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Retinopathy of Prematurity

Introduction Retinopathy of prematurity (ROP) was first described ~70 years ago as retrolental fibroplasia . The introduction of closed incubators with the use of high levels of supplemental oxygen caused inhibition of the growth of retinal vessels in premature infants, followed by vasoproliferation and traction eventually resulting in a complete retinal detachment behind the lens. Supplemental oxygen increased the risk of blindness but also improved survival.…

Examination and Common Problems in the Neonatal Eye

“The eye is the light of the body; therefore, if the eye is good, then the whole body will be full of light, but if the eye is bad, then the whole body will be full of darkness.” Clinicians should develop the ability to recognize the signs and symptoms of serious eye diseases or complications of diseases early in their course to prevent visual loss and,…

The Skin of the Neonate

This chapter provides an overview of the principles of newborn skin care followed by a summary of the many diseases of the newborn presenting with primary or secondary cutaneous manifestations. A basic understanding of the structural development of the skin as well as the multiple functions subserved by the skin during transition to extrauterine life will be highlighted. The caregiver will be able to distinguish benign…

The Kidney and Urinary Tract of the Neonate

In the past 25 years, the field of clinical neonatal nephrology has expanded significantly in concert with major advances and changes in the care and survival of neonates, particularly premature neonates. The widespread use of invasive vascular catheters, for example, has resulted in a new set of complications, including acute kidney injury (AKI) and renovascular hypertension related to thromboembolic disease. The improved survival of infants with…

Fluid, Electrolytes, and Acid-Base Homeostasis

Fluid and electrolyte and acid–base management are essential components in the care of neonates who are considered high risk. This is particularly true for infants with very low birth weight (VLBW) for several reasons. Premature neonates typically require parenteral fluids, the quantity and composition of which can be highly variable. They also have important developmental limitations in renal homeostatic mechanisms. Finally, immature infants may be particularly…

Neonatal Jaundice and Liver Diseases

Bilirubin is one of three biologically active end-products of heme catabolism. Its clinical significance in the neonate relates to its propensity for deposition in the skin and mucous membranes, producing easily identifiable jaundice (French jaune , yellow) or icterus (Greek ikteros ). The yellow color, or the serum (or plasma) total bilirubin (TB) concentration at any point in time, represents the combined processes of bilirubin production…

Inborn Errors of Metabolism

The main problems facing the physician caring for a sick newborn infant are to know when to consider the possibility of a metabolic disorder, what to do to determine quickly and efficiently whether a child has a metabolic disease, and how to treat the patient until a diagnosis is established. A listing of strategic clinical and laboratory findings characteristic of inborn errors of metabolism are presented.…

Disorders of Sex Development

Genetic sex is determined at the time of fertilization, but carrying out the steps of sexual differentiation takes place over 14 weeks of embryonic and fetal development. An error in this process may result in a disorder of sex development (DSD), defined as a discrepancy in the genetic, gonadal, or genital makeup of an individual. This chapter reviews normal fetal sexual differentiation; the approaches to the…

Thyroid Disorders in the Neonate

Thyroid hormone is critical for linear growth and maturation of thyroid-dependent tissues, including the brain. Many physiologic factors influence fetal and neonatal thyroid function, including fetal–maternal relationships and the dynamic alteration of thyroid function with birth. Understanding the action of thyroid hormones, the synthesis and transport of these hormones, and mechanisms regulating thyroid function is also important in the evaluation and management of thyroid disorders. This…

Disorders of Calcium, Phosphorus, and Magnesium Metabolism in the Neonate

Approximately 98% of the calcium, 80% of the phosphorus, and 65% of the magnesium in the body are in the skeleton; these elements, often referred to as the “bone minerals,” are also constituents of the intracellular and extracellular spaces. The metabolism of these bone minerals and mineralization of the skeleton are complex functions that require the interaction of various parameters. These include an adequate supply of…

Disorders of Carbohydrate Metabolism in the Neonate

The fetus depends entirely on the mother for its nutritional needs, of which glucose is the principal energy substrate that fuels fetal growth and metabolism. At birth, when the maternal supply is discontinued, the neonate must adjust to an independent existence. This transition to the extrauterine environment is often perturbed by alterations in the mother's metabolism or by intrinsic fetal and placental problems that result in…

