Rennie & Roberton's Textbook of Neonatology by Rennie, Janet M. -- Read -- Imperial Library of Trantor

Index

Title page Table of Contents Copyright Contributors Preface Acknowledgements Section 1: Organisation, Delivery and Outcome of Neonatal Care

Chapter 1: Epidemiology

Introduction Births and birth rates The incidence of preterm birth and low birthweight Multiple births Mortality in the first year of life Geographical variations and international comparisons in mortality Classification of clinical causes of death Confidential enquiries Morbidity in childhood in relation to circumstances at birth The increasing demand for neonatal care The need for better data

Chapter 2: Organisation and evaluation of perinatal care

Organisation of care Relationship of organisational factors to outcome Philosophy of care and survival Service evaluation Definitions – mortality and morbidity Neonatal data recording Guidelines and evidence-based care Conclusions

Chapter 3: Outcome following preterm birth

History: early neonatal care Reporting outcomes and study design Outcome in early infancy School-age outcomes The ex-preterm young adult

Chapter 4: Developmental care

Introduction Brain development in relation to developmental care Developmental care Newborn Individualized Developmental Care and Assessment Program Discussion of evidence for developmental care Summary

Chapter 5: Counselling and support for parents and families

Introduction The relationship with parents Consent to treatment Life and death decision-making The dying baby Conflict Dealing with complaints Special situations The parent who is a healthcare professional The mother with threatened extreme preterm labour Preserving your own health Concluding thoughts

Chapter 6: Ethical and legal aspects of neonatology

Introduction Plurality of moral beliefs and ethical approaches The value of life of the newborn Recent philosophical challenges Best interests Balancing burdens and benefits Withholding and withdrawing life-sustaining treatment Neonatal euthanasia Quality of life and disability perspectives Resuscitation of extreme preterm Conclusion Introduction Clinicians and litigation Situations with a high risk of litigation in neonatology Relations with parents Discontinuation of futile treatment Negligence Criminal cases Child protection law

Chapter 7: Science and the emergence of neonatal medicine

Introduction Emerging care of the premature infant Feeding the premature infant Thermoregulation and the premature infant Respiratory distress syndrome Intraventricular haemorrhage Periventricular leukomalacia Necrotising enterocolitis Retinopathy of prematurity Birth asphyxia Rhesus haemolytic disease

Section 2: Prenatal Life

Chapter 8: Basic genetics

The nature and structure of a gene Decoding the information in DNA Chromosomes and cell division Chromosome analysis Patterns of inheritance Molecular genetic analysis for single gene disorders New diagnostic genetic technology Glossary

Chapter 9: Antenatal diagnosis and fetal medicine

Introduction Fetal physiology Antenatal diagnosis Fetal medicine Fetal surgery

Chapter 10: Fetal growth, intrauterine growth restriction and small-for-gestational-age babies

Introduction and definitions Incidence and recurrence rate The aetiology of IUGR Physiological sequelae of IUGR The consequences of IUGR Primary prevention of IUGR Antenatal screening and diagnosis Management of IUGR and timing of delivery Fetal therapy for IUGR

Chapter 11: Maternal illness in pregnancy

Thromboembolic disease Hypertension Pre-eclampsia HELLP syndrome Eclampsia Heart disease Diabetes Mellitus (see Ch. 22 for management of the infant of a diabetic mother) Thyroid disease Neurological disorders in pregnancy Antiepileptic drugs Renal disease and pregnancy Renal transplantation and pregnancy Haematology Malignant disease and pregnancy Respiratory disease Rheumatological disorders Liver disease Gasteroentrology Psychiatric diseases Drugs of misuse How are pharmacological agents handled in pregnancy and breastfeeding?

