Fanaroff and Martin's Neonatal-Perinatal Medicine, 2-Volume Set: Diseases of the Fetus and Infant (Current Therapy in Neonatal-Perinatal Medicine)

cover front matter Fanaroff and Martin's Neonatal-Perinatal Medicine, 2-Volume Set copyright Copyright Page dedication Dedication content contributors Contributors preface Preface 1 1 Growth of Neonatal Perinatal Medicine—A Historical Perspective Abstract Keywords Perinatal Pioneers The High-Risk Fetus and Perinatal Obstetrics Midwives and Perinatal Care Neonatal Resuscitation: Tales of Heroism and Desperation Apgar and the Language of Asphyxia Foundling Asylums and Infant Care Saving Infants to Man the Army An Ingenious Contrivance, the Couveuse, and Premature Baby Stations Incubators, Baby Shows, and Origins of Neonatal Intensive Care Units Supportive Care and Oxygen Therapy Ventilatory Care: “Extended Resuscitation” Supportive Care: Intravenous Fluid and Blood Transfusions Tools and Supplies for Neonatal Intensive Care Units Pediatric Surgery: Not for Rabbits Anymore Global Neonatal Care Medical Errors and “Patient Safety” as a New Discipline Controlled Clinical Trials, Evidence-Based Medicine, and Research Networks Future of Neonatal Research, Education, and Databases in the Internet Era Some Famous High-Risk Infants Acknowledgment Key Points References 2 2 Epidemiology for Neonatologists Abstract Keywords Introduction Common Epidemiologic Concepts Health Statistics and Data Sources Birth Data Fetal Deaths Infant Deaths Pregnancy-Related Deaths Maternal Morbidity Neonatal Morbidity Prematurity and Low Birth Weight Key Points References 3 3 Medical Ethics in Neonatal Care Abstract Keywords Principles in Medical Ethics Autonomy Beneficence Nonmaleficence Justice Key Terms and Concepts Communication With Parents Teams and Communication Family-Centered Neonatal Intensive Care Consensual Decision Making Team Consensus in Ethical Issues Clinical Applications in Specific Moral Problems Refusal of Treatment During Pregnancy Prenatal Consultation at the Limits of Viability Withholding and Withdrawing Life-Sustaining Medical Treatment in the Neonatal Intensive Care Unit Collaborative, Procedural Framework for End-of-Life Decision Making Specific Issues in End-of-Life Care Brain Death, Donation After Cardiac Death, and Organ Donation Brain Death Donation After Cardiac Death Use of Analgesic Agents at the Time of Withdrawing Life-Sustaining Medical Treatment Palliative Care in the Neonatal Intensive Care Unit Conflict Resolution When Consensus Cannot Be Reached Ethics of Research in the Neonatal Intensive Care Unit Ethical Responsibilities of Neonatal Physicians Acknowledgment Key Points References 4 4 Legal Issues in Neonatal-Perinatal Medicine Abstract Keywords Disclaimer General Legal Principles Legislative Law and Case Law State Law and Federal Law General Structure of the Federal and State Court Systems Supervision of Others Theories of Liability for Attending Physicians Residents and Fellows Physician Assistants Advanced Practice Neonatal Nurses Malpractice Duty Supervising Others Telephone Advice Telemedicine Prenatal Consultation Breach Standard of Care Role of the Expert Witness Res Ipsa Loquitur Causation Damages Burden of Proof Protected (Nondiscoverable) Proceedings Other Tort Actions Wrongful Birth Wrongful Life Wrongful Death Strategies for Avoiding Tort Litigation Trends in Malpractice Legislation Conclusions Live Birth Born-Alive Infants Protection Act Handicapped Newborns Baby Doe Baby Jane Doe Baby K Sun Hudson Conclusions Providing Care Against Parents’ Wishes Miller Case Messenger Case Montalvo Case Conclusions Summary Key Points References 5 5 Evaluating and Improving the Quality and Safety of Neonatal Intensive Care Abstract Keywords The Case for Improvement Brief History of Industrial Quality Improvement Definition and Conceptual Frameworks for Quality Definition Conceptual Framework for Quality Donabedian: Structure, Process, Outcomes Pawson and Tilley: Realistic Evaluation Batalden: Five Knowledge Systems Complexity Theory Translation of Frameworks into Action