Gomella’s Neonatology 8th Edition

Tricia Lacy Gomella

Visit to download the full and correct content document:
https://ebookmass.com/product/gomellas-neonatology-8th-edition-tricia-lacy-gomella/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Gomella and Haist's Clinician's Pocket Reference, 12th

Edition Leonard G. Gomella

https://ebookmass.com/product/gomella-and-haists-clinicians-
pocket-reference-12th-edition-leonard-g-gomella/

Neurology: Neonatology Questions and Controversies

(Neonatology: Questions & Controversies) 3rd Edition
Jeffrey Md Perlman Mbchb

https://ebookmass.com/product/neurology-neonatology-questions-
and-controversies-neonatology-questions-controversies-3rd-
edition-jeffrey-md-perlman-mbchb/

Workbook in Practical Neonatology 6th Edition Edition

Richard A. Polin

https://ebookmass.com/product/workbook-in-practical-
neonatology-6th-edition-edition-richard-a-polin/

Canine Reproduction and Neonatology [Print Replica]

(Ebook PDF)

https://ebookmass.com/product/canine-reproduction-and-
neonatology-print-replica-ebook-pdf/
The Newborn Lung: Neonatology Questions and
Controversies 3rd Edition Eduardo Bancalari

https://ebookmass.com/product/the-newborn-lung-neonatology-
questions-and-controversies-3rd-edition-eduardo-bancalari/

Must Love Football (Sweetheart Shorts Book 6) Lacy

Williams

https://ebookmass.com/product/must-love-football-sweetheart-
shorts-book-6-lacy-williams/

Must Love Stargazing (Sweetheart Shorts Book 2) Lacy

Williams

https://ebookmass.com/product/must-love-stargazing-sweetheart-
shorts-book-2-lacy-williams/

Must Love Eclairs (Sweetheart Shorts Book 4) Lacy

Williams

https://ebookmass.com/product/must-love-eclairs-sweetheart-
shorts-book-4-lacy-williams/

Must Love Dogs (Sweetheart Shorts Book 1) Lacy Williams

https://ebookmass.com/product/must-love-dogs-sweetheart-shorts-
book-1-lacy-williams/
 SECTION I. Prenatal, Labor, Delivery, and Transport Management

SECTION II. Basic Management

SECTION III. Advanced Management

SECTION IV. Procedures

SECTION V. On-Call Problems

SECTION VI. Diseases and Disorders, General

SECTION VII. Infectious Diseases

SECTION VIII. Neonatal Pharmacology

A ppendices

Gomella_FM_pi-xxxii.indd 1 18/10/19 11:55 am

 This page intentionally left blank

Gomella_FM_pi-xxxii.indd 2 18/10/19 11:55 am

 a LANGE medical book

GOMELLA’S

NEONATOLOGY
Management, Procedures, On-Call Problems,
Diseases, and Drugs
EIGHTH EDITION

Editor
TRICIA LACY GOMELLA, MD
Assistant Professor of Pediatrics, Part-Time
Johns Hopkins University School of Medicine
Baltimore, Maryland

Senior Associate Editor

FABIEN G. EYAL, MD
Professor of Pediatrics
University of South Alabama Health System
Chief, Division of Neonatology
USA Children’s and Women’s Hospital
Mobile, Alabama

Associate Editor
FAYEZ BANY-MOHAMMED, MD, FAAP
Clinical Professor of Pediatrics
Program Director
Neonatal-Perinatal Medicine Fellowship Program
University of California, Irvine School of Medicine
UC Irvine Medical Center
Orange, California

New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto

Gomella_FM_pi-xxxii.indd 3 18/10/19 11:55 am

Copyright © 2020, 2013, 2009 by McGraw-Hill Education. All rights reserved. Except as permitted under
the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in
any form or by any means, or stored in a database or retrieval system, without the prior written permission
of the publisher.

ISBN: 978-1-25-964482-5
MHID: 1-25-964482-0

The material in this eBook also appears in the print version of this title: ISBN: 978-1-25-964481-8,
MHID: 1-25-964481-2.

eBook conversion by codeMantra

Version 1.0

All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every
occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the
trademark owner, with no intention of infringement of the trademark. Where such designations appear in
this book, they have been printed with initial caps.

McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales
promotions or for use in corporate training programs. To contact a representative, please visit the Contact
Us page at www.mhprofessional.com.

Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge,
changes in treatment and drug therapy are required. The authors and the publisher of this work have checked
with sources believed to be reliable in their efforts to provide information that is complete and generally in
accord with the standards accepted at the time of publication. However, in view of the possibility of human
error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been
involved in the preparation or publication of this work warrants that the information contained herein is in
every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the
results obtained from use of the information contained in this work. Readers are encouraged to confirm the
information contained herein with other sources. For example and in particular, readers are advised to check
the product information sheet included in the package of each drug they plan to administer to be certain that
the information contained in this work is accurate and that changes have not been made in the recommended
dose or in the contraindications for administration. This recommendation is of particular importance in con-
nection with new or infrequently used drugs.

TERMS OF USE

This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the
work. Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and
the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer,
reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or
sublicense the work or any part of it without McGraw-Hill Education’s prior consent. You may use the work
for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to
use the work may be terminated if you fail to comply with these terms.

THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO
GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF
OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION
THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EX-
PRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED
TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PUR-
POSE. McGraw-Hill Education and its licensors do not warrant or guarantee that the functions contained
in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither
McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or
omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education
has no responsibility for the content of any information accessed through the work. Under no circumstances
shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive,
consequential or similar damages that result from the use of or inability to use the work, even if any of them
has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or
cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
 Section Editors
PROCEDURES
Brooke D. Vergales, MD
Associate Professor of Pediatrics
Division of Neonatology
University of Virginia School of Medicine
Program Director, Neonatal Perinatal Fellowship Program
University of Virginia Health System
Charlottesville, Virginia

PHARMACOLOGY
Kristin K. Bohannon, PharmD
Clinical Pharmacist
Pediatric Pulmonary Clinic
Cook Children’s Medical Center
Fort Worth, Texas

Pui-Man (Julia) Ho, PharmD, BCPPS

Clinical Staff Pharmacist–Pediatrics
Kentucky Children’s Hospital
UK HealthCare, Pharmacy Services
Lexington, Kentucky

Valerie D. Nolt, PharmD, BCPPS

General Pediatrics Clinical Pharmacist Specialist
Department of Pharmacy
C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital
Michigan Medicine
University of Michigan
Ann Arbor, Michigan

Gomella_FM_pi-xxxii.indd 5 18/10/19 11:55 am

 This page intentionally left blank

Gomella_FM_pi-xxxii.indd 6 18/10/19 11:55 am

 International Editorial Board
Captain Mutaz Aljader, MD Omar El Khateeb, MD
Department of Surgery Consultant Neonatologist
King Hussein Medical City King Fahad Medical City
Royal Medical Services Riyadh, Saudi Arabia
Amman, Jordan
Arjan te Pas, MD, PhD
Marianne Besnard, MD Professor of Pediatrics
Pediatrician Department of Pediatrics
Department of Neonatology Division of Neonatology
Centre Hospitalier de la Polynésie Française Leiden University Medical Center
Taaone Hospital Leiden, the Netherlands
Pirae, Tahiti
French Polynesia, France Françoise Pawlotsky, MD
Pediatrician
Manisha Bhandankar, MBBS, MD, PhD Department of Neonatology
Professor of Pediatrics Centre Hospitalier de la Polynésie Française
Consultant in Neonatology Taaone Hospital
Jawaharlal Nehru Medical College Pirae, Tahiti
KLES Dr. Prabhakar Kore Hospital & French Polynesia, France
Medical Research Centre
Belgaum, Karnataka J. Rosmary Hinojosa Pérez, MD, MPH
India Clinical Professor of Neonatology
San Juan Bautista Private University
Imelda Consunji Vinzon Bautista, Master Chief of Neonatology
MD, MPH, FAAP, FPPS, FPSNbM National Maternal Perinatal Institute
Chief, Section of Neonatology Lima, Peru
Head, Neonatal Intensive Care Unit
Head, NICU Team Siddarth Ramji, MD
Institute of Pediatrics and Child Health Director-Professor
St. Luke’s Medical Center Global City Department of Neonatology
Taguig City, Philippines Maulana Azad Medical College
New Delhi, India
Musaddaq Inayat, MBBS, FAAP
Consultant Neonatologist Mary (Molly) Seshia, MBChB, DCH,
Department of Neonatology FRCP (Ed)
Danat Al Emarat Hospital Neonatologist, Professor of Pediatrics
Abu Dhabi, United Arab Emirates Max Rady College of Medicine
Rady Faculty of Health Sciences
Marek Jaszczak, MD Winnipeg, Manitoba
Chief, Division of Neonatology
Hospital Rudolf Weigl, Blachownia Tzipora Strauss, MD, MSc
Czestochowa, Poland Director of Neonatology
Albert Katz Department of Neonatology
Neelima Kharidehal, MD (Peds), The Edmond and Lily Safra Children’s
MRCPCH (UK) Hospital
Consultant Neonatologist Sheba Medical Center
Fellowship in Neonatology Tel HaShomer, Israel
Rainbow Children’s Hospital
Hyderabad, Telangana
India
vii

Gomella_FM_pi-xxxii.indd 7 18/10/19 11:55 am

 viii
Outi Tammela, MD, PhD
Docent in Neonatology
Head of Division of Neonatology
Department of Pediatrics
Pirkanmaa Hospital District
Tampere University Hospital
Tampere, Finland
Christiane Theda, FRACP, MD, PhD, MBA
Associate Professor
Royal Women’s Hospital Melbourne
University of Melbourne
PIPER Newborn Transport at the Royal
Children’s Hospital Melbourne
Murdoch Children’s Research Institute
Melbourne, Australia
Gomella_FM_pi-xxxii.indd 8
International Editorial Board
Carlos Ogilvie Thomas, MBBS, FAAP
Attending Neonatologist
Princess Margaret Hospital
Nassau, Bahamas
Alejandro Víquez Víquez, MD
Neonatologist
Department of Neonatology
National Children’s Hospital, C.C.S.S
University of Costa Rica
San Jose, Costa Rica
18/10/19 11:55 am
 To my twin sons, Leonard and Patrick, and singletons Andrew and Michael.

Gomella_FM_pi-xxxii.indd 9 18/10/19 11:55 am

 This page intentionally left blank

Gomella_FM_pi-xxxii.indd 10 18/10/19 11:55 am

 Contents
Emergency Medications Used in the Delivery Room, ETT Sizes,
Cardioversion, and Defibrillation............................................... inside front cover
Emergency Medications for Neonates................................................. inside back cover
Contributors............................................................................................................... xvii
In Honor of Dr. M. Douglas Cunningham................................................................... xxix
Preface.................................................................................................................. xxxi
SECTION I. Prenatal, Labor, Delivery, and Transport Management
1 Fetal Assessment......................................................................................................1
2 Obstetric Anesthesia and the Neonate.....................................................................13
3 Resuscitation of the Newborn..................................................................................19
4 Neonatal Transport..................................................................................................31

SECTION II. Basic Management

5 The Golden Hour......................................................................................................37
6 Gestational Age and Birthweight Classification.........................................................42
7 Newborn Physical Examination................................................................................59
8 Temperature Regulation..........................................................................................92
9 Respiratory Management........................................................................................97
10 Fluid and Electrolytes............................................................................................117
11 Nutritional Management........................................................................................125

