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269 results for

Fetal Scalp Stimulation

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221. Platelet Disorders (Diagnosis)

the presence of petechiae and ecchymoses. The presence of lymphadenopathy or suggests other secondary causes of thrombocytopenia rather than ITP. The peripheral smear shows a decreased number of platelets. Often, the smear shows giant platelets, which is a reflection of increased thrombopoietin-induced stimulation of the bone marrow (see images below). Examination of the peripheral smears in immune thrombocytopenic purpura often shows giant platelets. These platelets reflect the increased megakaryocytic (...) mass in the marrow. Peripheral smear of a patient with Bernard-Soulier syndrome showing giant platelets. These platelets are not counted as platelets in most particle counters. At times, the smear may show eosinophilia and lymphocytosis, possibly reflecting hypersensitivity to the inciting viral antigens. The bone marrow shows an increase in the number of megakaryocytes and signs of thrombopoietin-induced megakaryocyte stimulation (increase in number and ploidy, decrease in cytoplasm), resulting

2014 eMedicine.com

222. Erythrocyte Alloimmunization and Pregnancy (Diagnosis)

and at 28 weeks gestation. Pending fetal blood type, the patient should also receive Rhesus Immunoglobulin following delivery. [ ] Fetal hydrops. Ultrasound image of edema of the scalp and face in a hydropic fetus. Additionally, advancements in fetal surveillance and treatment have allowed for successful outcomes for most affected fetuses. This article reviews the pathophysiology, diagnosis, and management of erythrocyte Rh D alloimmunization and includes a discussion of rarer erythrocyte antigens. Next (...) from white individuals, and agglutination was observed in 85% of the samples (Rh D positive). The remaining 15% of the samples were Rh D negative; this finding corresponds remarkably to the currently known prevalence of Rh D–negative blood type in whites. Following this discovery, Levine determined that hemolytic disease of the fetus and newborn was usually caused by Rh incompatibility (ie, the fetal stimulation of Rh D antibody development in an Rh D–negative woman). In 1953, Chown verified

2014 eMedicine.com

223. Extremely Low Birth Weight Infant (Follow-up)

, including chronic oxygen dependency. Immediately after birth, the infant should be dried and placed on a radiant warmer, and a hat or another covering should be placed on his or her head, as the scalp is a site of large heat loss. Studies have shown that placing a plastic film over the baby immediately after drying or placing the infant on a warming mattress can further minimize evaporative and convective heat losses. [ , ] For transport to the neonatal intensive care unit (NICU) from the delivery room (...) . Although chemical heating pads are commonly used to provide a warm surface on which to place the baby, the unregulated heat source may burn the very fragile skin of the infant; therefore, such pads are not recommended. Caution is due when using any of the currently available methods to prevent hypothermia; frequent monitoring of temperature is necessary to prevent overheating given any combination of approaches. Hypoglycemia Fetal euglycemia (maintenance of normal blood glucose levels) is maintained

2014 eMedicine Pediatrics

224. Meconium Aspiration Syndrome (Overview)

gastrointestinal (GI) tract, usually due to fetal hypoxic stress. As the fetus approaches term, the GI tract matures, and vagal stimulation from head or spinal cord compression may cause peristalsis and relaxation of the rectal sphincter, leading to meconium passage. The effects of meconium in amniotic fluid are well documented. [ ] Meconium directly alters the amniotic fluid, reducing antibacterial activity and subsequently increasing the risk of perinatal bacterial infection. In addition, meconium (...) is irritating to fetal skin, thus increasing the incidence of erythema toxicum. However, the most severe complication of meconium passage in utero is perinatal aspiration of stained amniotic fluid (before, during, or immediately after birth)—ie, meconium aspiration syndrome (MAS). Aspiration of meconium-stained amniotic fluid may occur if the fetus is in distress, leading to a gasping breathing pattern. This aspiration induces hypoxia via four major pulmonary effects: airway obstruction, surfactant