Model for Improvement Integrated Quality Management Lean Data and Methods for Quality Improvement Data Elements for Assessment Structure and Institutional Context Processes Outcomes Balancing Measures Assessing the Total Impact of a Quality Improvement Initiative Risk Adjustment/Fair Comparisons Data Sources Administrative Data Clinical Data Qualitative Data Quality Measurement and Improvement Data for Selection National Quality Measures Data for Improvement Global Assessments of Perinatal Quality: The Value Compass Global Assessments of Perinatal Quality: The Baby-MONITOR Quality and Safety Applied Local Quality Improvement Applied: An Example Sustainability Quality Improvement Research Quality and Safety in the International Context Conclusion Acknowledgments Key Points References 6 6 Simulation and Debriefing in Neonatal-Perinatal Medicine Abstract Keywords Introduction Simulation-Based Training in High-Risk Industries Simulation-Based Training in Health Care Simulation-Based Training in Neonatal-Perinatal Medicine Debriefing Simulated Events Debriefing Actual Clinical Events Simulation-Based Assessment Simulation-Based Research Simulation as the Basis of Clinical Care The Future of Simulation in Neonatal-Perinatal Medicine Key Points References 7 7 Practicing Evidence-Based Neonatal-Perinatal Medicine Abstract Keywords Asking a Focused Clinical Question Finding Evidence Sources of Evidence Efficient Strategies for Searching for Evidence Primary Reports Reviews Cochrane Systematic Reviews Critically Appraising Evidence for Its Validity Extracting the Data and Expressing the Effect of Treatment Applying the Results to Patient Care Promoting Evidence-Based Clinical Practice Acknowledgments Key Points References 8 8 Perinatal and Neonatal Care in Developing Countries Abstract Keywords Global Initiatives to Reduce Infant Mortality Rate and Neonatal Mortality Rate Historical Perspective The Millennium Development Goals (MDGs) The Sustainable Development Goals Tracking the Global Progress of the Sustainable Development Goals Global Burden of Maternal and Neonatal Deaths Maternal Mortality Neonatal and Infant Mortality Causes of Global Maternal and Neonatal Mortality Socioeconomic and Cultural Factors Influence of Political Instability, War, and Conflict Medical Causes of Neonatal Mortality Rate Prematurity Birth Asphyxia Hypothermia Infections Burden of Neonatal Sepsis Diagnosis of Neonatal Sepsis Evidence-Based Interventions to Reduce Maternal Mortality Rates, Neonatal Mortality Rates, and Infant Mortality Rates The Impact of Progress The Burden of the High Cost of Advanced Neonatal Care Long-Term Neurodevelopmental Outcome Ethical Dilemmas Strategies to Improve Global Neonatal and Perinatal Outcome Summary Acknowledgments Key Points References 9 9 Social and Economic Contributors to Neonatal Outcome in the United States Abstract Keywords Epidemiology of Health Disparities in Neonatal and Perinatal Medicine Infant Mortality Maternal Mortality Determinants of Prematurity and Adverse Outcomes Social Determinants of Health Interventions to Reduce Neonatal Health Outcome Disparities Key Points References 10 10 Genetic Aspects of Perinatal Disease and Prenatal Diagnosis Abstract Keywords Principles of Inheritance Chromosomal Disorders Maternal Age Considerations Abnormalities of Chromosome Number Triploidy and Tetraploidy Aneuploidy Abnormalities of Chromosome Structure Single-Gene Disorders Autosomal Dominant Disorders Advanced Paternal Age Autosomal Recessive Disorders Sex-Linked Disorders Non-Mendelian Patterns of Inheritance Mitochondrial Inheritance Epigenetics and Uniparental Disomy Trinucleotide Repeat Expansion Multifactorial Inheritance Teratogens Diagnostic Imaging Airline Flights Congenital Anomalies and Ultrasonography Screening Modalities Screening for Aneuploidies First-Trimester Screening Second-Trimester Screening Cell Free DNA Screening Future Directions for Non-Invasive Screening and Diagnosis Microdeletions The Role of First-Trimester Ultrasound Non-Invasive Prenatal Diagnosis (NIPD) Screening for Multifactorial