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Book Details
Abstract
Dr. Richard Polin’s Neonatology Questions and Controversies series highlights the most challenging aspects of neonatal care, 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.
- Stay fully up to date in this fast-changing field with Infectious Disease and Pharmacology, an all-new volume in the series.
- Thorough, up-to-date content on the epidemiology, clinical manifestations, treatment, and outcomes for neonatal-perinatal infections, including necrotizing enterocolitis, neonatal HSV, and congenital Zika virus infection.
- The latest information on dosing of antibiotics, antivirals, and antifungals.
- Current coverage of therapies for neonatal gastroesophageal reflux, seizures, neuroprotection, and neonatal abstinence syndrome, as well as pharmacokinetic and pharmacogenetic considerations in neonatal care.
- Consistent chapter organization to help you find information quickly and easily.
- The most authoritative advice available from world-class neonatologists who share their knowledge of new trends and developments in neonatal care.
Purchase each volume individually, or get the entire 7-volume set! Gastroenterology and Nutrition Hematology, Immunology and Genetics Hemodynamics and Cardiology Infectious Disease and Pharmacology New Volume! Nephrology and Fluid/Electrolyte Physiology Neurology The Newborn Lung
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Half title page | i | ||
| Front Matter | ii | ||
| Infectious Disease and Pharmacology | ii | ||
| Infectious Disease and Pharmacology | iii | ||
| Copyright Page | iv | ||
| Contributors | v | ||
| Series Foreword | ix | ||
| Preface | xi | ||
| Table Of Contents | xiii | ||
| A Infectious Disease | 1 | ||
| 1 Management of the Asymptomatic Newborn at Risk for Sepsis | 3 | ||
| Abstract | 3.e1 | ||
| Keywords | 3.e1 | ||
| Introduction | 3 | ||
| Approaches to EOS Risk Assessment Among Well-Appearing Term Infants | 4 | ||
| Areas of Controversy | 6 | ||
| References | 11 | ||
| 2 Empiric Antimicrobials for Neonatal Sepsis | 15 | ||
| Abstract | 15.e1 | ||
| Keywords | 15.e1 | ||
| Early-Onset Sepsis | 15 | ||
| Ampicillin and Gentamicin | 16 | ||
| Ampicillin | 16 | ||
| Gentamicin | 16 | ||
| Limitations of Ampicillin and Gentamicin | 17 | ||
| Ampicillin Concerns | 17 | ||
| Gentamicin Concerns | 17 | ||
| Timing of Antibiotic Initiation | 17 | ||
| Late-Onset Sepsis | 18 | ||
| Ampicillin | 18 | ||
| Vancomycin | 19 | ||
| Nafcillin/Oxacillin | 19 | ||
| Cefazolin | 20 | ||
| Cefotaxime | 20 | ||
| Gentamicin | 21 | ||
| Pseudomonas Coverage | 21 | ||
| Antifungals | 21 | ||
| Antivirals | 22 | ||
| Conclusion | 22 | ||
| References | 22 | ||
| 3 When and How to Treat Neonatal CMV Infection | 27 | ||
| Abstract | 27.e1 | ||
| Keywords | 27.e1 | ||
| Clinical Significance | 27 | ||
| Congenital CMV Transmission and Outcomes | 27 | ||
| Postnatal CMV Transmission and Outcomes | 28 | ||
| Treatment of Congenital CMV | 28 | ||
| Congenital CMV With Central Nervous System Involvement | 28 | ||
| Limitations and Future Research | 30 | ||
| Summary | 30 | ||
