Essential neonatal medicine.

Essential Neonatal Medicine
Contents
Preface to the Sixth Edition
Acknowledgements
Preface to the First Edition
Abbreviations
How to use your textbook
About the companion website
CHAPTER 1 The fetus, placenta and changes at birth
	Introduction
	Placental function
		Transport
		Immunity
		Metabolism
	Fetal homeostasis
	Fetal circulation
		Umbilical vessels
	Assessment of fetal well-being
		Assessment of maturity
		Assessment of fetal growth and well-being
	Screening during pregnancy
		Maternal blood screening
		Fetal imaging
		Down’s syndrome screening
		Amniocentesis
		Chorionic villus sampling
		Fetal blood sampling (cordocentesis)
	Fetal monitoring during labour
		Intrapartum monitoring
		Fetal scalp pH
		Fetal electrocardiogram (ECG)
	Fetal compromise
		Physiological changes at birth
	Acknowledgements
	Further reading
CHAPTER 2 Perinatal epidemiology and audit
	Introduction
	Definitions of terms commonly used in perinatal medicine
	The role of perinatal and neonatal audit
	Classification of perinatal deaths
		The role of autopsy
	Factors affecting perinatal death rates
	Prevention of perinatal mortality and low birthweight
	Changing trends
	Further reading
CHAPTER 3 Multiple births
	Introduction
	Physiology of fertilization, implantation and placenta formation
		Fertilization
		Implantation
		Placenta
	Classification of multiple pregnancy
	Assisted reproductive technology
	Incidence of multiple pregnancies
	Parental counselling
	Complications of multiple pregnancy
		Discordant growth rates
		Disappearing twin phenomenon
		Conjoined twins
		Prematurity
		Malpresentation
		Congenital malformations
		Postural deformities
		Twin-to-twin transfusion (TTTS)
		Twin anaemia polycythaemia sequence (TAPS)
		Cord entanglement
		Infection
		Hypoxic ischaemic encephalopathy
		Respiratory distress syndrome
		Neurodevelopmental outcomes
	Further reading
CHAPTER 4 Neonatal consequences of maternal conditions
	Introduction
	Congenital anomalies: malformations and deformations
		Deformations
		Malformations
		Causes of congenital malformations
	Congenital anomalies associated with teratogens
	Congenital malformation secondary to maternal infections
	Consequences of maternal substance misuse
		Fetal alcohol spectrum disorder
		Smoking in pregnancy
		Infants of substance-misusing mothers
		Management of neonatal abstinence syndrome
		Prognosis
	Neonatal manifestations of maternal medical diseases
		Diabetes mellitus
		Maternal hyperthyroidism (Graves, disease)
		Maternal idiopathic thrombocytopenia
		Maternal systemic lupus erythematosus
		Transient neonatal myaesthenia
		Maternal epilepsy
	Further reading
CHAPTER 5 Resuscitation at birth
	Introduction
	Fetal responses during labour
	Fetal and neonatal responses to perinatal asphyxia
		Respiratory activity
		Cardiovascular activity
	Perinatal asphyxia
		Defining perinatal asphyxia
		Clinical evidence of asphyxia
		Medico-legal evidence of significant asphyxia
		Causes of perinatal asphyxia
		Prevention of perinatal asphyxia
	Assessment of the infant at birth
	Stabilization at birth
	Resuscitation
		Preparation
		Initial assessment and delayed cord clamping
		Establishing an open airway
		Resuscitation of the infant with moderate depression
		Ventilation
		Intubation and positive-pressure ventilation
		External cardiac massage
		Drugs in resuscitation
		Postnatal collapse
		When to stop resuscitation
	Post-resuscitation care of the asphyxiated infant
		Early sequelae
		Late sequelae
	Further reading
CHAPTER 6 Examination of the newborn
	Introduction
	The newborn examination as a screening test
		Who should perform the newborn examination?
