Management of neonatal hazards in intensive care units: a review

Amany K. A. Khalifa


The study aims at reviewing the neonatal morbidity and their management with a closer look to the intensive care units. The critical situation of high-risk infants, including preterm or within serious medical conditions, has been highlighted and elaborated. The management of every pertinent condition was accordingly detailed.

Keywords: Neonatal hazards, High-risk infants, Neonatal management

Full Text:



Patti J. Thureen, Marianne S. Anderson, William W. Hay. The small-for-gestational age infant neo reviews. Am Acad Pediatr. 2001;2(6):139-49.

CIA World Factbook. Egypt infant mortality rate, 2011. Available at:

Mosby’s Medical Dictionary. The free dictionary: infant mortality, 2009. Available at: http://medicaldictionary. The free

Campbell O, Gipson R, el-Mohandes A, Issa AH, Matta N, Mansour E, et al. The Egypt national perinatal/neonatal mortality study 2000. J Perinatol. 2004;24(5):284-9.

Martin JA, Kung HC, Mathews TJ, Hoyert DL, Strobino DM, Guyer B, et al. Annual summary of vital statistics: 2006. Pediatrics. 2006;121(4):788-801.

Subramanian K, Ted Rosenkrantz. Transient tachypnea of the new-born, 2012. Available at:

Mayor S Extremely low birth weight is linked to risk of chronic illness BMJ. 2005;331(7510):180.

Hodgman JE, Barton L, Pavlova Z, Fassett MJ. Infection as a cause of death in the extremely-low-birth-weight infant. J Matern Fetal Neonatal Med. 2003;14(5):313-7.

Freeman VA. Very low birth weight babies delivered at facilities for high risk neonates. Final Rep. 2010 Apr;8:1-41.

William H. Tooley; Intensive Care Nursery House Very low and extremely low birth weight infants. In: William H. Tooley, eds. Staff Manual. California: The Regents of the University of California; 2004: 66-68.

Matthews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. National vital statistics reports. In: Matthews TJ, MacDorman MF, eds. A Report. bHyattsville, MD: National Center for Health Statistics; 2010;58(17)1-20.

United Nations Children’s Fund and the World Health Organization (UNICEF & WHO). Low birthweight. In: WHO, eds. Country, Regional and Global Estimates. New York and Geneva: UNICEF and WHO; 2004: 2-3.

Mumbare S, Maindarkar G, Darade R, Yenge S, Tolani MK, Patole K. Maternal risk factors associated with term low birth weight neonates. Indian Pediatr. 2012;49(1):25-8.

Gupta RK. Care of low birth weight neonates, from the department of pediatrics. ASCOMS, Sidhra Jammu-J&K-India. 2008;10(4):158-9.

Akin Y, Cömert S, Turan C, Piçak A, Ağzikuru T, Telatar B. Macrosomic newborns: a 3-year review. Turk J Pediatr. 2010;52(4): 378-83.

Henriksen T. The macrosomic fetus: a challenge in current obstetrics. Acta Obstet Gynecol Scand. 2008;87:134-45.

Lindsay CA. Pregnancy complicated by diabetes mellitus. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin’s Neonatal-Perinatal Medicine. Diseases of the Fetus and Infant. 8th ed. Philadelphia: Mosby Elsevier; 2006: 326-327.

Carlo WA. Large for gestational age infants. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011: Chap 91.4.

Kendig JW. Postmature infant. The Merck Manuals Online Medical Library, 2007. Available at: Retrieved 2008-10-06.

Thureen PJ, Anderson MS, Hay WW. The small-for-gestational age infant neo reviews. Am Acad Pediatr. 2001;2(6):139-49.

Xu H, Simonet F, Luo ZC. Optimal birth weight percentile cut-offs in defining small- or large-for-gestational-age. Acta Paediatr. 2010;99:550.

Carlo WA. Large for gestational age infants. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011: Chap 91.4.

Divon MY, Ferber A. Fetal growth restriction: etiology [electronic version], 2007. Available at:

Severi FM, Rizzo G, Bocchi C, D’Antona D, Verzuri MS, Arduini D. Intrauterine growth retardation and fetal cardiac function. Fetal Diagn Ther. 2000;15(1):8-19.

Axt-Fliedner R, Schwarze A, Nelles I, Altgassen C, Friedrich M, Schmidt W, et al. The value of uterine artery Doppler ultrasound in the prediction of severe complications in a risk population. Arch Gynecol Obstet. 2005;271(1):53-8.