Disorders Serum Alpha-Fetoprotein Screening for Mendelian Disorders Screening for Hemoglobinopathies Carrier Screening for Cystic Fibrosis Jewish Carrier Screening Carrier Screening for Spinal Muscular Atrophy Diagnostic Modalities Chorionic Villus Sampling (CVS) Amniocentesis Cordocentesis Technical Advances in Molecular Cytogenetics Microarray Technology Future Directions for Prenatal Diagnostic Testing Assisted Reproductive Technologies (ART) Genetic Evaluation and Counseling Key Points References 11 11 Perinatal Ultrasound Abstract Keywords Ultrasound Equipment Fetal Imaging Techniques Bioeffects and Safety Who Should Perform Fetal Ultrasound Examination? Ethical Considerations Classification of Fetal Sonographic Examinations A. First-Trimester Examination B. Standard Second- or Third-Trimester Examination C. Limited Examination D. Specialized Examinations Applications of Ultrasound Studies Genetic Screening Assisted Reproduction Multiple Gestations Pregnancy Evaluation Fetal Growth Placental Abnormalities Placental Location Amniotic Fluid Volume Cervical Length and Pelvic Structures Second-Trimester Ultrasound Study of the Fetus Doppler Ultrasound Doppler Studies of the Growth-Restricted Fetus Ultrasound-Guided Procedures Fetal Well-Being Assessment Fetal Anomalies Central Nervous System Fetal Ventriculomegaly Meningomyelocele and (Type II) Chiari Malformation The Skull and Brain in Spina Bifida Anencephaly Encephalocele Holoprosencephaly Dandy-Walker Malformation Choroid Plexus Cyst Spine Head and Neck Heart Gastrointestinal Tract Normal Bowel Appearance Esophageal Atresia and Tracheoesophageal Fistula Small Bowel Obstruction Anterior Abdominal Wall Defects Diaphragmatic Hernia and Thoracic Lesions Gallbladder and Bile Ducts Genitourinary Tract Musculoskeletal System Two-Vessel Umbilical Cord Summary Key Points References 12 12 Estimation of Fetal Well-Being Abstract Keywords Introduction Antepartum Fetal Surveillance Indications for Surveillance Physiologic Basis for Antenatal Surveillance Patient Assessment of Fetal Movement Non-Stress Test Contraction Stress Test Biophysical Profile Amniotic Fluid Volume Assessment Doppler Flow Velocimetry Interpretation of Test Results Evaluation of the Intrapartum Fetus Intrapartum Oxygenation and Neurologic Morbidity Continuous Versus Intermittent Fetal Heart Rate Monitoring Interpretation of Continuous FHR Recordings Baseline Fetal Heart Rate Fetal Heart Rate Variability Accelerations Decelerations Interpretative Systems for Classification of Fetal Heart Rate Patterns Category I Category II Category III Management of Non–Category I FHR Patterns During Labor Key Points References 13 13 Surgical Treatment of the Fetus Abstract Keywords Summary Fetal Access Percutaneous Interventions Fetoscopic Surgery Open Hysterotomy Exit Procedure Anesthetic Considerations Anomalies Amenable to Fetal Surgery Congenital Diaphragmatic Hernia Congenital Pulmonary Airway Malformations Fetal Hydrothorax Amniotic Bands Neoplastic Mass Lesions Sacrococcygeal Teratoma Fetal Neck Mass Myelomeningocele Urinary Tract Abnormalities Hydronephrosis Lower Urinary Tract Obstruction Abnormalities of Twin Gestations Twin–Twin Transfusion Syndrome Selective Fetal Reduction Congenital Heart Disease Conclusion Key Points References 14 14 Adverse Exposures to the Fetus and Neonate Abstract Keywords Exposures Not Concurrent With Pregnancy Preconceptual Effects The Epigenome Maternal Exposures Paternal Exposures Secondary Fetal Exposure: Maternal Body Burden Polychlorinated Biphenyls Lead Maternal Exposures Concurrent With Pregnancy Occupation and Paraoccupation Air Pollution Drinking Water Diet Pathways of Fetal Exposure Placenta-Dependent Pathways Placenta-Independent Pathways Radiation Heat Noise Fetal Pharmacokinetics Absorption and Distribution Metabolism Specific Exposures Cigarette Smoke Sources of Exposure Toxic Effects Prevention Strategies Ethanol Sources of Exposure Toxic Effects Prevention Strategies Pesticides Sources of Exposure Toxic Effects Prevention Strategies Bisphenol A, S, and F Sources of