- APPENDIX 1: NEONATAL TRANSPORT EQUIPMENT
CHAPTER 22:Abdominal Distension
- INTRODUCTION
- EVALUATION AND EXAMINATION
CHAPTER 23:Approach to Apnea
- DEFINITION
  - Apnea Mimic
  - What is the Cause of Apnea?
- FIRST LINE INVESTIGATIONS
  - Management (Fig. 1)
    - General
- SPECIFIC THERAPY
SECTION 2: CARE OF WELL NEWBORN
CHAPTER 24:Evaluation of the Newborn in Delivery Room
- PREPARATION BEFORE BIRTH
- POSTNATAL CARE OF NEWBORN
  - Potential Harmful Practices in Delivery Room
CHAPTER 25:First Evaluation in Outpatient Department
- KEY POINTS
- SEQUENCE OF EXAMINATION
CHAPTER 26:Growth Monitoring
CHAPTER 27:Newborn Metabolic Screening
- SCOPE OF THE PROBLEM
- COMPONENTS OF NEWBORN SCREENING
  - Types of Disorders to be Screened
  - Types of Metabolic Screening
CHAPTER 28:Vitamin K
- INTRODUCTION
- ROLE OF PROPHYLACTIC VITAMIN K
- ROLE OF THERAPEUTIC VITAMIN K
- SUGGESTED READING
- APPENDIX 1: VITAMIN K FORMS
  - Storage of Vitamin K
CHAPTER 29:Not Passed Urine in the First 48 Hours
- INTRODUCTION
- DIAGNOSIS OF OLIGOANURIA
- EVALUATION
- PHYSICAL EXAMINATION
- URINE ANALYSIS
- URINARY SODIUM EXCRETION (TABLE 1)
CHAPTER 30:Not Passed Stools in the First 48 Hours
- INTRODUCTION
- TIMING FOR FIRST PASSAGE OF MECONIUM
CHAPTER 31:Direct Hyperbilirubinemia
- INTRODUCTION
- CLINICAL FEATURES
- INVESTIGATIONS (TABLE 2)
  - Management
    - General
- SPECIFIC MANAGEMENT
  - Surgical
  - Prognosis
CHAPTER 32:Congenital Hydronephrosis
- INTRODUCTION
- PHYSICAL EXAMINATION
- RADIOLOGIC STUDIES
- APPROACH
  - Normal Postnatal Ultrasound
  - Prognosis
CHAPTER 33:Common Problems in Newborn in Outpatient Department
- DIAPER RASH
  - Treatment
- COLIC: THE CRYING INFANT
- NOT ENOUGH MILK!
- HEALTH SUPPLEMENTS
- HEMANGIOMAS
- JAUNDICE
- BREAST DISCHARGE
- NATAL/NEONATAL TEETH
- ORAL THRUSH
- PHIMOSIS
- SEBORRHEIC DERMATITIS/CRADLE CAP
- TRANSITIONAL STOOLS/DIARRHEA
- UMBILICAL DISCHARGE/BLEEDING
- UMBILICAL HERNIA
- VAGINAL BLEEDING
- BATHING/SKIN CARE OF THE PRETERM INFANT AT HOME
CHAPTER 34:Optimizing Breastfeeding in a Normal Newborn
- BREASTFEEDING INITIATION AND MAINTENANCE
  - Key Position during Breastfeeding
  - Key Points of Attachment during Breastfeeding
- ASSESSING BREASTFEEDING ADEQUACY
- ISSUES/CONCERNS FOR BREASTFEEDING IN THE FIRST FEW DAYS AND THEIR MANAGEMENT
CHAPTER 35:Golden Hour Care for Preterm
- PREPARATION PRIOR TO BIRTH
- CARE OF PRETERM AT BIRTH
  - STABILIZATION in NURSERY
SECTION 3: CARE OF PRETERM/LOWBIRTH WEIGHT/HIGH-RISK NEWBORN
CHAPTER 36:Kangaroo Mother Care
- INTRODUCTION
- DEFINITION
- COMPONENTS OF KANGAROO MOTHER CARE
- ADVANTAGES OF KANGAROO MOTHER CARE
- PROCEDURE
- PREPARATIONS FOR THE KMC PROVIDER
- PREPARATIONS FOR THE BABY (FIG 2 and 3)
  - Duration of Kangaroo Mother Care (Table 2 and Fig. 4)
  - Monitoring a Baby in KMC (Table 3)
- DISCHARGE
  - Follow-up
- DONTS OF KANGAROO MOTHER CARE
- DISCONTINUATION OF KMC
  - Overcoming Bottle—Necks in KMC Implementation
    - System Changes
    - Improving acceptance to KMC
CHAPTER 37:Low-birth Weight Feeding
- INTRODUCTION
- WHEN TO START FEEDING A LOW-BIRTH WEIGHT BABY?
- WHICH MILK TO FEED?