	Approach to the newborn examination
		Growth measurement
	General appearance
		Colour
		Posture
		Skin appearance
	Head and neck
		Face
		Cry
		Skull shape
		Eyes (see also Chapter 23)
		Ears
		Nose
		Mouth
		Neck
	Chest
		Respiratory
		Shape and size
	Cardiovascular
		Pulses
		Apex beat
		Auscultation
		Saturation screening
	Abdomen
		Liver
		Spleen
		Kidney
		Anus
		Umbilicus
		Stump
		Genitalia
	Back
		Spine
		Scoliosis
		Sacrum
	Extremities
		Posture
		Movements
		Assessment of tone
		Primitive reflexes
		Upper limbs
		Lower limbs
	Congenital abnormalities of the hips and limbs
		Developmental dysplasia of the hip
		Limb malformations
		Arthrogryposis multiplex
		Neonatal dwarfism
		Skeletal dysplasia
	Skin disorders
		Vascular birthmarks
		Epidermal naevi
		Hyperpigmented and hypopigmented birthmarks
		Ichthyotic disorders
		Blistering and bullous disorders
		Miscellaneous
	Communication with parents
	Further reading
CHAPTER 7 Birth injury
	Introduction
	Risk factors for birth injury
	Injuries to the scalp, skull and brain
		Caput succedaneum
		Chignon
		Erythema, abrasions and lacerations
		Cephalhaematoma
		Subaponeurotic haemorrhage (subgaleal haemorrhage)
		Skull fractures
		Intracranial haemorrhages
	Bone and joint injuries
		Clavicle
		Humerus
		Femur
		Multiple or unusual fractures
		Dislocation of joints and separation of epiphyses
	Peripheral nerve injuries
		Facial nerve palsy
		Obstetric brachial palsy
		Radial nerve injury
		Sciatic nerve injury
		Phrenic nerve injury
		Recurrent laryngeal nerve
		Spinal cord injury
	Soft-tissue injuries
		Traumatic petechiae
		Ecchymoses (bruising)
		Subcutaneous fat necrosis
		Sternomastoid tumour
	Organ injuries
		Liver and spleen
		Adrenals
		Kidneys
		Testicles
	Injuries sustained in the neonatal intensive care unit (NICU)
	Further reading
CHAPTER 8 Genetic disorders
	Introduction
	Gene structure
	Commonly used investigations
		Chromosome analysis
		Polymerase chain reaction
		Fluorescence in-situ hybridization
		Microarrays
		Indications for investigations
	Genetic variation
		Structural changes
		Changes in DNA sequence
	Multifactorial inheritance
		Epigenetics
	Approach to the dysmorphic neonate
	Prevention of congenital abnormalities
	Further reading
CHAPTER 9 Infant feeding and nutrition
	Introduction
	Specific nutritional requirements
		Fluids
		Energy and macronutrients
		Carbohydrate
		Fat
		Protein
		Minerals
		Trace elements
		Iron
		Vitamins
	Breastfeeding
		Physiology of lactation
		Nutritional aspects
		Variations in breast milk
		Anti-infective properties of breast milk
		Contraindications to breastfeeding
		Excretion of drugs in breast milk
		Techniques of breastfeeding
		Problems with breastfeeding
		Changing from breast milk to another milk
		Advice to breastfeeding mothers
		Iron and multivitamin supplementation
		Breast milk banks
		Breast milk and intelligence
	Artificial feeding/formulas
		Cows’ milk
		Major nutrients in milk
		Elemental or partially elemental formulas
	Techniques of artificial feeding
		Volumes
		Interval between feeds
		Sterilization
		Preparation of feeds
	Feeding the preterm infant
		Growth
		Feeding the very-low-birthweight infant
		Expressed breast milk (EBM)
		Breast or human milk fortifiers
		Low-birthweight formulas
		Trophic feeding
		Practical management guidelines
	Parenteral nutrition
		Indications
		Methods of delivery
		Clinical management
		Laboratory tests
		Complications
	Common feeding disorders
		Vomiting
		Management of the vomiting baby
		Organic causes of vomiting
		Infant colic
		Constipation
		Diarrhoea
		Failure to thrive
	Further reading
CHAPTER 10 Infection in the newborn
	Introduction
	The immune system
		Non-specific immunity
		Specific immunity
	Susceptibility of the neonate to infection
	Congenital infection
		Cytomegalovirus (CMV)