SECTION III. Advanced Management

12 Imaging Studies....................................................................................................167
13 M
 anagement of the Extremely Low Birthweight Infant
During the First Week of Life..................................................................................196
14 Management of the Late Preterm Infant.................................................................208
15 Pain in the Neonate...............................................................................................211
16 Newborn Screening...............................................................................................223
17 Genetic and Genomic Testing in the Newborn Period..............................................234
18 Studies for Neurologic Evaluation..........................................................................239
19 Blood Component Therapy.....................................................................................248
20 Extracorporeal Life Support in the Neonate............................................................256

xi

Gomella_FM_pi-xxxii.indd 11 18/10/19 11:55 am

 xii Contents

21 Follow-Up of High-Risk Infants..............................................................................277

22 Complementary and Integrative Medical Therapies in Neonatology........................282
23 Neonatal Bioethics.................................................................................................289
24 Neonatal Palliative Care.........................................................................................295

SECTION IV. Procedures

25 Principles of Neonatal Procedures.........................................................................301
26 Arterial Access: Arterial Puncture...........................................................................305
27 Arterial Access: Percutaneous Arterial Catheterization............................................309
28 Arterial Access: Umbilical Artery Catheterization....................................................312
29 Bladder Aspiration (Suprapubic Urine Collection)....................................................322
30 Bladder Catheterization.........................................................................................325
31 Chest Tube Placement...........................................................................................329
32 Defibrillation and Cardioversion.............................................................................336
33 Endotracheal Intubation and Extubation.................................................................339
34 Exchange Transfusion............................................................................................350
35 Gastric and Postpyloric Tube Placement.................................................................356
36 Heelstick (Capillary Blood Sampling)......................................................................362
37 Laryngeal Mask Airway..........................................................................................368
38 Lumbar Puncture (Spinal Tap)................................................................................371
39 Ostomy Care..........................................................................................................375
40 Paracentesis (Abdominal)......................................................................................379
41 Pericardiocentesis.................................................................................................382
42 Peripheral Intravenous Extravasation and Infiltration: Initial Management..................385
43 Therapeutic Hypothermia......................................................................................388
44 Transillumination and Point-of-Care Ultrasound.....................................................392
45 Venous Access: Intraosseous Infusion....................................................................403
46 Venous Access: Peripherally Inserted Central Catheter...........................................407
47 Venous Access: Peripheral Intravenous Catheterization..........................................413
48 Venous Access: Umbilical Vein Catheterization.......................................................417
49 Venous Access: Venipuncture (Phlebotomy)............................................................423

SECTION V. On-Call Problems

50 Abdominal Distension............................................................................................427
51 Abnormal Blood Gas..............................................................................................431

Gomella_FM_pi-xxxii.indd 12 18/10/19 11:55 am

 Contents xiii

52 Apnea and Bradycardia (A’s and B’s): On Call.........................................................442

53 Arrhythmia............................................................................................................459
54 Bloody Stool..........................................................................................................468
55 Counseling Parents Before High-Risk Delivery.......................................................477
56 Cyanosis...............................................................................................................481
57 Death of an Infant..................................................................................................493
58 Eye Discharge and Conjunctivitis...........................................................................501
59 Gastric Residuals...................................................................................................517
60 Gastrointestinal Bleeding from the Upper Tract......................................................524
61 Hematuria.............................................................................................................532
62 Hyperbilirubinemia: Conjugated, On Call................................................................537
63 Hyperbilirubinemia: Unconjugated, On Call.............................................................546
64 Hyperglycemia......................................................................................................558
65 Hyperkalemia........................................................................................................566
66 Hypertension.........................................................................................................574
67 Hypoglycemia........................................................................................................587
68 Hypokalemia.........................................................................................................602
69 Hyponatremia........................................................................................................608
70 Hypotension and Shock.........................................................................................617
71 Is the Infant Ready for Discharge?.........................................................................630
72 No Stool in 48 Hours..............................................................................................645
73 No Urine Output in 24 Hours..................................................................................655
74 Pneumoperitoneum...............................................................................................667
75 Pneumothorax.......................................................................................................676
76 Polycythemia: On Call............................................................................................686
77 Poor Perfusion.......................................................................................................694
78 Postdelivery Antibiotics..........................................................................................701
79 Pulmonary Hemorrhage.........................................................................................719
80 Rash and Dermatologic Problems..........................................................................726
81 Sedation and Analgesia.........................................................................................743
82 Seizure Activity: On Call.........................................................................................749
83 Traumatic Delivery.................................................................................................769
84 Vasospasms and Thromboembolism......................................................................784

Gomella_FM_pi-xxxii.indd 13 18/10/19 11:55 am

 xiv Contents

SECTION VI. Diseases and Disorders, General

85 ABO Incompatibility...............................................................................................801
86 Acute Kidney Injury................................................................................................803
87 Air Leak Syndromes..............................................................................................808
88 Anemia..................................................................................................................815
89 Apnea....................................................................................................................823
90 Bronchopulmonary Dysplasia/Chronic Lung Disease..............................................827
91 Calcium Disorders (Hypocalcemia, Hypercalcemia)................................................833
92 Coagulation Disorders...........................................................................................838
93 C
 ommon Multiple Congenital Anomalies: Syndromes, Sequences,
and Associations...................................................................................................853
94 Congenital Heart Disease.......................................................................................863
95 Disorders of Sex Development...............................................................................874
96 Eye Disorders of the Newborn................................................................................881
97 Hydrocephalus and Ventriculomegaly.....................................................................885
98 Hyperbilirubinemia: Conjugated.............................................................................891
99 Hyperbilirubinemia: Unconjugated.........................................................................902
100 Inborn Errors of Metabolism with Acute Neonatal Onset.........................................915
101 Infant of a Diabetic Mother....................................................................................937
102 Infant of a Mother with Substance Use Disorder.....................................................945
103 Intracranial Hemorrhage........................................................................................955
104 Intrauterine (Fetal) Growth Restriction....................................................................963
105 Magnesium Disorders (Hypomagnesemia, Hypermagnesemia)...................................976
106 Meconium Aspiration.............................................................................................978
107 Multiple Gestation..................................................................................................984
108 Myasthenia Gravis (Transient Neonatal).................................................................988
109 Necrotizing Enterocolitis........................................................................................991
110 Neonatal Encephalopathy......................................................................................997
111 Neural Tube Defects............................................................................................1005
112 Orthopedic and Musculoskeletal Problems...........................................................1013
113 Osteopenia of Prematurity (Metabolic Bone Disease)...........................................1022
114 Patent Ductus Arteriosus.....................................................................................1027

