Workbook in Practical Neonatology

367 Pages·2019·30.84 MB·English

by  Richard A. Polin, Mervin C. Yoder

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2015v1.0
WORKBOOK IN
Practical
Neonatology
SIXTH EDITION
EDITORS:
Richard A. Polin, MD
William T. Speck Professor of Pediatrics
College of Physicians and Surgeons
Columbia University
Executive Vice-Chair Department of Pediatrics
Director, Division of Neonatology
Morgan Stanley Children’s Hospital of New York—
Presbyterian
New York, New York
Mervin C. Yoder, MD
Distinguished Professor and Richard and Pauline Klingler
Professor of Pediatrics
Assistant Dean for Entrepreneurial Research
and Associate Director for Entrepreneurship
for Indiana Clinical and Translational Sciences Institute
Indiana University School of Medicine
Associate Chair for Basic Research
Attending Neonatologist
Riley Hospital for Children
Indianapolis, Indiana
Elsevier
Philadelphia, PA
Elsevier
3251 Riverport Lane
St. Louis, Missouri 63043
WORKBOOK IN PRACTICAL NEONATOLOGY, SIXTH EDITION ISBN: 978-0-323-62479-4
Copyright © 2020 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
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This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notice
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds or experiments described herein. Because of rapid
advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages
should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors
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negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
Library of Congress Control Number: 2019948032
Previous editions copyrighted © 2015, 2007, 2001, 1993 and 1983
Content Development Specialist: Angie Breckon
Content Strategist: Sarah Clark
Publishing Services Manager: Deepthi Unni
Project Manager: Bharat Narang
Cover Design: Margaret Reid
Printed in the United States of America
Last digit in the printer: 9 8 7 6 5 4 3 2 1
L I S T O F C O N T R I B U TO R S
David Adamkin, MD Maria Roberta Cilio, MD, PhD William W. Hay, Jr., MD
Professor of Pediatrics Professeure Ordinaire de Neurologie Professor of Pediatrics (Neonatology)
University of Louisville Pediatrique Scientific Director, Perinatal Research
Louisville, Kentucky Université catholique de Louvain Center
Epileptologie pédiatrique et néonatale University of Colorado School of Medicine
Cigdem Akman, MD Cliniques universitaires Saint-Luc Anschutz Medical Campus
Chief, Child Neurology Adjunct Professor of Neurology and Pediatrics Scientific Director, Perinatal Research
Director, Pediatric Epilepsy University of California, San Francisco Center
Neurology Aurora, Colorado
Columbia University Medical Center Erika Claud, MD
New York, New York Professor Kendra Hendrickson, MS, RD,
Pediatrics and Medicine CNSC, CSP
Chad Andersen, MBBS The University of Chicago Clinical Dietitian II
Neonatal Medicine Chicago, Illinois Neonatal Intensive Care Unit
Women’s and Children’s Hospital University of Colorado Hospital
Adelaide, Australia Alain C. Cuna, MD Department of Nutrition
Neonatologist Aurora, Colorado
Lauren Astrug, MD Children’s Mercy Kansas City
Assistant Professor of Neonatology Assistant Professor of Pediatrics Stuart Brian Hooper, BSc(Hons), PhD
Department of Pediatrics University of Missouri-Kansas City The Ritchie Centre
Loyola University Chicago Kansas City, Missouri Hudson Institute of Medical Research
Chicago, Illinois The Department of Obstetrics and
Vincent Duron, MD Gynecolory
William E. Benitz, MD Assistant Professor, Surgical Director of Monash University
Professor of Neonatology Critical Care Melbourne, Australia
Pediatric/Neonatal & Developmental Medicine Pediatric Surgery
Stanford University Morgan Stanley Children’s Hospital/ Thomas A. Hooven, MD
Stanford, California New York-Presbyterian Assistant Professor
New York, New York Pediatrics
Jatinder Bhatia, MD, FAAP Columbia University
Professor, Department of Pediatrics Lin Fangming, MD, PhD New York, New York
Chief, Division of Neonatology Director of Pediatric Nephrology
Director, Fellowship Program, Neonatal- Columbia University Elie G. Abu Jawdeh, MD
Perinatal Medicine New York, New York Neonatal-Perinatal Medicine
Director, Transport/ECMO/Nutrition Kentucky Children’s Hospital
Vice Chair, Clinical Research Kirsten Glaser, MD University of Kentucky College of
Medical College of Georgia University Children’s Hospital Medicine
Augusta University University of Wuerzburg Lexington, Kentucky