2014 eMedicine Pediatrics

225. Meconium Aspiration Syndrome (Treatment)

fluid. Obstet Gynecol . 2017 Mar. 129 (3):593-4. . Nangia S, Pal MM, Saili A, Gupta U. Effect of intrapartum oropharyngeal (IP-OP) suction on meconium aspiration syndrome (MAS) in developing country: A RCT. Resuscitation . 2015 Dec. 97:83-7. . Boujenah J, Oliveira J, De La Hosseraye C, Benbara A, Tigaizin A, Bricou A, et al. Should fetal scalp blood sampling be performed in the case of meconium-stained amniotic fluid?. J Matern Fetal Neonatal Med . 2016 Dec. 29 (23):3875-8. . Liu J, Cao HY, Fu W (...) : the prevention of meconium aspiration in labour. Aust N Z J Obstet Gynaecol . 1993 Feb. 33 (1):51-4. . Ranzini AC, Chan L. Meconium and fetal-neonatal compromise. In: Spitzer AR, ed. Intensive Care of the Fetus and Neonate . St Louis, Mo: Mosby; 1996. 297-303. Roberton NRC. Aspiration syndromes. In: Greenough A, Robertson NRC, Milner AD, eds. Neonatal Respiratory Disorders . London, UK: Arnold Publication; 1996. 313-33. Soll RF, Dargaville P. Surfactant for meconium aspiration syndrome in full term infants

2014 eMedicine Pediatrics

226. Human Immunodeficiency Virus Infection (Follow-up)

weeks old Unfortunately, antepartum treatment is not without risk to the fetus. In a study of HIV-negative infants born to HIV-positive mothers, Lipshultz et al concluded that fetal exposure to ART was associated with various cardiac effects, including reduced left ventricular (LV) dimension, LV mass, and septal wall thickness z-scores, as well as increased LV fractional shortening and contractility up to age 2 years. [ ] These effects are more pronounced in girls than in boys Exposure to ART (...) Flucytosine Amphotericin Sulfonamides Trimethoprim, trimethoprim-sulfamethoxazole Pyrimethamine Pentamidine Infectious agents such as parvovirus B19 can cause myelosuppression, as can invasive neoplastic processes of the marrow. Granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) are used to treat neutropenia and to promote granulocyte production and function. GM-CSF has more adverse effects than G-CSF, and it promotes viral replication. However, GM

2014 eMedicine Pediatrics

227. Meconium Aspiration Syndrome (Follow-up)

fluid. Obstet Gynecol . 2017 Mar. 129 (3):593-4. . Nangia S, Pal MM, Saili A, Gupta U. Effect of intrapartum oropharyngeal (IP-OP) suction on meconium aspiration syndrome (MAS) in developing country: A RCT. Resuscitation . 2015 Dec. 97:83-7. . Boujenah J, Oliveira J, De La Hosseraye C, Benbara A, Tigaizin A, Bricou A, et al. Should fetal scalp blood sampling be performed in the case of meconium-stained amniotic fluid?. J Matern Fetal Neonatal Med . 2016 Dec. 29 (23):3875-8. . Liu J, Cao HY, Fu W (...) : the prevention of meconium aspiration in labour. Aust N Z J Obstet Gynaecol . 1993 Feb. 33 (1):51-4. . Ranzini AC, Chan L. Meconium and fetal-neonatal compromise. In: Spitzer AR, ed. Intensive Care of the Fetus and Neonate . St Louis, Mo: Mosby; 1996. 297-303. Roberton NRC. Aspiration syndromes. In: Greenough A, Robertson NRC, Milner AD, eds. Neonatal Respiratory Disorders . London, UK: Arnold Publication; 1996. 313-33. Soll RF, Dargaville P. Surfactant for meconium aspiration syndrome in full term infants