Ballard JL, Novak KK, Driver M. A simplified score for assessment of fetal maturation of newly born infants. J Pediatr. 1979;95(5 Pt 1):769-74.

Kimberly G. Lee. Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 379. Management of delivery of a newborn with meconium-stained amniotic fluid. Obstet Gynecol. 2007;110:739.

Escobar GJ, McCormick MC, Zupancic JA, Coleman-Phox K, Armstrong MA, Greene JD, et al. Unstudied infants: outcomes of moderately premature infants in the NICU. Arch Dis Child Fetal Neonatal Ed. 2006 Jul;91(4):F238-44.

Raju TN, Higgins RD, Stark AR, Leveno KJ. Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics. 2006;118:1207-14.

National Center for Health Statistics. Final natality data, 2009. Available at: Accessed February 2009.

Engle WA, Kominiarek MA. Late preterm infants, early term infants, and timing of elective deliveries section of neonatal-perinatal pediatrics. Clin Perinatol. 2008;35:325-41.

Institute of Medicine (IOM). Preterm Birth: causes, consequences, and prevention. In: IOM, eds. IOM Report. Washington, D.C.: National Academies Press; 2006.

Boyle EM, Poulsen G, Field DJ, Kurinczuk JJ, Wolke D, Alfirevic Z, et al. Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study. BMJ. 2012;344:e896.

Martin JA, Hamilton BE, Ventural SJ, Osterman MJ, Kirmeyer S, Mathews TJ, et al. Births: final data for 2009. Natl Vital Stat Rep. 2011;60:1.

Nakling J, Backe B. Pregnancy risk increases from 41 weeks of gestation. Acta Obstet Gynecol Scand. 2006;85:663.

Resnik R. Fetal macrosomia: 3 management dilemmas. J Fam Pract. 2003;5(12)28-36.

American College of Obstetricians and Gynecologists (ACOG). Antenatal corticosteroid therapy for fetal maturation. In: ACOG, eds. ACOG Committee Opinion, Number 273, May 2002. America: ACOG; 2005.

Lissauer T, Clayden A. Transitory tachypnea of newborn. In: Lissauer T, Clayden A, eds. Illustrated Textbook of Paediatrics. 3rd ed. US: Mosby/Elsevier; 2007: 162

Kasap B, Duman N, Ozer E, Tatli M, Kumral A, Ozkan H. Transient tachypnea of the newborn: predictive factor for prolonged tachypnea. Pediatr Int. 2008;50(1):81-4.

Miller-Keane, Benjamin F. Miller, Marie T. O’Toole. Miller-Keane encyclopedia & dictionary of medicine, nursing and allied health. In: Miller-Keane, Benjamin F. Miller, Marie T. O’Toole, eds. A Book. 7th ed. Philadelphia: Saunders; 2003.

Rodriguez RJ, Martin RJ and Fanaroff AA. Respiratory distress syndrome and its management. In: Fanaroff, Martin eds. Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 7th ed. St. Louis: Mosby; 2001: 1001-1011.

Qiu X, Lee SK, Tan K, et al. Comparison of singleton and multiple-birth outcomes of infants born at or before 32 weeks gestation. Obstet Gynecol. 2008;111:365-371.

Cloherty JP, Eichenwald EC, Stark AR. Manual of neonatal care, North American. In: Cloherty JP, Eichenwald EC, Stark AR, eds. A Book. 6th ed. Philadelphia: Williams and Wilkins Lippincott; 2007.

Cloherty J, Stark A, Eichenwald E. Manual of neonatal care. In: Cloherty J, Stark A, Eichenwald E, eds. A Book. 6th ed. Philadelphia: Lippincott, Wilkins and Williams; 2008.

Palta M, Sadek-Badawi M, Evans M, Weinstein MR, McGuinnes G. Functional assessment of a multicenter very low-birth-weight cohort at age 5 years: new-born lung project. Arch Pediatr Adolesc Med. 2000;154:23-30.

Panickar J, Scholefield H, Kumar Y, Pilling DW, Subhedar NV. Atypical chronic lung disease in preterm infants. J Perinat Med. 2004;32(2):162-7.

Cowie RL, Murray J and Becklake MR. Disorders of the intrathoracic airways. In: Mason RJ, Broaddus VC, Martin TR, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010: Chap 44.