| Symptomatic Congenital CMV Without CNS Involvement and Asymptomatic Congenital CMV | 30 | ||
| Symptomatic Congenital CMV Without CNS Involvement | 30 | ||
| Asymptomatic Congenital CMV Infection | 31 | ||
| Limitations and Future Research | 32 | ||
| Summary | 32 | ||
| Treatment of Postnatal CMV Infection | 32 | ||
| Limitations and Future Research | 33 | ||
| Summary | 33 | ||
| References | 33 | ||
| 4 Neonatal Herpes Simplex Virus Infection | 37 | ||
| Abstract | 37.e1 | ||
| Keywords | 37.e1 | ||
| Introduction | 37 | ||
| Timing of Infection | 37 | ||
| Risk Factors for Neonatal Infection | 37 | ||
| Clinical Manifestations of Neonatal Infection and Disease | 38 | ||
| Diagnosis of Neonatal HSV Disease | 39 | ||
| Treatment of Neonatal HSV Disease | 40 | ||
| Outcomes of Neonatal HSV With Treatment | 42 | ||
| Conclusion | 42 | ||
| References | 43 | ||
| 5 Antibiotic Stewardship | 45 | ||
| Abstract | 45.e1 | ||
| Keywords | 45.e1 | ||
| Introduction | 45 | ||
| Rationale for Empiric Use of Antibiotics in Infants: What Is Causing the Infections? | 46 | ||
| Variations in Antimicrobial Practice: What Is the Range of Practice Among Neonatologists? | 47 | ||
| Empiric Broad-Spectrum and Prolonged Antibiotic Use and NICU Outcomes | 48 | ||
| Antibiotic Resistance: Emerging Problem for Neonatal Infections | 48 | ||
| Antibiotic Practice and Stewardship Efforts in NICUs | 49 | ||
| Starting Antibiotics: Who to Treat? | 49 | ||
| Biomarkers for Neonatal Infection: Are They Useful? | 50 | ||
| Initial Therapy for Suspected Early- and Late-Onset Sepsis: What to Use? | 51 | ||
| Reevaluating Antibiotic Therapy: How Long to Treat? | 52 | ||
| Reducing Infection Risk | 53 | ||
| Examples of Targeted Antibiotic Stewardship | 53 | ||
| National Attention for Antibiotic Stewardship | 54 | ||
| Summary | 55 | ||
| References | 56 | ||
| 6 Candida Prophylaxis | 63 | ||
| Abstract | 63.e1 | ||
| Keywords | 63.e1 | ||
| Epidemiology | 63 | ||
| Incidence and Mortality | 63 | ||
| Candida Species in Infants | 64 | ||
| Risk Factors | 64 | ||
| Prophylaxis | 64 | ||
| Fluconazole | 64 | ||
| Evidence for Efficacy of Fluconazole | 64 | ||
| Dosage for Fluconazole Prophylaxis | 65 | ||
| Antifungal Prophylaxis and Development of Resistance | 66 | ||
| Number Needed to Treat (NNT) | 66 | ||
| Conclusions | 66 | ||
| References | 66 | ||
| 7 Diagnosis, Risk Factors, Outcomes, and Evaluation of Invasive Candida Infections | 69 | ||
| Abstract | 69.e1 | ||
| Keywords | 69.e1 | ||
| How Are ICI Infections Defined? | 69 | ||
| How Does Candida Cause Invasive Infections? (Fig. 7.1) | 70 | ||
| What Are Predisposing Factors for ICI in the NICU? | 70 | ||
| Prematurity | 70 | ||
| Colonization (Fig. 7.1 and Table 7.1) | 70 | ||
| The Immune System | 72 | ||
| The Gut Microbiome | 72 | ||
| Medications | 73 | ||
| Lines, Tubes, and Feedings | 73 | ||
| Gastrointestinal Pathology and Abdominal Surgery | 73 | ||
| Candida Pathogenesis | 73 | ||
| Biofilm Formation (Fig. 7.3A) | 73 | ||
| Evading Host Immune System (Fig. 7.3B) | 73 | ||
| Morphologic Switching (Fig. 7.3C) | 74 | ||
| Hydrolyzing Enzymes (Fig. 7.3D) | 74 | ||
| Which Organisms Cause ICI in the NICU? | 74 | ||
