Dr. Richard Polin's Neonatology Questions and Controversies series highlights the toughest challenges facing physicians and care providers in clinical practice, offering trustworthy guidance on up-to-date diagnostic and treatment options in the field. In each volume, renowned experts address the clinical problems of greatest concern to today's practitioners, helping you handle difficult practice issues and provide optimal, evidence-based care to every patient.

Cover image
Title page
Table of Contents
Other Volumes in the Neonatology Questions and Controversies Series
Copyright
Contributors
Series Foreword
Preface
List of Illustrations
List of Tables
1. Neurological and neurobehavioral evaluation
What skill sets do neonates possess?
Overview of the history of neurological and neurobehavioral assessment
The neurological exam
Beyond the neuro exam: The neurobehavioral assessment
The value of the bedside exam
Choosing the right neurobehavioral assessment
Neurobehavioral assessment training
Tools available for the perinatal period
Other assessments during the neonatal period
Developmental assessments that include the birth time frame
Beyond the neurobehavioral assessment
Standardized assessments of oral feeding during the perinatal period
Importance of early assessment
Acknowledgments
References
2. Cerebral circulation and hypotension in the premature infant: Diagnosis and treatment
Key points
Introduction
Definition of hypotension
Pathogenesis and diagnosis of pathologic cerebral blood flow
Monitoring of blood pressure, systemic and organ blood flow, and cerebral function
Treatment strategies
Summary and recommendations
Acknowledgment
References
3. Intraventricular hemorrhage in the premature infant
Background
Case history
Neuropathology: Relevance to clinical findings
Pathogenesis
Periventricular white matter injury associated with IVH
Clinical features
Complications
Prevention
Postnatal factors associated with an increased risk
Postnatal administration of medications to reduce severe IVH
Indomethacin
Nursing care interventions
Outcome
Gaps in knowledge
Conclusions
References
4. White matter injury in the premature infant
Case history
The scope and spectrum of white matter injury
Diagnosis and imaging
Pathogenesis
Chronic diffuse WMI
Clinical risk factors for WMI
Outcome
Treatment
Gaps in knowledge
References
5. Cerebellar hemorrhage in the preterm newborn
Key points
Case history
Introduction
Cerebellar development, organization, functional topography, and injury
Preterm cerebellar hemorrhage
Outcomes following preterm cerebellar hemorrhage
Returning to the case
Conclusions
References
6. Posthemorrhagic hydrocephalus management strategies
Case history: Infant A
Question 1: What measurements of ventricular size are used in diagnosis of PHVD?
Question 2: How can ventricular dilation driven by cerebrospinal fluid under pressure be distinguished from ventricular dilation due to loss of periventricular white matter?
Question 3: How is excessive head enlargement defined?
Question 4: How is raised intracranial pressure recognized?
Question 5: What is infant A's prognosis?
Question 6: What is the mechanism of PHVD?
Question 7: How can PHVD injure white matter?
Question 8: What interventions have been used in PHVD? When should intervention be started and is there evidence of improved outcome?
When should intervention be started?
Ventriculo-subgaleal shunt
Ventricular lavage
Stem cell therapy
Conclusions on clinical management
Areas where further research is needed
References
7. Recent trials for hypoxic-ischemic encephalopathy: Extending hypothermia to infants not previously studied
Key points
Introduction
Rationale for further investigations of therapeutic hypothermia
What is the optimal temperature and duration for therapeutic hypothermia?
Does rewarming affect neuroprotection?
How late can hypothermia be initiated?
Should infants with mild HIE receive hypothermia therapy?
Should hypothermia be used in preterm infants with HIE?
How should cooling on transport be conducted?
Is therapeutic hypothermia neuroprotective when used in low- and middle-income countries?
Use of adjunct erythropoietin therapy: high dose erythropoietin for asphyxia and encephalopathy (HEAL) updates
Conclusions
References
8. General supportive management of the term infant with neonatal encephalopathy following intrapartum hypoxia-ischemia
Key points
Case history
Introduction
Delivery room management
Early identification of infants at highest risk for development of hypoxic-ischemic brain injury
Supportive care
Potential neuroprotective strategies aimed at ameliorating secondary brain injury
Conclusions
Gaps in knowledge
References
9. Diagnosis and management of acute symptomatic seizures in neonates
Neonatal seizures introduction
Diagnosis
Seizure causes in neonates
Seizure treatment
Prognosis
Conclusions
References
10. Glucose and perinatal brain injury: Questions and controversies
Introduction
Perinatal glucose regulation
Mechanisms underlying hypoglycemia-induced brain injury
Hypoglycemia and neurologic markers
Measurement of blood glucose in neonates
Definitions of hypoglycemia
Hypoglycemia and developmental outcomes
Prevention and treatment of hypoglycemia
Unanswered questions and key controversies
Conclusions
References
11. Neonatal meningitis: Current treatment options an update
Summary
Question 1: What risk factors predispose this infant to have early-onset bacterial meningitis?