Klingner MC, Kruse J. Meconium aspiration syndrome: pathophysiology and prevention. J Am Board Fam Pract. 1999;12(6):450-66.

Clark MB. Meconium aspiration syndrome, 2009. Available at:

Cheng Y, Nicholson J, Nakagawa S, Bruckner TA, Washington AE, Caughey AB. Perinatal outcomes in low-risk term pregnancies: do they differ by week of gestation? Am J Obstet Gynecol. 2008;199(4):370.3e1-7.

Dargaville PA, Copnell B. The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome. Pediatrics. 2006;117(5):1712.

Kendig James W. Postmature infant. The Merck Manuals Online Medical Library, 2007. Available at: Accessed 06 October 2008.

Haobijam J. Hypothermia and its management in new-born, 2013. Available at: epSubPageExtractor.asp?src=education.Health_Issue.Hypothermia_and_its_management.

Kumar Abbas, Fausto. TORCH infections. In: Kumar Abbas, Fausto, eds. Robbins and Cotran’s Pathologic Basis of Disease. 7th ed. Philadelphia: Saunders; 2009: 470.

Mersch J. Neonatal sepsis (Sepsis neonatorum), 2009. Available at: Accessed 3 April 2009.

Klinger G, Levy I, Sirota L, Boyko V, Reichman B, Lerner-Geva L, et al. Epidemiology and risk factors for early onset sepsis among very-low-birth weight infants. Am J Obstet Gynecol. 2009;201(1):38.e1-6.

van den Hoogen A, Gerards LJ, Verboon-Maciolek MA, Fleer A, Krediet TG. Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents. Neonatology. 2009 Jul;97(1):22-8.

Carr R, Brocklehurst P, Doré CJ, Modi N. Granulocyte-macrophage colony stimulating factor administered as prophylaxis for reduction of sepsis in extremely preterm, small for gestational age neonates (the PROGRAMS trial): a single-blind, multicentre, randomised controlled trial. Lancet. 2009;373(9659):226-33.

Jospe N. Neonatal hyperbilirubinemia. In: Jospe N, eds. A Merck Manual of Patient Symptoms Podcast. US: Merck; 2009.

Georgy ML, Martin CR, Clothery JP. Neonatal hyperbilirubinemia. In: Georgy ML, Martin CR, Clothery JP, eds. Manual of Neonatal Care. US: Merck; 2011.

Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med. 2001;344:581-90.

Gartner LM, Herschel M. Jaundice and breast-feeding. Pediatr Clin North Am. 2001;48:389-99.

Preer GL, Philipp BL. Understanding and managing breast milk jaundice. Arch Dis Child Fetal Neonatal Ed. 2011;96(6):461-6.

[Laciou-Petruccell A. Perinatal asphyxia. New York, NY: Vantage Press; 2006. Available at:

Wyatt JS, Gluckman PD, Liu PY, Azzopardi D, Ballard R, Edwards AD, et al. Determinants of outcomes after head cooling for neonatal encephalopathy. Pediatrics. 2007;119:912-921.

Rutherford MA, Azzopardi D, Whitelaw A, Cowan F, Renowden S, Edwards AD, et al. Mild hypothermia and the distribution of cerebral lesions in neonates with hypoxic-ischemic encephalopathy. Pediatrics. 2005;116:1001-6.

Parker LA. Early recognition and treatment of birth trauma: injuries to the head and face. Adv Neonatal Care. 2005;5(6):288-97.

Moczygemba CK, Paramsothy P, Meikle S, Kourtis AP, Barfield WD, Kuklina E, et al. Route of delivery and neonatal birth trauma. Am J Obstet Gynecol. 2010;202(4):361.e1-6.

Beck CT. Birth trauma and its sequelae. J Trauma Dissociation. 2009;10(2):189-203.

Manco-Johnson MJ. Bleeding disorders in the neonate. Neo Rev. 2008;9:162-9.

Christensen. Hematologic problems of the neonate. In: Christensen, eds. A Book. 1st ed. Philadelphia: W.B. Saunders Company; 2000.

McGowan JE. Neonatal hypoglycemia. Pediatr Rev. 1999;20:6.

Sperling MA, Menon RK. Differential diagnosis and management of neonatal hypoglycemia. Pediatr. Clin North Am. 2004;51:703-23.

Gomella TM, Cunningham F. Eyal. Neonatology: management, procedures, on-call problems, diseases and drugs. In: Gomella TM, Cunningham F. Eyal, eds. A Book. 6th ed. New York: McGraw-Hill Professional; 2009.

