Flip Chart-Converted 2

Download as pdf or txt
Download as pdf or txt
You are on page 1of 10

EMERGENCY MEDICATIONS AND THERAPY FOR NEONATES (continued on back cover)a

UMBILICAL CATHETER DOSINGb

MEDICATION INDICATIONS DOSING RANGE NOTES UAC UVC


Furosemide Volume overload, pulmonary 1 mg/kg/dose, IM, IV Yes
edema
Lorazepam Anticonvulsant 0.05 mg/kg/dose IV, infuse over May cause respiratory depression and hypotension, Yes
3–5 minutes may repeat in 10–15 minutes.
Naloxone Narcotic reversal 0.1 mg/kg IM/IV (IV preferred; IM Not recommended as part of initial resuscitation of newborns Yes
acceptable but delayed onset of with respiratory depression in delivery room. If respiratory
action). ETT route: no studies in depression continues, naloxone may be given if mother
neonates had narcotics within 4 hours of delivery.
Phenobarbital Anticonvulsant 15–20 mg/kg IV load over Respiratory depression possible if diazepam used first. Follow Yes
15–30 minutes with maintenance dose.
Phenytoin Anticonvulsant 15–20 mg/kg IV load IV rate 0.5 mg/kg/min maximum; mix only with NS. Yes

Sodium bicarbonate Documented metabolic acidosis 1–2 mEq/kg IV over at least Use 0.5 mEq/mL; infuse over 30 minutes or more. Yes
with adequate ventilation, 30 minutes or more
hyperkalemia

Volume Expansion

Normal saline Volume expansion 10 mL/kg IV over 5–10 minutes; Check Hct and serum glucose before and after dose. Yes Yes
(preferred) or lactated may repeat
Ringer’s solution
O Rh-negative packed Volume expansion (severe 10 mL/kg IV over 5–10 minutes; If time permits, blood should be cross-matched Yes (not Yes
RBCs anemia/blood loss) may repeat to the mother. preferred)

a
For abbreviations, see Appendix A.
b
Avoid infusion of catecholamines into UAC. UVC in good position preferred to administer medications.
In emergency situations, a UVC inserted only to the point where blood can be aspirated (at least 2–4 cm; less in preterm infants), but whose position is not verified by radiograph, can be used for volume expanders,
epinephrine, glucose (not >12.5%), and bicarbonate that is diluted. Intraosseous access can be used as an alternative route. Note: No hypertonic solutions should be used in a catheter that is not confirmed by x-ray.
SEVENTH EDITION

NEONATOLOGY
Management, Procedures, On-Call Problems,
Diseases, and Drugs
Editor
TRICIA LACY GOMELLA, MD
Part-Time Assistant Professor of Pediatrics
Johns Hopkins University School of Medicine
Baltimore, Maryland
Associate Editors
M. DOUGLAS CUNNINGHAM, MD
Professor of Pediatrics/Neonatology
Interim Chief of the Division of Neonatology, Department of Pediatrics
College of Medicine
University of Kentucky
Lexington, Kentucky
Clinical Professor of Pediatrics/Neonatology
Department of Pediatrics, School of Medicine
University of California, Irvine
Irvine, California
FABIEN G. EYAL, MD
Professor of Pediatrics
Chief and Louise Lenoir Locke Professor of Neonatology
Medical Director, Intensive Care Nurseries
University of South Alabama Children’s and Women’s Hospital
Mobile, Alabama
Consulting Editor
DEBORAH J. TUTTLE, MD
Assistant Professor of Pediatrics
Jefferson Medical College
Thomas Jefferson University
Philadelphia, Pennsylvania
Director, Performance Improvement
Christiana Care Health System
Director, Milk Bank
Attending Neonatologist
Christiana Care Health System
Newark, Delaware

New York   Chicago   San Francisco   Lisbon   London   Madrid   Mexico City
Milan   New Delhi   San Juan   Seoul   Singapore   Sydney   Toronto
Copyright © 2013 by McGraw-Hill Education, LLC. All rights reserved. Except as permitted
under the United States Copyright Act of 1976, no part of this publication may be reproduced or
distributed in any form or by any means, or stored in a database or retrieval system, without the
prior written permission of the publisher.