Chapter 12: Obstetrics for the neonatologist

Introduction Intrapartum assessment and management Diagnosis of labour Interventions during labour Electronic fetal heart rate monitoring Fetal scalp blood sampling Umbilical cord blood sampling Delivery of the baby Shoulder dystocia Induction of labour Breech presentation Multiple pregnancy Other high-risk situations for the fetus Preterm infants

Section 3: Care around Birth

Chapter 13: Resuscitation and transport of the newborn

Epidemiology of neonatal resuscitation The approach to newborn resuscitation Assessment of the newborn Techniques of resuscitation Supporting the circulation Drugs Meconium-stained liquor A baby born under general anaesthesia Congenital anomalies Babies still attached to the placenta Ethics issues Teaching and training Research in neonatal resuscitation Remit of neonatal transport Clinical and physiological stresses and pretransport stabilisation Clinical care during transport Care at receiving hospital Communication Organisation of services

Section 4: General Neonatal Care

Chapter 14: Examination of the newborn

Introduction Examination in the delivery room Full routine examination Systematic review Gestational age

Chapter 15: Temperature control and disorders

Introduction Body temperature control mechanisms Normal heat transfer Measurement of temperature Body temperature and thermal neutrality ‘Normal’ temperature Practical management of the thermal environment Disorders of temperature control Therapeutic hypothermia (see Ch. 40.4 for further details)

Chapter 16: Infant feeding

Nutritional programming Nutrition during fetal life Adaptations to extrauterine nutrition Biological consequences of depriving babies of enteral feeds after birth Non-nutritional consequences of enteral feeding Individual nutrients: physiology and dietary needs of term and preterm infants Breastfeeding Artificial feeding for the normal term infant Breast versus formula General considerations Choice of diet Human milk Types of breast milk ‘Term’ infant formulas Special preterm infant formulas Diets for preterm infants: overview Route of administration of feeds Feeding schedules Psychosocial aspects Postdischarge nutrition (Fewtrell 2003) The term growth-retarded infant

Chapter 17: Parenteral nutrition

Composition of infusates Techniques Hazards Transition to enteral nutrition Conclusion Appendix: How to write a total parenteral nutrition (TPN) prescription

Chapter 18: Fluid and electrolyte balance

Introduction Postnatal alterations in body water distribution Non-renal influences on water balance Clinical implications of postnatal and developmental changes: constructing a fluid prescription Monitoring fluid balance Common clinical problems

Chapter 19: Intensive care monitoring and data handling

Introduction Cardiovascular monitoring Respiratory system monitoring Neurological system monitoring Temperature monitoring Monitoring the sick baby Clinical and laboratory monitoring Data handling

Chapter 20: Care of the normal term newborn baby

Anticipatory care Care immediately after birth The normal neonate Postnatal care Routine neonatal clinical examination (Ch. 14) Biochemical screening Hearing screening Feeding the normal term baby Feeding problems

Chapter 21: Care of the normal small baby and convalescent NICU graduate

Introduction The normal small baby Care of the intensive-care graduate Feeding the convalescent premature baby Discharging small babies

Chapter 22: Neonatal complications following diabetes in pregnancy

Congenital abnormalities Macrosomia Hypertrophic cardiomyopathy Intrauterine growth restriction Effects of antenatal and intrapartum hypoxia–ischaemia Respiratory complications Hypocalcaemia and hypomagnesaemia Disordered postnatal metabolic adaptation (see Ch. 34.1) Iatrogenic complications Outcome Avoiding harm

Chapter 23: Twins

Epidemiology Perinatal mortality Zygosity Chorionicity Monoamniotic twins Conjoined twins Monochorionic, diamniotic twins Postnatal determination of zygosity Fetal growth in multiple pregnancy Antenatal management Chromosomal anomalies Congenital anomalies Death of one fetus Intrapartum management Postnatal management: routine Co-bedding Postnatal management: high-risk care Bereavement Social Acknowledgement

Chapter 24: Pharmacology

Introduction History of drug toxicity in neonates Licensing Drug handling Drug prescribing and administration Drug interactions Drug therapy for the fetus Drugs in breast milk Therapeutic drug monitoring

Chapter 25: Neonatal analgesia

Introduction Nociception in the infant Effects of nociception Measurement of pain/nociception in the neonate Pharmacological considerations Clinical analgesia