Jain A, Agarwal R, Sankar MJ, Deorari AK, Paul VK. Hypocalcemia in the newborn. Indian J Pediatr. 2010;77(10):1123-8.

Thomas TC, Smith JM, White PC, Adhikari S. Transient neonatal hypocalcemia: presentation and outcomes. Pediatrics. 2012;129(6):e1461-7.

Sharma S, Kumar P, Agarwal R, Kabra M, Deorari AK, Paul VK. Approach to inborn errors of metabolism presenting in the neonate. Indian J Pediatr. 2008;75(3):271-6.

Rao AN, Kavitha J, Koch M, Suresh Kumar V. Inborn errors of metabolism: review and data from a tertiary care center. Indian J Clin Biochem. 2009;24(3):215-22.

Phelps DL. Retinopathy of prematurity: history, classification, and pathophysiology. Neo Rev. 2001;2(7):e153-66.

Bashour M. Retinopathy of prematurity, 2012. Available at:

Varughese S, Gilbert C, Pieper C, Cook C. Retinopathy of prematurity in South Africa: an assessment of needs, resources and requirements for screening programmes. Br J Ophthalmol. 2008;92(7):879-82.

Kenna M, Behrman RE, Kliegmen R. Nelson textbook of pediatrics. In: Kenna M, Behrman RE, Kliegmen R, eds. 16th ed. Philadelphia: Saunder’s Company; 2000: 1940-1949.

Levene MI, Tudehope DI, Sinha S. Examination of the newborn. In: Essential Neonatal Medicine. 4th ed. Australia: Blackwell Publishing; 2008: 25-34.

Fuloria M, Kreiter S. The new-born examination: part I. Emergencies and common abnormalities involving the skin, head, neck, chest, and respiratory and cardiovascular systems. Am Fam Physician. 2002;65(1):61-8.

Chirico G, Loda C. Laboratory aid to the diagnosis and therapy of infection in the neonate. Pediatr Rep. 2011;3(1):e1.

Sharma S, Kumar P, Agarwal R, Kabra M, Deorari AK, Paul VK. Approach to inborn errors of metabolism presenting in the neonate. Indian J Pediatr. 2010;75(3):271-6.

Hansen TWR, Itani O, Windle ML. Neonatal jaundice, 2012. Available at: 974786-overview.

Mcmillan DD, Wu J. Approach to the bleeding newborn. Paediatr Child Health. 1998;3(6):399-401.

Pramanik AK, Rosenkrantz T, David AC. Respiratory distress syndrome, 2006. Available at:

Verónica RM, Gallo LL, Medina DR, De la Torre MG, Mancilla J-L, Amezcua MM, et al. Safe neonatal transport in the State of Jalisco: Impact of the S.T.A.B.L.E. program on morbidity and mortality. Bol Med Hosp Infant Mex. 2011;68(1):31-5.

Yeager SB, Horbar JD, Greco KM, Duff J, Thiagarajan RR, Laussen PC. Pretransport and posttransport characteristics and outcomes of neonates who were admitted to a cardiac intensive care unit. Pediatrics. 2006;118:1070-7.

Chen P, Macnab AJ, Sun C. Effect of transport team interventions on stabilization time in neonatal and pediatric interfacility transports. Air Med J. 2005;24(6):244-7.

Carell M. Children’s hospital at Vanderbilt 2200 children’s way Nashville. TN. 2012;37232(615):936-1000.

Bellig L. Neonatal sepsis. Emedicine, 2004. Available at: Accessed 12 July 2004.

Jain A, Agarwal R, Sankar MJ, Deorari AK, Paul VK. Hypocalcemia in the newborn. Indian J Pediatr. 2010;77(10):1123-8.

Ten VS, Matsiukevich D. Room air or 100% oxygen for resuscitation of infants with perinatal depression. Curr Opin Pediatr. 2009;21(2):188-93.

Sabir H, Jary S, Tooley J, Liu X, Thoresen M. Increased Inspired oxygen in the first hours of life is associated with adverse outcome in newborns treated for perinatal asphyxia with therapeutic hypothermia. J Pediatr. 2012;161(3):409-16.

Kecskes Z, Healy G, Jensen A. Fluid restriction for term infants with hypoxic-ischaemic encephalopathy following perinatal asphyxia. Cochrane Database Syst Rev. 2005;(3):CD004337.