ISBN: 978-0-07-177206-8

MHID: 0-07-177206-5

The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-176801-6,
MHID: 0-07-176801-7.

All trademarks are trademarks of their respective owners. Rather than put a trademark symbol
after every occurrence of a trademarked name, we use names in an editorial fashion only, and to
the benefit of the trademark owner, with no intention of infringement of the trademark. Where
such designations appear in this book, they have been printed with initial caps.

McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums
and sales promotions, or for use in corporate training programs. To contact a representative
please e-mail us at [email protected].

Notice

Medicine is an ever-changing science. As new research and clinical experience broaden


our knowledge, changes in treatment and drug therapy are required. The authors and the
publisher of this work have checked with sources believed to be reliable in their efforts to
provide information that is complete and generally in accord with the standards accepted at the
time of publication. However, in view of the possibility of human error or changes in medical
sciences, neither the authors nor the publisher nor any other party who has been involved in the
preparation or publication of this work warrants that the information contained herein is in every respect
accurate or complete, and they disclaim all responsibility for any errors or omissions or for the
results obtained from use of the information contained in this work. Readers are encouraged
to confirm the information contained herein with other sources. For example and in particular,
readers are advised to check the product information sheet included in the package of each drug
they plan to administer to be certain that the information contained in this work is accurate
and that changes have not been made in the recommended dose or in the contraindications for
administration. This recommendation is of particular importance in connection with new or
infrequently used drugs.

TERMS OF USE

This is a copyrighted work and McGraw-Hill Education, LLC. and its licensors reserve all rights
in and to the work. Use of this work is subject to these terms. Except as permitted under the
Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not
decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based
upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of
it without McGraw-Hill Education’s prior consent. You may use the work for your own
noncommercial and personal use; any other use of the work is strictly prohibited. Your right to
use the work may be terminated if you fail to comply with these terms.

THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS


LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY,
ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING
THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH
THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY
WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED
WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
McGraw-Hill Education and its licensors do not warrant or guarantee that the functions contained
in the work will meet your requirements or that its operation will be uninterrupted or error free.
Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any
inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom.
McGraw-Hill Education has no responsibility for the content of any information accessed
through the work. Under no circumstances shall McGraw-Hill Education and/or its licensors
be liable for any indirect, incidental, special, punitive, consequential or similar damages that
result from the use of or inability to use the work, even if any of them has been advised of the
possibility of such damages. This limitation of liability shall apply to any claim or cause
whatsoever whether such claim or cause arises in contract, tort or otherwise.
International Editorial Board
Marek Jaszczak, MD Siddarth Ramji, MD
Neonatologist Professor of Pediatrics
Department of Neonatology Department of Neonatology
UJASTEK Hospital of Obstetrics and Gynecology Maulana Azad Medical College
Kraków, Poland New Delhi, India
Neelima Kharidehal, MD (Peds), Mary (Molly) Seshia MBChB, DCH,
MRCPCH (UK) FRCP (Ed)
Senior Consultant, NICU Professor of Pediatrics
Suraksha Children’s Hospital Section of Neonatology
Hyderabad, AP University of Manitoba
India Winnipeg, Manitoba, Canada
Makiko Ohyama, MD, PhD, IBCLC Outi Tammela, MD
Japan Pediatric Society Adjunct Professor in Neonatology
Japan Society of Perinatal-Neonatal Medicine Pediatric Research Center
Japan Society of Premature and Newborn Tampere University Hospital
Medicine Tampere, Finland
Japan Placenta Association
Japanese Society of Clinical Cytology Christiane Theda, MD, PhD, MBA
Japanese Association of Lactation Consultants Neonatologist and Medical Geneticist
International Lactation Consultant Royal Women’s Hospital
Association University of Melbourne
Academy of Breastfeeding Medicine Murdoch Children’s Research Institute
Department of Neonatology Newborn Emergency Transport Service
Kanagawa Children’s Medical Center Royal Children’s Hospital
Minamiku, Yokohama-City, Japan Melbourne, Australia

