Neonatology practice

Neonatology Practice Made Easy® Neonatology Practice Made Easy® MMA Faridi  MD (Pediatrics)  DCH MNAMS FIAP FNNF Professor and Head, Department of Pediatrics Incharge, Division of Neonatology University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India President, National Neonatology Forum, Delhi State Formerly President, Indian Academy of Pediatrics, Delhi State WHO/UNICEF/IBFAN/BPNI Course Director Infant and Young Child Feeding Counseling Course Priyanka Gupta  MD (Pediatrics) Specialist, Department of Pediatrics Sanjay Gandhi Memorial Hospital, New Delhi, India Formerly Assistant Professor, Department of Pediatrics Era’s Lucknow Medical College Lucknow, Uttar Pradesh, India Foreword Ajay Gambhir ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi  •  London  •  Philadelphia  •  Panama ® Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: jaypee@jaypeebrothers.com Overseas Offices J.P Medical Ltd 83, Victoria Street, London SW1H 0HW (UK) Phone: +44-2031708910 Fax: +02-03-0086180 Email: info@jpmedpub.com Jaypee-Highlights Medical Publishers Inc City of Knowledge, Bld 237, Clayton Panama City, Panama Phone: +507-301-0496 Fax: +507-301-0499 Email: cservice@jphmedical.com Jaypee Brothers Medical Publishers (P) Ltd 17/1-B, Babar Road, Block-B Shaymali, Mohammadpur Dhaka-1207, Bangladesh Mobile: +08801912003485 Email: jaypeedhaka@gmail.com Jaypee Brothers Medical Publishers Ltd The Bourse 111, South Independence Mall East Suite 835, Philadelphia, PA 19106, USA Phone: + 267-519-9789 Email: joe.rusko@jaypeebrothers.com Jaypee Brothers Medical Publishers (P) Ltd Shorakhute Kathmandu, Nepal Phone: +00977-9841528578 Email: jaypee.nepal@gmail.com Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2013, Jaypee Brothers Medical Publishers All rights reserved No part of this book may be reproduced in any form or by any means without the prior permission of the publisher Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com This book has been published in good faith that the contents provided by the authors contained herein are original, and is intended for educational purposes only While every effort is made to ensure accuracy of information, the publisher and the authors specifically disclaim any damage, liability, or loss icurred, directly or indirectly, from the use or application of any of the contents of this work If not specifically stated, all figures and tables are courtesy of the authors Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device Neonatology Practice Made Easy® First Edition: 2013 ISBN  978-93-5090-421-3 Printed at Dedicated to Our tiny and tender patients who motivated us… Our teachers who moulded our destiny… Our parents whom we owe our life and… Our family who stood by us always Foreword Neonatal mortality rate in India continues to be high at 37 per 1000 and contributes to over 64 percent of infant deaths and more than half of under-5 deaths It is estimated that two-thirds of these deaths occur during first week of life Facility based newborn care encompasses care at peripheral health posts, such as subcenter and primary health center, community health center and first referral units, and the district hospitals During the last two decades, the specialized newborn care facilities in India have grown by leaps and bounds A number of level II special care nurseries and neonatal intensive care units (NICUs) have been established in a number of teaching hospitals and corporate hospitals in the metropolitan cities The revolution in newborn care continues, but it is seriously hampered by the lack of adequate number of manpower specially trained in the science and art of neonatal care It is a matter of great satisfaction that the Neonatology Practice Made Easy® which has been written by a senior and experienced faculty and Fellow of NNF, Dr MMA Faridi, Professor and Head, Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India, and a young pediatrician Dr Priyanka Gupta There has been