Laptook A, Tyson J, Shankaran S, McDonald S, Ehrenkranz R, Fanaroff A, et al. Elevated temperature after hypoxic-ischemic encephalopathy: risk factor for adverse outcomes. Pediatrics. 2008;122(3):491-9.

Miller SP, Weiss J, Barnwell A, Ferriero DM, Latal-Hajnal B, Ferrer-Rogers A, et al. Seizure-associated brain injury in term newborns with perinatal asphyxia. Neurology. 2002;58(4):542-8.

Gunn AJ, Gunn TR. The ‘pharmacology’ of neuronal rescue with cerebral hypothermia. Early Hum Dev. 1998;53(1):19-35.

Shankaran S, Pappas A, Laptook AR, McDonald SA, Ehrenkranz RA, Tyson JE, et al. Outcomes of safety and effectiveness in a multicenter randomized, controlled trial of whole-body hypothermia for neonatal hypoxic-ischemic encephalopathy. Pediatrics. 2008;122(4):e791-8.

Atkinson LR, Escobar GJ, Takyama JI, Newman TB. Phototherapy use in jaundiced newborns in a large managed care organization: do clinicians adhere to the guideline. Pediatrics. 2003;111:555.

Gottstein R, Cooke RW. Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal Ed. 2003;88(1):6-10.

Huizing K, Roislien J, Hansen T. Intravenous immune globulin reduces the need for exchange transfusions in Rhesus and AB0 incompatibility. Acta Paediatr. 2008;97(10):1362-5.

Kumral A, Ozkan H, Duman N, Yesilirmak DC, Islekel H, Ozalp Y. Breast milk jaundice correlates with high levels of epidermal growth factor. Pediatr Res. 2009;66(2):218-21.

Engle WA, Kominiarek MA. Late Preterm infants, early term infants, and timing of elective deliveries section of neonatal-perinatal pediatrics. Clin Perinatol. 2008;35:325-41.

Truffert P, Paris-Llado J, Escande B, Magny JF, Cambonie G, Saliba E, et al. Neuromotor outcome at 2 years of very preterm infants who were treated with high-frequency oscillatory ventilation or conventional ventilation for neonatal respiratory distress syndrome. Pediatrics. 2007;119:e860-5.

Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J, et al. Neonatal resuscitation: 2010 American Heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics. 2010;126(5):1400-13.

El Shahed AI, Dargaville P, Ohlsson A, Soll RF. Surfactant for meconium aspiration syndrome in full term/near term infants. Cochrane Database Syst Rev. 2007;18(3):CD002054.

Abman SH, Kinsella JP. Inhaled nitric oxide therapy for pulmonary disease in pediatrics. Curr Opin Pediatr. 1998;10(3):236-42.

Kugelman A, Gangitano E, Taschuk R, Garza R, Riskin A, McEvoy C, et al. Extracorporeal membrane oxygenation in infants with meconium aspiration syndrome: a decade of experience with venovenous ECMO. J Pediatr Surg. 2005;40(7):1082-9.

Weiss M, Johnson NL, Malin S, Jerofke T, Lang C, Sherburne E. Readiness for discharge in parents of hospitalized children. J Pediatr Nurs. 2008;23(4):282-95.

Msall ME, Tremont MR. Functional outcomes in self-care, mobility, communication, and learning in extremely low-birth weight infants. Clin Perinatol. 2000;27(2):381-401.

McGrath MM, Sullivan MC, Lester MC. Longitudinal neurologic follow-up in neonatal intensive care unit survivors with various neonatal morbidities. Pediatrics. 2000;106(6):1397-405.

van Baar AL, van Wassenaer AG, Briet JM, Dekker FW, Kok JH. Very preterm birth is associated with disabilities in multiple developmental domains. Pediatr Psychol. 2005;30(3):247-255.

Welzel-Muler K, Stephan K, Nekahem D, Hirst-Stadlmann. A, Weichbold V. Hearing screening: normal newborn nursery versus neonatal intensive care unit. Int Pediatr. 2001;16(1):1-3.

Lutman ME, Davis AC, Fortnum HM, Wood S. Field sensitivity of targeted neonatal hearing screening by transientevoked otoacoustic emissions. Ear Hear. 1997;18(4):256-76.

Neault MW. Pediatric audiology. In: Wetmore RF, eds. Pediatric Otolaryngology, Principle and Practice. 2nd ed. New York: Thieme; 2000: 191-200.