Augusta, Georgia Wuerzburg, Germany
Erik A. Jensen, MD
Shazia Bhombal, MD Pamela Isabel Good, MD Department of Pediatrics
Clinical Assistant Professor of Pediatrics Neonatal-Perinatal Medicine Fellow Division of Neonatology
Division of Neonatal and Developmental Department of Pediatrics The Children’s Hospital of Philadelphia
Medicine Morgan Stanley Children’s Hospital of The University of Pennsylvania School of
Stanford University School of Medicine New York—Presbyterian Medicine
Palo Alto, California Columbia University Medical Center Philadelphia, Pennsylvania
New York, New York
Waldemar A. Carlo, MD Michael Kaplan, MB, ChB
Edwin M. Dixon Professor of Pediatrics Cathy Hammerman, MD Emeritus Director
University of Alabama at Birmingham Director Newborn Nurseries Department of Neonatology
Director, Division of Neonatology Neonatology Shaare Zedek Medical Center
Director, Newborn Nurseries Shaare Zedek Medical Center Professor of Pediatrics
Birmingham, Alabama Professor Faculty of Medicine
Pediatrics Hebrew University
Hebrew University Faculty of Medicine Jerusalem, Israel
Jerusalem, Israel
iii
iv LIST OF CONTRIBUTORS
Martin Keszler, MD Shahab Noori, MD, MS, CBTI, RDCS Veniamin Ratner, MD
Professor of Pediatrics Fetal and Neonatal Institute Assistant Professor of Pediatrics
Alpert Medical School of Brown Division of Neonatology Columbia University Medical Center
University Children’s Hospital Los Angeles Neonatologist
Associate Director of NICU Department of Pediatrics Morgan Stanley Children’s Hospital of New
Director of Respiratory Services Keck School of Medicine York-Presbyterian
Women and Infants Hospital of Rhode University of Southern California New York, New York
Island Los Angeles, California
Providence, Rhode Island Kimberly J. Reidy, MD
Camilia R. Martin MD, MS Assistant Professor
Haresh Kirpalani, MB, MSc Assistant Professor of Pediatrics Pediatrics/Nephrology
Professor Harvard Medical School Children’s Hospital at Montefiore/Albert
Neonatology, Department of Pediatrics Associate Director, NICU Einstein College of Medicine
The Children’s Hospital of Philadelphia Beth Israel Deaconess Medical Center Bronx, New York
Philadelphia, Pennsylvania Boston, Massachusetts
Emeritus Professor Ana P. Duarte Ribeiro, MD
Clinical Epidemiology Richard J. Martin, MD Case Western Reserve University School of
McMaster University Case Western Reserve University School of Medicine
Hamilton, Canada Medicine Rainbow Babies & Children’s Hospital
Rainbow Babies& Children’s Hospital Cleveland, Ohio
Ganga Krishnamurthy, MBBS Cleveland, Ohio
Assistant Professor of Pediatrics S. David Rubenstein, MD
Columbia University Medical Center Bobby Mathew, MBBS Professor of Pediatrics
Director, Neonatal Cardiac Care Assistant Professor of Pediatrics Columbia University Medical Center
Morgan Stanley Children’s Hospital of University of Buffalo Director, Neonatal Intensive Care Unit
New York-Presbyterian Attending Neonatologist, Associate Director Morgan Stanley Children’s Hospital of
New York, New York Neonatal Perinatal Medicine Fellowship New York-Presbyterian
Program Director, Fellowship Training Program in
Satyan Lakshminrusimha, MBBS, The Women & Children’s Hospital of Neonatal-Perinatal Medicine
MD, FAAP Buffalo New York Presbyterian Hospital, Columbia
Professor of Pediatrics Buffalo, New York Campus
Chief, Division of Neonatology New York, New York
Director, Center for Developmental Biology Shahab Noori, MD
of the Lung Associate Professor of Pediatrics Ashley M. Reilly, PharmD
University at Buffalo Keck School of Medicine of the University Clinical Pharmacy Specialist
The Women and Children’s Hospital of of Southern California, Attending Neonatal Intensive Care Unit/ Labor &
Buffalo Neonatologist Delivery
Buffalo, New York Children’s Hospital Los Angeles and the University of Colorado Hospital
LAC USC Medical Center Department of Pharmacy
Abbot R. Laptook, MD Los Angeles, California Aurora, Colorado
Professor of Pediatrics
Alpert Medical School of Brown University Brenda B. Poindexter, MD, MS Calum T. Roberts
Medical Director, Neonatal Intensive Professor of Pediatrics Department of Paediatrics
Care Unit Section of Neonatal-Perinatal Medicine Monash University
Staff Neonatologist Indiana University School of Medicine The Ritchie Centre
Women & Infants Hospital of Rhode Island Riley Hospital for Children at IU Health Hudson Institute of Medical Research
Providence, Rhode Island Indianapolis, Indiana Monash Newborn
Monash Medical Centre
