Neonatal echoencephalography

The recent development of high-resolution real-time ultrasound scanners has coincided with the awareness of the high incidence of intracranial haemorrage in low birthweight babies, resulting in a considerable expansion in the use of echoencephalography in newborns in recent years. The uses are now further expanded and an overview of the subject is presented.     

Neonatal Therapeutics

When a mother takes drugs, her unborn child may suffer the consequences. For example, narcotics or barbiturates can depress the central nervous system; anticoagulants can cause hemorrhage; and antibiotics can retard growth, produce flaccidity and stupor, or cause kernicterus. Clinicians should be aware that doses safe for the mother may endanger or, indeed, overwhelm the fetus.     

Neonatal nutrition

Using propranolol or lidocaine as an antiarrhythmic agent takes keen clinical judgment if optimal efficacy is to be obtained at minimal risk. Serious adverse effects of propranolol are cardiac, while those of lidocaine are usually dose-related and most often involve the central nervous system.     

Neonatal craniotabes

Craniotabes is a frequent, benign physical finding in newborn infants. Resolution occurs spontaneously by two to three months of age. If the history and physical examination are otherwise normal, no further investigation is necessary or desirable. Craniotabes may be related to pressure due to early engagement of the fetal head or to subtle abnormalities of maternal calcium and vitamin D metabolism.     

Neonatal Jaundice

This article briefly indicates the metabolism and fate of bilirubin, some thoughts to go over when faced with a jaundiced baby in the nursery, the causes and sequelae, and some modern methods of treatment.     

Neonatal resuscitation

The long-term outcome of infants subjected to perinatal asphyxia can be improved if they are recognized as high risk before birth and managed so as to reduce the period of hypoxemia to a minimum. Prompt and effective resuscitation of asphyxiated infants at the time of birth can contribute much to improving the long-term outcome of these infants.     

Neonatal circumcision

Because of an economically motivated study, there has been an attempt to shift insurance dollars from neonatal circumcision to neonatal intensive care. Negative comments regarding the advisability of early circumcision have created confusion for both physicians and parents. Neonatal circumcision is the most common surgical operation in the United States, with probably fewer complications than any other. I believe this valid prophylactic procedure is falling victim to an unwarranted bias.     

Neonatal resuscitation

Three decades of ongoing research and obstetric and pediatric education have seen neonatal resuscitation develop into a well-organized delivery room procedure. Because neonatal resuscitation does not occur frequently in the Emergency Department, few are well prepared. A designated site in the Emergency Department, trained personnel, appropriate equipment and well defined procedures are necessary. These recommendations for the organization of the resuscitation site, procedures, therapeutic drugs, and required equipment must be individualized to each Emergency Department.