| What Is the Incidence of ICI in the NICU? | 75 | ||
| What Are the Associated Morbidities and Mortality? | 75 | ||
| Neurodevelopmental Impairment (NDI) | 75 | ||
| Survival | 75 | ||
| Invasive Candida Infections (Fig. 7.4) | 76 | ||
| Congenital Cutaneous Candidiasis | 76 | ||
| Cutaneous Candidiasis (CC) | 76 | ||
| Candidemia | 77 | ||
| Renal Candidiasis | 79 | ||
| Urinary Tract Infection | 79 | ||
| Renal Abscess | 79 | ||
| Central Nervous System (CNS) Candidiasis and Sequelae | 79 | ||
| Meningitis and Encephalitis | 79 | ||
| Central Nervous System Abscess | 80 | ||
| Gastrointestinal Disease | 80 | ||
| Peritonitis | 80 | ||
| Respiratory Disease | 80 | ||
| Pneumonia | 80 | ||
| Endocarditis and Infected Vascular Thrombi | 80 | ||
| Endophthalmitis and Retinopathy of Prematurity | 80 | ||
| End-Organ Dissemination | 81 | ||
| Screening and Diagnosis of End-Organ Dissemination With ICI (Fig. 7.4) | 81 | ||
| Are Cultures Perfect? | 81 | ||
| How Good Are the Newer Laboratory Diagnostic Adjunctive Tests? | 82 | ||
| References | 83 | ||
| 8 When to Perform Lumbar Puncture in Infants at Risk for Meningitis in the Neonatal Intensive Care Unit | 87 | ||
| Abstract | 87.e1 | ||
| Keywords | 87.e1 | ||
| Introduction | 87 | ||
| Increased Susceptibility to Meningitis in Premature Infants | 88 | ||
| Role of Lumbar Puncture in the Evaluation of Early-Onset Sepsis | 88 | ||
| Role of Lumbar Puncture in the Evaluation of Late-Onset Sepsis | 89 | ||
| Role of Lumbar Puncture in Viral Meningitis | 91 | ||
| Risks Associated With Lumbar Punctures in Newborn Infants | 92 | ||
| Are There Any Contraindications to Performing a Lumbar Puncture in the Newborn Infant? | 93 | ||
| Lumbar Punctures in the Setting of Antibiotic Exposure: Are They Useful? | 94 | ||
| Repeating Lumbar Punctures in Infants With Meningitis: Is It Necessary? | 95 | ||
| Lumbar Punctures in Infants With Intraventricular Drainage Device–Associated Infection | 96 | ||
| Summary | 96 | ||
| References | 97 | ||
| 9 Biomarkers in the Diagnosis of Neonatal Sepsis | 103 | ||
| Abstract | 103.e1 | ||
| Keywords | 103.e1 | ||
| Introduction | 103 | ||
| Pathogen Biomarkers | 104 | ||
| Host Response | 104 | ||
| Acute-Phase Response Proteins | 105 | ||
| WBC and WBC Indices | 106 | ||
| WBC Surface Markers | 107 | ||
| Metabolomic, Proteomic, and Transcriptomic Biomarker Approaches | 108 | ||
| Summary | 109 | ||
| References | 109 | ||
| 10 Congenital Zika Syndrome | 113 | ||
| Abstract | 113.e1 | ||
| Keywords | 113.e1 | ||
| The Zika Virus | 113 | ||
| Mode of Transmission | 113 | ||
| Mechanisms of Vertical Transmission | 113 | ||
| Maternal Infection During Pregnancy | 114 | ||
| Fetal Infection | 115 | ||
| The Congenital ZIKA Syndrome | 115 | ||
| Ocular Anomalies | 117 | ||
| Hearing | 117 | ||
| Neuroimaging | 118 | ||
| Diagnosis | 118 | ||
| Serologic Testing | 119 | ||
| Amniocentesis | 119 | ||
| Differential Diagnosis | 119 | ||
| Supportive Care to Children and Families: Early Intervention in Development | 119 | ||
| Prevention and Treatment | 119 | ||
| References | 120 | ||
| B Pharmacology | 121 | ||
| 11 Pharmacokinetic Considerations in Neonates | 123 | ||