2014 eMedicine Pediatrics

228. Graves Disease (Follow-up)

, liver transplantation, or both has been reported with PTU, and prompted a label warning by the US Food and Drug Administration (FDA) since May 2010. Less significant adverse effects include ageusia or dysgeusia. PTU is the drug of choice in pregnant women with Graves disease. Methimazole has been associated with fetal scalp aplasia cutis. Methimazole also crosses to the fetus much more easily than PTU and, therefore, is more likely to be a fetal goitrogen, even when cautiously used. The FDA had (...) of thyroid hormone levels in the high range typical of pregnancy. Overtreatment can lead to fetal hypothyroidism and goiter, with concomitant poor intellectual outcome. Undertreatment can lead to fetal loss. Surgery also can lead to fetal loss and should be carried out only if absolutely necessary. Assess adolescent girls treated for Graves disease for pregnancy risk and start contraception if indicated. Do not administer RAI therapy to a sexually active adolescent girl until she is known to have

2014 eMedicine Pediatrics

229. Extremely Low Birth Weight Infant (Treatment)

, including chronic oxygen dependency. Immediately after birth, the infant should be dried and placed on a radiant warmer, and a hat or another covering should be placed on his or her head, as the scalp is a site of large heat loss. Studies have shown that placing a plastic film over the baby immediately after drying or placing the infant on a warming mattress can further minimize evaporative and convective heat losses. [ , ] For transport to the neonatal intensive care unit (NICU) from the delivery room (...) . Although chemical heating pads are commonly used to provide a warm surface on which to place the baby, the unregulated heat source may burn the very fragile skin of the infant; therefore, such pads are not recommended. Caution is due when using any of the currently available methods to prevent hypothermia; frequent monitoring of temperature is necessary to prevent overheating given any combination of approaches. Hypoglycemia Fetal euglycemia (maintenance of normal blood glucose levels) is maintained

2014 eMedicine Pediatrics

230. Lyme Disease (Overview)

by erythematous skin lesions. In the United States, Lyme disease was not recognized until the early 1970s, when a statistically improbable cluster of pediatric arthritis cases occurred in the region around Lyme, Connecticut. This outbreak was investigated by Allen Steere, MD, and others from Yale and stimulated intense clinical and epidemiologic research that led to the discovery of the causative agent and its ecology and an expanding geographic range and list of clinical manifestations. The recognition (...) and that it is not directly responsible for adverse fetal outcomes. Post-treatment Lyme disease syndrome Lingering symptoms, which may persist for more than 6 months, affect 10-20% of patients who receive recommended treatment for Lyme disease. [ ] Common complaints include cognitive disturbances, fatigue, joint or muscle pain, headaches, hearing loss, vertigo, mood disturbances, paresthesias, and difficulty sleeping. This condition is often termed chronic Lyme disease, but is more appropriately called post-treatment

2014 eMedicine Pediatrics

231. Human Immunodeficiency Virus Infection (Diagnosis)

, and significant pruritic dermatoses. Mucocutaneous eruptions may be the first sign of HIV infection and may vary in presentation, depending on the child's immune status. For information on HIV infection in adults and adolescents, see . Previous Next: Pathophysiology HIV can be transmitted vertically, sexually, or via contaminated blood products or IV drug abuse. Vertical HIV infection occurs before birth, during delivery, or after birth. With infection before birth (period 1), the fetus can be hematologically (...) hematopoietic stem cells, the importance is minor. Hematopoietic disturbances are believed to occur as a consequence of changes in the microenvironment of the marrow and of deficiencies in local and systemic growth factors. In typical conditions, the stroma of the marrow promotes stem cell proliferation and differentiation by producing granulocyte colony-stimulating factor (G-CSF) and interleukin (IL)-3. HIV-infected stroma produces less G-CSF and IL-3 than normal and produces excessive tumor necrosis

2014 eMedicine Pediatrics

232. Meconium Aspiration Syndrome (Diagnosis)

gastrointestinal (GI) tract, usually due to fetal hypoxic stress. As the fetus approaches term, the GI tract matures, and vagal stimulation from head or spinal cord compression may cause peristalsis and relaxation of the rectal sphincter, leading to meconium passage. The effects of meconium in amniotic fluid are well documented. [ ] Meconium directly alters the amniotic fluid, reducing antibacterial activity and subsequently increasing the risk of perinatal bacterial infection. In addition, meconium (...) is irritating to fetal skin, thus increasing the incidence of erythema toxicum. However, the most severe complication of meconium passage in utero is perinatal aspiration of stained amniotic fluid (before, during, or immediately after birth)—ie, meconium aspiration syndrome (MAS). Aspiration of meconium-stained amniotic fluid may occur if the fetus is in distress, leading to a gasping breathing pattern. This aspiration induces hypoxia via four major pulmonary effects: airway obstruction, surfactant