a long standing demand and felt need of Neonatologists and Pediatricians for having neonatology practice guidelines suitable for Indian situations Present publication is an important step towards the solution of that problem The book answers various questions related to the management in a large majority of clinical situations in neonatal practice It also describes the available evidence for the recommended management approach Gaps in the evidence especially applicable to Indian situations have also been brought out We hope that, these gaps will be filled through new researches in the near future Simple, short and crisp narration is the strength of this book viii Neonatology Practice Made Easy Dr MMA Faridi and Dr Priyanka Gupta need to be complimented on bringing out this stimulating and useful document which is bound to improve the neonatal care in the country This will be useful to all neonatologists, pediatricians, obstetricians, general practitioners and nurses working in the field of neonatology Ajay Gambhir MD (Pediatrics) MD (PSM) LLB FNNF FIAP FIAMS President Elect, National Neonatology Forum (NNF) Member, Delhi Medical Council Board Member, National Accreditation Board for Hospitals and Healthcare Providers (NABH) Finance Secretary, Indian Medical Association (HQ) Preface Years of working with newborn infants; normal and healthy, sick and distressed and with their mothers; happy and contented, or anxious and worried, made us realize that newborn care is a science as well as an art Observation of newborn is more rewarding than palpation and percussion; presence of a dedicated nurse is life-saving than having highly advanced monitoring gadgets; attending to alarms is more important than completing neonatal intensive care unit (NICU) errands; for him/her time is now and in minutes only It is truly the work of a jeweler Improving neonatal survival is crucial for achieving Millennium Development Goal-4 Several good books are available on the subject but in contrast the book is comprehensive, handy and concise The book starts itself from control measures for infection in NICUs and importance of hand hygiene and then goes ahead to impart both the basic and advanced knowledge for management of almost all common/uncommon clinical situations came across in the neonatology practice The book is structured with an idea that the medical students or the medical personnel working in the NICU or with neonates get some crisp and to the point on-table information to manage neonatal concerns and to common procedures in neonatology Some important annexures which are very useful for day-to-day working in the NICU are also here We hope that the book will be proved useful for medical students; in fact, for anyone taking care of newborn anywhere, and our endeavor to simplify neonatology practice get successful All comments and queries for enriching the book are welcome at gims2gui@yahoo.com Wishing you a happy reading and easy learning… MMA Faridi Priyanka Gupta 372 Neonatology Practice Made Easy 14 Manroe BL, Weinberg AG, Rosenfeld CR, Browne R The neonatal blood count in health and disease Reference values for neutrophilic cells J Pediatr 1979;95:89-98 15 Mouzinho A, Rosenfeld CR, Sánchez PJ, Risser R Revised reference ranges for circulating neutrophils in very-low-birthweight neonates Pediatrics 1994;94:76-82 16 Bose CL, Laughon MM Patent ductus arteriosus: lack of evidence for common treatments Arch Dis Child Fetal Neonatal Ed 2007;92:498-502 17 Raval MV, Laughon MM, Bose CL, Phillips JD Patent ductus arteriosus ligation in premature infants: who really benefits, and at what cost? J Pediatr Surg 2007;42:69-75 18 Jeevasankar M, Agarwal R, Chawla D, Paul VK, Deorari Ak Polycythemia in the Newborn Indian J Pediatr 2008;75:68-72 19 Rawlings JS, Pettett G, Wiswell TE, Clapper J Estimated blood volumes in polycythemic neonates as a function of birth weight J Pediatr 1982;101:594-9 20 Bhutani VK, Johnson L, Sivieri EM Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns Pediatrics 1999;103:6-14 21 Management of Hyperbilirubinemia in the newborn infant 35 or more weeks of gestation Subcommittee on Hyperbilirubinemia Pediatrics 2004; 114;297-316 22 Mishra S, Agarwal R, Deorari AK, Paul VK Jaundice in the newborns Indian J Pediatr 2008;75:157-63 23 Consensus report on Neonatal Cholestasis Sundrome Pediatric Gastroenterology Subspecialty Chapter of Indian Academy of Pediatrics Indian Pediatrics 2000;37:845-51 24 Gemelli M, Manganaro R, Mamì C, De Luca F Longitudinal study of blood pressure during the 1st year of life Eur J Pediatr 1990;149: 318-20 25 Hegyi T, Carbone MT, Anwar M, Ostfeld B, Hiatt M, Koons A, et al Blood pressure ranges in premature infants The first hours of life J Pediatr 1994;124:627-33 References 373 26 Hegyi T, Anwar M, Carbone MT, Ostfeld B, Hiatt M, Koons A, et al Blood pressure ranges in premature infants The first week of life Pediatrics 1996;97:336-42 27 Rapid Advice Use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants WHO 2009 28 Co-trimoxazole prophylaxis for HIV-exposed and HIV-infected infants and children UNICEF, WHO 2009 29 Skevaki, Chrysanthi L, Kafetzis, Dimitrios A Tuberculosis in neonates and infants: Epidemiology, pathogenesis, clinical manifestations, diagnosis and management issues Paediatr Drugs 2005;7:219-234 30 Technical guidelines for tuberculosis control Revisd National Tuberculosis Control Programme Central TB division Directorate General of Health services Nirman Bhavan, New Delhi, India 31 Management, Control and Prevention of Tuberculosis Guidelines for Health Care Providers (2002–2005) Published by, Department of Human Services, Melbourne, Victoria, 2002 32 Sarff LD, Platt LH, McCracken GH Jr Cerebrospinal fluid evaluation in neonates: comparison of high-risk infants with and without meningitis J Pediatr 1976;88:473-7 33 Dunn PM Localization of the umbilical catheter by postmortem measurement Arch Dis Child 1966;41:69-75 34 Tanswell AK, Sherwin E, Smith BT Single-step gastric aspirate shake test Arch Dis Child 1977;52:541-4 Index Page numbers followed by f for figure and t for table, respectively A Abacavir 276 Abdominal X-ray 129 Acute renal failure 256 Acyclovir 288 Adjunctive therapies 132 Adjuncts to mechanical ventilation 153 Adrenaline 30 Adult hemoglobin 354 Advantages over serum testing 342 Alagille syndrome 247, 248 Amikacin 131 Amino acids 119 Aminophylline 174, 182 Anemia 135, 184 of prematurity 192 Antenatal history 186 Antiretroviral drugs for pregnant woman and baby 275 Antitubercular drugs 292 Anuria 259 Anuric 257 Aortopulmonary window 166 Apnea 42, 170 monitors 171 of prematurity 170 Appropriate for gestational age 51 APT test 198, 354 Arterial blood 317 Arterialized capillary blood 317 Arteriovenous fistula 166 Artificial feeding 97 Aspects of care in any sick neonate 42 low birth weight care 110 Asphyxia 215 Assessment for adequacy of PPV 27 medical condition 38 perinatal transition 37 Asymptomatic hypocalcemia 212 hypoglycemia 207 newborn 195 B Baby born after 34 weeks of gestational age 93 before 34 weeks of gestational age 92 Baby fed with EBM alone 116 Baby’s hands 55 history 186 mouth 99 temperature 40 Beats per minute 21 Before transport 67 Benefits of breastfeeding 97 Benefits to baby 97 family 98 376 Neonatology Practice Made Easy mother 98 society 98 Benign neonatal sleep myoclonus 226 Beside serum calcium 211 Betadine Bicarbonate 84 Bile duct stenosis 247 Bilirubin Estimation by micro method 236 in venous blood 236 levels considered for photo therapy and exchange transfusion 243 toxicity 240 Biochemical changes after exchange transfusion 324 Biotin 113 Bladder tap 308 Bleach solution Bleeding 105 neonate 198 Blood culture and sensitivity 127 gas examination 317 picture in metabolic acidosis 86 gases 72 group incompatibility 17 oxygen saturation 43 pH 123 sampling 303 sugar 207 transfusion 188 sets 12 urea and creatinine 72 Bottle feeding 97 Bovine 159 BP cuffs Brain evoked response audiometry 