| Abstract | 123.e1 | ||
| Keywords | 123.e1 | ||
| Introduction | 123 | ||
| Clinical Pharmacokinetic Principles | 124 | ||
| Pharmacokinetic Exposure Measures | 124 | ||
| Volume of Distribution | 125 | ||
| Clearance | 126 | ||
| Elimination Rate Constant, Half-Life, and Steady-State | 127 | ||
| Linear versus Nonlinear Pharmacokinetics | 130 | ||
| Pharmacokinetic Variation in Neonates | 131 | ||
| Volume of Distribution Considerations | 131 | ||
| Clearance Considerations | 132 | ||
| Size | 132 | ||
| Maturation and Development | 134 | ||
| Pathophysiology and Organ Function | 136 | ||
| Dosing Strategies and Therapeutic Drug Monitoring | 137 | ||
| References | 138 | ||
| 12 Neonatal Pharmacogenetics | 141 | ||
| Abstract | 141.e1 | ||
| Keywords | 141.e1 | ||
| Introduction to Pharmacogenetics | 141 | ||
| Intersection of Ontogeny and Pharmacogenetics | 143 | ||
| Pharmacogenetics of the Dose → Exposure → Response Paradigm | 146 | ||
| Examples of Pharmacogenetics Relevant to Neonatology | 147 | ||
| Maternal SNPs and Drug Effects During Pregnancy and Lactation | 147 | ||
| Pharmacogenetics of Pain Medications | 148 | ||
| Pharmacogenetics of Neonatal Abstinence Syndrome | 150 | ||
| Pharmacogenetics of Steroid Treatment for Bronchospasm | 151 | ||
| Conclusion | 151 | ||
| References | 152 | ||
| 13 Antibiotic Considerations for Necrotizing Enterocolitis | 155 | ||
| Abstract | 155.e1 | ||
| Keywords | 155.e1 | ||
| Pathogenesis of Necrotizing Enterocolitis | 155 | ||
| Clinical Presentation and Diagnosis of Necrotizing Enterocolitis | 156 | ||
| Management of Necrotizing Enterocolitis | 157 | ||
| Antimicrobial Therapy | 157 | ||
| Ampicillin | 157 | ||
| Cefotaxime | 157 | ||
| Piperacillin-Tazobactam | 158 | ||
| Meropenem | 159 | ||
| Gentamicin | 159 | ||
| Clindamycin | 159 | ||
| Metronidazole | 159 | ||
| Fluconazole | 160 | ||
| Antimicrobial Regimens | 160 | ||
| Duration of Medical Treatment | 161 | ||
| Bowel Rest and Supportive Care | 161 | ||
| Surgical Intervention | 162 | ||
| Prevention of Necrotizing Enterocolitis | 162 | ||
| Conclusion | 162 | ||
| References | 162 | ||
| 14 Antibiotic Dosing Considerations for Term and Preterm Infants | 167 | ||
| Abstract | 167.e1 | ||
| Keywords | 167.e1 | ||
| Introduction | 167 | ||
| Antibiotic Dosing Based on Markers of Neonatal Growth and Maturation | 168 | ||
| Postnatal Age | 169 | ||
| Postmenstrual Age | 174 | ||
| Birth Weight and Postnatal Age | 174 | ||
| Postnatal Age and Gestational Age | 174 | ||
| Antibiotic Dosing Based on Indicators of Renal Dysfunction | 174 | ||
| Serum Creatinine | 175 | ||
| Glomerular Filtration Rate | 175 | ||
| Cystatin-C | 177 | ||
| Other Potential Biomarkers | 177 | ||
| Continuous, Prolonged, and Extended Infusion Dosing Regimens | 177 | ||
| Continuous Infusion | 178 | ||
| Prolonged Infusions | 178 | ||
| Extended Interval | 178 | ||
| Dosing Targeting the Central Nervous System | 179 | ||
| Dosing to Prevent Surgical Site Infections | 180 | ||
| Dosing in Severe Illness | 180 | ||
| Extracorporeal Membrane Oxygenation | 180 | ||
| Hypothermia | 181 | ||
| Conclusion | 181 | ||
| References | 181 | ||