Arjan te Pas, MD PhD Imelda Consunji Vinzon-Bautista, MD,


Associate Professor of Pediatrics MPH, FAAP, DPPS, DPSNbM
Department of Pediatrics Chairman, Institute of Pediatrics
Division of Neonatology and Child Health
Leiden University Medical Center Chief, Section of Neonatology
Leiden, the Netherlands St. Luke’s Medical Center Global City
Taguig City, Philippines

iii
This page intentionally left blank
To my twin sons, Leonard and Patrick, and singletons Andrew and Michael.
This page intentionally left blank
Contents
Emergency Medications and Therapy
for the Neonates..............................................(inside front and back covers)
Color insert.............................................................between pages 554 and 555
Contributors...................................................................................................xiii
Preface......................................................................................................... xxi
Section I. Antepartum, Intrapartum, Delivery, and Transport Management
1 Fetal Assessment................................................................................................................1
2 Obstetric Anesthesia and the Neonate................................................................................9
3 Resuscitation of the Newborn...........................................................................................15
4 Infant Transport................................................................................................................24

Section II. Basic Management


5 Gestational Age and Birthweight Classification................................................................29
6 Newborn Physical Examination.........................................................................................43
7 Temperature Regulation....................................................................................................65
8 Respiratory Management..................................................................................................71
9 Fluid and Electrolytes........................................................................................................89
10 Nutritional Management...................................................................................................98

Section III. Advanced Management


11 Imaging Studies..............................................................................................................133
12 Management of the Extremely Low Birthweight Infant During the
First Week of Life.............................................................................................................157
13 Management of the Late Preterm Infant.........................................................................169
14 Pain in the Neonate.........................................................................................................172
15 Newborn Screening.........................................................................................................176
16 Studies for Neurologic Evaluation...................................................................................181
17 Blood Component Therapy...............................................................................................189
18 Extracorporeal Life Support in the Neonate.....................................................................195
19 Follow-Up of High-Risk Infants.......................................................................................209
20 Complementary and Alternative Medical Therapies in Neonatology................................213
21 Neonatal Bioethics..........................................................................................................221

vii
viii neonatology

Section IV. Procedures: Principles of Neonatal Procedures................................................227


22 Arterial Access: Arterial Puncture (Radial Artery Puncture).............................................230
23 Arterial Access: Percutaneous Arterial Catheterization (Radial Arterial Line)..................232
24 Arterial Access: Umbilical Artery Catheterization............................................................236
25 Bladder Aspiration (Suprapubic Urine Collection)...........................................................244
26 Bladder Catheterization..................................................................................................246
27 Chest Tube Placement....................................................................................................249
28 Defibrillation and Cardioversion.....................................................................................255
29 Endotracheal Intubation and Extubation.........................................................................258
30 Exchange Transfusion.....................................................................................................267
31 Peripheral IV Extravasation and Infiltration: Initial Management...................................272
32 Gastric and Transpyloric Intubation................................................................................273
33 Heelstick (Capillary Blood Sampling)..............................................................................278
34 Laryngeal Mask Airway....................................................................................................282
35 Lumbar Puncture (Spinal Tap)........................................................................................284
36 Ostomy Care....................................................................................................................289
37 Paracentesis (Abdominal)...............................................................................................292
38 Pericardiocentesis...........................................................................................................295
39 Therapeutic Hypothermia................................................................................................297
40 Transillumination............................................................................................................301
41 Venous Access: Intraosseous Infusion.............................................................................303
42 Venous Access: Percutaneous Central Venous Catheterization.......................................306
43 Venous Access: Peripheral Intravenous Catheterization..................................................312
44 Venous Access: Umbilical Vein ­Catheterization...............................................................316
45 Venous Access: Venipuncture (Phlebotomy)....................................................................322

Section V. On-Call Problems


46 Abnormal Blood Gas........................................................................................................325
47 Apnea and Bradycardia (“A’s and B’s”)..........................................................................333
48 Arrhythmia......................................................................................................................343
49 Bloody Stool....................................................................................................................351
50 Counseling Parents Before High-Risk Delivery................................................................357
51 Cyanosis.........................................................................................................................361

You might also like