Exposure Toxic Effects Prevention Strategies Phthalates Sources of Exposure Toxic Effects Prevention Strategies Organic Solvents Sources of Exposure Toxic Effects Prevention Strategies Conclusions Key Points References 15 15 Intrauterine Growth Restriction Abstract Keywords Summary Definitions and Terminology The Health Burden of IUGR Classification of IUGR Etiology of IUGR Fetal Etiologies Maternal Etiologies Environmental Etiologies Placental Etiologies Pathophysiology Antenatal Screening and Prenatal Management Prevention Postnatal Diagnosis of IUGR Postnatal Management Hypoglycemia Hypothermia Respiratory Complications Necrotizing Enterocolitis Seizures, Intraventricular Hemorrhage Other Long-Term Consequences of IUGR Conclusions Key Points References 16 16 Developmental Origins of Adult Health and Disease Abstract Keywords Fetal Origins of Adult Disease Concept Influences on the Early Embryo Postnatal Growth and Nutrition Mismatch Concept Fetal Origins of Vascular Structural Abnormalities and Dysfunction in Adult Cardiometabolic Disease Placental Abnormalities and Association With Adult Disease Gestational Diabetes and Long-Term Metabolic Effects on Offspring Cancer Psychosocial Aspects Toxins, Endocrine Disrupters, and Micronutrient Metabolism (See Also Chapter 14) Epigenetics Translation to Neonatology Key Points References 17 17 Hypertensive Disorders of Pregnancy Abstract Keywords Classification of Hypertensive Disorders of Pregnancy Gestational Hypertension Preeclampsia Eclampsia Chronic Hypertension Superimposed Preeclampsia HELLP Syndrome Epidemiology of Preeclampsia Maternal Effects Short Term Recurrence in Subsequent Pregnancies Long-Term Cardiovascular Risks Fetal and Neonatal Effects Risk Factors Pregnancy-Specific Characteristics Maternal Characteristics Pathophysiology Angiogenic Factors Immunologic/Inflammatory Factors Renin Angiotensin System Genetics Endothelial Dysfunction Pathophysiology by Organ System Cardiovascular Renal Brain Hepatic Placenta Clinical Presentation of Preeclampsia Initial Evaluation Principles of Management Administration of Corticosteroids Seizure Prophylaxis Antihypertensive Therapy Ongoing Maternal and Fetal Surveillance Timing of Delivery Mode of Delivery Other Hypertensive Disorders of Pregnancy Gestational Hypertension HELLP Syndrome Chronic Hypertension Superimposed Preeclampsia Prediction Prevention Key Points References 18 18 Pregnancy Complicated by Diabetes Mellitus Abstract Keywords Gestational Diabetes Mellitus Screening and Diagnosis Antenatal Management Treatment Fetal Surveillance Screening for Congenital Anomalies Monitoring Fetal Well-Being Assessment of Fetal Weight Timing and Mode of Delivery Intrapartum Management Postpartum Maternal Management Pregestational Diabetes Mellitus Implications for the Neonate Breastfeeding in Women With Gestational Diabetes Mellitus Key Points References 19 19 Obstetric Management of Prematurity Abstract Keywords Prematurity Pathogenesis Risk Factors Demographics Obstetric History Cervical and Uterine Factors Multifetal Gestations Bleeding Infection Genetic Factors Other Risk Factors Predicting Preterm Labor Biochemical Predictors Ultrasound Predictors Prevention Treatment Bed Rest Hydration or Sedation Progesterone Cerclage Pessaries Tocolytics β-Sympathomimetic Agents Ritodrine Terbutaline Magnesium Sulfate Prostaglandin Synthetase Inhibitors Indomethacin Sulindac Cyclooxygenase-2 Inhibitors Calcium Channel Blockers Oxytocin Antagonists Nitric Oxide Donors Antibiotics Corticosteroids Additional Interventions Summary Acknowledgments Key Points References 20 20 Fetal Effects of Autoimmune Disease Abstract Keywords Placental Transfer: General Remarks Fetal Thrombocytopenia Immune Thrombocytopenic Purpura Neonatal Alloimmune Thrombocytopenia Management of the Neonate Management of a Subsequent Pregnancy Fetal-Neonatal Consequences of Maternal Antinuclear Antibodies Fetal-Neonatal Consequences of Maternal Antiphospholipid Antibodies Myasthenia Gravis Herpes Gestationis Summary Key Points References 21 21 Obstetric Management of Multiple