Table Of Content

i OXFORD MEDICAL PUBLICATIONS Oxford Handbook of Neonatology ii Published and forthcoming Oxford Handbooks Oxford Handbook for the Foundation Programme 4e Oxford Handbook of Acute Medicine 3e Oxford Handbook of Anaesthesia 4e Oxford Handbook of Applied Dental Sciences Oxford Handbook of Cardiology 2e Oxford Handbook of Clinical and Healthcare Research Oxford Handbook of Clinical and Laboratory Investigation 3e Oxford Handbook of Clinical Dentistry 6e Oxford Handbook of Clinical Diagnosis 3e Oxford Handbook of Clinical Examination and Practical Skills 2e Oxford Handbook of Clinical Haematology 4e Oxford Handbook of Clinical Immunology and Allergy 3e Oxford Handbook of Clinical Medicine—Mini Edition 9e Oxford Handbook of Clinical Medicine 9e Oxford Handbook of Clinical Pathology Oxford Handbook of Clinical Pharmacy 2e Oxford Handbook of Clinical Rehabilitation 2e Oxford Handbook of Clinical Specialties 10e Oxford Handbook of Clinical Surgery 4e Oxford Handbook of Complementary Medicine Oxford Handbook of Critical Care 3e Oxford Handbook of Dental Patient Care Oxford Handbook of Dialysis 4e Oxford Handbook of Emergency Medicine 4e Oxford Handbook of Endocrinology and Diabetes 3e Oxford Handbook of ENT and Head and Neck Surgery 2e Oxford Handbook of Epidemiology for Clinicians Oxford Handbook of Expedition and Wilderness Medicine 2e Oxford Handbook of Forensic Medicine Oxford Handbook of Gastroenterology and Hepatology 2e Oxford Handbook of General Practice 4e Oxford Handbook of Genetics Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health 2e Oxford Handbook of Geriatric Medicine 2e Oxford Handbook of Infectious Diseases and Microbiology 2e Oxford Handbook of Key Clinical Evidence 2e Oxford Handbook of Medical Dermatology 2e Oxford Handbook of Medical Imaging Oxford Handbook of Medical Sciences 2e Oxford Handbook of Medical Statistics Oxford Handbook of Neonatology 2e Oxford Handbook of Nephrology and Hypertension 2e Oxford Handbook of Neurology 2e Oxford Handbook of Nutrition and Dietetics 2e Oxford Handbook of Obstetrics and Gynaecology 3e Oxford Handbook of Occupational Health 2e Oxford Handbook of Oncology 3e Oxford Handbook of Operative Surgery 3e Oxford Handbook of Ophthalmology 3e Oxford Handbook of Oral and Maxillofacial Surgery Oxford Handbook of Orthopaedics and Trauma Oxford Handbook of Paediatrics 2e Oxford Handbook of Pain Management Oxford Handbook of Palliative Care 2e Oxford Handbook of Practical Drug Therapy 2e Oxford Handbook of Pre-Hospital Care Oxford Handbook of Psychiatry 3e Oxford Handbook of Public Health Practice 3e Oxford Handbook of Reproductive Medicine and Family Planning 2e Oxford Handbook of Respiratory Medicine 3e Oxford Handbook of Rheumatology 3e Oxford Handbook of Sport and Exercise Medicine 2e Handbook of Surgical Consent Oxford Handbook of Tropical Medicine 4e Oxford Handbook of Urology 3e 1 iii Oxford Handbook of Neonatology Second Edition Dr Grenville Fox Consultant Neonatologist, Evelina London Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust, London, UK Dr Nicholas Hoque Consultant Neonatologist, Queen Charlotte’s and St Mary’s Hospitals, Imperial College Healthcare NHS Trust, UK and Dr Timothy Watts Consultant Neonatologist, Evelina London Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust, London, UK iv Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2017 The moral rights of the authors have been asserted First Edition published in 2010 Second Edition published in 2017 Impression: 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2016945507 ISBN 978– 0– 19– 870395– 2 Printed and bound in China by C&C Offset Printing Co., Ltd. Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up- to- date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non- pregnant adult who is not breast- feeding Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. 1 v v The original idea for this handbook arose from files of clinical guidelines from our own neonatal unit. Our ethos in developing these guidelines was that they should avoid dogma and provide practical guidance rather than rigid rules and regulations. These have been rewritten to provide much of the practical advice given in this handbook, with succinct background notes added to each topic. We hope this will provide enough detail to inform medical and nursing staff at all levels and act as an aide-memoire to those with more experience in the specialty. Practical guidance and a suggested approach to different clinical situations have been written using the best available evidence, but we have relied on consensus of opinion where evidence is lacking. This second edition has a revised chapter order and a new chapter on neonatal endocrinology, with updates to all other sections reflecting recent changes and evidence in the specialty. Grenville Fox Nicholas Hoque Timothy Watts Preface vi vii vii We are grateful to our consultant colleagues, trainees, senior nursing staff, and subspecialty teams at the Evelina London Children’s Hospital Neonatal Unit at St.Thomas’ Hospital, who have contributed to the guidelines which formed the original idea for this handbook. We are particularly grateful to Michael Champion from the Evelina London Children’s Hospital for his con- tribution to the metabolic section; and to Julia Phillips from King’s College Hospital, and Tony Hulse from the Evelina London Children’s Hospital for the new endocrinology chapter. We are also grateful to Victoria Barr for rendering of selected illustrations. Acknowledgements viii ix ix Symbols and abbreviations xi 1 Antenatal care, obstetrics, and