Gomella_FM_pi-xxxii.indd 14 18/10/19 11:55 am

 Contents xv

115 Persistent Pulmonary Hypertension of the Newborn.............................................1032

116 Polycythemia and Hyperviscosity.........................................................................1040
117 Respiratory Distress Syndrome............................................................................1043
118 Retinopathy of Prematurity..................................................................................1051
119 Rh Incompatibility................................................................................................1056
120 Seizures..............................................................................................................1061
121 Spontaneous Intestinal Perforation.......................................................................1067
122 Surgical Diseases of the Newborn: Abdominal Masses.........................................1069
123 Surgical Diseases of the Newborn: Abdominal Wall Defects.................................1072
124 Surgical Diseases of the Newborn: Alimentary Tract Obstruction..........................1076
125 S urgical Diseases of the Newborn: Diseases of the Airway,
Tracheobronchial Tree, and Lungs........................................................................1080
126 Surgical Diseases of the Newborn: Retroperitoneal Tumors..................................1085
127 Surgical Diseases of the Newborn: Urologic Disorders.........................................1088
128 Thrombocytopenia and Platelet Dysfunction.........................................................1092
129 Thyroid Disorders................................................................................................1097
130 Transient Tachypnea of the Newborn...................................................................1107

SECTION VII. Infectious Diseases

131 Chlamydial Infection............................................................................................1115
132 Cytomegalovirus..................................................................................................1117
133 Dengue Infection, Neonatal..................................................................................1121
134 Enteroviruses and Parechoviruses.......................................................................1123
135 Gonorrhea...........................................................................................................1127
136 Hepatitis..............................................................................................................1128
137 Herpes Simplex Viruses.......................................................................................1136
138 Human Immunodeficiency Virus...........................................................................1143
139 Lyme Disease......................................................................................................1151
140 Meningitis...........................................................................................................1154
141 Methicillin-Resistant Staphylococcus aureus Infections.......................................1157
142 Parvovirus B19 Infection......................................................................................1162
143 Pertussis.............................................................................................................1165
144 Respiratory Syncytial Virus...................................................................................1168
145 Rubella................................................................................................................1171

Gomella_FM_pi-xxxii.indd 15 18/10/19 11:55 am

 xvi Contents

146 Sepsis.................................................................................................................1175
147 Syphilis...............................................................................................................1189
148 TORCH (TORCHZ) Infections.................................................................................1196
149 Toxoplasmosis.....................................................................................................1197
150 Tuberculosis........................................................................................................1202
151 Ureaplasma Infection...........................................................................................1206
152 Urinary Tract Infection..........................................................................................1207
153 Varicella-Zoster Infections...................................................................................1211
154 Zika Virus (Congenital Zika Syndrome).................................................................1215

SECTION VIII. Neonatal Pharmacology

155 Medications Used in the Neonatal Intensive Care Unit..........................................1225
156 Effects of Drugs and Substances on Lactation and Infants...................................1316

Appendices
A Abbreviations......................................................................................................1345
B Apgar Score/Expanded Apgar Score....................................................................1360
C Blood Pressure Determinations............................................................................1363
D Chartwork...........................................................................................................1364
E Immunization Guidelines.....................................................................................1368
F Isolation Guidelines.............................................................................................1372
G Temperature Conversion Table.............................................................................1382
H Weight Conversion Table......................................................................................1383

Index ...........................................................................................................................1385