Stéphanie Levasseur, MD, FRCPC Richard A. Polin, MD Melbourne, Australia
Assistant Professor of Pediatrics William T. Speck Professor of Pediatrics
Columbia University Medical Center College of Physicians and Surgeons Tristan T. Sands, MD, PhD
Morgan Stanley Children’s Hospital of Columbia University Assistant Professor
New York-Presbyterian Director, Division of Neonatology Neurology
New York, New York Morgan Stanley Children’s Hospital of Columbia University Medical Center
New York—Presbyterian New York, New York
Jack Lorenz, MD New York, New York
Emeritus Professor of Pediatrics
Columbia University Tara M. Randis, MD, MS
College of Physicians & Surgeons Assistant Professor
New York, New York Department of Pediatrics and Microbiology
NYU School of Medicine
New York, New York
LIST OF CONTRIBUTORS v
Istvan Seri, MD Steven Stylianos, MD Clyde J. Wright, MD
Fetal and Neonatal Institute Rudolph Schullinger Professor of Pediatric Section of Neonatology
Division of Neonatology Surgery Department of Pediatrics
Children’s Hospital Los Angeles Department of Surgery University of Colorado School of Medicine
Department of Pediatrics Columbia University School of Physicians and Children’s Hospital Colorado
Keck School of Medicine & Surgeons Aurora, Colorado
University of Southern California Surgeon-in-Chief
Los Angeles, California Morgan Stanley Children’s Hospital Tai-Wei Wu, MD
First Department of Pediatrics New York, New York Fetal and Neonatal Institute
Faculty of Medicine Division of Neonatology
Semmelweis University Arjan B. te Pas, MD, PhD Children’s Hospital Los Angeles
Budapest, Hungary Division of Neonatology Department of Pediatrics
Department of Pediatrics Keck School of Medicine
Michael Stark, BSc (Hons), MBChB, PhD Leiden University Medical Center University of Southern California
Associate Professor Leiden, The Netherlands Los Angeles, California
Department of Neonatal Medicine
Women’s and Children’s Hospital Payam Vali, MD Ariela Zenilman, MD
The Robinson Research Institute Assistant Professor of Clinical Pediatrics Columbia University Medical Center
University of Adelaide University of California Davis New York, New York
Adelaide, Australia Sacramento, California
P R E FAC E
This is the sixth edition of the Workbook in Practical Neonatol- knowledge in which you are deficient so that you may read up
ogy. There is no doubt that the practice of our discipline has and enhance your armamentarium of knowledge; to keep
changed in numerous ways since the first edition of this text was you engaged and alert as you solve the problems presented
published in 1983. However, we remain passionately convinced and to have fun while learning.
that the study of neonatology is best conducted in a format We have recruited new authors to provide a fresh perspec-
similar to the dialogue between a learner and teacher as they tive on all the given areas. Each were chosen for their recog-
“see” the patient. The dialogue is informed by the specific ele- nized expertise and status within the discipline, as has been
ments of acquired patient data that give some evidence for the the tradition since the first edition. Thus, the goal of the
status of the patient in supplement of the physical examination, present edition is to provide new avenues from which to
and assessments for the daily plan of the patient are constructed. glean the available evidence, new insights into pathophysiol-
In each chapter, specific case studies are presented, followed by a ogy, and advances in treatment of critically ill neonates.
series of questions that seek the reader to choose an intervention, We wish to thank Angie Breckon from Elsevier for her
and then the various approaches are discussed to bring the outstanding guidance through the entire project. MCY wishes
reader to identify the most appropriate plan of action. to thank his wife, Holly, children Andrew, Cait, Chris and
As true for the first edition, this book is designed to pro- Emily and grandchildren Isaac, Jacob, Gracie, and Charlotte
vide an opportunity to directly solve problems as you read for all their support. RAP wishes to thank his wife Helene,
through the clinical scenarios. The workbook format has four children Allison, Mitchell, Jessica and Gregory and grandchil-
objectives: to allow you to evaluate your own knowledge for dren Lindsey, Eli, Willa, Jasper, Casey, Smith, Calla and Elliott
each problem presented; to permit you to identify areas of for their love and support.