2014 eMedicine Pediatrics

233. Lyme Disease (Diagnosis)

by erythematous skin lesions. In the United States, Lyme disease was not recognized until the early 1970s, when a statistically improbable cluster of pediatric arthritis cases occurred in the region around Lyme, Connecticut. This outbreak was investigated by Allen Steere, MD, and others from Yale and stimulated intense clinical and epidemiologic research that led to the discovery of the causative agent and its ecology and an expanding geographic range and list of clinical manifestations. The recognition (...) and that it is not directly responsible for adverse fetal outcomes. Post-treatment Lyme disease syndrome Lingering symptoms, which may persist for more than 6 months, affect 10-20% of patients who receive recommended treatment for Lyme disease. [ ] Common complaints include cognitive disturbances, fatigue, joint or muscle pain, headaches, hearing loss, vertigo, mood disturbances, paresthesias, and difficulty sleeping. This condition is often termed chronic Lyme disease, but is more appropriately called post-treatment

2014 eMedicine Pediatrics

234. Histiocytosis (Diagnosis)

macrophages. Normal histiocytes originate from pluripotent stem cells, which can be found in bone marrow. [ ] Under the influence of various cytokines (eg, stem cell factor [SCF], granulocyte colony-stimulating factor [G-CSF], granulocyte-macrophage colony-stimulating factor [GM-CSF], tumor necrosis factor-alpha [TNF-alpha], interleukin [IL]-3, IL-4, and others), histiocytes can become committed, differentiating into specific groups of specialized cells. Committed histiocytes can mature into one of two (...) lymphocytes has been increasingly recognized. Dendritic cells appear to develop in several pathways. [ ] Immature dendritic cells respond to GM-CSF (not to macrophage colony-stimulating factor [M-CSF]) and become committed to generating dendritic cells, which are “professional” antigen-presenting cells (APCs). [ ] These cells can capture antigen and migrate to lymphoid organs, where they present the antigens to naive T cells. [ ] Dendritic cells are also efficient stimulators of B-cell lymphocytes

2014 eMedicine Pediatrics

235. Graves Disease (Treatment)

, liver transplantation, or both has been reported with PTU, and prompted a label warning by the US Food and Drug Administration (FDA) since May 2010. Less significant adverse effects include ageusia or dysgeusia. PTU is the drug of choice in pregnant women with Graves disease. Methimazole has been associated with fetal scalp aplasia cutis. Methimazole also crosses to the fetus much more easily than PTU and, therefore, is more likely to be a fetal goitrogen, even when cautiously used. The FDA had (...) of thyroid hormone levels in the high range typical of pregnancy. Overtreatment can lead to fetal hypothyroidism and goiter, with concomitant poor intellectual outcome. Undertreatment can lead to fetal loss. Surgery also can lead to fetal loss and should be carried out only if absolutely necessary. Assess adolescent girls treated for Graves disease for pregnancy risk and start contraception if indicated. Do not administer RAI therapy to a sexually active adolescent girl until she is known to have

2014 eMedicine Pediatrics

236. Human Immunodeficiency Virus Infection (Treatment)

weeks old Unfortunately, antepartum treatment is not without risk to the fetus. In a study of HIV-negative infants born to HIV-positive mothers, Lipshultz et al concluded that fetal exposure to ART was associated with various cardiac effects, including reduced left ventricular (LV) dimension, LV mass, and septal wall thickness z-scores, as well as increased LV fractional shortening and contractility up to age 2 years. [ ] These effects are more pronounced in girls than in boys Exposure to ART (...) Flucytosine Amphotericin Sulfonamides Trimethoprim, trimethoprim-sulfamethoxazole Pyrimethamine Pentamidine Infectious agents such as parvovirus B19 can cause myelosuppression, as can invasive neoplastic processes of the marrow. Granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) are used to treat neutropenia and to promote granulocyte production and function. GM-CSF has more adverse effects than G-CSF, and it promotes viral replication. However, GM