360 Breast 45, 46, 96 abscess or mastitis 109 milk 89, 96 feeding 96 intake, objective assessment for 101 jaundice 239 related problems 105 Breastfeeding 356 jaundice 238 policy 104 Breastmilk feeding 356 jaundice 238 Bronchodilators 182 Build confidence of mother 343 Byler syndrome 247 C Caffeine 174 Calcium 113, 114, 116, 121, 249 gluconate 221 Calculation of daily fluid requirements 70 GIR 205 Calories 114, 116, 118 Candida infection 105 Capillary and venous blood gas parameters 84 blood sampling 304 refill time 38 Index 377 Carbohydrates 112 Carbolic acid Cardiac 135 causes 176 dysfunction 51 Cardiovascular system 216 Care of well newborn 40 Causes of meconium aspiration syndrome 162 neonatal seizures 226 pathological unconjugated Hb 238 shock 250 Ceftriaxone 131 Central nervous cannulation 252, 329 system 64, 216 Cerebral dysgenesis 226 hypothermia 222 Chart pulse 41, 42 Cheatle forceps Chest circumference 48 compression 26, 28 X-ray 129 Chlamydia 180 Chloride 121 Choice between whole blood and red cell concentrate 189 of antibiotics 130 of initial enteral feeding method 91 Choledocal cyst 247 Cholestasis 236 syndromes 247 Chronic lung disease 179 Clearing airways 23 Clinical assessment for adequacy of breastfeeding 100 Clonic seizures 225 Cold stress 57 Collection of blood culture 305 Combination or assist-control ventilation 147 Common procedure for neonate 59, 303 Complications of patent ductus arteriosus 168 Components of transport process 67 Concerns in high-risk babies 357 infants of diabetic mothers 270 Conditions mimicking seizures 225 with diseased lungs 150 with normal lung compliance 149 Congenital diaphragmatic hernia 311 tuberculosis 290 Conjugated hyperbilirubinemia 235 Continuous positive airway pressure 29, 140, 310 Contraindications for breast milk feeding 107 Controlled mandatory ventilation 146 Corticosteroids 182 Cotrimoxazole prophylaxis 281 CPAP failure 144 Cracked nipples 105 Cranial USG 218 378 Neonatology Practice Made Easy Crigler-Najjar syndrome 238 Culture media 306 negative 131 Cup, katori feeding in newborn 346f spoon or paladai feeding 91 Curosurf 159 D Daily requirements of calories 118 proteins 118 Decision over infant feeding policy 279 Decreased glycogen stores 204 hepatic blood flow 237 ligandin 237 production of glucose 204 Definition of anemia 185 respiratory failure 138 Dehydration 73 Delivery room 59 Depth of insertion 312 Deuterium oxide dose to mother technique 101 Diabetes mellitus, future risk of 273 Diabetic mother 238 Dialysis 261 Diazoxide 208 Direct or conjugated hyperbilirubinemia 247 Discharge policy 355 Disorders of amino-acid metabolism 296 bile acid metabolism 247 carbohydrate metabolism 296 lipid metabolism 296 potassium balance 76 purine 296 pyrimidine metabolism 296 sodium 76 weight and gestation 45 Disseminated intravascular bleeding 201 Diuretic therapy 75 Diuretics 181 Donor human milk 89 Dopamine 252 Dose schedule 167 Double volume exchange transfusion 321 Downe’s score 136 system 136 Doxapram 174 Drugs 67 schedule 167 Dubin-Johnson syndrome 247 Duration of antibiotic therapy 131 E Ear 45, 46 Early onset 125 Efavirenz 276 Electroencephalography 219 Electrolyte derangements 259 Electronic monitoring 43 Elicit prolactin reflex 344 Emtricitabine 276 Endocrine 247 Endotracheal intubation 27, 311 suctioning 313 Index 379 Energy 112 density 120 Enteral feeding options 89 nutrition 89 vs parenteral feeding 90 Environment control 68 Epinephrine 30 Escherichia coli 351 Ethambutol 292 Exchange transfusion 232 Exclusive breastfeeding 96 Expression of breast milk 104, 343 External jugular vein 330 Extrahepatic biliary atresia 247 Eye 45, 46 F Face mask 8, 139 Failure of phototherapy 341 Fats 112 Feeding problems 357 Femoral vein 331 Fetal causes 195 hemoglobin 354 Fibrin degradation products 199 Fibrinogen 199 Fluid homeostasis and derangements 69 management in intrinsic renal failure 259 overload 74 Folic acid 113 Folinic acid 232 Formalin Formula feeding 89 Fractional excretion