Fanaroff and Martin’s Neonatal-Perinatal Medicine. Diseases of the Fetus and Infant [11 ed.] 9780323567114, 9996122883, 9996122948
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English Pages [2157] Year 2020
![Fanaroff and Martin’s Neonatal-Perinatal Medicine. Diseases of the Fetus and Infant [11 ed.]
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Table of contents :
cover
front matter
Fanaroff and Martin's Neonatal-Perinatal Medicine, 2-Volume Set
copyright
Copyright Page
dedication
Dedication
content
contributors
Contributors
preface
Preface
1
1 Growth of Neonatal Perinatal Medicine—A Historical Perspective
Abstract
Keywords
Perinatal Pioneers
The High-Risk Fetus and Perinatal Obstetrics
Midwives and Perinatal Care
Neonatal Resuscitation: Tales of Heroism and Desperation
Apgar and the Language of Asphyxia
Foundling Asylums and Infant Care
Saving Infants to Man the Army
An Ingenious Contrivance, the Couveuse, and Premature Baby Stations
Incubators, Baby Shows, and Origins of Neonatal Intensive Care Units
Supportive Care and Oxygen Therapy
Ventilatory Care: “Extended Resuscitation”
Supportive Care: Intravenous Fluid and Blood Transfusions
Tools and Supplies for Neonatal Intensive Care Units
Pediatric Surgery: Not for Rabbits Anymore
Global Neonatal Care
Medical Errors and “Patient Safety” as a New Discipline
Controlled Clinical Trials, Evidence-Based Medicine, and Research Networks
Future of Neonatal Research, Education, and Databases in the Internet Era
Some Famous High-Risk Infants
Acknowledgment
Key Points
References
2
2 Epidemiology for Neonatologists
Abstract
Keywords
Introduction
Common Epidemiologic Concepts
Health Statistics and Data Sources
Birth Data
Fetal Deaths
Infant Deaths
Pregnancy-Related Deaths
Maternal Morbidity
Neonatal Morbidity
Prematurity and Low Birth Weight
Key Points
References
3
3 Medical Ethics in Neonatal Care
Abstract
Keywords
Principles in Medical Ethics
Autonomy
Beneficence
Nonmaleficence
Justice
Key Terms and Concepts
Communication With Parents
Teams and Communication
Family-Centered Neonatal Intensive Care
Consensual Decision Making
Team Consensus in Ethical Issues
Clinical Applications in Specific Moral Problems
Refusal of Treatment During Pregnancy
Prenatal Consultation at the Limits of Viability
Withholding and Withdrawing Life-Sustaining Medical Treatment in the Neonatal Intensive Care Unit
Collaborative, Procedural Framework for End-of-Life Decision Making
Specific Issues in End-of-Life Care
Brain Death, Donation After Cardiac Death, and Organ Donation
Brain Death
Donation After Cardiac Death
Use of Analgesic Agents at the Time of Withdrawing Life-Sustaining Medical Treatment
Palliative Care in the Neonatal Intensive Care Unit
Conflict Resolution When Consensus Cannot Be Reached
Ethics of Research in the Neonatal Intensive Care Unit
Ethical Responsibilities of Neonatal Physicians
Acknowledgment
Key Points
References
4
4 Legal Issues in Neonatal-Perinatal Medicine
Abstract
Keywords
Disclaimer
General Legal Principles
Legislative Law and Case Law
State Law and Federal Law
General Structure of the Federal and State Court Systems
Supervision of Others
Theories of Liability for Attending Physicians
Residents and Fellows
Physician Assistants
Advanced Practice Neonatal Nurses
Malpractice
Duty
Supervising Others
Telephone Advice
Telemedicine
Prenatal Consultation
Breach
Standard of Care
Role of the Expert Witness
Res Ipsa Loquitur
Causation
Damages
Burden of Proof
Protected (Nondiscoverable) Proceedings
Other Tort Actions
Wrongful Birth
Wrongful Life
Wrongful Death
Strategies for Avoiding Tort Litigation
