2025 – PAGE 178 – NEONATOLOGY

VERY LOW BIRTH WEIGHT (VLBW)

On admission to the ICU, 10% Dextrose in Water (D10W) is fine for a Very Low Birth Weight (VLBW) baby. Using D5 will provide insufficient calories.

PEARL: Electrolytes do not need to be added for the first 72 hours because of high free water losses.

PREGNANCY INDUCED HYPERTENSION (PIH)

Pregnancy Induced Hypertension (PIH) is associated with LOW weight, LOW length, and LARGE head.

NALOXONE

Do NOT use Naloxone in a baby with respiratory depression if the mother was on chronic opioids or ADDICTED to opioids. This can precipitate withdrawal and SEIZURES. If the mom was given opioids for PAIN CONTROL during labor, using naloxone for infant respiratory depression is acceptable.

FAILURE TO THRIVE (FTT)

Always look for dietary and psychosocial issues within the family first when dealing with Failure to Thrive (FTT) cases. Then look for organic causes, including cardiac, malabsorptive, metabolic, and renal issues.

PEARLS: RENAL TUBULAR ACIDOSIS is a VERY COMMON reason for FTT. Any child growing less than 5 cm/year needs a workup and a diagnosis, even if the overall height is “normal” for age.

ARTHROGRYPOSIS MULTIPLEX

Arthrogryposis multiplex is characterized by contractures due to idiopathic fetal akinesia (decreased fetal movement).

IMAGE: www.pbrlinks.com/ARTHROGRYPOSIS1

CEPHALOHEMATOMA

A cephalohematoma is a firm, localized and tense subperiosteal hematoma of the calvaria.

PEARL: It is subperiosteal, so it does NOT cross suture lines.

MNEMONIC: It has the word HEMATOMA in it. Like any hematoma, it is firm and tense, NOT boggy and soft like a caput.

CAPUT SUCCEDANEUM

Caput succedaneum is a swelling of the scalp from uterine wall or vaginal wall pressure; it results in a soft and boggy lesion on the head.

PEARL: CAN cross suture lines.

MNEMONIC: “Caput” is Latin for hat. Hats are placed on the scalp and cross multiple suture lines!