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Fetal Scalp pH

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161. Birth Trauma (Treatment)

sampling for pH or fetal scalp electrode for fetal heart monitoring, which has a low incidence of hemorrhage, infection, or abscess at the site of sampling. Cephalhematoma Cephalhematoma is a subperiosteal collection of blood secondary to rupture of blood vessels between the skull and the periosteum; suture lines delineate its extent. Most commonly parietal, cephalhematoma may occasionally be observed over the occipital bone. The extent of hemorrhage may be severe enough to cause anemia and hypotension (...) and neurologic evaluation of the infant to establish whether additional injuries are present. Symmetry of structure and function should be assessed, the cranial nerves should be examined, and specifics such as individual joint range of motion and scalp/skull integrity should be evaluated. Next: Etiology The birth process is a blend of compression, contractions, torques, and traction. When fetal size, presentation, or neurologic immaturity complicates this event, such intrapartum forces may lead to tissue

2014 eMedicine Pediatrics

162. Gonorrhea (Overview)

partners frequently enough to sustain the infection in a community are defined as core transmitters. Neonatal and pediatric gonococcal infection Neonatal gonococcal infection may follow conjunctival infection, which is obtained during passage through the birth canal. In addition, direct infection may occur through the scalp at the sites of fetal monitoring electrodes. In children, infection may occur from sexual abuse by an infected individual or possibly nonsexual contact in the child's household (...) disseminate to the blood due to a variety of predisposing factors, such as host physiologic changes, virulence factors of the organism itself, and failures of the host's immune defenses. [ ] For example, changes in the vaginal pH that occur during menses and pregnancy and the puerperium period make the vaginal environment more suitable for the growth of the organism and provide increased access to the bloodstream. (Three fourths of the cases of DGI occur in women; susceptibility is increased

2014 eMedicine Pediatrics

163. 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

164. Histiocytosis (Follow-up)

Immunol Methods . 1996 Sep 27. 196(2):137-51. . Defrance T, Casamayor-Pallejà M, Krammer PH. The life and death of a B cell. Adv Cancer Res . 2002. 86:195-225. . Irmler M, Thome M, Hahne M, Schneider P, Hofmann K, Steiner V, et al. Inhibition of death receptor signals by cellular FLIP. Nature . 1997 Jul 10. 388(6638):190-5. . Ingulli E, Mondino A, Khoruts A, Jenkins MK. In vivo detection of dendritic cell antigen presentation to CD4(+) T cells. J Exp Med . 1997 Jun 16. 185(12):2133-41. . . Reis e (...) AC, Davenport V, Gordon I, Smith M, et al. Successful in vivo immunolocalization of Langerhans cell histiocytosis with use of a monoclonal antibody, NA1/34. J Pediatr . 1994 Nov. 125(5 Pt 1):717-22. . Carstensen H, Ornvold K. The epidemiology of Langerhans cell histiocytosis in children in Denmark 1975-89. Med Pediatr Oncol . 1993. 21:387-8. Isaacs H Jr. Fetal and neonatal histiocytoses. Pediatr Blood Cancer . 2006 Aug. 47(2):123-9. . Arnaud L, Hervier B, Neel A, et al. CNS involvement

2014 eMedicine Pediatrics

165. 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 (...) affect or be affected by absorption kinetics. Didanosine contains an aluminum and magnesium buffer that may affect the absorption of other drugs (eg, ciprofloxacin). Delavirdine, atazanavir, and rilpivirine are poorly absorbed when the pH of the GI tract increases. Many ARD pharmacokinetic interactions alter the cytochrome P450 (CYP) metabolic enzyme system. Cytochromes are metabolic enzymes in the liver, and CYP denotes the specific enzyme. The CYP system is classified into families, 3 of which

2014 eMedicine Pediatrics

166. 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

167. Hemolytic Disease of Newborn (Follow-up)

maternal antibody titers are monitored until a critical titer of 1:32, which indicates that a high risk of fetal hydrops has been reached. At this point, the fetus requires very intense monitoring for signs of anemia and fetal hydrops. In Kell alloimmunization, hydrops can occur at low maternal titers because of suppressed erythropoiesis, and, thus, a titer of 1:8 has been suggested as critical. Hence, delta-OD 450 values are also unreliable in predicting disease severity in Kell alloimmunization (...) is on average less than 30 minutes, and maternal plasma is subjected to filtration and microcentrifugation to remove all cellular elements before testing. This eliminates false-positive results from engrafted fetal cells of previous pregnancies in maternal lymphoid organs. Cell-free fetal DNA is subjected to real-time polymerase chain reaction (PCR) for the presence of RHD gene–specific sequences and has been found to be accurate in 99.5% of cases. The SRY gene (in the male fetus) and DNA polymorphisms