Trends in Malpractice Legislation
Conclusions
Live Birth
Born-Alive Infants Protection Act
Handicapped Newborns
Baby Doe
Baby Jane Doe
Baby K
Sun Hudson
Conclusions
Providing Care Against Parents’ Wishes
Miller Case
Messenger Case
Montalvo Case
Conclusions
Summary
Key Points
References
5
5 Evaluating and Improving the Quality and Safety of Neonatal Intensive Care
Abstract
Keywords
The Case for Improvement
Brief History of Industrial Quality Improvement
Definition and Conceptual Frameworks for Quality
Definition
Conceptual Framework for Quality
Donabedian: Structure, Process, Outcomes
Pawson and Tilley: Realistic Evaluation
Batalden: Five Knowledge Systems
Complexity Theory
Translation of Frameworks into Action
Model for Improvement
Integrated Quality Management
Lean
Data and Methods for Quality Improvement
Data Elements for Assessment
Structure and Institutional Context
Processes
Outcomes
Balancing Measures
Assessing the Total Impact of a Quality Improvement Initiative
Risk Adjustment/Fair Comparisons
Data Sources
Administrative Data
Clinical Data
Qualitative Data
Quality Measurement and Improvement
Data for Selection
National Quality Measures
Data for Improvement
Global Assessments of Perinatal Quality: The Value Compass
Global Assessments of Perinatal Quality: The Baby-MONITOR
Quality and Safety Applied
Local Quality Improvement Applied: An Example
Sustainability
Quality Improvement Research
Quality and Safety in the International Context
Conclusion
Acknowledgments
Key Points
References
6
6 Simulation and Debriefing in Neonatal-Perinatal Medicine
Abstract
Keywords
Introduction
Simulation-Based Training in High-Risk Industries
Simulation-Based Training in Health Care
Simulation-Based Training in Neonatal-Perinatal Medicine
Debriefing Simulated Events
Debriefing Actual Clinical Events
Simulation-Based Assessment
Simulation-Based Research
Simulation as the Basis of Clinical Care
The Future of Simulation in Neonatal-Perinatal Medicine
Key Points
References
7
7 Practicing Evidence-Based Neonatal-Perinatal Medicine
Abstract
Keywords
Asking a Focused Clinical Question
Finding Evidence
Sources of Evidence
Efficient Strategies for Searching for Evidence
Primary Reports
Reviews
Cochrane Systematic Reviews
Critically Appraising Evidence for Its Validity
Extracting the Data and Expressing the Effect of Treatment
Applying the Results to Patient Care
Promoting Evidence-Based Clinical Practice
Acknowledgments
Key Points
References
8
8 Perinatal and Neonatal Care in Developing Countries
Abstract
Keywords
Global Initiatives to Reduce Infant Mortality Rate and Neonatal Mortality Rate
Historical Perspective
The Millennium Development Goals (MDGs)
The Sustainable Development Goals
Tracking the Global Progress of the Sustainable Development Goals
Global Burden of Maternal and Neonatal Deaths
Maternal Mortality
Neonatal and Infant Mortality
Causes of Global Maternal and Neonatal Mortality
Socioeconomic and Cultural Factors
Influence of Political Instability, War, and Conflict
Medical Causes of Neonatal Mortality Rate
Prematurity
Birth Asphyxia
Hypothermia
Infections
Burden of Neonatal Sepsis
Diagnosis of Neonatal Sepsis
Evidence-Based Interventions to Reduce Maternal Mortality Rates, Neonatal Mortality Rates, and Infant Mortality Rates
The Impact of Progress
The Burden of the High Cost of Advanced Neonatal Care
Long-Term Neurodevelopmental Outcome
Ethical Dilemmas
Strategies to Improve Global Neonatal and Perinatal Outcome
Summary
Acknowledgments
Key Points
References
9
9 Social and Economic Contributors to Neonatal Outcome in the United States
Abstract
Keywords