of sodium 72 Fresh animal milk 89 Full breastfeeding 97 Fumigation policy Fungal sepsis 132 Fungi 180 G Galactose-1-phosphate-uridyl transferase 298 Gastric aspirate 94 for polymorphs 352 Gastrointestinal bleed 167 tract 217 Genetic counseling and prenatal diagnosis 302 predisposition 176 Genitals female 46 male 46 Gestational age 110, 357 assessment 45 hypertension 194 Gilbert syndrome 238 Glucagon 208 Glucose infusion rate calculator 206f Good attachment of baby breast 100f Gram staining 307, 350 Growth problems 357 Guidance to fluid management 73 Guide to nutrient supplementation in neonates 113 380 Neonatology Practice Made Easy H Haemophilus influenzae-b 281 Hand hygiene 9, 13 Hand-rubbing 14 Handwashing 14 Hazards of external heating devices 63 surfactant therapy 160 HBV infection in infant diagnosis 285 treatment 285 Hearing evaluation 360 or vision problems 357 Heart 215 rate 21, 42, 44 Hematological changes after exchange transfusion 324 Hepatitis-B immuno-globulin 284 infection 109 vaccine 283 High plasma osmolarity 76 Higher infant mortality 357 High-risk babies 358 neonatal follow-up 357 neonates 360 HIV infection in infant diagnosis of 280 House-keeping routines Human immunodeficiency virus 274 Hyaline membrane disease 110, 156, 353 Hydrocortisone 208 Hyperbilirubinemia 235 Hyperinsulinism 203 Hyperkalemia 81 Hypermagnesemia 170 Hypernatremia 78 Hyperphosphatemia 213, 260 Hyperthermia 63, 64 Hypervolemia 74, 79 Hypocalcemia 51, 170, 209, 260 Hypoglycemia 135, 170, 203, 207 Hypokalemia 80 Hypomagnesemia 212 Hyponatremia 76 Hypoparathyroidism 213 Hypothermia 57, 58, 135 Hypovolemia 73, 135 Hypoxemia 85, 121 Hypoxic ischemic brain injury 216 encephalopathy 216, 226 I Immediate action for apnea attack 172 postnatal assessment 37 Immediately reversible causes 176 Immune thrombocytopenia 202 Important amino acids 119 lipids 120 Inborn errors of metabolism 229, 296 Increased anion gap 86 oxygen tension 165 Index 381 Indications of transfer to NICU 38 transport 65 to level II care unit 66 to level III care unit 66 Indomethacin 167 Infant factors 107 Infant of diabetic mother 270 hepatitis-B infected mother 282 HIV infected mother 274 tuberculosis infected mother 290 varicella infected mother 286 Infasurf 159 Infection control in neonatal intensive care unit Inflation pressure 26 Initial ventilator settings 149 Inotropes 252 Insertion of orogastric tube 27, 310 Intermittent mandatory ventilation 146 Internal jugular route 331 vein 330 Interpretation of blood gases 84 temperature measured by manual method 56 Intestine 215 Intracranial bleed 135 hemorrhage 226 Intrahepatic causes 247 Intrauterine growth chart 50f restriction 49, 110 Iron 113, 115, 116 Isoimmune hemolytic anemia 238 Isolation of varicella exposed NICU staff 289 infected 289 Isoniazid 292 J Jaundice 235 in eyes and skin 248 Jaundiced baby 240 K Kangaroo mother care 59, 348, 349f Kenny-Caffey syndrome 210 Kidney 215 trays 9, 69 Kinesthetic stimulation 175 Klebsiella 351 Kleihauer-Betke test 188 L Lactic acidosis 300 Lamivudine 276 Lanugo 45, 46 Large for gestational age 51, 53 Laryngoscope blades Last menstrual period 45 Leishman’s stain 352 Levene’s classification 219 Lidocaine 232 Limitations over serum testing 343 Lipid storage disorders 248 Liver 215 function tests 248 Lobar emphysema 155 382 Neonatology Practice Made Easy Lopinavir 276 Low birth weight 49 ECF volume 77 plasma osmolarity 77 with hypovolemia 77 Lumbar puncture 129, 306 Lungs 215 M Magnesium 121 Major congenital anomaly 39 Management for feed intolerance 93 Management of asymptomatic neonate 293 cold stress 61 hypertension 260 hypothermia 62 meconium stained amniotic fluid delivery 34 newborn with sibling suspected 301 Manufacturer’s guidelines Mastitis 106 Maternal cyanotic heart disease 194 diabetes 194 factors 108 smoking 194 Measurement of temperature and interpretation 55 Measures to decrease pulmonary vascular resistance 178 Mechanical ventilation 145 Meconium aspiration syndrome 34, 52, 110, 