fetal medicine 1 2 Management at birth and routine postnatal care 19 3 Problems on the postnatal ward 31 4 Admission, discharge, and outcome 51 5 Fluids and electrolytes 71 6 Nutrition 87 7 Respiratory problems 105 8 Respiratory support 149 9 Cardiovascular problems 169 10 Gastrointestinal problems 235 11 Neurological problems 275 12 Infection 323 13 Metabolic problems and jaundice 371 14 Haematological problems 393 15 Nephrological and urological problems 423 16 Endocrinology 439 17 Iatrogenic problems 457 18 Neonatal transport 465 19 Family support, consent, and end of life care 483 20 Practical procedures 493 21 Normal values, therapeutic drug levels, and useful formulae 531 Index 543 Contents x xi xi < less than > greater than 7 approximately +/ – with or without i increased l leads to d decreased ΔP change in pressure A/ C assist control AAP American Academy of Pediatrics Ab antibody ABC(D) airway, breathing, circulation, (disability) ACE angiotensin converting enzyme AChR acetylcholine receptor ACTH adrenocorticotropic hormone ADH antidiuretic hormone ADHD attention deficit hyperactivity disorder ADPKD autosomal dominant polycystic kidney disease AED automatic external defibrillator AFB acid- fast bacilli ALCAPA anomalous origin of left coronary artery from pulmonary artery ALP alkaline phosphatase ALT alanine transferase ALTE acute life- threatening events AMH anti- Müllerian hormone ANNP advanced neonatal nurse practitioner anti- HBe HB e antibody AP antero- posterior APH antepartum haemorrhage APLS Advanced Paediatric Life Support APTT activated partial thromboplastin time ARDS acute respiratory distress syndrome ARPKD autosomal recessive polycystic kidney disease ART antiretroviral treatment AS aortic stenosis ASD atrial septal defect Symbols and abbreviations SYMBOLS AND ABBREVIATIONS xii xii AST aspartate transaminase AV atrioventricular aVF augmented vector foot (ECG lead) AVRT atrioventricular re- entry tachycardia AVSD atrioventricular septal defect AXR abdominal X- ray AZT zidovudine (azidothymidine) BAPM British Association of Perinatal Medicine BCG bacillus Calmette- Guérin bd twice daily BE base excess BMF breast milk fortifier BMI body mass index BP blood pressure BPD bronchopulmonary dysplasia BW birth weight CCAM congenital cystic adenomatoid malformation CDH congenital diaphragmatic hernia CF cystic fibrosis CFM cerebral function monitoring CGA corrected gestational age CGH comparative genomic hybridization CHAOS congenital high airway obstruction syndrome CHARGE Coloboma, Heart defects, choanal Atresia, Retardation of growth/ development, Genital abnormalities, and Ear abnormalities CHB complete heart block CHD congenital heart disease CK creatine kinase CLD chronic lung disease CMV cytomegalovirus CNS central nervous system CoA coarctation of the aorta CONS coagulase negative staphlyococci CPAP continuous positive airway pressure CPK creatinine kinase CPR cardiopulmonary resuscitation CRH corticotropin- releasing hormone CRP C- reactive protein CSF cerebrospinal fluid CT computed tomography SYMBOLS AND ABBREVIATIONS xiii xiii CTG cardiotocograph CUSS cranial ultrasound scan CVP central venous pressure CVS chorionic villous sampling CXR chest X- ray DAT direct antiglobulin test DC direct current DDH developmental dysplasia of the hip DEAFF detection of early antigen fluorescent foci DHEAS dehydroepiandosterone sulphate DIC disseminated intravascular coagulation DILV double inlet left ventricle DMSA dimercaptosuccinic acid scan DSD disorders of sexual differentiation DTaP diptheria, tetanus, pertussis (acellular) DWI diffusion- weighted imaging EBM expressed breast milk ECG electrocardiogram echo echocardiography ECMO extracorporeal membrane oxygenation ECV external cephalic version EDD expected date of delivery EDF end- diastolic flow EEG electroencephalogram EFM electronic fetal monitoring EIA enzyme immunoassay ELBW extremely low birth weight EMG electromyography ENT ear, nose, and throat ETT endotracheal tube EXIT ex utero intrapartum treatment FBC full blood count FDP fibrin degradation products FENa fractional excretion of sodium FFP fresh frozen plasma FGR fetal growth restriction FHM fetal heart rate monitoring FHR fetal heart rate FiO2 fraction of inspired oxygen FLAIR fluid- attenuated inversion recovery SYMBOLS AND ABBREVIATIONS xiv xiv FRC functional residual capacity FSH follicle- stimulating hormone G6PD glucose- 6- phosphate dehydrogenase GA gestational age GBS group B streptococcus G- CSF granulocyte colony stimulating factor GFR glomerular filtration rate GGT gamma glutamyl transferase GH growth hormone GI gastrointestinal GIT gastrointestinal tract GMH germinal matrix haemorrhage GOR gastro- oesophageal reflux GTN glyceryl trinitrate GU genitourinary HAART highly active antiretroviral treatment HAS human albumin solution HbA1C haemoglobin A1C HBeAg HB e antigen HBIG HB immunoglobulin HBsAg HB surface antigen HBV hepatitis B virus hCG human chorionic gonadotrophin Hct haematocrit HCV hepatitis C virus HDN haemolytic disease of the newborn HELLP haemolysis, elevated liver enzymes, and low platelets HFNC high- flow nasal cannula HFOV high- frequency oscillatory ventilation HHHF heated humidified high flow HIE hypoxic ischaemic encephalopathy HIHA hyperinsulinism hyperammonaemia HIV human immunodeficiency virus HLHS hypoplastic left heart syndrome HMA homovanillic acid HOOF Home Oxygen Order Form HPI haemorrhagic periventricular/ parenchymal infarction HR heart rate HSV herpes simplex virus HTLV human T- cell leukaemia virus

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