Epidemiology of Health Disparities in Neonatal and Perinatal Medicine
Infant Mortality
Maternal Mortality
Determinants of Prematurity and Adverse Outcomes
Social Determinants of Health
Interventions to Reduce Neonatal Health Outcome Disparities
Key Points
References
10
10 Genetic Aspects of Perinatal Disease and Prenatal Diagnosis
Abstract
Keywords
Principles of Inheritance
Chromosomal Disorders
Maternal Age Considerations
Abnormalities of Chromosome Number
Triploidy and Tetraploidy
Aneuploidy
Abnormalities of Chromosome Structure
Single-Gene Disorders
Autosomal Dominant Disorders
Advanced Paternal Age
Autosomal Recessive Disorders
Sex-Linked Disorders
Non-Mendelian Patterns of Inheritance
Mitochondrial Inheritance
Epigenetics and Uniparental Disomy
Trinucleotide Repeat Expansion
Multifactorial Inheritance
Teratogens
Diagnostic Imaging
Airline Flights
Congenital Anomalies and Ultrasonography
Screening Modalities
Screening for Aneuploidies
First-Trimester Screening
Second-Trimester Screening
Cell Free DNA Screening
Future Directions for Non-Invasive Screening and Diagnosis
Microdeletions
The Role of First-Trimester Ultrasound
Non-Invasive Prenatal Diagnosis (NIPD)
Screening for Multifactorial Disorders
Serum Alpha-Fetoprotein
Screening for Mendelian Disorders
Screening for Hemoglobinopathies
Carrier Screening for Cystic Fibrosis
Jewish Carrier Screening
Carrier Screening for Spinal Muscular Atrophy
Diagnostic Modalities
Chorionic Villus Sampling (CVS)
Amniocentesis
Cordocentesis
Technical Advances in Molecular Cytogenetics
Microarray Technology
Future Directions for Prenatal Diagnostic Testing
Assisted Reproductive Technologies (ART)
Genetic Evaluation and Counseling
Key Points
References
11
11 Perinatal Ultrasound
Abstract
Keywords
Ultrasound Equipment
Fetal Imaging Techniques
Bioeffects and Safety
Who Should Perform Fetal Ultrasound Examination?
Ethical Considerations
Classification of Fetal Sonographic Examinations
A. First-Trimester Examination
B. Standard Second- or Third-Trimester Examination
C. Limited Examination
D. Specialized Examinations
Applications of Ultrasound Studies
Genetic Screening
Assisted Reproduction
Multiple Gestations
Pregnancy Evaluation
Fetal Growth
Placental Abnormalities
Placental Location
Amniotic Fluid Volume
Cervical Length and Pelvic Structures
Second-Trimester Ultrasound Study of the Fetus
Doppler Ultrasound
Doppler Studies of the Growth-Restricted Fetus
Ultrasound-Guided Procedures
Fetal Well-Being Assessment
Fetal Anomalies
Central Nervous System
Fetal Ventriculomegaly
Meningomyelocele and (Type II) Chiari Malformation
The Skull and Brain in Spina Bifida
Anencephaly
Encephalocele
Holoprosencephaly
Dandy-Walker Malformation
Choroid Plexus Cyst
Spine
Head and Neck
Heart
Gastrointestinal Tract
Normal Bowel Appearance
Esophageal Atresia and Tracheoesophageal Fistula
Small Bowel Obstruction
Anterior Abdominal Wall Defects
Diaphragmatic Hernia and Thoracic Lesions
Gallbladder and Bile Ducts
Genitourinary Tract
Musculoskeletal System
Two-Vessel Umbilical Cord
Summary
Key Points
References
12
12 Estimation of Fetal Well-Being
Abstract
Keywords
Introduction
Antepartum Fetal Surveillance
Indications for Surveillance
Physiologic Basis for Antenatal Surveillance
Patient Assessment of Fetal Movement
Non-Stress Test
Contraction Stress Test
Biophysical Profile
Amniotic Fluid Volume Assessment
Doppler Flow Velocimetry
Interpretation of Test Results
Evaluation of the Intrapartum Fetus
Intrapartum Oxygenation and Neurologic Morbidity
Continuous Versus Intermittent Fetal Heart Rate Monitoring
Interpretation of Continuous FHR Recordings
Baseline Fetal Heart Rate