Gomella_FM_pi-xxxii.indd 16 18/10/19 11:55 am

 Contributors
Zubair H. Aghai, MD, FAAP
Professor of Pediatrics
Director of Neonatology Fellowship Program
Director of Neonatology Research at Jefferson
Sidney Kimmel Medical College–Thomas
Jefferson University
Attending Neonatologist
Nemours at Thomas Jefferson University
Philadelphia, Pennsylvania
The Golden Hour
Irfan Ahmad, MD, FAAP
Associate Clinical Professor of Pediatrics
University of California Irvine
Director, Surgical Neonatal Intensive
Care Unit
Children’s Hospital of Orange County
(CHOC) Children’s Hospital
Orange, California
Necrotizing Enterocolitis; Spontaneous
Intestinal Perforation
Noorjahan Ali, MD, MS
Assistant Professor of Pediatrics
Division of Neonatal-Perinatal Medicine
University of Texas Southwestern Medical
Center
Dallas, Texas
Resuscitation of the Newborn
Captain Mutaz Aljader, MD
Department of Surgery
King Hussein Medical City
Royal Medical Services
Amman, Jordan
Hematuria
Marilee C. Allen, MD
Professor of Pediatrics
The Johns Hopkins School of Medicine
Department of Pediatrics, Division of
Neonatology
The Johns Hopkins Charlotte Bloomberg
Children’s Center
Co-Director, Infant Neurodevelopmental Clinic,
The Kennedy Krieger Institute
Baltimore, Maryland
Counseling Parents Before High-Risk
Delivery; Follow-Up of High-Risk Infants
Gomella_FM_pi-xxxii.indd 17
Gad Alpan, MD, MBA
Clinical Professor of Pediatrics
New York Medical College
Regional Neonatal Center, Maria Fareri
Children’s Hospital
Valhalla, New York
Infant of a Mother with Substance Use
Disorder; Patent Ductus Arteriosus;
Persistent Pulmonary Hypertension of
the Newborn
Stephanie Attarian, MD, IBCLC
Assistant Professor of Clinical Pediatrics
Vanderbilt University School of Medicine
Mildred Stahlman Division of Neonatology
Monroe Carell Jr. Children’s Hospital at
Vanderbilt
Nashville, Tennessee
Nutritional Management
Fayez Bany-Mohammed, MD, FAAP
Clinical Professor of Pediatrics
Program Director
Neonatal/Perinatal Medicine Fellowship
Program
University of California, Irvine School of
Medicine
University of California, Irvine Medical
Center
Orange, California
Chlamydial Infection; Cytomegalovirus;
Gonorrhea; Hepatitis; Herpes Simplex
Viruses; Human Immunodeficiency
Virus; Meningitis; Methicillin-Resistant
Staphylococcus aureus Infections;
Parvovirus B19 Infection; Rubella;
Sepsis; Respiratory Syncytial Virus;
Syphilis; TORCH (TORCHZ) Infections;
Toxoplasmosis; Ureaplasma Infection;
Varicella-Zoster Infections
Daniel A. Beals, MD, FACS, FAAP
Professor, Surgery and Pediatrics
Chief, Division of Pediatric Surgery
Marshall University
Hoops Family Children’s Hospital
Huntington, West Virginia
Neonatal Bioethics
xvii
18/10/19 11:55 am
 xviii
Vincenzo Berghella, MD
Director of Division of Maternal-Fetal
Medicine
Director of Maternal-Fetal Medicine
Fellowship Program
Sidney Kimmel Medical College
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania
Fetal Assessment
Marianne Besnard, MD
Pediatrician
Department of Neonatology
Centre Hospitalier de la Polynésie Française
Taaone Hospital
Pirae, Tahiti
French Polynesia, France
Dengue Infection, Neonatal
Ramachandra Bhat, MD
Associate Professor
Department of Pediatrics
University of South Alabama Health System
USA Children’s and Women’s Hospital
Mobile, Alabama
Polycythemia and Hyperviscosity
Dilip R. Bhatt, MD, FAAP, FACC, FACMQ
Neonatologist and Pediatric Cardiologist
Kaiser Permanente Fontana Medical Center
Fontana, California
Associate Clinical Professor
Loma Linda University
Loma Linda, California
Isolation Guidelines
Kristin Bohannon, PharmD
Clinical Pharmacist
Pediatric Pulmonary Clinic
Cook Children’s Medical Center
Fort Worth, Texas
Effects of Drugs and Substances on
Lactation and Infants; Medications Used
in the Neonatal Intensive Care Unit;
Cover Tables “Emergency Medications
and Therapies for Neonates”; Aerosol
Therapy in Neonates; Medications for
Neonatal Seizures; Hyperkalemia
Management in Neonates; Medications
for Neonatal Hypotension; Medications
for Neonatal Hypertension
Gomella_FM_pi-xxxii.indd 18
Contributors
Andrew C. Bowe, DO, FAAP
Neonatologist
Pediatrix Medical Group
Assistant Professor of Pediatrics
Mercer University School of Medicine
Macon, Georgia
Immunization Guidelines; Rash and
Dermatologic Problems; Figures 80–1,
80–20, and 80–21
Vera Joanna Burton, MD, PhD
Assistant Professor of Neurology and
Developmental Medicine
Kennedy Krieger Institute
Johns Hopkins School of Medicine
Baltimore, Maryland
Counseling Parents Before High-Risk
Delivery; Follow-Up of High-Risk Infants
Glenn Canares, DDS, MSD
Clinical Assistant Professor
Clinical Director of Pediatric Dentistry
Department of Orthodontics and Pediatric
Dentistry
University of Maryland School of Dentistry
Baltimore, Maryland
Dental Section Update of Newborn Physical
Examination
Gary E. Carnahan, MD, PhD
Medical Director of Transfusion Medicine,
Coagulation, and Chemistry
Laboratories
USA Health Hospitals
Assistant Professor of Pathology
University of South Alabama Health System
Director of Pathology and Clinical
Laboratories
USA Health Children’s and Women’s Hospital
Mobile, Alabama
Blood Component Therapy
Leslie Castelo-Soccio, MD, PhD
Assistant Professor of Pediatrics and
Dermatology
University of Pennsylvania School of
Medicine
Philadelphia, Pennsylvania
Figures 7–2, 80–2, 80–3, 80–4, 80–5,
80–6, 80–7, 80–8, 80–9, 80–10,
80–11, 80–12, 80–13, 80–14, 80–15,
80–17, 80–18, 80–19, 93–1
18/10/19 11:55 am
 Contributors xix