| 15 Antifungal Dosing Considerations for Term and Preterm Infants | 185 | ||
| Abstract | 185.e1 | ||
| Keywords | 185.e1 | ||
| Introduction | 185 | ||
| Case Study | 186 | ||
| Triazoles | 187 | ||
| Polyenes (Conventional and Lipid-Preparation Amphotericin B) | 187 | ||
| Echinocandins | 188 | ||
| Conclusion | 189 | ||
| References | 189 | ||
| 16 Antiviral Dosing Considerations for Term and Preterm Infants | 193 | ||
| Abstract | 193.e1 | ||
| Keywords | 193.e1 | ||
| Introduction | 193 | ||
| Acyclovir and Valacyclovir for HSV Infections | 194 | ||
| Clinical Pharmacology and PK | 194 | ||
| PD Targets for Efficacy and Safety | 195 | ||
| Safety Considerations | 195 | ||
| Dosing Considerations for Neonatal HSV | 196 | ||
| Oral Suppressive Therapy | 197 | ||
| Ganciclovir and Its Oral Prodrug Valganciclovir | 197 | ||
| Clinical Pharmacology and PK | 197 | ||
| PD Targets for Efficacy and Safety | 198 | ||
| Safety Considerations | 199 | ||
| Dosing Considerations for Symptomatic Congenital CMV | 199 | ||
| Oseltamivir for Treatment of Influenza Infections | 199 | ||
| Brief Synopsis: Clinical Pharmacology, PK, and PD | 200 | ||
| Safety Considerations | 201 | ||
| Dosing Considerations for Influenza Infections | 201 | ||
| Medications Used to Prevent Perinatal Transmission of HIV | 202 | ||
| Single-Drug Prevention With Zidovudine | 202 | ||
| Combination Antiretroviral Prophylaxis Therapy | 202 | ||
| Conclusion | 203 | ||
| References | 203 | ||
| 17 Antiepileptic Drug Therapy in Neonates | 207 | ||
| Abstract | 207.e1 | ||
| Keywords | 207.e1 | ||
| Introduction | 207 | ||
| Goals of Therapy | 207 | ||
| Overview of Therapy | 208 | ||
| Antiepileptic Drugs | 209 | ||
| Phenobarbital | 209 | ||
| Mechanism of Action | 209 | ||
| Efficacy | 210 | ||
| Dosing | 211 | ||
| Adverse Effects, Contraindications, and Monitoring | 212 | ||
| Phenytoin/Fosphenytoin | 212 | ||
| Mechanism of Action | 212 | ||
| Efficacy | 212 | ||
| Dosing | 212 | ||
| Adverse Effects, Contraindications, and Monitoring | 213 | ||
| Lidocaine | 213 | ||
| Mechanism of Action | 213 | ||
| Efficacy | 213 | ||
| Dosing | 214 | ||
| Adverse Effects, Contraindications, and Monitoring | 214 | ||
| Benzodiazepines | 215 | ||
| Mechanism of Action | 215 | ||
| Efficacy | 215 | ||
| Dosing | 215 | ||
| Adverse Effects, Contraindications, and Monitoring | 216 | ||
| Levetiracetam | 216 | ||
| Mechanism of Action | 216 | ||
| Efficacy | 216 | ||
| Dosing | 217 | ||
| Adverse Effects, Contraindications, and Monitoring | 217 | ||
| Emerging Therapies | 218 | ||
| Topiramate | 218 | ||
| Carbamazepine | 218 | ||
| Valproic Acid | 219 | ||
| Bumetanide | 219 | ||
| Other Therapies | 219 | ||
| Ketogenic Diet | 219 | ||
| Surgery | 220 | ||
| Vitamin Supplementation | 220 | ||
| Pyridoxine | 220 | ||
| Pyridoxal 5ʹ-phosphate (PLP) | 221 | ||
| Folinic Acid | 221 | ||
| Biotin | 221 | ||
| Discontinuation of Therapy | 221 | ||
| Conclusion | 222 | ||
| References | 222 | ||
| 18 Neuroprotective Therapies in Infants | 227 | ||
| Abstract | 227.e1 | ||
| Keywords | 227.e1 | ||
| Introduction | 227 | ||
| Neuroprotective Therapies and Strategies for Premature Infants | 228 | ||