		Rubella
		Toxoplasmosis
		Syphilis
		Hepatitis B
		Hepatitis C
		HIV
		Parvovirus B19
		Varicella
		Zika virus
	Intrapartum (early-onset) infection
		Investigations
		Management
		Early-onset group B β-haemolytic streptococci
		Herpes simplex virus (HSV)
		Others
	Postnatal (late-onset) infection
		Clinical features
		Investigations
		Management
		Common acute acquired infections
		Prevention of acquired infections
		Extravasation injury
		Adjunctive therapy
	Further reading
CHAPTER 11 The extreme preterm infant
	Introduction
	Gestational age
	Causes and management of preterm labour
		Risk factors for preterm labour
		Predicting preterm delivery
		Clinical management of preterm labour
		Mode of delivery in preterm labour
	Survival and outcome for the preterm infant
		Short-term survival and outcome
		Long-term outcomes
	Preterm delivery at the margins of viability
	Stabilization at birth and management in the ‘golden hour’
	Common problems to be expected in the preterm infant
	Supportive care on the NICU
		Monitoring
		Oxygen therapy
		Respiratory distress syndrome (RDS)
		Blood pressure
		Intraventricular haemorrhage (IVH)
		Periventricular leukomalacia (PVL)
		Patent ductus arteriosus (PDA)
		Thermoregulation
		Feeding
		Necrotizing enterocolitis (NEC)
		Intravenous fluids
		Jaundice
		Vitamins
		Anaemia
	Preparation for discharge home
	Further reading
CHAPTER 12 The low-birthweight infant
	Introduction
	The infant who is small for gestational age
		Classification of small for gestational age infants
	Causes of intrauterine growth restriction
		Intrinsic fetal growth restriction
		Extrinsic fetal growth restriction
		Placental factors
	Problems to be expected in the growth-restricted fetus and SGA infant
		Problems manifesting in the neonatal period
		Congenital malformations
		Problems manifesting in infancy and childhood
	Management of the low-birthweight infant
		Perinatal management
		Investigations for IUGR
		Feeding
		Supportive care
	Further reading
CHAPTER 13 Respiratory physiology and respiratory support
	Introduction
	Fetal lung development
	Pulmonary surfactants
	Respiratory physiology
		Oxygen transport
		Carbon dioxide transport
		Acid–base balance
	Assessment of respiratory function
		Clinical assessment
		Blood gas measurements
		Radiographic evaluation
		Pulmonary function tests
		Cardiac assessment
	Respiratory failure
		Treatment of respiratory failure
		Blood oxygen monitoring
		Continuous positive airway pressure (CPAP)
		Other forms of non-invasive respiratory support
		Non-invasive/nasal intermittent positive pressure ventilation (NIPPV)
	Mechanical ventilation
		Basic principles of mechanical ventilation
		Classification of mechanical ventilators
		Neurally Adjusted Ventilatory Assist (NAVA)
		Alternative strategies for refractory respiratory failure
		General management of ventilated infants
		Troubleshooting
		Analgesia and sedation
		Complications of mechanical ventilation
	Further reading
CHAPTER 14 Respiratory disorders
	Introduction
	Respiratory distress
		Diagnosis
		Treatment of respiratory distress
	Transient tachypnoea of the newborn
		Pathogenesis
		Diagnosis
		Treatment
	Respiratory distress syndrome (RDS)
		Incidence
		Aetiology and pathogenesis
		Clinical features
		Radiology
		Laboratory abnormalities
		Treatment
	Pneumonia
		Aetiology
		Clinical features
		Radiology
		Treatment
	Pulmonary air leaks
		Clinical features
		Diagnosis
		Management
	Meconium aspiration syndrome
		Clinical features
		Pathogenesis and aetiology
		Radiology
		Prophylactic management
		Treatment of established meconium aspiration syndrome
		Pulmonary hypoplasia
		Clinical features
		Management and prognosis
	Pulmonary haemorrhage
		Pathogenesis
		Risk factors
		Treatment
	Congenital diaphragmatic hernia
		Diagnosis