Fetal Heart Rate Variability
Accelerations
Decelerations
Interpretative Systems for Classification of Fetal Heart Rate Patterns
Category I
Category II
Category III
Management of Non–Category I FHR Patterns During Labor
Key Points
References
13
13 Surgical Treatment of the Fetus
Abstract
Keywords
Summary
Fetal Access
Percutaneous Interventions
Fetoscopic Surgery
Open Hysterotomy
Exit Procedure
Anesthetic Considerations
Anomalies Amenable to Fetal Surgery
Congenital Diaphragmatic Hernia
Congenital Pulmonary Airway Malformations
Fetal Hydrothorax
Amniotic Bands
Neoplastic Mass Lesions
Sacrococcygeal Teratoma
Fetal Neck Mass
Myelomeningocele
Urinary Tract Abnormalities
Hydronephrosis
Lower Urinary Tract Obstruction
Abnormalities of Twin Gestations
Twin–Twin Transfusion Syndrome
Selective Fetal Reduction
Congenital Heart Disease
Conclusion
Key Points
References
14
14 Adverse Exposures to the Fetus and Neonate
Abstract
Keywords
Exposures Not Concurrent With Pregnancy
Preconceptual Effects
The Epigenome
Maternal Exposures
Paternal Exposures
Secondary Fetal Exposure: Maternal Body Burden
Polychlorinated Biphenyls
Lead
Maternal Exposures Concurrent With Pregnancy
Occupation and Paraoccupation
Air Pollution
Drinking Water
Diet
Pathways of Fetal Exposure
Placenta-Dependent Pathways
Placenta-Independent Pathways
Radiation
Heat
Noise
Fetal Pharmacokinetics
Absorption and Distribution
Metabolism
Specific Exposures
Cigarette Smoke
Sources of Exposure
Toxic Effects
Prevention Strategies
Ethanol
Sources of Exposure
Toxic Effects
Prevention Strategies
Pesticides
Sources of Exposure
Toxic Effects
Prevention Strategies
Bisphenol A, S, and F
Sources of Exposure
Toxic Effects
Prevention Strategies
Phthalates
Sources of Exposure
Toxic Effects
Prevention Strategies
Organic Solvents
Sources of Exposure
Toxic Effects
Prevention Strategies
Conclusions
Key Points
References
15
15 Intrauterine Growth Restriction
Abstract
Keywords
Summary
Definitions and Terminology
The Health Burden of IUGR
Classification of IUGR
Etiology of IUGR
Fetal Etiologies
Maternal Etiologies
Environmental Etiologies
Placental Etiologies
Pathophysiology
Antenatal Screening and Prenatal Management
Prevention
Postnatal Diagnosis of IUGR
Postnatal Management
Hypoglycemia
Hypothermia
Respiratory Complications
Necrotizing Enterocolitis
Seizures, Intraventricular Hemorrhage
Other
Long-Term Consequences of IUGR
Conclusions
Key Points
References
16
16 Developmental Origins of Adult Health and Disease
Abstract
Keywords
Fetal Origins of Adult Disease Concept
Influences on the Early Embryo
Postnatal Growth and Nutrition
Mismatch Concept
Fetal Origins of Vascular Structural Abnormalities and Dysfunction in Adult Cardiometabolic Disease
Placental Abnormalities and Association With Adult Disease
Gestational Diabetes and Long-Term Metabolic Effects on Offspring
Cancer
Psychosocial Aspects
Toxins, Endocrine Disrupters, and Micronutrient Metabolism (See Also Chapter 14)
Epigenetics
Translation to Neonatology
Key Points
References
17
17 Hypertensive Disorders of Pregnancy
Abstract
Keywords
Classification of Hypertensive Disorders of Pregnancy
Gestational Hypertension
Preeclampsia
Eclampsia
Chronic Hypertension
Superimposed Preeclampsia
HELLP Syndrome
Epidemiology of Preeclampsia
Maternal Effects
Short Term
Recurrence in Subsequent Pregnancies
Long-Term Cardiovascular Risks
Fetal and Neonatal Effects
Risk Factors
Pregnancy-Specific Characteristics
Maternal Characteristics
Pathophysiology
Angiogenic Factors
Immunologic/Inflammatory Factors
Renin Angiotensin System
Genetics
Endothelial Dysfunction
Pathophysiology by Organ System