vi
V I D E O TA B L E O F C O N T E N T S
Video 16-1: Echocardiogram—Relationship of Ventricles and Great Vessels
Video 16-2: Fluoroscopic Image of Balloon Atraial Septostomy
Video 16-3: Echocardiogram—Ebstein’s Anomaly
Video 16-4: Echocardiogram—Stenotic Pulmonary Valve
Video 16-5: Fluoroscopic Image of Pulmonary Balloon Valvoplasty
Video 19-1: Benign Neonatal Seizure
viii
A Physiologic Approach
to Neonatal Resuscitation
Stuart B. Hooper, Arjan B. te Pas and Roberts Ca/um T. Roberts
INTRODUCTION
the physiologic changes that occur at birth and highlight
Neonatal resuscitation is commonly defined as the assistance approaches that may best assist different subgroups of infants
given to infants immediately after birth as they transition to as their physiology changes. Many well-informed, recent
newborn life. From a physiologic perspective, this transition publications have already detailed the currently recom
involves some of the most complex and profound changes mended strategies for un_g_er aking neonatal resuscitation
that any human will likely encounter during their life. The from a practical Rerspective (Weiner et al, 2018). We intend
airways that are filled with liquid during fetal life must be to take a different approach and will focus on the physiology.
cleared to allow the entry of air and onset of pulmonary gas This is because currently recommended strategies for neona
exchange, and major vascular shunts must close to separate tal resuscitation will likely change as our understanding of
the pulmonary and systemic circulations. It is truly an amaz the pt.siology improves and better strategies for facilitating
ing feat of nature that the vast majority of infants transition the necess ry physiologic changes are identified. Indeed,
through these changes with such apparent ease. As a result, it much of, the evidence underpinning current neonatal resus
is easy to underestimate both the magnitude of the physio citati0n guidelines is regarded as weak and/or absent
logic changes and the complexity and difficulty of rendering SPerlman et al, 2015). The reasons for this are unclear, but it
assistance to infants struggling to adapt to life after birth. could be argued that a lack of scientific clarity regarding the
Very preterm infants commonly require assistance at birth physiology of transition is a major contributing factor.
because they are simply too immature to survive unassisted, Nevertheless, in the following discussion, it will become
but there is considerable debate about what assistance is evident that some of the emerging science is not consistent
required and how it should be provided. Nevertheless, a fun with current recommendations. This should not be misinter
damental tenet of neonatal resuscitation is to recognize that preted as a recommendation for changing practice, but as the
at birth, newborn infants, particularly ery Rreterm infants, first important step in designing studies that will provide the
are not "mini adults" but are essentially exteriorized fetuses required level of evidence needed to better guide practice.
with liquid-filled airways. As such, the type of assistance
given should be tailored to suit the infant's changing physiol
ESTABLISHING PULMONARY VENTILATION
ogy and its specific needs at any moment in time. For
instance, what is the logic of applying ventilation strategies
CASE1
that facilitate pulmonary gas exchange when the gas exchange
regions of the lung are liquid filled and so no pulmonary gas You are called to the delivery room to resuscitate a late pre
exchange can occur? Although this is only a transient consid term infant born at 34 weeks' gestation by repeat cesarean
eration for most infants, because the airways are rapidly section. The 1 min Apgar score is 2. You arrive at 90 sec of life.
cleared of liquid, it is a lingering consideration in very The infant is pale with a heart rate of 30 beats/min. The
preterm infants who have problems aerating their lungs infant is receiving nCPAP with 100% oxygen, but only gasp
( te Pas et al, 2008). ing intermittently. The Sao reading on the pulse oximeter is
2
A key component to a successful neonatal resuscitation is 65%. The anesthesiologist has just begun chest compressions.
understanding the physiologic changes that occur after birth
Exercise 1
and having the capacity to monitor the infant as it progresses
through these changes so that the right assistance can be Question
provided at the right time. As such, rather than utilizing an What is the next most appropriate next step in this infant's
algorithm-based approach for describing currently recom resuscitation, and what should have been done before you
mended strategies for neonatal resuscitation, we will discuss arrived?
1