| Care Bundles to Reduce IVH and Improve Neurodevelopmental Outcome | 229 | ||
| Antenatal Betamethasone | 229 | ||
| Magnesium Sulfate | 230 | ||
| Caffeine | 230 | ||
| Indomethacin | 231 | ||
| Erythropoiesis-Stimulating Agents (ESAs): Erythropoietin/Darbepoetin | 231 | ||
| Management of Pain Versus Impact of Analgesics and Sedatives on the Developing Brain | 232 | ||
| Neuroprotective Strategies for Term Infants | 233 | ||
| Clinically Available Treatments | 234 | ||
| Therapeutic Hypothermia | 234 | ||
| Therapies Under Study | 234 | ||
| Erythropoiesis-Stimulating Agents (ESAs) | 234 | ||
| Topiramate | 235 | ||
| Xenon | 235 | ||
| Melatonin | 236 | ||
| Allopurinol | 236 | ||
| Magnesium Sulfate | 237 | ||
| Stem Cell Therapy | 237 | ||
| References | 238 | ||
| 19 Pharmacologic Therapy for Neonatal Abstinence Syndrome | 243 | ||
| Abstract | 243.e1 | ||
| Keywords | 243.e1 | ||
| Incidence | 243 | ||
| Etiology | 244 | ||
| Pathophysiology | 245 | ||
| Clinical Presentation | 245 | ||
| Management | 246 | ||
| Nonpharmacologic Management | 246 | ||
| Pharmacologic Management | 247 | ||
| Protocol or No Protocol | 247 | ||
| Medications | 247 | ||
| Morphine | 249 | ||
| Methadone | 249 | ||
| Morphine or Methadone | 249 | ||
| Morphine: Score-Based or Weight-Based Dosing | 251 | ||
| Methadone: Standard Weaning or Pharmacokinetic Weaning | 253 | ||
| Buprenorphine | 253 | ||
| Phenobarbital | 253 | ||
| Clonidine | 254 | ||
| Adjunct Medications | 254 | ||
| Discharge and Follow-up | 254 | ||
| References | 255 | ||
| 20 Therapies for Gastroesophageal Reflux in Infants | 261 | ||
| Abstract | 261.e1 | ||
| Keywords | 261.e1 | ||
| Introduction | 261 | ||
| Pathogenesis of Reflux Disorders in Infants | 262 | ||
| Factors That Can Exacerbate Reflux in Infants | 262 | ||
| Clinical Presentation | 263 | ||
| Associations Between GERD and Other Extraesophageal Signs | 263 | ||
| Differential Diagnosis | 264 | ||
| Cow’s Milk Protein Allergy | 265 | ||
| Tools for Diagnosis | 265 | ||
| Radiologic Testing for GERD | 265 | ||
| Intraesophageal Monitoring for Acid and Nonacid Reflux | 265 | ||
| Endoscopy | 266 | ||
| Treatment | 266 | ||
| Nondrug Management | 266 | ||
| Thickening Feeds to Treat GER | 267 | ||
| Dietary Changes | 267 | ||
| Transpyloric Feeds | 268 | ||
| Fundoplication | 268 | ||
| Other Lifestyle Changes | 268 | ||
| Medications to Treat Gastroesophageal Reflux in Infants | 268 | ||
| Acid-Buffering Agents | 269 | ||
| Mucosal Surface Protectors | 269 | ||
| Antisecretory Agents | 269 | ||
| Histamine-2 (H2) Blockers | 269 | ||
| Proton-Pump Inhibitors (PPIs) | 270 | ||
| Promotility Agents | 270 | ||
| Counseling and Follow-Up | 273 | ||
| Conclusion | 274 | ||
| References | 274 | ||
| Index | 279 | ||
| A | 279 | ||
| B | 280 | ||
| C | 280 | ||
| D | 282 | ||
| E | 282 | ||
| F | 283 | ||
| G | 283 | ||
| H | 284 | ||
| I | 284 | ||
| K | 285 | ||
| L | 285 | ||
| M | 286 | ||
| N | 286 | ||
| O | 288 | ||
| P | 288 | ||
| R | 290 | ||
| S | 290 | ||
| T | 291 | ||
| U | 291 | ||
| V | 291 | ||
| W | 292 | ||
| X | 292 | ||
| Y | 292 | ||
| Z | 292 | ||
| Inside Back Cover | ibc1 |