Pik-Kwan Chow, NNP, MSN Rebecca A. Dorner, MD, MHS

Neonatal Nurse Practitioner Neonatology Fellow
Christiana Care Health System Department of Pediatrics
Newark, Delaware Division of Neonatology
Laryngeal Mask Airway The Johns Hopkins Charlotte R. Bloomberg
Children’s Center
Jermaine T. Clayborne, BSN, CCRN, The Johns Hopkins Hospital
CFRN, FP-C Baltimore, Maryland
Nurse Manager Counseling Parents Before High-Risk
Medical Transport Network Delivery; Follow-Up of High-Risk Infants
University of Virginia Health System
Charlottesville, Virginia John M. Draus, Jr, MD
Neonatal Transport Associate Professor of Surgery and
Pediatrics
Carol M. Cottrill, MD (deceased) Kentucky Children’s Hospital
Former Pediatric Cardiologist UK HealthCare
UK HealthCare University of Kentucky
Department of Pediatrics Lexington, Kentucky
University of Kentucky Surgical Diseases of the Newborn:
Lexington, Kentucky Abdominal Masses; Surgical Diseases of
Arrhythmia; Congenital Heart Disease; the Newborn: Abdominal Wall Defects;
Defibrillation and Cardioversion Surgical Diseases of the Newborn:
Kristin Lee Crisci, MD Alimentary Tract Obstruction; Surgical
Chief, Sections of Pediatric Radiology and Diseases of the Newborn: Diseases
Diagnostic Radiology of the Airway, Tracheobronchial Tree,
Senior Radiologist and Lungs; Surgical Diseases of the
Abington Hospital, Jefferson Health Newborn: Retroperitoneal Tumors;
Abington, Pennsylvania Figures 123–1, 123–2, 123–3, 126–2
Imaging Studies Kevin C. Dysart, MD
Lesley N. Davidson, MD Associate Medical Director
Neonatologist Newborn/Infant Intensive Care Unit
Pediatrix Medical Group of Kentucky Children’s Hospital of Philadelphia
Baptist Health Lexington Professor of Clinical Pediatrics
Lexington, Kentucky Perelman School of Medicine, University of
Pain in the Neonate Pennsylvania
Philadelphia, Pennsylvania
Nirmala S. Desai, MBBS, FAAP Infant of a Diabetic Mother
Professor of Pediatrics
Department of Pediatrics, Division of Fabien G. Eyal, MD
Neonatology Professor of Pediatrics
Kentucky Children’s Hospital University of South Alabama Health System
UK HealthCare Chief of Division of Neonatology
University of Kentucky USA Children’s and Women’s Hospital
Lexington, Kentucky Mobile, Alabama
Ostomy Care; Pain in the Neonate Temperature Regulation; Sedation and
Analgesia; Anemia; Coagulation
Disorders; Respiratory Management;
Hydrocephalus and Ventriculomegaly;
Fluid and Electrolytes; Air Leak
Syndromes

Gomella_FM_pi-xxxii.indd 19 18/10/19 11:55 am

Another random document with
no related content on Scribd:
and uncouthness. The perfection of the very earliest printed books is
a commonplace. Less generally known, perhaps, is the great beauty
to which the earliest of all the German engravers known to us at all
as a personality, though not by name, was capable of attaining. The
“Master of the Playing-Cards,” who was at work about 1430-40,
produced work of extraordinary charm, not only in some of the
figures, animals and flowers of the playing-cards themselves, but
especially in the large engraving of the Virgin Mary with the human-
headed serpent, or Lilith, beneath her feet, which is one of the most
splendid and mature creations of the fifteenth century. Then, again,
the early book illustrators of Augsburg and Ulm, in the seventies,
when the use of blocks for such a purpose had only recently come
in, produced woodcuts that were never surpassed by any
successors in their simple and direct vivacity and strength, with the
utmost economy of line. But the real beauty of some of the much
earlier single woodcuts, illustrating, chiefly, the legends of Our Lady
and the Saints, has been much less generally appreciated. They are
very rare, and most of them repose, in a seclusion seldom disturbed,
in their boxes in the great European print-rooms or even in monastic
libraries. They are only beginning to be reproduced, and they are
rarely exhibited. But such an exhibition of the earliest German
woodcuts as was held at Berlin in the summer of 1908 was truly a
revelation. The soft and rounded features, the flowing lines of the
drapery, in the prints of the generation before sharp, broken folds
were introduced under the influence of the Netherlands, have
something of the charm of Far Eastern art, and the gay coloring with
which most of the prints were finished has often a delightfully
decorative effect when they are framed and hung at a proper
distance from the eye. Such praise is due, of course, only to some of
the choicer examples; there are plenty of fifteenth-century woodcuts
in which the line is merely clumsy and the coloring merely gaudy, but
these are more often products of the last quarter of the century than
of its beginning or middle. It would not be true to say that the
advance of time brought with it progress and perfection in the
woodcutter’s art; on the contrary, the first vital impulse spent itself all
too soon, and gave way to thoughtless and unintelligent imitation.
 Albrecht Dürer Conterfeyt in seinem alter
Des L V I. Jares.