Cardiovascular
Renal
Brain
Hepatic
Placenta
Clinical Presentation of Preeclampsia
Initial Evaluation
Principles of Management
Administration of Corticosteroids
Seizure Prophylaxis
Antihypertensive Therapy
Ongoing Maternal and Fetal Surveillance
Timing of Delivery
Mode of Delivery
Other Hypertensive Disorders of Pregnancy
Gestational Hypertension
HELLP Syndrome
Chronic Hypertension
Superimposed Preeclampsia
Prediction
Prevention
Key Points
References
18
18 Pregnancy Complicated by Diabetes Mellitus
Abstract
Keywords
Gestational Diabetes Mellitus
Screening and Diagnosis
Antenatal Management
Treatment
Fetal Surveillance
Screening for Congenital Anomalies
Monitoring Fetal Well-Being
Assessment of Fetal Weight
Timing and Mode of Delivery
Intrapartum Management
Postpartum Maternal Management
Pregestational Diabetes Mellitus
Implications for the Neonate
Breastfeeding in Women With Gestational Diabetes Mellitus
Key Points
References
19
19 Obstetric Management of Prematurity
Abstract
Keywords
Prematurity
Pathogenesis
Risk Factors
Demographics
Obstetric History
Cervical and Uterine Factors
Multifetal Gestations
Bleeding
Infection
Genetic Factors
Other Risk Factors
Predicting Preterm Labor
Biochemical Predictors
Ultrasound Predictors
Prevention
Treatment
Bed Rest
Hydration or Sedation
Progesterone
Cerclage
Pessaries
Tocolytics
β-Sympathomimetic Agents
Ritodrine
Terbutaline
Magnesium Sulfate
Prostaglandin Synthetase Inhibitors
Indomethacin
Sulindac
Cyclooxygenase-2 Inhibitors
Calcium Channel Blockers
Oxytocin Antagonists
Nitric Oxide Donors
Antibiotics
Corticosteroids
Additional Interventions
Summary
Acknowledgments
Key Points
References
20
20 Fetal Effects of Autoimmune Disease
Abstract
Keywords
Placental Transfer: General Remarks
Fetal Thrombocytopenia
Immune Thrombocytopenic Purpura
Neonatal Alloimmune Thrombocytopenia
Management of the Neonate
Management of a Subsequent Pregnancy
Fetal-Neonatal Consequences of Maternal Antinuclear Antibodies
Fetal-Neonatal Consequences of Maternal Antiphospholipid Antibodies
Myasthenia Gravis
Herpes Gestationis
Summary
Key Points
References
21
21 Obstetric Management of Multiple Gestation and Birth
Abstract
Keywords
Biology
Maternal Consequences
Fetal and Neonatal Consequences
Malformations
Embryonic and Fetal Demise
Complications of the Monochorionic Placenta
Fetal Growth
Data From Multiple Birth Data Sets
Levels of Discordance
Mortality
Birth Weight Discordance in Monochorionic Twins
Delivery Considerations
Outcome
Summary: Prevention Versus Cure
Key Points
References
22
22 Post-Term Pregnancy
Abstract
Keywords
Risks of Post-Term Pregnancy
Macrosomia
Dysmaturity
Assessment of Fetal Well-Being
Should Labor Be Induced Before 42 Weeks?
How Should Labor Be Induced?
Post-Term Twin Pregnancies
Summary
Key Points
References
23
23 Immune and Nonimmune Hydrops Fetalis
Abstract
Keywords
Immune Hydrops Fetalis
Genetics of the Rh System
Pathophysiology of Rh-D Isoimmunization
Management
Prevention
Rh-Immunoglobulin Prophylaxis
Preimplantation Diagnosis
Rh Alloimmunization
Prediction of Anemia
Suppressive Therapy
Intravenous Immunoglobulin
Fetal Transfusion
Intravascular Transfusion
Intraperitoneal Transfusion
Timing of Delivery
Outcome
Short Term
Long Term
Atypical Antigens
Nonimmune Hydrops Fetalis
Diagnosis
Pathophysiology
Differential Diagnosis/Etiology
Antepartum Evaluation
Management
Prognosis
Summary
Key Points
References
24
24 Amniotic Fluid Volume
Abstract
Keywords
Amniotic Fluid Dynamics
Composition
Production and Regulation
Measurement of Amniotic Fluid Volume
Subjective Estimation
Amniotic Fluid Index Measurement