162 pathophysiology of 162 stained amniotic fluid 52, 310 Medical closure of PDA 167 Mental retardation 357 Metabolic 217 acidosis 86, 135, 260 autopsy 301 syndromes 210 Methods for bilirubin testing 236 hand hygiene 14 Micro-ESR 351 Minerals 121 Minimum enteral nutrition 95 Modes of heat loss in newborn 54 Monitor abnormal parameters 202 Monitoring for feed intolerance 93 in sick neonate 42 Mother chest 31 HBV status unknown 284 hepatitis-B positive 283 to child transmission 286, 290 Multiple organ involvement 215 Muscle relaxants 153 Mycoplasma 180 Myoclonic seizures 225 N Naegele’s formula 45 Nasal cannula 139 Naso/orogastric feeding 347 Nasogastric tube feeding 91 Necrotizing enterocoliitis 118, 167, 262 Index 383 Neonatal cold injury 58 depression 216 encephalopathy 216 hyperbilirubinemia 235 intensive care unit 1, 60 jaundice 120 resuscitation 19 seizures 224 sepsis 125 transport 60, 65 Neosurf 159 Neuronal migration defects 226 Nevirapine 276 New Ballard’s score 46t Niacin 113 Noninvasive BP monitoring 337 Non-nutritive sucking 92 Nonoliguric 257 Normal arterial blood gas parameters 84 low anion gap 86 plasma osmolarity 76 saline (0.9%) 30 Not enough milk 102 Nutrition 261 Nutritional composition of various milks 89 goals in LBW babies 112 O Octreotide 208 Oliguria 259 Oliguric 257 Optimum technique of breastfeeding 98 ventilator strategy 148 Orogastric tube feeding 91 Osmolarity of urine 72 Oxygen circuit concentration 25 hood therapy 138, 180 by hood 334 Oxygenation status 21 P Packed cell volume 304 Pantothenic acid 113 Paraldehyde 231 Parameters for nutritional assessment 48 Parathormone resistance 213 Parent to child transmission 274, 282 Parenteral nutrition 118 Partial breastfeeding 97 Patent ductus arteriosus 165 Pathological hyperbilirubinemia 237 Performance liquid chromatography 298 Perinatal asphyxia 215 Periodic breathing 171 Peripheral smear for platelet morphology and fragmented RBCs 198 Persistant pulmonary hypertension 176 Phenobarbitone 246 Phenol Phosphorus 113, 114, 116, 121 Physiological hyperbilirubinemia 237 384 Neonatology Practice Made Easy Plantar surface 45, 46 Plasma osmolarity 72 Platelet activating factor 263 count 198 of mother 198 Plugged ducts 106 Pneumocystis carinii 281 Pneumomediastinum 162 Pneumothorax 162 Polycythemia 135, 194, 238 Ponderal index 48 Porcine 159 Porphyrias 297 Positioning of baby 23 Positive pressure ventilation 21, 24 Post-extubation care 152 Postnatal ward 59 Potassium 121 Potentially infected newborn 289 Precautions in blood sampling 299 newborn care urine sampling 299 Predominant breastfeeding 96 Preparation for birth of baby 17 Pressure controlled ventilation 147 support ventilation 147 Preterm birth weight babies 245 Prevention of anemia 191 aspiration of MSAF 164 CLD 182 further attacks 172 HMD 160 hypocalcemia 213 hypoglycemia 207 IEM 301 MAS 164 mother to child transmission 287 of hepatitis B 283 of HIV 275 necrotizing enterocolitis 269 patent ductus arteriosus in preterm neonates 169 polycythemia 197 vitamin K deficiency bleeding 202 Primary concern in hypoglycemia 203 Probes of radiant warmers Procedure for administration of CPAP 142 Progression of enteral feedings 92 Prophylactic calcium 213 therapy 158 Proteins 112, 114, 116, 119 Provision of warmth 22 Pulmonary causes 176 Pulse oximeters oximetry 334 Pyrazinamide 292 Pyridoxine 113, 232 R Radial artery cannulation and Allen’s test 315 Rapidity of development of anemia 185 Rate of chest compression 29 Index 385 transfusion 190 ventilation 26 Recommended daily allowance in neonates 112 Refill time of capillary 42 Reliable signs 103 Removal of arterial/venous lines 333 Renal failure index 258 Rescue therapy 158 Reserved therapeutic options 231 Respiration 44 Respiratory Distress in newborn 135, 155 syndrome 156 failure 138 rate 140 support 177 measures 138 Retinopathy of prematurity 111, 359 Retracted nipples 106 Riboflavin 113 Rifampicin 292 Right upper limb 177 Ringer’s lactate 30 Ritonavir 276 Role of antibiotics 