2014 eMedicine Pediatrics

168. Ehlers-Danlos Syndrome (Treatment)

presents a specific set of risks for both mother and fetus/newborn. Maternal risks are cervical insufficiency, uterine prolapse, uterine tear, poor wound healing during the postpartum period, and excessive bleeding both during and postdelivery. Newborn risks are premature rupture of membranes with secondary premature delivery and all inherent complications. Be aware that significant joint laxity present in the newborn period may be mistaken for hypotonia, resulting in a misdirected diagnostic (...) ):e12. . Kim ST, Cloft H, Flemming KD, Kallmes DF, Lanzino G, Brinjikji W. Increased Prevalence of Cerebrovascular Disease in Hospitalized Patients with Ehlers-Danlos Syndrome. J Stroke Cerebrovasc Dis . 2017 Aug. 26 (8):1678-82. . Juul-Kristensen B, Rogind H, Jensen DV, et al. Inter-examiner reproducibility of tests and criteria for generalized joint hypermobility and benign joint hypermobility syndrome. Rheumatology (Oxford) . 2007 Dec. 46(12):1835-41. . Beighton PH Horan F. Orthopedic aspects

2014 eMedicine Pediatrics

169. Birth Trauma (Follow-up)

sampling for pH or fetal scalp electrode for fetal heart monitoring, which has a low incidence of hemorrhage, infection, or abscess at the site of sampling. Cephalhematoma Cephalhematoma is a subperiosteal collection of blood secondary to rupture of blood vessels between the skull and the periosteum; suture lines delineate its extent. Most commonly parietal, cephalhematoma may occasionally be observed over the occipital bone. The extent of hemorrhage may be severe enough to cause anemia and hypotension (...) and neurologic evaluation of the infant to establish whether additional injuries are present. Symmetry of structure and function should be assessed, the cranial nerves should be examined, and specifics such as individual joint range of motion and scalp/skull integrity should be evaluated. Next: Etiology The birth process is a blend of compression, contractions, torques, and traction. When fetal size, presentation, or neurologic immaturity complicates this event, such intrapartum forces may lead to tissue

2014 eMedicine Pediatrics

170. Histiocytosis (Diagnosis)

. Patients with single system involvement were older than those with multisystem involvement. The mean age for development of polycystic sclerosing histiocytosis is between 55 and 60 years, but rare cases in the pediatric age group have been reported. Fetal and neonatal cases, although also rare, can occur. [ , ] Previous Next: Prognosis Risk stratification for Langerhans cell histiocytosis (LCH) requires evaluation of the site and extent of disease involvement and response to therapy. Involvement (...) . Expression of c-FLIP(L) and resistance to CD95-mediated apoptosis of monocyte-derived dendritic cells: inhibition by bisindolylmaleimide. Blood . 2000 Jun 1. 95(11):3478-82. . Romani N, Reider D, Heuer M, Ebner S, Kämpgen E, Eibl B, et al. Generation of mature dendritic cells from human blood. An improved method with special regard to clinical applicability. J Immunol Methods . 1996 Sep 27. 196(2):137-51. . Defrance T, Casamayor-Pallejà M, Krammer PH. The life and death of a B cell. Adv Cancer Res . 2002

2014 eMedicine Pediatrics

171. Birth Trauma (Diagnosis)

sampling for pH or fetal scalp electrode for fetal heart monitoring, which has a low incidence of hemorrhage, infection, or abscess at the site of sampling. Cephalhematoma Cephalhematoma is a subperiosteal collection of blood secondary to rupture of blood vessels between the skull and the periosteum; suture lines delineate its extent. Most commonly parietal, cephalhematoma may occasionally be observed over the occipital bone. The extent of hemorrhage may be severe enough to cause anemia and hypotension (...) and neurologic evaluation of the infant to establish whether additional injuries are present. Symmetry of structure and function should be assessed, the cranial nerves should be examined, and specifics such as individual joint range of motion and scalp/skull integrity should be evaluated. Next: Etiology The birth process is a blend of compression, contractions, torques, and traction. When fetal size, presentation, or neurologic immaturity complicates this event, such intrapartum forces may lead to tissue