Single Deepest Pocket or Maximal Vertical Pocket
Comparing Amniotic Fluid Assessment Techniques
Other Techniques
Normal Volume and the Singleton Pregnancy
Twins and Amniotic Fluid
Abnormalities of Amniotic Fluid Volume and Their Management
Oligohydramnios
Clinical Implications
Etiology
Diagnostic Evaluation
Rule Out Ruptured Membranes
Assess Fetal Anatomy
Assess Fetal Growth
Assess Fetal Pulmonary Status
Treatment
Maternal Hydration
Amnioinfusion
Tissue Sealants
Polyhydramnios
Clinical Implications
Etiology
Diagnostic Evaluation
Assess Fetal Anatomy
Treatment
Amnioreduction
Prostaglandin Synthetase Inhibitors
Close Surveillance
Management of Fluid Abnormalities in Multifetal Pregnancies
The Future
Key Points
References
25
25 Perinatal Infections and Chorioamnionitis
Abstract
Keywords
Definitions and Epidemiology
Risk Factors
Microbiology
Diagnosis
Pathogenesis
Treatment
Obstetric Management
Management of the Exposed Infant
Outcomes
Areas for Future Investigation
Key Points
References
26
26 Placental Pathology
Abstract
Keywords
Optimal Use of Pathology Service
Structure, Function, and Pathologic Reaction Patterns
Overview
Maternal Uterine-Trophoblastic Lesions
Fetal Stromal-Vascular Lesions
Inflammatory and Infectious Lesions
Inflammatory Graft-Versus-Host–Type Lesions
Developmental and Structural Lesions
Clinical Correlation
Umbilical Cord Coiling
Summary
Key Points
References
27
27 Anesthesia for Labor and Delivery
Abstract
Keywords
Labor Pain Characteristics and Challenges
Techniques That Modify Pain
Nonpharmacologic Approaches
Natural Childbirth
Hypnosis
Water Birth
Acupuncture
Pharmacokinetics, Pharmacodynamics, and the Fetus
Sedatives
Opioids
Opioid Agonists
Opioid Agonist-Antagonists
Opioid Antagonists
Nitrous Oxide
Obstetric Nerve Blocks
Paracervical Blocks
Pudendal Blocks
Neuraxial Blocks
Techniques
Lumbar Epidurals
Patient-Controlled Epidural Analgesia (PCEA)
Intrathecal Injections (Spinals)
Combined Spinal-Epidurals (CSE)
Programmed Intermittent Epidural Bolusing
Maternal Risks and Benefits With Neuraxial Techniques
Benefits
Maternal Side Effects
Maternal Risks
Cesarean Sections
Labor Prolongation
Operative Vaginal Deliveries
Maternal Temperature Elevation
Inadvertent Injections and Excessively High Levels
Benefits and Potential Risks for the Fetus
Acid-Base Balance
Fetal Heart Rate
Breastfeeding
Delivery Modes and Anesthetic Techniques
Operative Vaginal Delivery
Cesarean Section
Neuraxial Anesthesia
General Anesthesia
Adjuvant Medications
Key Points
References
28
28 Physical Examination of the Newborn
Abstract
Keywords
Routine Examination
Preparation
Introduction to the Parents
Order of the Examination
Measurements
General Observation of Appearance, Posture, and Movements
Syndromes
Skin
Head
Eyes
Ears
Mouth and Palate
Neck
Breathing and Chest
Heart
Abdomen
Genitalia
Limbs and Hands and Feet
Hips
Back and Spine
Posture and Muscle Tone
Concluding the Exam
Detailed Neurologic Assessment
Level of Alertness
Inspection
Cranial Nerves
Motor Function
Deep Tendon Reflexes
Developmental Reflexes
Behavioral Evaluation
Assessment of Gestational Age
The Premature Infant
Interpretation of the Neurologic Examination
Limitations of the Routine Examination
Jaundice
Eye Abnormalities
Congenital Heart Disease
Developmental Dysplasia of the Hip
Health Promotion
Prevention of Sudden Unexpected Infant Death Syndrome
Promotion of Breastfeeding
Hearing, Vision, and Other Screening
Discharge
Key Points
References
29
29 Birth Injuries
Abstract
Keywords
Injuries to Soft Tissues
Erythema and Abrasions
Petechiae
Etiology
Differential Diagnosis
Treatment
Prognosis
Ecchymoses
Treatment
Prognosis