- HOW DO WE START AND GRADE UP FEEDS?
- WHICH ROUTE TO USE IN FEEDING?
- WHEN TO START ORAL FEEDING FROM TUBE FEEDS?
- HOW OFTEN AND HOW MUCH TO FEED (FLOWCHARTS 1 AND 2)?
- WHEN TO START BREAST MILK FORTIFICATION?
- HOW TO ASSESS OF FEED INTOLERANCE?
- WHAT AND WHEN TO SUPPLEMENTS?
  - How do we monitor growth and nutrition?
- WHAT OTHER STRATEGIES CAN PROMOTE NUTRITION?
  - Developmental Origins of Health and Disease
CHAPTER 38:Nutritional Supplementation
- INTRODUCTION
- ROLE OF HUMAN BREAST MILK
  - Supplementation in Preterm Breastfed Infants
    - Breast Milk Fortification
    - Individual Micronutrient Supplementations
  - Supplementation in Formula/Animal Milk Fed Preterm Infants
- SUGGESTED READING
- Appendix 1: NUTRITIONAL SUPPLEMENTATION IN LBW BABIES (ESPGHAN)
CHAPTER 39:Discharge Planning
- INTRODUCTION
- TIMING OF DISCHARGE
- PLANNING
CHAPTER 40:Retinopathy of Prematurity
- WHAT IS ROP?
- HOW DOES IT DEVELOP?
- WHY TO SCREEN?
- WHO WILL SCREEN?
- WHOM TO SCREEN?
- WHEN TO SCREEN?
- HOW TO PREPARE FOR THE SCREENING?
- HOW IS THE SCREENING DONE?
- HOW TO CLASSIFY ROP?
- WHEN TO TREAT?
  - Definitions of ROP for Treatment
    - Prethreshold Disease
- WHAT ARE THE TREATMENT MODALITIES?
- HOW TO FOLLOW-UP?
- WHEN TO STOP EXAMINATIONS?
- WHAT HAPPENS WHEN ROP GOES UNDETECTED?
- WHAT ARE POTENTIALLY BEST PREVENTIVE PRACTICES?
CHAPTER 41:Hearing Screening
- IMPORTANCE OF HEARING SCREENING
- HEARING LOSS
- HEARING TESTS TO IDENTIFY DEAFNESS IN A CHILD
- EARLY MANAGEMENT
CHAPTER 42:Follow-up of the High-risk Newborn
- CLASSIFICATION OF NEWBORNS AS PER RISK
CHAPTER 43:Intraventricular Hemorrhage and Periventricular Leukomalacia Screening and Classification
- DEFINITION
- RISK FACTORS
- SUGGESTED READING
- DEFINITION
CHAPTER 44:Developmentally Supportive Care
- INTRODUCTION
- STEPS FOR DEVELOPMENTALLY SUPPORTIVE CARE IN NURSERY
- INTERVENTIONS FOR DEVELOPMENTALLY SUPPORTIVE CARE IN NICU
SECTION 4: NEONATAL DILEMMAS
CHAPTER 45:Baby Born to HIV Positive Mother
- RISK FACTORS FOR PERINATAL HIV TRANSMISSION (TABLE 1)
  - Risk of Transmission
CHAPTER 46:Baby Born to HBsAg Positive Mother
- FACTORS ASSOCIATED WITH HIGH RATE OF MTCT
- CLINICAL MANIFESTATIONS AND TREATMENT
- PRACTICE POINTS
CHAPTER 47:Baby Born to Mother having Tuberculosis
- IDENTIFY THE PROBLEM
- IDENTIFY SEVERITY/RED SIGNS
- IDENTIFY CAUSE—HISTORY, PHYSICAL EXAM, LAB'S
- NEWER TESTS
- MANAGEMENT: GENERAL/SPECIFIC
CHAPTER 48:Baby Born to Mother with Chickenpox
- TIMING OF CHICKENPOX INFECTION
- SIGNIFICANT CHICKENPOX EXPOSURE
- RISK OF TRANSMISSION
- MANAGEMENT OF NEWBORNS WITH MATERNAL CHICKENPOX DURING DELIVERY
- ROLE OF ACYCLOVIR
- CHICKENPOX EXPOSURE DURING POSTNATAL WARDS OR AT HOME FROM SIBLINGS
- CHICKENPOX EXPOSURE WITHIN THE NEONATAL UNIT
- IMPLICATIONS FOR PRACTICE
CHAPTER 49:Approach to a Baby Born to VDRL-positive Mother
- PHYSICAL EXAMINATION FOR EVIDENCE OF CS
- SEROLOGIC AND DIAGNOSTIC TESTS
- FLUORESCENT TREPONEMAL ANTIBODY ABSORPTION (FTA-ABS)
- MICROHEMAGGLUTINATION TESTS [T. PALLIDUM-PARTICLE AGGLUTINATION (TP-PA)]
- OTHER SEROLOGIC TESTS
  - IgM Tests
  - Polymerase Chain Reaction
- SITUATIONS WHERE RADIOLOGY AND LUMBAR PUNCTURE IS WARRANTED