2014 eMedicine Pediatrics

172. Pediatrics, Fever (Diagnosis)

, maternal infections (eg, group B Streptococcus , sexually transmitted diseases such as genital herpes simplex), and congenital or chronic disease states. Neonates at risk for congenital herpes are those born to mothers with a history of recent genital infection and high-risk sexual activity; delivery-related risk factors include rupture of membranes for longer than 6 hours and use of a scalp electrode. Neonates who present with irritability, seizures, respiratory distress, jaundice, or a characteristic (...) of perceptions of fever and fever phobia by ethnicity. Clin Pediatr (Phila) . 2010 Mar. 49(2):172-6. . Poirier MP, Davis PH, Gonzalez-del Rey JA, Monroe KW. Pediatric emergency department nurses' perspectives on fever in children. Pediatr Emerg Care . 2000 Feb. 16(1):9-12. . Greensmith L. Nurses' knowledge of and attitudes towards fever and fever management in one Irish children's hospital. J Child Health Care . 2013 Mar 1. . American Academy of Pediatrics. Recommended Immunization Schedule for Children

2014 eMedicine Emergency Medicine

173. Pediatrics, Fever (Follow-up)

, maternal infections (eg, group B Streptococcus , sexually transmitted diseases such as genital herpes simplex), and congenital or chronic disease states. Neonates at risk for congenital herpes are those born to mothers with a history of recent genital infection and high-risk sexual activity; delivery-related risk factors include rupture of membranes for longer than 6 hours and use of a scalp electrode. Neonates who present with irritability, seizures, respiratory distress, jaundice, or a characteristic (...) of perceptions of fever and fever phobia by ethnicity. Clin Pediatr (Phila) . 2010 Mar. 49(2):172-6. . Poirier MP, Davis PH, Gonzalez-del Rey JA, Monroe KW. Pediatric emergency department nurses' perspectives on fever in children. Pediatr Emerg Care . 2000 Feb. 16(1):9-12. . Greensmith L. Nurses' knowledge of and attitudes towards fever and fever management in one Irish children's hospital. J Child Health Care . 2013 Mar 1. . American Academy of Pediatrics. Recommended Immunization Schedule for Children

2014 eMedicine Emergency Medicine

174. Pediatrics, Bacteremia and Sepsis (Follow-up)

pathology, such as prematurity, maternal infections (eg, group B Streptococcus , sexually transmitted diseases such as genital herpes simplex), and congenital or chronic disease states. Neonates at risk for congenital herpes are those born to mothers with a history of recent genital infection and high-risk sexual activity; delivery-related risk factors include rupture of membranes for longer than 6 hours and use of a scalp electrode. Neonates who present with irritability, seizures, respiratory distress (...) , Wittler R. A comparison of perceptions of fever and fever phobia by ethnicity. Clin Pediatr (Phila) . 2010 Mar. 49(2):172-6. . Poirier MP, Davis PH, Gonzalez-del Rey JA, Monroe KW. Pediatric emergency department nurses' perspectives on fever in children. Pediatr Emerg Care . 2000 Feb. 16(1):9-12. . Greensmith L. Nurses' knowledge of and attitudes towards fever and fever management in one Irish children's hospital. J Child Health Care . 2013 Mar 1. . American Academy of Pediatrics. Recommended

2014 eMedicine Emergency Medicine

175. Hemolytic Disease of Newborn (Treatment)

maternal antibody titers are monitored until a critical titer of 1:32, which indicates that a high risk of fetal hydrops has been reached. At this point, the fetus requires very intense monitoring for signs of anemia and fetal hydrops. In Kell alloimmunization, hydrops can occur at low maternal titers because of suppressed erythropoiesis, and, thus, a titer of 1:8 has been suggested as critical. Hence, delta-OD 450 values are also unreliable in predicting disease severity in Kell alloimmunization (...) is on average less than 30 minutes, and maternal plasma is subjected to filtration and microcentrifugation to remove all cellular elements before testing. This eliminates false-positive results from engrafted fetal cells of previous pregnancies in maternal lymphoid organs. Cell-free fetal DNA is subjected to real-time polymerase chain reaction (PCR) for the presence of RHD gene–specific sequences and has been found to be accurate in 99.5% of cases. The SRY gene (in the male fetus) and DNA polymorphisms

