Red Blood Cells Fetal Erythropoiesis and Changes in Erythropoiesis After Birth Rapid growth during fetal development demands a brisk pace for red blood cell production, and this capacity must expand with the increase in blood volume, which is proportionate to the weight of the fetus. Blood volumes average 80 mL/kg of fetal body weight at term, but the ratio is larger in the preterm fetus (∼90…
Advances in neonatology, perinatology, and molecular genetics have defined new disease processes and continue to raise exciting questions in the field of nephrology. Prenatal maternal-fetal care and ultrasound imaging continue to improve the diagnosis of many urinary tract anomalies, which allows for improved prenatal and perinatal care. The use of invasive vascular catheters introduced new complications, including renal artery and aortic thrombosis. The administration of loop…
Congenital heart disease remains the most common cause of infant death because of a congenital malformation in the United States. Infant mortality rates arising from congenital malformations has declined in the decade from 2005 to 2014. Critical congenital heart disease (CCHD) occurs in 25% of newborns with congenital heart disease and is defined as disease requiring surgery or procedural intervention in the first year of life.…
Introduction The fetus and the newborn are susceptible to multiple infections: bacterial, viral, and fungal. This susceptibility is multifactorial and stems from maternal risk factors, obstetrical complications, the postnatal environment, prematurity, and the immature host defenses of the newborn. Throughout this chapter, we will review common pathogens to which the neonate may be exposed, as well as briefly discuss newer congenitally-acquired infections. Bacteria and Fungi Epidemiology,…
Care of the high-risk neonate usually refers to care of the low-birth-weight infant or the sick term newborn. Although hyperbilirubinemia is certainly a matter of concern in these infants, the decisions that must be made regarding jaundice in the high-risk neonate are, in general, less complex than those that must be made in the healthy full-term infant. For the term and late preterm infant, shorter hospital…
These infants are remarkable not only because like foetal versions of Shadrach, Meshach and Abednego, they emerge at least alive from within the fiery metabolic furnace of diabetes mellitus, but because they resemble one another so closely that they might well be related. They are plump, sleek, liberally coated with vernix caseosa, full-faced and plethoric… They convey a distinct impression of having had such a surfeit…
But that life may, in a manner of speaking, be restored to the animal, an opening must be attempted in the trunk of the trachea, into which a tube or reed or cane should be put; you will then blow into this so that the lung may rise again and the animal take in air. Indeed, with a single breath in the case of this living…
When one considers the complexity of the pulmonary and hemodynamic changes occurring after delivery, it is surprising that the majority of infants make the transition from intrauterine to extrauterine life so smoothly and uneventfully. Nonetheless, the staff working in the intensive care nursery spends a lion’s share of their time caring for neonates with respiratory problems that are responsible for much of the morbidity and mortality…
“Our doctors and nurses didn’t just treat our baby. They loved her. They made us feel safe enough that we could love her, too.” Thomas and Kelly French, parents and authors of Juniper Introduction The complexity of managing the high-risk neonate and the convalescing premature infant is multifaceted. The number of surviving extremely low–birth-weight (22–25 weeks of gestation) infants has increased over the past decade, yet…
Acknowledgment The authors of this chapter gratefully acknowledge that they have built on the original chapter authored by Marshall Klaus, MD and John Kennell, MD. Both were pioneers in mother–infant bonding research and influential advocates of the principles of family-centered care. As written by Drs. Avroy Fanaroff and Richard Martin, “They paved the way to open the neonatal intensive care units for unlimited visitation and subsequently…
The Human Genome Project and the technological and information advances that it enabled mark the shift in clinical genetics from an observational and descriptive field to one of precise molecular diagnosis with a growing repertoire of meaningful therapeutic interventions. In the lifetime of most practicing senior neonatologists, that means going from a few recognizable syndromes, chromosome anomalies, and multifactorial birth defects to the more than 6000…
Part 1: Nutrition for the High-Risk Infant David H. Adamkin, Paula G. Radmacher Key Points 1. Begin intravenous amino acids in the first hours of life. 2. Consider using lipid emulsions early with long-chain polyunsaturated fatty acids (LCPUFA) (especially docosahexaenoic acid [DHA], arachidonic acid [ARA], and eicosapentaenoic acid [EPA]) to prevent omega 3 deficiencies. 3. Prioritize the use of human milk. If mother’s own milk is…
There are tiny, puny infants with great vitality. Their movements are untiring and their crying lusty, for their organs are quite capable of performing their allotted functions. These infants will live, for although their weight is inferior … their sojourn in the womb was longer. Pierre Budin, The Nursling An infant’s problems and prognosis are in large part determined by birth weight and gestational age. The…
The transition from fetal to neonatal life is a dramatic and complex process involving extensive physiologic changes that are most obvious at the time of birth. Individuals who care for newly born infants during these first few minutes of neonatal life must monitor the progress of the transition and be prepared to intervene when necessary. In the majority of births, this transition occurs without a requirement…
Everything ought to be done to ensure that an infant be born at term, well developed, and in a healthy condition. But in spite of every care, infants are born prematurely. Pierre Budin, The Nursling Identification of the Pregnancy at Risk The goal of prenatal care is to ensure optimal outcomes for both baby and mother. Prenatal care involves a series of assessments over time, as…
Health care is viewed as a system, a network of interdependent components working together to accomplish a specific aim, which is to meet the needs of patients, families, and communities while constantly improving its performance. The quality of health care is defined as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional…
Key points Early detection followed by rapid initiation of antimicrobial treatment and measures to prevent and treat organ dysfunction are key to optimizing the outcome of sepsis. Due to the non-specific presentation, the dynamic and heterogeneous nature of sepsis, and the difficulties in objectively defining clinical signs, there is no combination of clinical markers that offers high diagnostic accuracy. Molecular markers mainly assess the systemic inflammatory…
Key points Inborn errors of immunity (IEI) presenting in the newborn period include immune deficiencies affecting cellular and humoral immunity, diseases of immune dysregulation, congenital defects in phagocyte function, defects in intrinsic and innate immunity, and autoinflammatory disorders. There are many syndromes associated with IEI that can be recognized in the newborn period through extra-immune manifestations. However, many newborns with IEI appear healthy until they acquire…
Key points Drug-associated acute kidney injury is common in neonates and has important implications for therapeutic decisions and patient clinical outcomes. This chapter reviews the mechanisms of nephrotoxin-induced acute kidney injury and the various medications that are widely used in neonatal intensive care units. Our ability to understand the fundamental principles of management of drug-induced nephrotoxicity requires a multidisciplinary approach aimed at earlier recognition and close…
Key points Pulmonary hypertension (PH) is an important comorbidity associated with bronchopulmonary dysplasia that increases risk of right ventricular failure and death in premature infants. First-line treatment is aimed at correction of the respiratory status by optimizing lung volumes, oxygenation, and ventilation and eliminating sources of pulmonary inflammation, such as infection or aspiration. Depending on disease severity, PH-targeted therapies may be used in conjunction with or…