- TREATMENT OPTIONS
- FOLLOW-UP
- SUGGESTED READING
- APPENDIX 1: SURVEILLANCE CASE DEFINITIONS FOR CS
  - Confirmed Case
  - Presumptive Case
- APPENDIX 2: SCREENING AND TREATMENT OF PREGNANT WOMEN FOR SYPHILIS
CHAPTER 50:Breastfeeding and Medications
- FACTORS DETERMINING COMPATIBILITY OF A DRUG WITH BREASTFEEDING
- WAYS TO MINIMIZE INFANT DRUG EXPOSURE
CHAPTER 51:Stem Cell Banking: Scope and Practice
- SOURCES OF STEM CELLS
- UMBILICAL CORD BLOOD BANKING
SECTION 5: SPECIFIC THERAPIES
CHAPTER 52:Antibiotic Policy in Neonatal Intensive Care Unit
- SELECTION OF EMPIRIC ANTIBIOTIC THERAPY
- RE-EVALUATING THE ANTIBIOTIC REGIME
CHAPTER 53:Surfactant Replacement Therapy
- INTRODUCTION
- EVIDENCE-BASED USE OF SURFACTANT
  - Preterm Infants and Surfactant Replacement
- ANIMAL-DERIVED VERSUS SYNTHETIC SURFACTANT
  - Types of Surfactant
  - Natural Surfactant—Which one is Better?
- PROPHYLACTIC VERSUS RESCUE SURFACTANT
- EARLY VERSUS DELAYED SELECTIVE SURFACTANT
  - Early Administration of Surfactant followed by Brief Ventilation and Extubation to Cpap (Insure Strategy)
- SURFACTANT ADMINISTRATION
CHAPTER 54:Continuous Positive Airway Pressure Therapy
- INDICATIONS
- CONTRAINDICATIONS
- COMPONENTS OF CPAP
CHAPTER 55:Blood Component Therapy
- INTRODUCTION
- INDICATIONS FOR TRANSFUSION
  - Whole Blood
  - Which Blood Group to Use?
    - Volume of Blood to be Used for Exchange Transfusion
- PRECAUTIONS BEFORE TRANSFUSION
- PACKED RED BLOOD CELLS
- PLATELETS
CHAPTER 56:Total Parenteral Nutrition
- INTRODUCTION
  - Who should TPN be Given?
  - Which Babies Need TPN?
- BROAD OUTLINE OF TPN THERAPY
  - How to Prepare TPN?
  - How to Administer TPN?
- NUTRIENTS IN TPN
- MONITORING WHILE ON TPN
SECTION 6: MISCELLANEOUS TOPICS
CHAPTER 57:Parent Counseling
- PARENT COUNSELING
- QUALITIES OF A GOOD COUNSELOR
CHAPTER 58:Disinfection, Sterilization and Handwashing
- DISINFECTION AND STERILIZATION
- HANDWASHING
- CONCLUSION
CHAPTER 59:Pain Management in Newborns
- INTRODUCTION
  - Pain Assessment
  - Pain Management
- NONPHARMACOLOGIC STRATEGIES
- PHARMACOLOGIC AGENTS
- REDUCTION OF PAINFUL PROCEDURES
CHAPTER 60:Coping with Death
- IMPLICATIONS FOR PRACTICE
- BEFORE DEATH
  - During the last Moments
- AFTER DEATH
CHAPTER 61:Checklists (Presurgery, Exchange Transfusion, Golden Hour of Preterm, Predischarge Normal Newborn, Predischarge VLBW Infant, VAP Bundle, CLABSI Bundle, Formula Feed Preparation)
- PREDISCHARGE CHECK LIST FOR VLBW INFANT
- PREDISCHARGE CHECK LIST FOR NORMAL NEWBORN
- SURGICAL CHECK LIST FOR NEWBORN
- CHECKLIST FOR PREPARATION OF FORMULA FEED
- CLABSI BUNDLE CHECK LIST
- EXCHANGE TRANSFUSION CHECK LIST
- VENTILATOR ASSOCIATED PNEUMONIA (VAP) BUNDLE CHECK LIST
CHAPTER 62:Use of NICU Charts, Algorithms, Calculators: Mobile Apps and Website Links
- CHARTS
- WEB-BASED GROWTH CHARTS
- MOBILE APPS
- ALGORITHMS
- DISEASE DIAGNOSIS TOOLS
  - Websites for Computer-aided Syndrome Diagnosis
- MOBILE APPS
- CALCULATORS
  - Web-based
  - Mobile Apps (Table 1)
    - Resources for e-learning

INDEX

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Index

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Chapter Notes