Dürer. Portrait of Albert Dürer, aged 56

The rare second state (of 3 states) before the monogram of
Dürer and the date 1527
Size of the original woodcut, 12¾ × 10 inches
Dürer. The Four Riders of the Apocalypse
From “The Apocalypse”
Size of the original woodcut, 15¼ × 11 inches
What was the state of things when Dürer appeared upon the scene?
He did so long before the close of the fifteenth century, for his first
authenticated woodcut is an illustration to St. Jerome’s Epistles,
printed at Basle in 1492. Whether he or an unknown artist is
responsible for a large number of other illustrations produced at
Basle about 1493-95, is a question about which no consensus of
opinion has been formed, and this is not the place to discuss it. All
the woodcuts that the world knows and esteems as Dürer’s were
produced at Nuremberg after his return from the first Venetian
journey (1495). Let us see, for a moment, how they stand
comparison with what had gone before them. The older woodcuts
are nearly all anonymous, and if they bear any signature, it is that of
a woodcutter (Formschneider or Briefmaler) who was a craftsman
allied to the joiner, rather than the painter. Just before Dürer’s time
the painter begins to make his appearance on the scene as a
designer of woodcuts. There are a few isolated cases in which the
almost universal rule of anonymity is broken, and we learn from the
preface to a book the name of the artist who designed the
illustrations. Breydenbach’s “Travels to the Holy Land” (Mainz, 1486)
was illustrated by woodcuts after Erhard Reuwich, or Rewich, a
native of Utrecht, who had accompanied the author on his journey,
and the immense number of woodcuts in the “Nuremberg Chronicle”
by Hartmann Schedel (1493) were the work of the painters
Wohlgemuth and Pleydenwurff; to whom the much finer illustrations
of the “Schatzbehalter” (1491) may also safely be attributed. It is now
almost universally believed that the “Master of the Hausbuch,” one of
Dürer’s most gifted predecessors in the art of engraving on copper,
was also a prolific illustrator, the principal work assigned to him being
the numerous illustrations in the “Spiegel der menschlichen
Behaltnis” printed by Peter Drach at Speyer about 1478-80. There
are speculations, more or less ill-founded, about the illustrators of a
few other woodcut books of the fifteenth century, but I believe it is
true that the first book after those already named in which the artist’s
name is settled beyond doubt is Dürer’s “Apocalypse” of 1498.
Dürer. The Whore of Babylon, Seated upon the Beast with Seven
Heads and Ten Horns
From “The Apocalypse”
Size of the original woodcut, 15¼ × 11 inches
 Dürer. Christ Bearing His Cross
From “The Great Passion”
Size of the original woodcut, 15¼ × 11⅛ inches
Dr. Naumann, the editor of a recent facsimile of the cuts in the
Speyer book just mentioned, claims for the “Hausbuchmeister” that
he was the first painter, or painter-engraver, who attempted to get
the most out of the craftsmen employed in cutting blocks from his
designs. That is rather a speculative opinion, and the woodcuts in
question are not, from the technical point of view, superior to many
other contemporary illustrations. But there can be no question that
Dürer effected an immense reform in this respect, and carried the
technique of wood-engraving to a perfection unparalleled in its
previous history. Not by his own handiwork, for there is no reason to
suppose that Dürer ever cut his blocks himself. All the evidence
points, on the contrary, to his having followed the universal practice
of the time, according to which the designer drew the composition in
all detail upon the wood block, and employed a professional
engraver to cut the block, preserving all the lines intact, and cutting
away the spaces between them, so that the result was a facsimile of
the drawing as accurate as the craftsman was capable of making it.
Dürer set his engravers, we may be sure, a harder task than they
had ever had to grapple with before, and he must have succeeded in
gradually training a man, or group of men, on whom he could rely to
preserve his drawing in all its delicacy and intricate complexity. This
was a work of time, and perfection was not reached till after Dürer’s
return from his second journey to Venice, when a great increase of
refinement on the technical side becomes noticeable, culminating in
that extraordinary performance, the Holy Trinity woodcut of 1511. But
even in the large fifteenth-century blocks, the “Apocalypse,” the
earlier portion of the “Great Passion” and the contemporary single
subjects, much cross-hatching is used and the space is filled with
detail to an extent hitherto unknown. Without ever losing sight of the
general decorative effect, the telling pattern of black and white, Dürer
put in a vast amount of interesting little things, with the
conscientiousness and care that characterized everything that he
did, and every detail of the leaves of a thistle or fern, or of the
elaborate ornament, birds and flowers and foliage and rams’ heads,
on the base of a Gothic candle-stick, had to be reproduced so that
the crisp clearness of the original pen-drawing lost nothing of its
precision. The result was a work so perfectly complete in black and
white, as it stood, that nobody ever thought of coloring it, and that in
itself was a great innovation and advance. The fifteenth-century
“Illuminirer,” or the patron who gave him his orders, seems to have
had an instinctive respect for excellent and highly finished work in
black and white, which made him leave it alone. Line-engravings of
the fifteenth century are very frequently found colored, but they are
usually quite second-rate specimens, and prints by the great men,
such as the “Master E. S.” and Schongauer, were respected and left
alone. But such consideration was not often shown to woodcuts,
which were frequently colored, especially when used as illustrations,
well into the sixteenth century. It was very rarely, however, that any
illuminator laid profane hands on anything of Dürer’s, woodcut or
engraving, and when he did so the result is stupid and disagreeable,
for it is always the work of a later generation, out of touch with
Dürer’s genius.
 Dürer. The Resurrection
From “The Great Passion”
Size of the original woodcut, 15⅜ × 10⅞ inches
 Dürer. Samson and the Lion
Size of the original woodcut, 15 × 10⅞ inches
It may be said that if Dürer and his contemporaries did not cut their
own blocks, the woodcuts are not original prints by the masters
themselves. It must be conceded that they are not original prints
quite in the same sense as engravings and etchings, in which the
whole work was carried out upon the plate by the masters’ own
hand, but it would be a mistake to describe them as examples of
reproductive engraving. Such a thing as a reproductive engraving
was, in fact, unknown in the Germany of Dürer’s time. A design
originally projected in one medium might be reproduced in another in
a case where an engraving by Schongauer, or Meckenen, or Dürer
himself, was copied by some inferior woodcutter, as an act of piracy,
for a bookseller who was too stingy to pay an artist to draw him a
new Virgin or Saint for his purpose. But it would never have occurred
to any one to reproduce an engraving or woodcut, a picture or
drawing, done for its own sake, as a separate and complete work of
art. Reproductions of pictures scarcely exist in German art of the
sixteenth century; they are commoner in the Venetian School,
among the woodcutters influenced by Titian, and Rubens
established the practice once for all by his encouragement of
engraving from his pictures, a century after Dürer’s time. But when
woodcutting was taken up by the German painters, with Dürer as
their leader, for the purpose of circulating their compositions at a
cheaper price than they could charge for engravings of their own,
they always had a strictly legitimate object according to the canons