Gestation and Birth Abstract Keywords Biology Maternal Consequences Fetal and Neonatal Consequences Malformations Embryonic and Fetal Demise Complications of the Monochorionic Placenta Fetal Growth Data From Multiple Birth Data Sets Levels of Discordance Mortality Birth Weight Discordance in Monochorionic Twins Delivery Considerations Outcome Summary: Prevention Versus Cure Key Points References 22 22 Post-Term Pregnancy Abstract Keywords Risks of Post-Term Pregnancy Macrosomia Dysmaturity Assessment of Fetal Well-Being Should Labor Be Induced Before 42 Weeks? How Should Labor Be Induced? Post-Term Twin Pregnancies Summary Key Points References 23 23 Immune and Nonimmune Hydrops Fetalis Abstract Keywords Immune Hydrops Fetalis Genetics of the Rh System Pathophysiology of Rh-D Isoimmunization Management Prevention Rh-Immunoglobulin Prophylaxis Preimplantation Diagnosis Rh Alloimmunization Prediction of Anemia Suppressive Therapy Intravenous Immunoglobulin Fetal Transfusion Intravascular Transfusion Intraperitoneal Transfusion Timing of Delivery Outcome Short Term Long Term Atypical Antigens Nonimmune Hydrops Fetalis Diagnosis Pathophysiology Differential Diagnosis/Etiology Antepartum Evaluation Management Prognosis Summary Key Points References 24 24 Amniotic Fluid Volume Abstract Keywords Amniotic Fluid Dynamics Composition Production and Regulation Measurement of Amniotic Fluid Volume Subjective Estimation Amniotic Fluid Index Measurement Single Deepest Pocket or Maximal Vertical Pocket Comparing Amniotic Fluid Assessment Techniques Other Techniques Normal Volume and the Singleton Pregnancy Twins and Amniotic Fluid Abnormalities of Amniotic Fluid Volume and Their Management Oligohydramnios Clinical Implications Etiology Diagnostic Evaluation Rule Out Ruptured Membranes Assess Fetal Anatomy Assess Fetal Growth Assess Fetal Pulmonary Status Treatment Maternal Hydration Amnioinfusion Tissue Sealants Polyhydramnios Clinical Implications Etiology Diagnostic Evaluation Assess Fetal Anatomy Treatment Amnioreduction Prostaglandin Synthetase Inhibitors Close Surveillance Management of Fluid Abnormalities in Multifetal Pregnancies The Future Key Points References 25 25 Perinatal Infections and Chorioamnionitis Abstract Keywords Definitions and Epidemiology Risk Factors Microbiology Diagnosis Pathogenesis Treatment Obstetric Management Management of the Exposed Infant Outcomes Areas for Future Investigation Key Points References 26 26 Placental Pathology Abstract Keywords Optimal Use of Pathology Service Structure, Function, and Pathologic Reaction Patterns Overview Maternal Uterine-Trophoblastic Lesions Fetal Stromal-Vascular Lesions Inflammatory and Infectious Lesions Inflammatory Graft-Versus-Host–Type Lesions Developmental and Structural Lesions Clinical Correlation Umbilical Cord Coiling Summary Key Points References 27 27 Anesthesia for Labor and Delivery Abstract Keywords Labor Pain Characteristics and Challenges Techniques That Modify Pain Nonpharmacologic Approaches Natural Childbirth Hypnosis Water Birth Acupuncture Pharmacokinetics, Pharmacodynamics, and the Fetus Sedatives Opioids Opioid Agonists Opioid Agonist-Antagonists Opioid Antagonists Nitrous Oxide Obstetric Nerve Blocks Paracervical Blocks Pudendal Blocks Neuraxial Blocks Techniques Lumbar Epidurals Patient-Controlled Epidural Analgesia (PCEA) Intrathecal Injections (Spinals) Combined Spinal-Epidurals (CSE) Programmed Intermittent Epidural Bolusing Maternal Risks and Benefits With Neuraxial Techniques Benefits Maternal Side Effects Maternal Risks Cesarean Sections Labor Prolongation Operative Vaginal Deliveries Maternal Temperature Elevation Inadvertent Injections and Excessively High Levels Benefits and Potential Risks for the Fetus Acid-Base Balance Fetal Heart Rate Breastfeeding Delivery Modes and Anesthetic Techniques Operative Vaginal Delivery Cesarean Section Neuraxial Anesthesia General Anesthesia Adjuvant Medications Key Points References 28 28 Physical Examination of the Newborn Abstract Keywords Routine Examination Preparation Introduction to the Parents