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

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 International Editorial Board
Marek Jaszczak, MD
Neonatologist
Department of Neonatology
UJASTEK Hospital of Obstetrics and Gynecology
Kraków, Poland
Neelima Kharidehal, MD (Peds),
MRCPCH (UK)
Senior Consultant, NICU
Suraksha Children’s Hospital
Hyderabad, AP
India
Makiko Ohyama, MD, PhD, IBCLC
Japan Pediatric Society
Japan Society of Perinatal-Neonatal Medicine
Japan Society of Premature and Newborn
Medicine
Japan Placenta Association
Japanese Society of Clinical Cytology
Japanese Association of Lactation Consultants
International Lactation Consultant
Association
Academy of Breastfeeding Medicine
Department of Neonatology
Kanagawa Children’s Medical Center
Minamiku, Yokohama-City, Japan
Arjan te Pas, MD PhD
Associate Professor of Pediatrics
Department of Pediatrics
Division of Neonatology
Leiden University Medical Center
Leiden, the Netherlands
Siddarth Ramji, MD
Professor of Pediatrics
Department of Neonatology
Maulana Azad Medical College
New Delhi, India
Mary (Molly) Seshia MBChB, DCH,
FRCP (Ed)
Professor of Pediatrics
Section of Neonatology
University of Manitoba
Winnipeg, Manitoba, Canada
Outi Tammela, MD
Adjunct Professor in Neonatology
Pediatric Research Center
Tampere University Hospital
Tampere, Finland
Christiane Theda, MD, PhD, MBA
Neonatologist and Medical Geneticist
Royal Women’s Hospital
University of Melbourne
Murdoch Children’s Research Institute
Newborn Emergency Transport Service
Royal Children’s Hospital
Melbourne, Australia
Imelda Consunji Vinzon-Bautista, MD,
MPH, FAAP, DPPS, DPSNbM
Chairman, Institute of Pediatrics
and Child Health
Chief, Section of Neonatology
St. Luke’s Medical Center Global City
Taguig City, Philippines
iii
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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