2014 eMedicine Pediatrics

237. Human Immunodeficiency Virus Infection (Overview)

, and significant pruritic dermatoses. Mucocutaneous eruptions may be the first sign of HIV infection and may vary in presentation, depending on the child's immune status. For information on HIV infection in adults and adolescents, see . Previous Next: Pathophysiology HIV can be transmitted vertically, sexually, or via contaminated blood products or IV drug abuse. Vertical HIV infection occurs before birth, during delivery, or after birth. With infection before birth (period 1), the fetus can be hematologically (...) hematopoietic stem cells, the importance is minor. Hematopoietic disturbances are believed to occur as a consequence of changes in the microenvironment of the marrow and of deficiencies in local and systemic growth factors. In typical conditions, the stroma of the marrow promotes stem cell proliferation and differentiation by producing granulocyte colony-stimulating factor (G-CSF) and interleukin (IL)-3. HIV-infected stroma produces less G-CSF and IL-3 than normal and produces excessive tumor necrosis

2014 eMedicine Pediatrics

238. Histiocytosis (Overview)

macrophages. Normal histiocytes originate from pluripotent stem cells, which can be found in bone marrow. [ ] Under the influence of various cytokines (eg, stem cell factor [SCF], granulocyte colony-stimulating factor [G-CSF], granulocyte-macrophage colony-stimulating factor [GM-CSF], tumor necrosis factor-alpha [TNF-alpha], interleukin [IL]-3, IL-4, and others), histiocytes can become committed, differentiating into specific groups of specialized cells. Committed histiocytes can mature into one of two (...) lymphocytes has been increasingly recognized. Dendritic cells appear to develop in several pathways. [ ] Immature dendritic cells respond to GM-CSF (not to macrophage colony-stimulating factor [M-CSF]) and become committed to generating dendritic cells, which are “professional” antigen-presenting cells (APCs). [ ] These cells can capture antigen and migrate to lymphoid organs, where they present the antigens to naive T cells. [ ] Dendritic cells are also efficient stimulators of B-cell lymphocytes

2014 eMedicine Pediatrics

239. Extremely Low Birth Weight Infant (Overview)

, including chronic oxygen dependency. Immediately after birth, the infant should be dried and placed on a radiant warmer, and a hat or another covering should be placed on his or her head, as the scalp is a site of large heat loss. Studies have shown that placing a plastic film over the baby immediately after drying or placing the infant on a warming mattress can further minimize evaporative and convective heat losses. [ , ] For transport to the neonatal intensive care unit (NICU) from the delivery room (...) . Although chemical heating pads are commonly used to provide a warm surface on which to place the baby, the unregulated heat source may burn the very fragile skin of the infant; therefore, such pads are not recommended. Caution is due when using any of the currently available methods to prevent hypothermia; frequent monitoring of temperature is necessary to prevent overheating given any combination of approaches. Hypoglycemia Fetal euglycemia (maintenance of normal blood glucose levels) is maintained

2014 eMedicine Pediatrics

240. Extremely Low Birth Weight Infant (Diagnosis)

, including chronic oxygen dependency. Immediately after birth, the infant should be dried and placed on a radiant warmer, and a hat or another covering should be placed on his or her head, as the scalp is a site of large heat loss. Studies have shown that placing a plastic film over the baby immediately after drying or placing the infant on a warming mattress can further minimize evaporative and convective heat losses. [ , ] For transport to the neonatal intensive care unit (NICU) from the delivery room (...) . Although chemical heating pads are commonly used to provide a warm surface on which to place the baby, the unregulated heat source may burn the very fragile skin of the infant; therefore, such pads are not recommended. Caution is due when using any of the currently available methods to prevent hypothermia; frequent monitoring of temperature is necessary to prevent overheating given any combination of approaches. Hypoglycemia Fetal euglycemia (maintenance of normal blood glucose levels) is maintained

2014 eMedicine Pediatrics

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