Pediatrics

Care of the high-risk neonate by M. Klaus, et al.,

By M. Klaus, et al.,

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Intrauterine infection occurred in 19% before delivery. Fetal tachycardia, maternal leukocytosis, and uterine contractions were not predictive of intrauterine infection in afebrile patients; however, amniocentesis positive for bacteria either with Gram stain or with subsequent positive culture correlated with antenatal maternal fever. Postpartum endometritis was the only major maternal complication associated with chorioamnionitis. Neonatal outcome-as evidenced by an increased perinatal mortality rate and a higher incidence of neonatal infection and RDS-was adversely affected in the presence of maternal fever before the onset of labor, a prognostic ally ominous sign for the fetus.

Stimulation of myometrial l3-receptors inhibits activity as it does in smooth muscles. The myocardium responds with increased activity when its l3-receptors are stimulated. Ritodrine hydrochloride was the first of the agents to undergo rigorous clinical in- vestigation in the United States. Whereas ritodrine was specifically synthesized for its predominant 132 effect, by which uterine relaxation is achieved, there is invariably a degree of 131 stimulation, resulting in tachycardia, widened pulse pressure, tremor, and restlessness.

The method of delivery, operative vaginal or cesarean section, will depend on cervical dilatation, station, and position of the fetal head. COMMENT: Prolonged preparation of the mother on the delivery or operating table in a supine position (for instance, during the preparation for cesarean delivery) may bring about these adverse effects at a time when monitoring is frequently discontinued. Mildred T. Stahlman Adequate preparation is desirable for prompt effective resuscitation of the newborn. The pediatrician should be alerted when a decision is being made to intervene operatively for a fetus in distress (Table 1-8) (also see Chapter 2, Resuscitation of the Newborn Infant).

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