164 erythropoietin 191 Rotor syndrome 247 Route for central venous access 330 enteral feeding 91 parenteral nutrition 122 Routine neonatal screening 301 Rubella 248 Ruptured sinus of valsalva 166 S Safer transport like nest 68 Sarnat and sarnat staging 218 Savlon Secondary to intrauterine hypoxia 194 perinatal hypoxia 194 Sedation and analgesia 153 Selection of blood 321 Sepsis 120 screen 127 Septic shock 251 Serial weight charting 71 Serum K levels 88 sodium 72 Severe hypothermia 58 pulmonary insufficiency 121 Sexually transmitted diseases 275 Shake test 353 Shingles 286 Shock 250, 262 Sick baby 200 Side effects of medical management 167 Side-laboratory procedures 350 Silverman scoring system 136 Skin 45, 46 Small for gestational age 49, 52, 357 Sodium 121 valproate 231 Some important alarm settings 44 Sore nipples 105 Specific treatment for late onset hypocalcemia 212 SPO2 target 336 Spontaneous pneumothorax 155 386 Neonatology Practice Made Easy Stabilize arterial blood pressure 68 blood sugar 68 Steps of hand-rubbing 15 handwashing 14, 15f Stethoscope Storage of expressed breastmilk 345 Streptomycin 292 Subclavian vein 330 Subtle seizures 224 Suction apparatus catheter size 314 Supplementation 112 Surgical ligation of PDA 168 subtotal pancreatectomy 208 Survanta 159 Swab containers and injection trays Symptomatic hypocalcemia 211 hypoglycemia 205 Synchronized intermittent ventilation 146 T Tachycardia 253 Tactile stimulation 24 Tandem mass spectroscopy 298 Tenofovir 276 Term babies 243 Termination of inspiration 147 Thermal disturbances 57 Thermogenesis in newborn 55 Thermometer Thermoneutral zone 55 Thermoregulation in newborn 54 Thiamine 113 Thrombocytopenia 201 Tonic seizures 225 Topiramate 232 TORCH 228 Total parenteral nutrition 122 Toxic bilirubin level 241 Toxins 247 Trained manpower 19 Transcutaneous bilirubinometry 341 partial pressure of oxygen in blood 43 PCO2 estimation 336, 337 Transient tachypnea of newborn 154 Transplacental or hematogenous 290 Traumatized 105 Treatment of hypocalcemia 211 seizure activity 229 Treatment policy 167 Tromethamine 88 Tube feeding in newborn 348f Tumor necrosis factor-A 263 Types of central venous cannulation catheters 331 seizures 224 shock 250 transport 65 U Umbilical artery cannulation 326 vein cannulation 318 Index 387 Unconjugated hyperbilirubinemia 238 or indirect hyperbilirubinemia 235 Undetected infection 63 Unreliable signs 103 Urinary calcium 211 sodium 258 Urine culture and sensitivity 130 output 72, 257 testing for reducing sustances 351 Ursodeoxycholic acid 249 Use in prevention of CLD 183 Use of thermometer 56 Vitamins 114, 116, 121 A 113, 249 B1 113 B12 113 B2 113 B6 113 C 113 D 113, 249 D deficiency 210, 213 E 113, 249 K 113, 249 K deficiency bleeding 41, 201 Volume controlled ventilation 147 of blood 306, 322 of milk required 90 replacement 252 V W Vaccination policy 281 Varicella 286 infection in neonate diagnosis of 288 treatment of 288 Zoster immunoglobulin 287, 288 Zoster virus 286 VDRL test 228 Ventilation and control parameters 146 Ventilator controlled 146 Very low birth weight 49 babies 245 Vigabatrin 232 Vigorous 34 Virginia apgar 37 Vital sign monitors Warm chain 61 Wash-basin area Waste disposal 11 Water soluble vitamins 249 Weaning 144 Weighing machine White blood cell 307 White’s classification 270 Wilson’s disease 297 X Xpression of breast milk 346 Z Zidovudine 276 Zinc 113, 114, 116, 121 ... Neonatology Practice Made Easy® MMA Faridi  MD (Pediatrics)  DCH MNAMS FIAP FNNF Professor and Head, Department of Pediatrics Incharge, Division of Neonatology University... readers should consult with a specialist or contact the manufacturer of the drug or device Neonatology Practice Made Easy® First Edition: 2013 ISBN  978-93-5090-421-3 Printed at Dedicated to Our... trained in the science and art of neonatal care It is a matter of great satisfaction that the Neonatology Practice Made Easy® which has been written by a senior and experienced faculty and Fellow