Chapter 26: The baby of a substance-abusing mother

Introduction General effects of substance abuse in pregnancy Approach to management of substance abuse in pregnancy General management of infants of substance-abusing mothers Specific drugs of abuse Other drugs of abuse Summary

Section 5: Disorders of the Newborn

Chapter 27: Pulmonary disease of the newborn

Introduction Morphological development of the lung Factors influencing lung growth and development Pulmonary circulation Cardiorespiratory adaptation at birth Postnatal function Gas exchange in the neonatal lung Regulation of breathing Responses to changes in oxygen tension (Fig. 27.4) Response to carbon dioxide/acidosis Respiratory reflexes Lung mechanics (Table 27.3) Surfactant Respiratory distress syndrome Transient tachypnoea of the newborn Minimal respiratory disease Pulmonary airleaks Persistent pulmonary hypertension of the newborn Meconium aspiration syndrome Aspiration of amniotic fluid Aspiration of fluid at delivery Other aspiration syndromes (Table 27.8) Pulmonary haemorrhage Asphyxial lung disease/acute respiratory distress syndrome Pleural effusions Management of neonatal respiratory failure Bronchopulmonary dysplasia Other forms of chronic lung disease Introduction Definition Incidence of clinical apnoea Types of apnoea Mechanisms of apnoea Factors involved in apnoea Bradycardia Monitoring Investigation of apnoea Treatment of apnoea of prematurity Stopping treatment, predischarge monitoring and discharge home Prognosis Pulmonary agenesis Pulmonary hypoplasia Small-chest syndromes Congenital cystic adenomatoid malformation Congenital lung cysts Pulmonary sequestration Congenital pulmonary lymphangiectasis Pulmonary alveolar proteinosis (congenital alveolar proteinosis) Congenital lobar emphysema Ciliary abnormalities Introduction Congenital posterolateral diaphragmatic hernia Anterior diaphragmatic hernias Diaphragmatic eventration Introduction Development of the nose, larynx and trachea and lungs Higher upper airway obstruction Oropharyngeal airway obstruction and stertor Laryngotracheal airway obstruction Care of the intubated baby Laryngotracheal airway obstruction: conditions and management

Chapter 28: Cardiovascular disease

Introduction Fetal circulation Fetal cardiology Incidence and aetiology of fetal and neonatal heart disease Clinical implications of adaptation to birth History and examination Investigations Treatment Persistent pulmonary hypertension of the newborn Cardiovascular problems in the preterm infant Structural heart disease in the newborn Cardiac conditions likely to present in the asymptomatic newborn (Table 28.24) Acknowledgement

Chapter 29: Gastroenterology

Introduction Bilirubin biochemistry Biochemical basis of phototherapy The normal pattern of neonatal jaundice Epidemiology and genetics Jaundice in the healthy breastfed infant Pathophysiology of bilirubin encephalopathy Identifying the newborn at risk of bilirubin encephalopathy Assessing the level of serum bilirubin Identifying different types of jaundice Clinical management of the jaundiced infant Guidelines for the use of phototherapy and exchange transfusion Introduction Hepatitis syndrome of infancy Identifying bile duct obstruction Surgically correctable disorders Structure and function of the developing gastrointestinal tract Signs of gastrointestinal disease Necrotising enterocolitis Short bowel syndrome Neonatal appendicitis Intractable diarrhoea Gastro-oesophageal reflux Milk protein intolerance Pancreatic disease Schwachman–Diamond syndrome Introduction Mouth and nasopharynx Oesophagus and stomach Duodenum and small bowel Large bowel Anterior abdominal wall defects Hernias Acknowledgements

Chapter 30: Haematology

Developmental haemopoiesis Neonatal anaemia and other red cell disorders White cell disorders Haemostasis and thrombosis in the newborn Transfusion of blood and blood products in the newborn