Neonatal Necrotizing Enterocolitis

Summary Necrotizing enterocolitis (NEC) is a devastating disease of the gastrointestinal tract that affects mostly premature infants. It is the most significant contributor of gastrointestinal morbidity and mortality in preterm infants. NEC was first described over 60 years ago but despite significant research efforts, its pathogenesis remains poorly understood. A general lack of reliable and specific early clinical or laboratory signs affects the ability to promptly…

Selected Gastrointestinal Anomalies in the Neonate

Thoracic Anomalies Esophageal Atresia and Tracheoesophageal Fistula Combined anomalies of the esophagus and trachea are regular occurrences in most tertiary neonatal units caring for high-risk infants. The spectrum of recognized deformities comprises a variety of combinations involving esophageal atresia (EA) and tracheoesophageal fistula (TEF). These malformations are well-recognized entities, yet they continue to stimulate a great deal of interest for a variety of reasons, and almost…

Disorders of Digestion in the Neonate

Chronic and prolonged diarrhea is a symptom complex with a variety of underlying etiologies. This chapter focuses on the approach to infants with protracted diarrhea and is a review of recent literature on infantile diarrheal illnesses. Intractable diarrhea is a term developed many years ago by Avery to describe chronic, unexplained diarrhea in young children. This phrase describes a symptom complex rather than a discrete disease…

Gastrointestinal Reflux and Motility in the Neonate

Definitions Gastroesophageal reflux (GER) is the physiologic retrograde passage of fluid from the stomach to the esophagus. Gastroesophageal reflux events occur in healthy infants multiple times per day. Gastroesophageal reflux disease (GERD) is the pathologic condition wherein such retrograde flow into the esophagus causes medical complications. Regurgitation and vomiting are common and often nonpathologic complications of GER. A definitive determination of GERD in infants is often…

Development of the Neonatal Gastrointestinal Tract

The human gastrointestinal (GI) tract is a complex combination of organs whose primary function is to digest and absorb nutrients. Many important secondary functions are also performed, such as the endocrine function of the pancreas. In fact, what was once considered a simple system of digestion and absorption is now recognized as something much more complex and dynamic. Furthermore, as with the respiratory system, to perform…

Blood Component Therapy for the Neonate

Special Considerations for Transfusion Therapy in the Neonate Neonates constitute one of the most heavily transfused patient groups in the hospital. In a Canadian study, over 50% of infants at less than 30 weeks’ gestation and more than 80% of infants with a birth weight of less than 1000 grams received at least one red blood cell (RBC) transfusion during their initial hospitalization. Neonatal transfusion practices…

Hematologic and Oncologic Problems in the Fetus and Neonate

Human Hematopoietic Development Hematopoietic Stem Cells Blood cells arise from the differentiating embryonic mesoderm. Human erythroid and macrophage progenitor cells have been observed in the yolk sac by days 16-19 and at day 19 in the aortic-gonad-mesonephros (AGM). After the development of the circulatory system on day 21, pluripotent hematopoietic cells localize in the AGM, placenta, and liver by days 24-28. Myeloid, lymphoid, and megakaryocytic precursors…

Neonatal Management of Congenital Heart Disease

Introduction Neonates with congenital heart disease require a well-integrated and multidisciplinary team approach to achieve optimal outcomes. The complexity of managing a critically ill newborn is compounded greatly when the cardiovascular physiology and/or anatomy are significantly altered. Many of the important management principles routinely followed by neonatologists can be applied to critically ill newborn cardiac patients, including thermal regulation, prematurity issues, nutritional strategies, and ventilator support.…

Disorders of Cardiac Rhythm and Conduction in Newborns

Neonates experience a variety of cardiac arrhythmias, varying from benign and asymptomatic to life threatening. In this chapter we will discusses the normal and abnormal variations in cardiac rate and rhythms that are frequently encountered in the newborn period. Normal Sinus Rhythm and Sinus Node Dysfunction Normal Sinus Rhythm and Its Variations The initiation of cardiac electrical activity typically begins in the sinus node, a small,…