2014 eMedicine Pediatrics

176. Histiocytosis (Treatment)

regard to clinical applicability. J Immunol Methods . 1996 Sep 27. 196(2):137-51. . Defrance T, Casamayor-Pallejà M, Krammer PH. The life and death of a B cell. Adv Cancer Res . 2002. 86:195-225. . Irmler M, Thome M, Hahne M, Schneider P, Hofmann K, Steiner V, et al. Inhibition of death receptor signals by cellular FLIP. Nature . 1997 Jul 10. 388(6638):190-5. . Ingulli E, Mondino A, Khoruts A, Jenkins MK. In vivo detection of dendritic cell antigen presentation to CD4(+) T cells. J Exp Med . 1997 Jun (...) 767-9. . Kelly KM, Beverley PC, Chu AC, Davenport V, Gordon I, Smith M, et al. Successful in vivo immunolocalization of Langerhans cell histiocytosis with use of a monoclonal antibody, NA1/34. J Pediatr . 1994 Nov. 125(5 Pt 1):717-22. . Carstensen H, Ornvold K. The epidemiology of Langerhans cell histiocytosis in children in Denmark 1975-89. Med Pediatr Oncol . 1993. 21:387-8. Isaacs H Jr. Fetal and neonatal histiocytoses. Pediatr Blood Cancer . 2006 Aug. 47(2):123-9. . Arnaud L, Hervier B, Neel

2014 eMedicine Pediatrics

177. 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 (...) affect or be affected by absorption kinetics. Didanosine contains an aluminum and magnesium buffer that may affect the absorption of other drugs (eg, ciprofloxacin). Delavirdine, atazanavir, and rilpivirine are poorly absorbed when the pH of the GI tract increases. Many ARD pharmacokinetic interactions alter the cytochrome P450 (CYP) metabolic enzyme system. Cytochromes are metabolic enzymes in the liver, and CYP denotes the specific enzyme. The CYP system is classified into families, 3 of which

2014 eMedicine Pediatrics

178. Histiocytosis (Overview)

. Patients with single system involvement were older than those with multisystem involvement. The mean age for development of polycystic sclerosing histiocytosis is between 55 and 60 years, but rare cases in the pediatric age group have been reported. Fetal and neonatal cases, although also rare, can occur. [ , ] Previous Next: Prognosis Risk stratification for Langerhans cell histiocytosis (LCH) requires evaluation of the site and extent of disease involvement and response to therapy. Involvement (...) . Expression of c-FLIP(L) and resistance to CD95-mediated apoptosis of monocyte-derived dendritic cells: inhibition by bisindolylmaleimide. Blood . 2000 Jun 1. 95(11):3478-82. . Romani N, Reider D, Heuer M, Ebner S, Kämpgen E, Eibl B, et al. Generation of mature dendritic cells from human blood. An improved method with special regard to clinical applicability. J Immunol Methods . 1996 Sep 27. 196(2):137-51. . Defrance T, Casamayor-Pallejà M, Krammer PH. The life and death of a B cell. Adv Cancer Res . 2002

2014 eMedicine Pediatrics

179. Birth Trauma (Overview)

sampling for pH or fetal scalp electrode for fetal heart monitoring, which has a low incidence of hemorrhage, infection, or abscess at the site of sampling. Cephalhematoma Cephalhematoma is a subperiosteal collection of blood secondary to rupture of blood vessels between the skull and the periosteum; suture lines delineate its extent. Most commonly parietal, cephalhematoma may occasionally be observed over the occipital bone. The extent of hemorrhage may be severe enough to cause anemia and hypotension (...) and neurologic evaluation of the infant to establish whether additional injuries are present. Symmetry of structure and function should be assessed, the cranial nerves should be examined, and specifics such as individual joint range of motion and scalp/skull integrity should be evaluated. Next: Etiology The birth process is a blend of compression, contractions, torques, and traction. When fetal size, presentation, or neurologic immaturity complicates this event, such intrapartum forces may lead to tissue

2014 eMedicine Pediatrics

180. Gonorrhea (Diagnosis)

partners frequently enough to sustain the infection in a community are defined as core transmitters. Neonatal and pediatric gonococcal infection Neonatal gonococcal infection may follow conjunctival infection, which is obtained during passage through the birth canal. In addition, direct infection may occur through the scalp at the sites of fetal monitoring electrodes. In children, infection may occur from sexual abuse by an infected individual or possibly nonsexual contact in the child's household (...) disseminate to the blood due to a variety of predisposing factors, such as host physiologic changes, virulence factors of the organism itself, and failures of the host's immune defenses. [ ] For example, changes in the vaginal pH that occur during menses and pregnancy and the puerperium period make the vaginal environment more suitable for the growth of the organism and provide increased access to the bloodstream. (Three fourths of the cases of DGI occur in women; susceptibility is increased

2014 eMedicine Pediatrics

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