Order of the Examination Measurements General Observation of Appearance, Posture, and Movements Syndromes Skin Head Eyes Ears Mouth and Palate Neck Breathing and Chest Heart Abdomen Genitalia Limbs and Hands and Feet Hips Back and Spine Posture and Muscle Tone Concluding the Exam Detailed Neurologic Assessment Level of Alertness Inspection Cranial Nerves Motor Function Deep Tendon Reflexes Developmental Reflexes Behavioral Evaluation Assessment of Gestational Age The Premature Infant Interpretation of the Neurologic Examination Limitations of the Routine Examination Jaundice Eye Abnormalities Congenital Heart Disease Developmental Dysplasia of the Hip Health Promotion Prevention of Sudden Unexpected Infant Death Syndrome Promotion of Breastfeeding Hearing, Vision, and Other Screening Discharge Key Points References 29 29 Birth Injuries Abstract Keywords Injuries to Soft Tissues Erythema and Abrasions Petechiae Etiology Differential Diagnosis Treatment Prognosis Ecchymoses Treatment Prognosis Subcutaneous Fat Necrosis Etiology Pathology Clinical Manifestations Differential Diagnosis Treatment Prognosis Lacerations Injuries to the Head Skull Caput Succedaneum Etiology Clinical Manifestations Differential Diagnosis Treatment Prognosis Cephalhematoma Etiology Clinical Manifestations Radiographic Manifestations Differential Diagnosis Treatment Prognosis Subgaleal Hemorrhage Etiology Mechanism of Injury Clinical Manifestations Radiographic Manifestations Differential Diagnosis Treatment Prognosis Skull Fractures Etiology Clinical Manifestations Radiographic Manifestations Differential Diagnosis Treatment Prognosis Intracranial Hemorrhage Face Facial Nerve Palsy Etiology Clinical Manifestations Differential Diagnosis Treatment Prognosis Fractures and Dislocations of Facial Bones Treatment Prognosis Eyes Eyelids Orbit Sympathetic Nervous System Subconjunctival Hemorrhage External Ocular Muscles Optic Nerve Cornea Intraocular Hemorrhage Ears Abrasions and Ecchymoses Hematomas Lacerations Vocal Cord Paralysis Etiology Clinical Manifestations Differential Diagnosis Treatment Prognosis Injuries to the Neck, Shoulder Girdle, and Chest Fracture of the Clavicle Etiology Clinical Manifestations Differential Diagnosis Treatment Prognosis Fracture of Ribs Etiology Clinical Manifestations Mechanism of Injury Treatment Prognosis Brachial Palsy Etiology Clinical Manifestations Differential Diagnosis Treatment Prognosis Phrenic Nerve Paralysis Etiology Clinical Manifestations Radiographic Manifestations Differential Diagnosis Treatment Prognosis Injury to the Sternocleidomastoid Muscle Etiology Clinical Manifestations Differential Diagnosis Treatment Prognosis Injuries to the Spine and Spinal Cord Etiology Clinical Manifestations Differential Diagnosis Treatment Prognosis Injuries to Intra-Abdominal Organs Rupture of the Liver Etiology Clinical Manifestations Differential Diagnosis Treatment Prognosis Rupture of the Spleen Etiology Clinical Manifestations Differential Diagnosis Treatment Prognosis Adrenal Hemorrhage Etiology Clinical Manifestations Radiographic Manifestations Differential Diagnosis Treatment Prognosis Renal Injury Etiology Clinical Manifestations Differential Diagnosis Treatment Prognosis Injuries to the Extremities Fracture of the Humerus Etiology Clinical Manifestations Differential Diagnosis Treatment Prognosis Fracture of the Radius Etiology Clinical Manifestations Treatment Prognosis Fracture of the Femur Etiology Clinical Manifestations Treatment Prognosis Dislocations Epiphyseal Separations Deep Tendon Injuries Risk Factors Associated With Deep Tendon Injury Management Other Peripheral Nerve Injuries Trauma to the Genitalia Scrotum and Labia Majora Deeper Structures Injuries Related to Intrapartum Fetal Monitoring Injuries Related to Direct Fetal Heart Rate Monitoring Injuries Related to Fetal Scalp Blood Sampling Injuries Related to Trauma During Pregnancy Key Points References 30 30 Congenital Anomalies Abstract Keywords General Clinical Approach Epidemiology and Etiology Major Malformations Genetic Complex or