of graphic art. Rarely working even from sketches, never from a work
already finished in another medium, they drew the subjects intended
for printing directly upon the block in a technique adapted for the
purpose, avoiding such combinations of lines as the most skilful
craftsmen would be unable to cut. Their actual handiwork was
preserved upon the surface of the block, much as in the modern
original lithograph the artist’s actual work survives upon the surface
of the stone; if it was in any way disfigured, as often, no doubt, it
was, that must be set down to failure on the cutter’s part. Anything
original that the cutter puts in, any swerving that accident or
clumsiness permits him to make from the line fixed by the painter’s
pen for him to follow, is a blemish, and the best woodcuts of Dürer,
Holbein, Baldung, Cranach, Burgkmair and the rest of their
generation have no such blemishes. They are strictly autographic:
the lines that the artist’s pen has traced remain and are immortalized
by the printing-press; the white spaces, also limited by his controlling
will and purpose, result from the mere mechanical cutting away of
blank wood that any neat-handed workman can perform. So when
we speak of the woodcuts of Millais, Rossetti, Whistler, Walker,
Pinwell, Sandys and the rest of the “Men of the Sixties,” we know
that the blocks were cut by Dalziel or Swain, but every good print is
none the less what the designer meant it to be, and what none but
himself could have made it.
 Dürer. The Annunciation to Joachim
From “The Life of the Virgin”
Size of the original woodcut, 11⅝ × 8³/₁₆ inches
 Dürer. The Annunciation
From “The Life of the Virgin”
Size of the original woodcut, 11⅝ × 8¼ inches
Of Dürer’s woodcutters, unluckily, we know nothing till the
comparatively late period when he had been enlisted in the service
of the Emperor Maximilian, whose imposing, but somewhat
ponderous and pedantic, Triumphal Arch was cut from the designs of
Dürer and his school by Hieronymus Andreä. There is much more
information about the Augsburg cutters than about those of
Nuremberg, and there is no single artist in the latter city whose work
is so strongly marked out by its excellence from that of his
contemporaries as was Lützelburger’s, who cut Holbein’s “Dance of
Death.”
To understand Dürer’s woodcuts aright, it is necessary to get to know
them in their chronological sequence. In conservative collections,
where they are arranged by order of subject, on the system of
Bartsch, the student is continually confused by the juxtaposition of
quite incongruous pieces, placed together merely because “Jérôme,”
for instance, comes in alphabetical order next after “Jean.” The
British Museum collection has been arranged for more than ten
years past in chronological order, which, in Dürer’s case, is unusually
easy to determine with approximate accuracy, because his
methodical turn of mind caused him to be fond of dates, while the
undated pieces can be fitted in without much difficulty by the
evidence of style. The justification of the system became all the more
apparent when the woodcuts were exhibited for a few months in
1909, and fell naturally into consistent and coherent groups upon the
screens, while separated, as a matter of practical convenience, from
the engravings. Since then two even more interesting experiments
have been made, in exhibitions held at Liverpool and Bremen,
toward a reconstruction of Dürer’s entire life-work in its chronological
sequence, his pictures, drawings, engravings and woodcuts—
represented mainly, of course, by reproductions—being merged in a
single series. That is a timely warning against the risks of excessive
concentration upon one single side of his many activities, but here
we will not digress further from the woodcuts, which are at present
our theme.
 Dürer. The Flight into Egypt
From “The Life of the Virgin”
Size of the original woodcut, 11⅝ × 8¼ inches
Dürer. The Assumption and Crowning of the Virgin
From “The Life of the Virgin”
Size of the original woodcut, 11½ × 8⅛ inches
The series opens magnificently with the group of large and stately
woodcuts, abounding in vitality and dramatic invention, produced by
Dürer between 1495 and 1500. These include the fifteen subjects of
the “Apocalypse,” the seven early subjects of the “Great Passion”
(not completed until 1510-11) and seven detached pieces uniform
with the two series already named in dimensions and style, but
independent of them in subject. The blocks of the majority of these
single pieces are now, by the way, in an American collection, that of
Mr. Junius S. Morgan, but they have suffered sadly from the ravages
of the worm. There is a certain exaggeration and over-emphasis of
gesture in the “Apocalypse” woodcuts, but Dürer never invented
anything more sublime than the celebrated Four Riders or the St.
Michael defeating the Rebel Angels, which I regard as at least equal
to the subject more frequently praised. Superb, too, is the group of
Angels restraining the Four Winds. The landscape at the foot of St.
John’s Vision of the Four-and-twenty Elders (B. 63) is a complete
picture by itself, and there is a rare early copy of this portion alone,
which is itself a beautiful print, and doubtless the earliest pure
landscape woodcut in existence. Samson and the Lion, the
mysteriously named Ercules and the Knight and Man-at-arms, often
described as its companion, and the Martyrdom of St. Catherine are
among the finest of the single subjects. After this tremendously
impressive group, there is for a time a certain relaxation of energy, or
rather Dürer was more bent on other things, especially engraving. To
the years 1500-04 belong a number of woodcuts of Holy Families
and Saints, much smaller than the “Apocalypse,” and rather roughly
cut. Some critics have wished to dismiss one or another of them as
pupils’ work, but for this there is really no justification. Then comes
another very good period, that of the “Life of the Virgin,” of which set
Dürer had finished seventeen subjects before he left for Venice in
1505, while the Death of the Virgin and The Assumption were added
in 1510, and the frontispiece in 1511, when the whole work came out
as a book, assuredly one of the most desirable picture-books the
world has ever seen! It is impossible to weary of the beautiful
compositions, the details drawn with such loving care, the tender and
homely sentiment, the humor, even, displayed in the accessory
figures of The Embrace of Joachim and Anne, the beer-drinking
gossips in the Birth of the Virgin, where the atmosphere of St. Anne’s
chamber is sweetened by an angelic thurifer, and the merry group of
angelic children playing round Joseph, bent on his carpenter’s
business, while their elders keep solemn watch round Mary at her
distaff and the Holy Child in the cradle. We find landscapes at least
as beautiful as those in Dürer’s best engravings in the pastoral
background of the Annunciation to Joachim and the mountainous
distance of the Visitation. The architectural setting of the
Presentation of Christ in the Temple, and the tall cross held aloft,
with the happiest effect on the composition, by the Apostle kneeling
on the left in Mary’s death-chamber, are among the memorable
features of the set.
Beautiful again, especially in fine proofs, is the next and latest of the
long sets, the “Little Passion,” consisting of thirty-six subjects and a
title-page, begun in 1509 and finished, like all the other books, in
1511. But it has not the monumental grandeur of the earlier religious
sets, and there is an inevitable monotony about the incessant
recurrence of the figure of Our Lord, when the history of the Passion
is set forth in such detail. The most original and impressive subjects,
in my opinion, are Christ Appearing to St. Mary Magdalen and the
next following it, The Supper at Emmaus.
 Dürer. St. Jerome in his Cell
Size of the original woodcut, 9¼ × 6¼ inches