		Treatment
		Prognosis
	Oesophageal atresia and tracheo-oesophageal fistula
		Clinical features
		Treatment
	Congenital lobar emphysema
	Congenital pulmonary airway malformation (CPAM) [formerly known as congenital cystic adenomatous malformation; CCAM]
	Chronic lung disease and bronchopulmonary dysplasia (BPD)
		Aetiology
		Clinical features
		Radiology
		Management
		Prognosis
	Further reading
CHAPTER 15 Apnoea, bradycardia and upper airway obstruction
	Introduction
	Physiology
	Apnoea
		Types of apnoea
		Aetiology of apnoea
		Investigation of apnoea
		Apnoea monitoring
		Treatment of apnoea
		Prognosis
	Acute life-threatening events (ALTEs)
	Sudden and unexpected infant death and sudden infant death syndrome
	Upper airway obstruction
		Clinical features
		Laryngomalacia (infantile larynx)
		Choanal atresia
		Pharyngeal obstruction
		Subglottic stenosis
		Tracheal obstruction
	Further reading
CHAPTER 16 Cardiovascular disorders
	Introduction
	Physiology of the cardiovascular system
		Cardiac output
		Stroke volume
	Blood pressure
		Normal range
		Hypotension and organ perfusion
		Management of hypotension
		Inotropic agents
	Hypertension
	Congenital heart disease
		Aetiology
		Mode of presentation
	Investigations
		Chest radiography
		Electrocardiograph (ECG)
		Nitrogen washout test
		More-specialized investigations
	Cyanotic heart disease
		Transposition of the great arteries (TGA)
		Tricuspid atresia
		Pulmonary atresia or pulmonary stenosis
		Tetralogy of Fallot
		Ebstein’s anomaly
		Total anomalous pulmonary venous drainage (TAPVD)
		Prostaglandin treatment in congenital heart disease
	Congestive heart failure
		Clinical features
	Left-to-right shunts
		Ventricular septal defect
		Patent ductus arteriosus (PDA)
	Obstructive lesions
		Hypoplastic left heart
		Coarctation of the aorta
		Aortic stenosis
		Management of congestive heart failure
	Dysrrhythmias
		Supraventricular tachycardia (SVT)
		Congenital heart block
		Ventricular tachycardia (VT) and ventricular fibrillation (VF)
		Cardiomyopathy
	Circulatory maladaptation at birth
		Persistent pulmonary hypertension of the newborn (PPHN)
	Further reading
CHAPTER 17 Gastrointestinal and abdominal disorders
	Introduction
	Development of the gastrointestinal tract
		Functional development
	Malformations
		Cleft lip and palate
		Intestinal obstruction
		Malrotation
		Pyloric stenosis
		Duodenal obstruction
		Jejunal and ileal atresia
		Colonic atresia
		Anorectal malformations
		Hirschsprung’s disease (aganglionosis)
		Meconium plug syndrome
		Meconium ileus
	Abdominal wall defects
		Omphalocoele or exomphalos
		Gastroschisis
		Congenital ascites
	Necrotizing enterocolitis
		Pathogenesis
		Clinical features
		Investigations
		Prevention
		Treatment
		Complications
	Short bowel syndrome
	Rectal bleeding
		Investigations
	Hernia
		Inguinal Hernia
		Umbilical hernia
	Hydrocoele
	Undescended testis
	Hypospadias
	Further reading
CHAPTER 18 Renal disorders
	Introduction
	Role of amniotic fluid
	Renal physiology
		Glomerular filtration rate
		Tubular function
		Sodium conservation
		Hormonal function
	Normal urine output
	Investigation of renal disease
		Ultrasound
		MAG 3 renogram
		DMSA scan
		Micturating cystourethrogram
	Presentation of renal disease
		Potter’s syndrome
		Renal pelvis dilatation
		Obstructive uropathy
	Acute kidney injury
		Clinical features
		Management
	Urinary tract infection
		Treatment
	Renal masses
	Cystic disease of the kidneys
		Autosomal dominant polycystic kidney disease
		Autosomal recessive polycystic kidney disease
		Cystic dysplastic (multicystic) kidneys
		Isolated renal cysts
	Haematuria
	Ectopia vesicae (bladder exstrophy)
	Further reading
CHAPTER 19 Jaundice
	Introduction
	Physiology of bilirubin metabolism
		Fetal
		Newborn
	Clinical assessment of the jaundiced infant