Multifactorial Single Gene (Mendelian) Chromosomal Environmental Exposure and Teratogens Unknown Anomalies in Aborted Fetuses Minor Anomalies and Phenotypic Variants Racial and Ethnic Differences Evaluation Patient and Family History Physical Examination Skin Hair Head Face Eyes Ears Nose Mouth Neck Chest Abdomen Anus Genitalia Spine Extremities Evaluation of the Stillborn Diagnostic Testing and Indications General Studies Genetic Laboratory Studies Genetic Counseling Educational Resources and Support Organizations Acknowledgments Key Points References 31 31 Overview and Initial Management of Delivery Room Resuscitation Abstract Keywords Fetus Transition at Birth Causes of Depression and Asphyxia Response to Asphyxia Preparation for Resuscitation Adequate Equipment Adequate Personnel Apgar Score Umbilical Cord Blood Gases Elements of a Resuscitation Initial Quick Overview Initial Steps Thermal Management Clearing the Airway Monitoring Tactile Stimulation and Assessment Free-Flow Oxygen Key Points References 32 32 Role of Positive Pressure Ventilation in Neonatal Resuscitation Abstract Keywords Normal Transition and Initial Spontaneous Breathing Delayed Transition and Need for Respiratory Support Basics of Positive Pressure Support Application of Noninvasive Positive Pressure Support How to Generate Positive Pressure Self-Inflating Bags (SIB) Flow-Inflating Bags (FIB) T-Piece Devices Other Options for Providing Positive Pressure Choosing an Interface to Deliver Positive Pressure Face Masks Single Nasal Tube and Bi-Nasal Prongs Assessing the Effectiveness of Non-Invasive Positive Pressure Ventilation Laryngeal Mask Airway Endotracheal Tube Intubation Procedure Applying Positive Pressure Support The First Breaths Peak Inflation Pressures and Tidal Volumes Positive End Expiratory Pressure Inflation Rate and Duration Gas Flow Key Points References 33 33 Oxygen Therapy in Neonatal Resuscitation Abstract Keywords Use of Oxygen in Perinatal Asphyxia and Resuscitation Oxidative Stress: Pathophysiologic Background Oxidative Stress: Differences Between Resuscitation With 100% Oxygen and Room Air Room Air versus Pure Oxygen for Resuscitation of the Newborn Animal Studies Clinical Data Oxygen Supplementation in the Delivery Room in Extremely Low Gestational Age Neonates Oxygen Saturation Nomogram Room Air versus 100% Oxygen— or Something Else Key Points References 34 34 Chest Compression, Medications, and Special Problems in Neonatal Resuscitation Abstract Keywords Importance of Effective Ventilation Chest Compressions Medications Epinephrine Volume Other Drugs Intravenous Access When to Discontinue Resuscitation Efforts Documentation and Debriefing Immediate Care After Establishing Adequate Ventilation and Circulation Induced Therapeutic Hypothermia Sodium Bicarbonate Naloxone Dopamine Prolonged Assisted Ventilation Glucose Fluids Feeding Other Problems Special Problems During Resuscitation Infants With Very Low Birth Weight and Extremely Premature Infants Meconium Aspiration Pneumothorax Congenital Diaphragmatic Hernia Erythroblastosis and Hydrops Fetalis Screening for Congenital Defects Physical Examination Key Points References 35 35 Thermal Environment of the Intensive Care Nursery Abstract Keywords Heat Exchange Physics The Four Modes of Heat Exchange Heat Exchange at Term Birth Evaporative Heat Loss Is Related to Infant Maturity and Ambient Humidity Respiratory Loss of Heat Thermal Physiology The Fetal Thermal Equilibrium Neonatal Thermoregulation Thermoneutrality Overwarming Versus Fever Hypothermia Temperature Monitoring Central (“Core”) Body Temperature What Temperature Should Be Aimed for? Peripheral Temperature and Central-Peripheral Temperature Difference Thermal Aspects of the Care Environment Convective Thermal Support—Incubator Care Incubator Humidification Radiant Thermal Support—Radiant Warmers Conductive Thermal Support— Skin-to-Skin Care Heated Mattresses and Cot Nursing Clothing Phototherapy Recommendations for Practice Before Birth Term and Moderate to Late Preterm (>32 Weeks) Infants Very (28-31 Weeks) and Extremely (