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.     

Neonatal hyperbilirubinemia

Evidence of bilirubin-related brain damage has been reported in infants with kernicterus discharged as healthy from well-baby nurseries. Lapses in care have been attributed as root causes for kernicterus in an era when there should be no barriers to safe and effective bilirubin reduction strategies. Between 1984 and 2002, at least 125 cases of kernicterus occurred in the United States. This may be an underestimate because kernicterus is not a reportable condition in this country. In almost all cases, kernicterus is a preventable condition. The updated 2004 American Academy of Pediatrics guidelines recommend a systems approach, which, if implemented by all birthing institutions, should prevent virtually all cases of kernicterus in term and near-term infants.     

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 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 sepsis

Neonates are susceptible to infection since several elements of the immune system are deficient. At present, the most common pathogens are Group B streptococci and Escherichia coli. Prolonged rupture of membranes with amnionitis is a high-risk setting. Clinical signs suggesting neonatal sepsis include respiratory distress, poor feeding, hypothermia, seizures and hypotonia. After the sepsis work-up is completed, the initial choice of antibiotics is based on the prevailing organisms and antibiotic sensitivities within the community.