		Management
	Unconjugated hyperbilirubinaemia
		Causes
		Investigations
		Management
		Bilirubin encephalopathy and kernicterus
	Conjugated hyperbilirubinaemia
		Causes
		Investigations
	Further reading
CHAPTER 20 Haematological disorders
	Introduction
	Placental transfusion
	Anaemia
		Physiological anaemia
		Haemorrhage
		Haemolysis
		Thalassaemia
		Infantile pyknocytosis
	Hydrops fetalis
		Causes
		Investigations
		Treatment
	Aplasia
	Polycythaemia
		Clinical features
		Management
	Bleeding and coagulation disorders
		Clinical features
		Investigations
	Thrombocytopenia
		Alloimmune thrombocytopenia
		Maternal idiopathic thrombocytopenia
	Haemorrhagic disease of the newborn (Vitamin K-deficient bleeding)
		Clinical features
		Investigations
		Treatment
		Vitamin K prophylaxis
	Disseminated intravascular coagulation (DIC)
		Investigations
		Treatment
	Inherited disorders of coagulation
		Management
	Congenital deficiency of anticoagulant proteins (hypercoagulable states)
		Leukocytosis
		Neonatal leukaemia
		Neutropenia
	Further reading
CHAPTER 21 Endocrine and metabolic disorders
	Introduction
	Glucose homeostasis and its abnormalities
		Glucose metabolism
		Measurement of blood glucose
		Hypoglycaemia
		Specific causes of hypoglycaemia
		Congenital hyperinsulinism
		Beckwith–Wiedemann syndrome
		Iatrogenic hypoglycaemia
		Hyperglycaemia
		Transient neonatal diabetes mellitus
	Disorders of calcium, phosphate and magnesium metabolism
		Hypocalcaemia
		Metabolic bone disease (rickets or osteopenia of prematurity)
		Hypercalcaemia
	Disorders of magnesium metabolism
		Hypomagnesaemia
		Hypermagnesaemia
	Disorders of sodium and potassium metabolism
		Sodium metabolism
		Potassium metabolism
	Endocrine gland disorders
		Disorders of thyroid function
	Abnormalities of the adrenal gland
		Congenital adrenal hyperplasia
		Adrenal hypoplasia
		Ambiguous genitalia
	Inborn errors of metabolism
		Newborn screening
		Diagnosis
		Investigations
		Management
		Phenylketonuria (PKU)
		Galactosaemia
	Further reading
CHAPTER 22 The central nervous system
	Introduction
	Brain development
		Neuronogenesis
		Differentiation
		Proliferation
		Neuronal migration
		Neuronal regression
		Synapse development
		Myelination
	Malformations of the central nervous system
		Neural tube disorders (NTDs)
		Anencephaly
		Encephalocoele
		Spina bifida
		Screening for neural tube defects (NTDs)
		Disorders of ventral induction
	Disorders of head size and shape
		Microcephaly
		Craniostenosis (craniosynostosis)
		Macrocephaly (large head)
		Hydrocephalus
		Hydranencephaly
		Porencephaly
		Lissencephaly
	Intracranial haemorrhage (ICH)
		Subarachnoid haemorrhage (SAH)
		Subdural haemorrhage
		Intraventricular haemorrhage (IVH)
		Intracerebral haemorrhage
		Intracerebellar haemorrhage
	Periventricular leukomalacia
		Causes
		Diagnosis
	Neonatal stroke
	Hypoxic–ischaemic encephalopathy
		Clinical features
		Management of encephalopathy
		Cerebral neuroprotection
		Therapeutic hypothermia
		Prognosis
	Neonatal convulsions
		Seizure type
		Aetiology
		Treatment
		Prognosis
	Neonatal hypotonia (‘floppy infant’)
		Clinical features
		Causes
		Investigations
		Prognosis
	Further reading
CHAPTER 23 Neurodevelopmental follow-up and assessment of hearing and vision
	Introduction
	Neurodevelopmental outcome
		Cerebral palsy
	Hearing impairment (deafness)
		Screening for hearing in the neonatal period
		Incidence
		Aetiology
		Management
	Visual impairment
		Retinopathy of prematurity (ROP)
		Cerebral visual impairment
		Cataracts
		Glaucoma (buphthalmos)
	Further reading
CHAPTER 24 Developmental care and the neonatal environment
	Introduction
	Thermoregulation
		Normal physiology
		Mechanisms of heat loss
		Physiological mechanisms to conserve heat
		Why is the newborn prone to heat loss?