Chapter 31: Malformation syndromes

Introduction Basic terms in dysmorphology Sequence Clinical evaluation of a neonate with birth defects Prenatal history Perinatal history Family history Instant syndrome diagnosis by pattern recognition – gestalt Investigating the malformed neonate in the absence of diagnosis Genetic counselling and support for families Chromosomal anomalies/microdeletion syndromes Single-gene disorders identifiable in the neonatal period Genetic conditions related to growth deficiency Genetic conditions related to overgrowth

Chapter 32: Neonatal dermatology

Introduction Structure and function of the neonatal skin Pustules, blisters and erosions in the neonate Other transient neonatal conditions The red scaly baby Birthmarks, congenital tumours and other naevoid conditions Some congenital tumours Aplasia cutis

Chapter 33: Ophthalmology

When does a neonatologist need an ophthalmologist? Development of the eye Development of vision Amblyopia Eye conditions that require screening examinations Congenital abnormalities of the eyes: unusual appearances seen by the neonatologist The infant with poor vision Disorders of the eyes and related tissues The infant with unusual eye movements

Chapter 34: Metabolic and endocrine disorders

Introduction Glucose homeostasis in the healthy fetus and neonate Hypoglycaemia Hyperglycaemia Summary Acknowledgement Hypothalamus and anterior pituitary Posterior pituitary (Robertson 2001) Thyroid Disorders of calcium metabolism Adrenal Disorders of sex development Introduction The organisation of clinical and laboratory services Pathogenesis of inborn errors of metabolism Clinical presentation of inborn errors of metabolism Investigation of a baby who may have an inborn error of metabolism Consideration of specific inborn errors of metabolism Background Diagnosing metabolic bone disease in preterm infants Aetiology Treatment: prevention is better than cure Inherited metabolic bone disease

Chapter 35: Disorders of the kidney and urinary tract

Morphological development of the kidney Assessing renal function Chronic renal failure Polycystic kidney disease Congenital nephrotic syndrome Tubulopathies The renal sequelae of preterm birth Urinary tract anomalies Abnormal formation, migration and fusion of the kidney Genitourinary tract anomalies

Chapter 36: Neonatal malignancy

Introduction Incidence and survival Neuroblastoma Teratoma and other germ cell tumours Acute leukaemia Transient myeloproliferative disorder and Down syndrome Renal tumours Brain tumours Retinoblastoma Sarcomas Liver tumours Histiocytosis Other rare tumours

Chapter 37: Orthopaedic problems in the neonate

Introduction Lower limb abnormalities Lower limb deficiencies Upper limb abnormalities Upper limb deficiencies Abnormalities of the spine and axial skeleton Fractures in the newborn Vascular conditions associated with orthopaedic problems in the newborn Nerve and muscle conditions associated with orthopaedic problems in the newborn Infectious disease associated with orthopaedic problems in the newborn

Chapter 38: Neonatal gynaecology

The physiology of the fetal hypothalamopituitary axis Neonatal breast development Vulval problems Abnormalities of the hymen Vaginal bleeding problems Uterine prolapse Urethral prolapse Paraurethral cysts Ovarian cysts

Chapter 39: Neonatal infection

Introduction The immune system The development of the immune system The maternofetal immunological relationship Immune development and the neonatal gut (written with Alison Bedford Russell) Immunodeficiency disorders: general principles Diagnosis and investigation of immunodeficiency Specific primary immunodeficiencies DNA repair defects and immunodeficiency Immunoregulation disorders Other immunodeficiencies Defects of antibody production Disorders of phagocytic cells Treatment of immunodeficiency The origins of nosocomial infection related to feeding practices Neonatal skin and infection Incidence of infection and causative organisms Clinical presentation, investigation and management of neonatal sepsis Treatment of neonatal sepsis Treatment of fungal infection Treatment of ‘very sick septic neonates’ Additional (adjuvant) treatments for infection Prevention of infection – infection control Care bundles in the reduction of nosocomial infection Focal bacterial infections in the newborn Specific neonatal lung infections Superficial infections Other neonatal bacterial infections Perinatal viral infections Parasitic infections Non-bacterial congenital infections Congenital infections in the developing world Other congenital infections