Subcutaneous Fat Necrosis
Etiology
Pathology
Clinical Manifestations
Differential Diagnosis
Treatment
Prognosis
Lacerations
Injuries to the Head
Skull
Caput Succedaneum
Etiology
Clinical Manifestations
Differential Diagnosis
Treatment
Prognosis
Cephalhematoma
Etiology
Clinical Manifestations
Radiographic Manifestations
Differential Diagnosis
Treatment
Prognosis
Subgaleal Hemorrhage
Etiology
Mechanism of Injury
Clinical Manifestations
Radiographic Manifestations
Differential Diagnosis
Treatment
Prognosis
Skull Fractures
Etiology
Clinical Manifestations
Radiographic Manifestations
Differential Diagnosis
Treatment
Prognosis
Intracranial Hemorrhage
Face
Facial Nerve Palsy
Etiology
Clinical Manifestations
Differential Diagnosis
Treatment
Prognosis
Fractures and Dislocations of Facial Bones
Treatment
Prognosis
Eyes
Eyelids
Orbit
Sympathetic Nervous System
Subconjunctival Hemorrhage
External Ocular Muscles
Optic Nerve
Cornea
Intraocular Hemorrhage
Ears
Abrasions and Ecchymoses
Hematomas
Lacerations
Vocal Cord Paralysis
Etiology
Clinical Manifestations
Differential Diagnosis
Treatment
Prognosis
Injuries to the Neck, Shoulder Girdle, and Chest
Fracture of the Clavicle
Etiology
Clinical Manifestations
Differential Diagnosis
Treatment
Prognosis
Fracture of Ribs
Etiology
Clinical Manifestations
Mechanism of Injury
Treatment
Prognosis
Brachial Palsy
Etiology
Clinical Manifestations
Differential Diagnosis
Treatment
Prognosis
Phrenic Nerve Paralysis
Etiology
Clinical Manifestations
Radiographic Manifestations
Differential Diagnosis
Treatment
Prognosis
Injury to the Sternocleidomastoid Muscle
Etiology
Clinical Manifestations
Differential Diagnosis
Treatment
Prognosis
Injuries to the Spine and Spinal Cord
Etiology
Clinical Manifestations
Differential Diagnosis
Treatment
Prognosis
Injuries to Intra-Abdominal Organs
Rupture of the Liver
Etiology
Clinical Manifestations
Differential Diagnosis
Treatment
Prognosis
Rupture of the Spleen
Etiology
Clinical Manifestations
Differential Diagnosis
Treatment
Prognosis
Adrenal Hemorrhage
Etiology
Clinical Manifestations
Radiographic Manifestations
Differential Diagnosis
Treatment
Prognosis
Renal Injury
Etiology
Clinical Manifestations
Differential Diagnosis
Treatment
Prognosis
Injuries to the Extremities
Fracture of the Humerus
Etiology
Clinical Manifestations
Differential Diagnosis
Treatment
Prognosis
Fracture of the Radius
Etiology
Clinical Manifestations
Treatment
Prognosis
Fracture of the Femur
Etiology
Clinical Manifestations
Treatment
Prognosis
Dislocations
Epiphyseal Separations
Deep Tendon Injuries
Risk Factors Associated With Deep Tendon Injury
Management
Other Peripheral Nerve Injuries
Trauma to the Genitalia
Scrotum and Labia Majora
Deeper Structures
Injuries Related to Intrapartum Fetal Monitoring
Injuries Related to Direct Fetal Heart Rate Monitoring
Injuries Related to Fetal Scalp Blood Sampling
Injuries Related to Trauma During Pregnancy
Key Points
References
30
30 Congenital Anomalies
Abstract
Keywords
General Clinical Approach
Epidemiology and Etiology
Major Malformations
Genetic
Complex or Multifactorial
Single Gene (Mendelian)
Chromosomal
Environmental Exposure and Teratogens
Unknown
Anomalies in Aborted Fetuses
Minor Anomalies and Phenotypic Variants
Racial and Ethnic Differences
Evaluation
Patient and Family History
Physical Examination
Skin
Hair
Head
Face
Eyes
Ears
Nose
Mouth
Neck
Chest
Abdomen
Anus
Genitalia
Spine
Extremities
Evaluation of the Stillborn
Diagnostic Testing and Indications
General Studies
Genetic Laboratory Studies
Genetic Counseling
Educational Resources and Support Organizations
Acknowledgments
