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  • Neonatology A Practical Approach to Neonatal Diseases

  • 123

    Giuseppe Buonocore • Rodolfo Bracci Michael Weindling Editors


    A Practical Approach to Neonatal Diseases

  • Editors

    Giuseppe Buonocore Michael Weindling Professor of Pediatrics and Neonatology Professor of Perinatal Medicine Head of School of Pediatrics University of Liverpool Department of Pediatrics, Obstetrics Director of Postgraduate Research and Reproductive Medicine Department of Women’s and Children’s Health Division of Neonatology Institute of Translational Medicine University of Siena Head of School of Paediatrics Mersey Deanery General Hospital S. Maria alle Scotte Liverpool Women’s Hospital Azienda Ospedaliera Universitaria Senese Liverpool, United Kingdom Siena, Italy

    Rodolfo Bracci Formerly Professor of Pediatrics and Head of Department of Pediatrics, Obstetrics and Reproductive Medicine University of Siena Siena, Italy

    ISBN 978-88-470-1404-6 e-ISBN 978-88-470-1405-3

    DOI 10.1007/978-88-470-1405-3

    Springer Milan Dordrecht Heidelberg London New York

    Library of Congress Control Number: 2011940798

    © Springer-Verlag Italia 2012

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  • All practitioners, doctors and nurses, who care for newborn babies have an enormous responsibility. They are entrusted with the care of approximately 130 million children who are born each year worldwide, about 20 million of whom are of low birth weight. Because they are born light and early, these children are at high risk of dying during the perinatal period, have reduced survival during infancy and are at risk of survival with cognitive impairment. Their health later in life may be adversely affected and even the next generation may suffer. Some babies become sick because they are born small, others because of inherited diseases, which often provide diagnostic and therapeutic challenges. Still others, about one in every thousand, have thrived during the pregnancy but are subjected to severe and potentially damaging hypoxic ischaemia at full-term. We firmly believe that good care can help improve the survival of these small vulnerable patients and this book was produced with the aim of providing healthcare practitioners in neonatology with an up-to-date, readily available and comprehensive source of prac- tical advice for the expert management of their patients and their diverse illnesses.

    Neonatology is a science in rapid evolution and all the contributors to this new text- book are experts in their fields, clinically active and committed to developing the best possible care for their patients. This book brings together their expertise in a clear and easy-to-follow manner. Although some may feel that in the age of the internet such a textbook is an anachronism, we feel passionately that those caring for newborn babies will be helped by the accessibility of the information, written by experts, in this single volume. Our intention is that healthcare practitioners with responsibility for babies will be helped by the knowledge of the contributors to this book and their collective expe- rience acquired over many years. The evidence base for practice has been set out where available, but there are gaps in the research-based evidence and sick babies still deserve to be given first-class care. We firmly believe that this textbook will enable the better delivery of such high quality care by making widely available the personal expertise of the contributors, who have been selected because of their international reputations and renown. We hope this textbook finds a place in the library of every neonatal unit and on the bookshelf of every practitioner committed to the care of newborn babies.

    The book has been organized in a logical manner. In the first section, relevant epi- demiology and fetal medicine are considered. Here consideration is given to epigenetic mechanisms and well as more traditional risk factors. Intrauterine growth restriction is considered from obstetric, neonatal and therapeutic aspects. There are chapters devoted to the difficult ethical problems in this area of care, how to make decisions, and how to measure the quality of the care that our small patients receive. The vital issue of follow up outcomes is considered, as well as the complexities of cerebral plasticity and func- tional reorganization in children with congenital brain lesions.

    The second section deals with therapeutic issues, including the organization of peri- natal care, transport services, resuscitation and oxygen toxicity, home care after dis- charge from hospital and the training of specialist doctors and nurses. Here legal issues are also considered. The third section on nutrition begins with a consideration of the


  • physiology of the gastrointestinal tract and of the developing endocrine milieu. Nutri- tion of the baby in hospital is considered in its various aspects, as is post-discharge nu- trition, calcium and phosphorous homeostasis and micronutrients and vitamins. Section IV provides a detailed consideration of the problems due to drugs taken during preg- nancy and there is an expert review of developmental pharmacology and therapeutics. Issues relating to infants born to mothers with diabetes are also considered here. Section V deals with the respiratory system in all its complexity, ranging from its development and physiology, through a consideration of the control of breathing and the molecular structure of surfactant and rare lung disorders, to practical therapeutic considerations. The following sections deal with the cardiovascular system, hyperbilirubinemia and liver diseases. Section VIII deals with surgery, including the treatment of orofacial mal- formations and necrotizing enterocolitis, and pre- and post- natal management. Subse- quent sections deal with hematology, immunology and inflammation, and the rare but important topic of neonatal malignancies. Sections on infection and endocrine and meta- bolic disease follow. Finally there are sections on neurology, including brain develop- ment, injury, electrophysiology and imaging, and relevant ophthalmology, orthopedics and dermatology.

    This book is comprehensive and provides an easily accessible single reference point. It is intended for all involved in the care of newborn babies – pediatricians, neonatal nurses, nurse practitioners, midwives, pediatric surgeons, anesthesiologists, neonatol- ogists and those training in these various areas.

    Siena and Liverpool, November 2011 Giuseppe Buonocore Rodolfo Bracci

    Michael Weindling Editors

    Acknowledgements The Editors are grateful to the Europe Against Infant Brain Injury (EURAIBI - Onlus) Foundation for its most generous support. Particular thanks to Barbara Marzocchi, who gave so much energy contacting contributors and getting back manuscripts, and to Marco Martorelli for his unfailing help in copy editing. Last, but no means least, we are very grateful to our trainees and residents, Sara Bertrando, Sara Cornacchione, Tei Monica, and Gemma Stazzoni, who carefully checked the index.

    VI Preface

  • Section I Epidemiology and Fetal Neonatal Medicine

    1 Epidemiology: Mortality and Morbidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Marcello Orzalesi and Carlo Corchia

    2 The Development from Fetus to Newborn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Domenico Arduini and Marianne Vendola

    3 General Characteristics of Preterm and Term Newborn . . . . . . . . . . 17 Stefano Parmigiani, Daniela Gianotti and Giulio Bevilacqua

    4 Risk Factors for Gestational Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Maria De Bonis, Michela Torricelli and Felice Petraglia

    5 Epigenetic Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Felicia M. Low, Emilia Tng and Peter D. Gluckman

    6 Congenital Malformations and Syndromes: Early Diagnosis and Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Giovanni Corsello and Mario Giuffrè

    7 Prenatal and Postnata