Chapter 40: Neurological problems in the newborn

Introduction Examination systems Scheme of neonatal neurological examination Neonatal neurological alarm signals Special senses Imaging Examination of cerebrospinal fluid and intracranial pressure Electroencephalography Neurological examination before discharge, and follow-up Introduction Pathophysiology Incidence Time of onset Diagnosis and classification Physiological changes during seizures EEG diagnosis of seizures Electrographic seizures Electroclinical dissociation Aetiology Metabolic causes Congenital malformations of the brain Inborn errors of metabolism Syndromic neonatal seizures Epileptic encephalopathies Early myoclonic epilepsy (EME) Introduction Incidence and prevalence of intracranial haemorrhage Risk factors for intracranial haemorrhage Clinical presentation of intracranial haemorrhage Investigations Pathogenesis of subdural haemorrhage Mechanism of subdural haemorrhage Clinical features of subdural haemorrhage Clinical management and prognosis following subdural and intracranial haemorrhage Extradural haemorrhage Subarachnoid haemorrhage Intraventricular, intraparenchymal, thalamic and cerebellar haemorrhage Subgaleal (subaponeurotic) haemorrhage Perinatal stroke Thrombophilic state and the newborn Perinatal arterial ischaemic stroke Cerebral sinovenous thrombosis Introduction Pathophysiology of hypoxia–ischaemia Pathology Clinical aspects The preterm infant with hypoxic–ischaemic injury Neuroprotective treatments Neurodevelopmental outcome Preterm cerebral haemorrhage Preterm brain injury: white-matter disease of prematurity Conclusion Introduction Disorders of myelin and myelination Neuroaxonal dystrophies Neuronal degeneration Pontocerebellar hypoplasias Intracerebral calcification Vasculopathies Introduction Clinical presentation Obstetric history Clinical investigations Congenital myotonic dystrophy Congenital muscular dystrophy Forms of congenital muscular dystrophy with structural brain changes and eye involvement Motor neuron disorders Congenital myopathies Myasthenia gravis Introduction Epidemiology of CNS malformations Cephaloceles Neural tube defects Disorders of prosencephalic development Malformation of cortical development Ventriculomegaly Posterior fossa abnormalities Arachnoid cysts Cerebrovascular malformations

Section 6: Pathology, Radiology and Biochemistry

Chapter 41: The perinatal postmortem examination

Introduction Role of the perinatal autopsy Contribution of autopsy findings Factors influencing the value of the perinatal autopsy Changes in perinatal autopsy rates Attitudes to the perinatal postmortem examination Consented versus coronial autopsies Consent The postmortem examination The minimally invasive autopsy Placental examination Specific neonatal autopsy scenarios and common associated autopsy findings Conclusion

Chapter 42: The clinical biochemistry laboratory

Introduction Specimen collection Reference ranges Alert limits Quality control, accreditation and clinical governance Point-of-care testing Inherited metabolic disease Neonatal screening Conclusion

Chapter 43: Neonatal imaging

Introduction Radiation safety Chest imaging Chest ultrasonography Magnetic resonance imaging of the chest Abdominal imaging Genitourinary imaging Musculoskeletal imaging Central nervous system imaging

Section 7: Practical Procedures

Chapter 44: Procedures and iatrogenic disorders

Introduction Consent for procedures Pain management (Ch. 25) Aseptic technique and skin preparation Procedures and their complications

Appendices

Appendix 1: Haematological values in the newborn Appendix 2: Coagulation values in term and preterm infants Appendix 3: Normal ranges for commonly assessed ECG values in the newborn Appendix 4: Normal values for neonatal blood pressure Appendix 5: UK-WHO chart source data Appendix 6: Neonatal biochemical reference ranges Appendix 7: Normal blood gas values Appendix 8: Normal cerebrospinal fluid values Appendix 9: Oxyhaemoglobin dissociation curve Appendix 10: The Siggaard-Andersen nomogram

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