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The Outcome of Neonatal Intensive Care

Technical advances and aggressive improvements in perinatal care have been primarily responsible for the improved survival of high-risk neonates ( Fig. 19.1 , Tables 19.1 and 19.2 ) Despite marked improvements in survival, there has been minimal progress in decreasing morbidities. A major concern persists that neonatal intensive care can result in an increase in the number of permanently handicapped children. Because perinatal interventions can impact…

Neonatal Imaging

Imaging provides anatomic and functional information critical to the care of the high-risk neonate. An expanding selection of imaging tools offers safe and timely diagnostic procedures for infants both before and after birth. Advances such as fetal magnetic resonance imaging (MRI) and point-of-care ultrasound provide new opportunities to impact patient care earlier in the disease process. This chapter reviews imaging modalities key to the evaluation of…

Neonatal Brain Disorders

Brain Development in the Fetus and the Newborn Maturation of the brain is defined through descriptions of sequential and overlapping developmental processes, beginning with conception and involving continual interactions of the gene environment. Beginning during gestation and following trimester-specific stages of development of the embryo and fetus, anatomic, biochemical, and physiologic processes occur: neural induction followed by neuronogenesis, programmed cell death and neuroblast migration, formation of…

Hematologic Problems

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…

The Kidney

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…

The Heart

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.…

Infections in the Neonate

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,…

Neonatal Hyperbilirubinemia

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…

Glucose, Calcium, and Magnesium

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…

Respiratory Problems

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…

Developmental Care—Understanding and Applying the Science

“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…

Care of the Parents

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…

Genetics, Inborn Errors of Metabolism, and Newborn Screening

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…

Nutrition and Selected Disorders of the Gastrointestinal Tract

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…

Physical Growth: Physical Examination of the Newborn Infant and the Physical Environment

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…

Resuscitation and Initial Stabilization

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…

Antenatal and Intrapartum Care of the High-Risk Infant

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…

Patient Safety, Quality, and Evidence-Based Medicine

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…

Clinical and molecular markers to assist decision-making in neonatal sepsis

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…