Preface p. xi
Contributing Authors p. xiii
Development and Care of the Fetus: Conception to Birth p. 1
Embryological Development of the Cardiopulmonary System p. 3
Embryologic Development of the Fetus p. 4
Development of the Pulmonary System p. 5
Surface Forces and the Role of Surfactant p. 10
Fetal Lung Fluid p. 15
Development of the Cardiovascular System p. 16
Fetal Circulation p. 18
The Development of Baroreceptors and Chemoreceptors p. 21
Development and Function of Intrauterine Structures p. 21
Summary p. 25
Assessment of Fetal Growth and Development p. 30
Modalities to Assess Fetal Status p. 31
Estimating the delivery Date p. 40
Biophysical Tests of Fetal Well-Being p. 41
Factors Identifying a High-Risk Pregnancy p. 46
Summary p. 46
Labor, Delivery, and Physiological Changes After Birth p. 53
Parturition p. 54
Stages of Normal Labor and delivery p. 54
Abnormal Labor and Delivery p. 57
Adaptation to Extrauterine Life p. 67
Summary p. 71
Care of the Neonatal and Pediatric Patient p. 75
Techniques of Resuscitation and Stabilization p. 77
Overview p. 78
When to Resuscitate p. 78
Standard Precautions p. 84
Steps in a Resuscitation p. 84
Management of Serum Glucose p. 101
Obtaining Umbilical Vessel Blood Samples During Resuscitation p. 104
Summary p. 106
Assessment of the Neonatal and Pediatric Patient p. 111
Anatomic and Physiologic Considerations p. 112
Physical Assessment of the Neonate p. 113
Physical Assessment of the Pediatric Patient p. 130
Neonatal and Pediatric Pulmonary Function Testing (PFT) p. 135
Summary p. 141
Respiratory Care Procedures p. 147
Airway Clearance p. 148
Aerosolized Drug Therapy p. 156
Suctioning p. 165
Oxygen Therapy p. 170
Summary p. 183
General Considerations of Continuing Care p. 188
Thermoregulation p. 189
Developmental Needs of the High-Risk Neonate p. 196
Skin Care of the Premature Neonate p. 199
Fluid and Electrolyte Balance p. 201
Neonatal Jaundice p. 210
Necrotizing Enterocolitis (NEC) p. 214
Summary p. 216
Pharmacology in Neonatal and Pediatric Respiratory Care p. 222
Introduction p. 223
Placental Drug Transfer p. 223
Neonatal and Pediatric Pharmokinetics p. 225
Medications p. 228
Cardiovascular Medications p. 235
Effects of Maternal Drug Abuse on the Fetus p. 255
Summary p. 255
Assessment of Oxygenation and Ventilation p. 259
The Basics p. 260
Arterial Blood Gas Analysis p. 260
Arterial Blood Gas Assessment p. 266
Transcutaneous Monitoring p. 273
Pulse Oximetry p. 278
Capnography/Capnometry p. 280
Summary p. 285
Causes and Care of Illness in Perinatal and Pediatric Patients p. 291
Perinatal Lung Disease and Other Problems of Prematurity p. 293
Consequences of Premature Birth p. 294
Processes of Intrauterine Origin p. 310
Barotraumatic Diseases: Air Leak Syndromes p. 316
Other Respiratory Diseases of the Neonate p. 319
Summary p. 327
Causes of Persistent Perinatal Illness p. 335
Infections p. 336
Fetal Immunities p. 343
Congenital Anomalies p. 345
Respiratory Care of the Patient with Cardiac Defects p. 356
Summary p. 357
Pediatric Diseases Requiring Respiratory Care p. 362
Ventilatory Diseases p. 363
Neuromuscular Disorders p. 378
Infectious Lung Diseases p. 386
Diseases of the Upper Airways p. 389
Inhalation of Noxious Gases p. 395
Sudden Infant Death Syndrome (SIDS) p. 397
Summary p. 397
Interpretation of Chest X-Rays p. 408
Basic Concepts p. 409
Method of Interpretation p. 411
Radiographic Findings in Neonatal Lung Pathology p. 421
Radiographic Findings in Pediatric Lung Pathology p. 437
Summary p. 440
Management of Ventilation and Oxygenation p. 445
Concepts of Mechanical Ventilation p. 447
Goals of Mechanical Ventilation p. 448
Definitions p. 448
Clinical Applications p. 458
Pressure-Volume Relationships (Compliance) p. 460
Pressure-Flow Relationships (Resistance) p. 465
Time Constants (Kt) p. 467
Management of the Patient-Ventilator System p. 474
Indications for Ventilatory Support of the Neonate and Child p. 474
Modes of Mechanical Ventilation p. 476
Partial Ventilatory Support (PVS) p. 476
Full Ventilatory Support p. 484
Setting Initial Ventilator Parameters p. 486
Volume Versus Pressure-Controlled Ventilation p. 493
Changing Ventilator Parameters in Volume and Pressure Ventilation p. 496
Hazards of Mechanical Ventilation and How to Avoid Them p. 499
Weaning and Extubation p. 501
Neonatal Patient p. 502
Pediatric Patient p. 504
Summary p. 506
Common Ventilators and Monitors p. 512
Common Neonatal Ventilators p. 513
Ventilator Monitors p. 547
Summary p. 552
Special Procedures and Ventilatory Techniques p. 557
Introduction p. 558
Surfactant Replacement Therapy p. 558
High-Frequency Ventilation (HFV) p. 560
Specialty Medical Gases p. 564
Extracorporeal Life Support (ECLS) p. 566
Partial Liquid Ventilation (PLV) p. 569
Negative Pressure Ventilation (NPV) p. 570
Summary p. 571
Transport, Home Care, and Care of the Parents p. 577
Perinatal Transport p. 579
History p. 580
Types of Transport p. 581
Personnel p. 586
Equipment p. 586
Infant Preparation and Transportation p. 590
Special Needs p. 591
Summary p. 594
Home Care p. 598
Overview p. 599
Patient Selection p. 601
Home Care of the Ventilator-Dependent Child p. 602
Home Aerosol Therapy p. 605
Chest Physiotherapy and Suctioning p. 606
Apnea Monitoring p. 607
Oxygen Therapy p. 608
Discharge Planning p. 613
Discharge p. 616
The Effects of Home Care on the Family p. 616
Failure of Home Care p. 617
Summary p. 618
Care of the Parents p. 622
Overview p. 622
Bonding p. 623
Causes of Parental Stress p. 624
Understanding Grief p. 627
Summary p. 630
Clinical Case Studies p. 635
Clinical Case Study 1 p. 635
Clinical Case Study 2 p. 638
Clinical Case Study 3 p. 640
Clinical Case Study 4 p. 642
Clinical Case Study 5 p. 644
Clinical Case Study 6 p. 647
Clinical Case Study 7 p. 649
Clinical Case Study 8 p. 651
Clinical Case Study 9 p. 653
Clinical Case Study 10 p. 655
Appendix A p. 657
Appendix B p. 741
Appendix C p. 784
Appendix D p. 785
Appendix E p. 786
Appendix F p. 787
Appendix G p. 788
Appendix H p. 789
Appendix I p. 790
Glossary p. 791
Index p. 805