		Prevention of excessive heat loss
		Neonatal cold injury
	Skin care on the neonatal intensive care unit
	Optimizing the neonatal environment
	Procedural pain and analgesia
	Developmental care
		Kangaroo care
		Positioning
		Stimulation
		Newborn Individualized Developmental Care and Assessment Program
		Family Integrated Care
	Further reading
CHAPTER 25 Organization of perinatal services
	Introduction
	Organization of perinatal services
	Levels of perinatal care
		Models of care
	Neonatal networks
	Further reading
CHAPTER 26 Neonatal transport
	Introduction
	Transport in utero
	Preparation for transport
		Important decisions to be made
	Transport equipment
	The role of a neonatal transport service
		Care of parents
		Relationships with referring hospital and staff
		Special considerations
	Further reading
CHAPTER 27 Discharge and follow-up of high-risk infants
	Introduction
	Discharge of high-risk infants
		Rooming in
		Feeding advice
		Nutritional supplementation
	Immunization
		Special vaccine circumstances
		Modification to immunization schedule for preterm infants
	Specialized follow-up clinics
		Purposes of multidisciplinary follow-up clinics
	Follow-up of preterm infants
		Problems encountered in follow-up
	Further reading
CHAPTER 28 Parent–infant attachment and support for parents of critically ill infants
	Introduction
	Parent–infant attachment (bonding)
		Steps in attachment
		Attachment after birth
		Factors that promote attachment
		Risk factors for failure to produce attachment
		Failure of bonding or attachment
	Care of parents of critically ill infants
		Antenatal contact
		Labour ward
		Intensive care nursery
		Parents’ first visit to the intensive care nursery
		Parents’ subsequent visits to the intensive care nursery
	Family integrated care
		Babies as individuals
		How is my baby doing?
		The social worker
		Babies transferred from other hospitals
		Preparation for discharge
	Further reading
CHAPTER 29 Ethical issues and decision-making process in the treatment of critically ill newborn infants
	Introduction
	Principles of ethical reasoning
		Beneficence (discontinuing futile treatment)
		Non-malificence (burdensome treatment)
		Autonomy
		Equity or distributive justice
	Decision-making processes
		‘Wait until certainty’ approach
		Statistical approach
		Individualized approach (prognostic decision-making)
		Antenatal diagnosis
	The role of the Institutional Ethics Committee
	Withholding and withdrawing life-sustaining treatment
	Common neonatal ethical dilemmas
		Whether to resuscitate at birth
		‘How small is too small?’: when not to resuscitate on gestational age or birthweight criteria
		Major congenital malformations
		Withdrawal of life support
		Selective withdrawal of neonatal intensive care
	Parents in the decision-making process
		Circumstances in which parents’ wishes might be overruled, or when parents are incapable of decision-making
		Role of the case conference
		Communication of withdrawal of life support
		Care of parents
	Further reading
CHAPTER 30 End-of-life care and palliative care
	Introduction – why babies die
	Unexpected deaths (including sudden unexpected postnatal collapse)
	What is palliative care?
	Expected deaths and care planning
	Making a care plan
	Place of death: hospice versus home versus hospital
	Symptom control
	Organ donation
	Autopsy
	Caring for parents – grief and bereavement
	Caring for staff
	Further reading
Index
EULA