A Manual of Neonatal Intensive Care

The fifth edition of this highly successful and well-regarded book has been extensively updated and revised, and continues to provide the busy paediatrician or nurse working in neonatal intensive care units with precise instructions on the diagnosis and management of common neonatal problems. As in previous editions, the book provides background physiology with key references and diagrams. It is unique in style, providing guidance with reasoning in a clear, readable style, rather than merely a book of lists. Several new chapters have been added, including the subjects of foetal medicine, antenatal diagnosis, and obstetrics for the neonatologist. The book has been improved by the introduction of more easy-to-digest lists, as well as evidence-based medicine.The text has been made more internationally-applicable, including a re-focus of the chapter on organization of neonatal care to concentrate on reasons for admitting a baby to the intensive care ward, rather than UK-specific admission criteria. A Manual for Neonatal Intensive Care provides invaluable guidance for trainees in paediatrics, neonatology and neonatal nursing and forms a useful ready-reference for the practising paediatrician and nurse. Features     Provides concise, up-to-date information in an accessible style on all aspects of neonatal intensive care     Introduces evidence-based medicine to enable readers to evaluate the advice given     Emphasizes international relevance     Includes key points in boxes to aid in rapid assimilation of information CONTENTS Epidemiology and neonatal outcomes Epidemiology: definitions in perinatal medicine Neonatal outcomes References Further reading Web links Organization of neonatal care Organization of neonatal care: definition of levels of care Provision of intensive care facilities References Clinical governance, risk management and legal aspects of neonatal practice Clinical Governance Serious untoward incident (SUI) reporting and investigation Medical negligence Consent Death Further reading Maternal-fetal medicine for the neonatologist Prenatal diagnosis of fetal disease Maternal conditions affecting the fetus Hypertension in pregnancy Multiple pregnancy Immunological conditions Placental insufficiency Preterm membrane rupture Prelabour rupture of the membranes at term Induction of labour Intrapartum monitoring Mode of delivery Further information Further reading Genetic disease Good ‘handles’ for genetic diagnosis Further reading Web links Neonatal resuscitation and stabilization Physiological adaptation at birth Neonatal resuscitation Resuscitation equipment Practice of neonatal resuscitation Special situations in neonatal resuscitation Problems with resuscitation First-hour care after resuscitation References Further reading Nursing, monitoring and transport of the sick neonate Thermal control Minimal handling Monitoring Clinical and laboratory monitoring References Physical examination of the newborn Timing of the examination Physical examination of the newborn References Further reading Congenital anomalies and common postnatal problems Common findings in day-to-day practice Reference Further reading Web link Fluid and electrolyte balance Neonatal renal function and physiology Water Sodium Potassium Hydrogen ions and bicarbonate Calcium and phosphate Magnesium Practical fluid and electrolyte management References Further reading Neonatal enteral nutrition Infant nutrient requirements Which milk to give? Anti-infection agents Healthy LBW babies Sick LBW babies References Further reading Web link Parenteral nutrition Composition of parenteral nutrition solutions Intravenous feeding solutions Route of infusion Monitoring of i.v. feeding Complications of PN References Further reading Acute disorders of the respiratory tract Respiratory physiology Differential diagnosis of neonatal respiratory disease Respiratory distress syndrome (RDS); hyaline membrane disease (HMD) Treatment of RDS Continuous positive airways pressure (CPAP) Mechanical ventilation: intermittent positive pressure ventilation Ventilation Sudden deterioration on IPPV Gradual deterioration on IPPV Transient tachypnoea of the newborn Meconium aspiration Pulmonary interstitial emphysema (PIE), pneumothorax, pneumomediastinum Massive pulmonary haemorrhage Persistent pulmonary hypertension of the newborn (PPHN) Pulmonary hypoplasia Congenital malformations affecting the respiratory tract References Further reading Chronic lung disease