Question 2: Do infants with meningitis have positive blood cultures?
Question 3: What is the optimal evaluation for possible late-onset sepsis in preterm infants in the NICU-when should a lumbar puncture be included?
Question 4: What factors can make a lumbar puncture be most successful?
Question 5: What is the empirical antimicrobial choice for possible late-onset sepsis in the NICU?
Question 6: What is the treatment of meningitis in neonates, particularly that caused by gram-negative bacilli?
Question 7: Do intrathecal or intraventricular antibiotic treatment have a role?
Question 8: What is the duration of treatment for meningitis in neonates?
Question 9: When should neuroimaging be considered, and what type of examination is recommended?
Question 10: Should other adjunctive therapies be provided to an infant with meningitis?
Question 11: What if the infant's CSF is abnormal but routine bacterial cultures of CSF and blood are sterile?
Question 12: What is the outcome of meningitis in neonates?
Conclusion
References
12. Neonatal herpes simplex vi rus, congenital cytomegalovirus, congenital Zika, and congenital and neonatal SARS-CoV-2 virus infections
Key points
Question 1: When does infection occur?
Congenital SARS-CoV-2 or neonatal SARS-CoV-2 infection
Question 2: What are the risk factors for neonatal infection?
Congenital SARS-CoV-2 or neonatal SARS-CoV-2
Question 3: What are the clinical manifestations of neonatal infection and disease?
Congenital SARS-CoV-2 or neonatal SARS-CoV-2 infection
Question 4: What are the treatments and outcomes for HSV, CMV, Zika, and SARS-CoV-2 virus infections in neonates?
Question 5: Do all infants with HSV, CMV, Zika, and SARS-CoV-2 infections have to be treated?
Question 6: What is the appropriate diagnostic approach to an infant in whom HSV, CMV, congenital Zika, or congenital SARS-CoV-2 infection is suspected?
Question 7: How should you monitor the response to treatment?
Question 8: What are the biggest gaps in our current understanding of the natural history, diagnosis, and management of these infections?
Conclusions
References
13. Neonatal hypotonia and neuromuscular disorders
Gaps in knowledge
Introduction
Definition of hypotonia
Physical examination and assessment of a hypotonic child
Differential anatomic diagnosis of hypotonia
Common neuromuscular disorders presenting principally with hypotonia
Muscle disorders
Approach to hypotonia
References
14. Amplitude-integrated EEG and its potential role in improving neonatal care within the NICU
Case description (Fig. 14.1)
Key points
Introduction
Amplitude-integrated EEG
Comparison with cEEG
Pitfalls and artifacts
Gaps in knowledge
Conclusion
References
15. Magnetic resonance imaging newer techniques and overall value in diagnosis and predicting long-term outcome
Introduction
Brain injury in the term newborn
Cranial ultrasonography in the evaluation of perinatal asphyxia or HIE
MR techniques in the evaluation of perinatal asphyxia or HIE
MRI in the settings of therapeutic neonatal hypothermia
Focal and multifocal ischemic brain necrosis without asphyxia
MR techniques in the evaluation of focal ischemic infarction in the term newborn
Traumatic brain lesions of the posterior fossa
MR techniques in the evaluation of traumatic brain injury in the term newborn
Brain injury in the preterm infant
Cranial ultrasonography in the preterm infant
Advanced quantitative MRI with image analysis tools
References
16. Congenital heart disease: An important cause of brain injury and dysmaturation
Key points
Introduction
CHD etiology and malformation grouping
Brain dysmaturation and brain injury in CHD
Key contributors to neurodevelopmental outcomes in CHD
Neuroprotective strategies under investigation
Knowledge gaps and future directions
Acknowledgments
References
17. Neurodevelopmental outcomes following very preterm birth: What clinicians need to know
Introduction
Neurodevelopmental outcomes following very preterm birth
Rates of impairments
Neurodevelopmental profiles
Developmental stability
Changing neurodevelopmental outcomes with medical advances
Factors contributing to variable outcomes
Key points and recommendations
References
Index