Key Points
References
31
31 Overview and Initial Management of Delivery Room Resuscitation
Abstract
Keywords
Fetus
Transition at Birth
Causes of Depression and Asphyxia
Response to Asphyxia
Preparation for Resuscitation
Adequate Equipment
Adequate Personnel
Apgar Score
Umbilical Cord Blood Gases
Elements of a Resuscitation
Initial Quick Overview
Initial Steps
Thermal Management
Clearing the Airway
Monitoring
Tactile Stimulation and Assessment
Free-Flow Oxygen
Key Points
References
32
32 Role of Positive Pressure Ventilation in Neonatal Resuscitation
Abstract
Keywords
Normal Transition and Initial Spontaneous Breathing
Delayed Transition and Need for Respiratory Support
Basics of Positive Pressure Support
Application of Noninvasive Positive Pressure Support
How to Generate Positive Pressure
Self-Inflating Bags (SIB)
Flow-Inflating Bags (FIB)
T-Piece Devices
Other Options for Providing Positive Pressure
Choosing an Interface to Deliver Positive Pressure
Face Masks
Single Nasal Tube and Bi-Nasal Prongs
Assessing the Effectiveness of Non-Invasive Positive Pressure Ventilation
Laryngeal Mask Airway
Endotracheal Tube
Intubation Procedure
Applying Positive Pressure Support
The First Breaths
Peak Inflation Pressures and Tidal Volumes
Positive End Expiratory Pressure
Inflation Rate and Duration
Gas Flow
Key Points
References
33
33 Oxygen Therapy in Neonatal Resuscitation
Abstract
Keywords
Use of Oxygen in Perinatal Asphyxia and Resuscitation
Oxidative Stress: Pathophysiologic Background
Oxidative Stress: Differences Between Resuscitation With 100% Oxygen and Room Air
Room Air versus Pure Oxygen for Resuscitation of the Newborn
Animal Studies
Clinical Data
Oxygen Supplementation in the Delivery Room in Extremely Low Gestational Age Neonates
Oxygen Saturation Nomogram
Room Air versus 100% Oxygen— or Something Else
Key Points
References
34
34 Chest Compression, Medications, and Special Problems in Neonatal Resuscitation
Abstract
Keywords
Importance of Effective Ventilation
Chest Compressions
Medications
Epinephrine
Volume
Other Drugs
Intravenous Access
When to Discontinue Resuscitation Efforts
Documentation and Debriefing
Immediate Care After Establishing Adequate Ventilation and Circulation
Induced Therapeutic Hypothermia
Sodium Bicarbonate
Naloxone
Dopamine
Prolonged Assisted Ventilation
Glucose
Fluids
Feeding
Other Problems
Special Problems During Resuscitation
Infants With Very Low Birth Weight and Extremely Premature Infants
Meconium Aspiration
Pneumothorax
Congenital Diaphragmatic Hernia
Erythroblastosis and Hydrops Fetalis
Screening for Congenital Defects
Physical Examination
Key Points
References
35
35 Thermal Environment of the Intensive Care Nursery
Abstract
Keywords
Heat Exchange Physics
The Four Modes of Heat Exchange
Heat Exchange at Term Birth
Evaporative Heat Loss Is Related to Infant Maturity and Ambient Humidity
Respiratory Loss of Heat
Thermal Physiology
The Fetal Thermal Equilibrium
Neonatal Thermoregulation
Thermoneutrality
Overwarming Versus Fever
Hypothermia
Temperature Monitoring
Central (“Core”) Body Temperature
What Temperature Should Be Aimed for?
Peripheral Temperature and Central-Peripheral Temperature Difference
Thermal Aspects of the Care Environment
Convective Thermal Support—Incubator Care
Incubator Humidification
Radiant Thermal Support—Radiant Warmers
Conductive Thermal Support— Skin-to-Skin Care
Heated Mattresses and Cot Nursing
Clothing
Phototherapy
Recommendations for Practice
Before Birth
Term and Moderate to Late Preterm (>32 Weeks) Infants
Very (28-31 Weeks) and Extremely (
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