Sepsis. Full cultures and empirical antibiotic therapy may be started at the discretion of the physician.
Cold stress. Gradual rewarming is necessary, usually at a rate of ≤1°C/h. It can be accomplished by means of a radiant warmer or incubator or a heating pad. (See Chapter 7.)
Hypotension or shock. If the blood pressure is low because of depleted intravascular volume, give crystalloid (normal saline), 10 mL/kg intravenously for 5–10 minutes. (See Chapter 65.)
Hypoventilation. If suspected, it may be necessary to increase the pressure being given by the ventilator. The amount of pressure must be decided on an individual basis. One method is to increase the pressure by 2–4 cm H2O and then obtain blood gas levels in 20 minutes. Another method is to use bag-and-mask ventilation, observing the manometer to determine the amount of pressure needed to move the chest. (See Chapter 46.)
Pneumothorax. See Chapter 70.
Hypoglycemia. See Chapter 62.
Polycythemia. See Chapters 71 and 122.
Anemia secondary to acute blood loss. See Chapter 82.
NEC. See Chapter 113.
Left-sided obstructive heart lesions. Initial stabilization with respiratory support (endotracheal intubation and mechanical ventilation if poor respiratory effort and hypoxemia), volume resuscitation, inotropic support with dopamine for low cardiac output, and correction of metabolic acidosis. Immediate cardiac consultation. PGE1 is considered before diagnosis is confirmed if ductal-dependent systemic blood flow is suspected. The infant should be stabilized and transferred to a pediatric cardiac center. Surgery is usually indicated in all these patients. For a full discussion of cardiac abnormalities, see Chapter 89.
Cutis marmorata. If this condition is secondary to cold stress, treat the patient as described in Section V.B.2. If the condition persists, consider formal genetic testing for various syndromes noted. Thyroid studies will be necessary if hypothyroidism is suspected. If CNS dysfunction is suspected, this should be evaluated further.
Periventricular hemorrhage/intraventricular hemorrhage (PVH/IVH). Initial supportive care (maintain blood pressure, stabilize blood gases, transfuse if necessary, treat for seizures, etc.). After stabilization, close follow-up is required. Serial lumbar punctures may be necessary. (See also Chapter 104.)
Subgaleal hemorrhage. Early recognition, appropriate resuscitation, supportive care as in volume replacement, blood transfusion, and coagulation factors if necessary. Pressure wrapping of the head is controversial.
Inborn errors of metabolism. See Chapter 101.
Seizures. See Chapter 129.
Hematologic problems. Blood transfusions and diagnosing and treating the specific bleeding disorder are necessary.
Adrenal insufficiency. Blood volume replacement and steroid therapy are usually necessary.
Renovascular hypertension. Usually treated with aggressive medical management.
Intestinal problems. See Chapters 113 and 131.
Enteroviral infections. Supportive management. See Chapter 92. Systemic air embolism. Supportive cardiac and respiratory care. One hundred percent oxygen therapy, hyperbaric oxygen.
Chronic pain. See Chapter 14.