Interventions for chronic lung disease Wilson–Mikity syndrome References Further reading Apnoeic attacks Definition of apnoea and periodic breathing Clinically significant apnoea Recurrent apnoea of prematurity Pathophysiology Radiology Treatment References Further reading Infection Infection control in neonatal units Host defences in the newborn and the inflammatory response Bacterial infection in the newborn Maintenance of homeostasis Virus infections Congenital infections Effect of perinatal maternal infections References Further reading Neurological problems Assessment of the nervous system Convulsions in the newborn Hypoxic ischaemic encephalopathy (HIE) Focal vascular lesions Extracranial haemorrhage Intracranial haemorrhage Preterm white matter injury/periventricular leukomalacia (PVL) Neonatal hypotonia Nerve palsies Central nervous system malformations Metabolic disorders, including glucose homeostasis and inborn errors of metabolism Glucose metabolism in the newborn Clinical causes of hypoglycaemia Unusual cases of neonatal hypoglycaemia Neonatal hyperglycaemia Inborn errors of metabolism Causes of severe early metabolic disease References Further reading Endocrine disorders Introduction Congenital adrenal hyperplasia Thyroid problems Further reading Neonatal jaundice and liver disease Physiology Bilirubin biochemistry Bilirubin encephalopathy (kernicterus) Differential diagnosis of neonatal jaundice Causes of unconjugated hyperbilirubinaemia Breast feeding and jaundice Some specific causes of unconjugated hyperbilirubinaemia Prolonged neonatal jaundice Prolonged unconjugated hyperbilirubinaemia Conjugated hyperbilirubinaemia Treatment of neonatal jaundice Gastroenterological problems Basic physiology of the fetal and neonatal gut Cleft lip and palate Oesophageal atresia and trachea-oesophageal fistula Intestinal obstruction Exomphalos Gastroschisis Necrotizing enterocolitis Isolated bowel perforation Short bowel syndrome Gastro-oesophageal reflux The baby with persistent vomiting Persisting diarrhea Haematemesis, melaena and bloody stools in the newborn Hirschprung’s disease References Further reading Congenital heart disease in the neonatal period The fetal circulation Changes in the circulation at birth Presentation of heart disease Investigations Heart murmurs in asymptomatic babies CHD presenting as shock with acidosis CHD presenting as heart failure Treatment of heart failure in the newborn Individual conditions which can cause heart failure or shock Cyanotic heart disease Arrhythmias in the neonatal period References Arrhythmias in the neonatal period Neonatal haematology Anaemia in the neonate Haemolytic disease of the newborn Guidelines for DAT+ babies Bleeding and bruising Neonatal thrombosis References Web links Genitourinary problems Urine Renal failure Urinary tract infection Congenital nephrotic syndrome Renal malformations Genitourinary tract anomalies References Further reading Eye disorders Retinopathy of prematurity Buphthalmos (neonatal glaucoma) Cataract Conjunctivitis Strabismus References Further reading Skin disorders Common benign neonatal skin disorders Other miscellaneous neonatal skin conditions Birthmarks and vascular disorders Further reading Orthopaedic and bone disorders Fractures Dislocations Skeletal malformations Further reading Neonatal abstinence syndrome Maternal opiate abuse References Further reading Procedures and iatrogenic complications Neonatal procedures Blood sampling and cannulation Management of extravasation injury Umbilical catherization Intraosseous lines Endotracheal intubation Urine collection Reference Further reading Appendix 1 Growth charts Appendix 2 Assessing the ill neonate Respiratory severity scoring Clinical Risk Index for Babies – CRIB II score References Appendix 3 Normal blood pressure Term neonates Preterm infants References Appendix 4 The neonatal ECG Rate and rhythm The axis Information about the atria Information about the ventricles Appendix 5 Normal biochemical values in the newborn Appendix 6 Haematological values in the newborn References Appendix 7 Normal CSF values in the newborn Traumatic lumbar puncture Reference Janet M Rennie, Consultant and Senior Lecturer in Neonatal Medicine, Elizabeth Garrett Anderson Obstetric Hospital, University College London Hospitals Giles Kendall, Academic Clinical Lecturer in Neonatal Neuroimging and Neuroprotection, UCL Elizabeth Garrett Anderson Institute for Women's Health and University College London Hospitals, London, UK