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  Do not use if srcr > 1. 5 mg/dl (133 μmol/l) or bun > 25 mg/dl (8. 9 mmol/l) 3.  give proper dosing for renal dysfunction crcl 46–60 ml/min (0. 77–1. 00 ml/s). Decrease dose by 50%. Crcl 31–50 ml/min (0. 51–0. 83 ml/s). Decrease dose by 75%. Crcl ≤ 30 ml/min (0. 50 ml/s). Do not use 4.   Appropriate antiemetic regimen for prevention of acute and delayed nausea 1.  monitor urine-to-creatinine baseline and every two cycles. Hold therapy if ratio > 2 or measure urine protein every cycle and addition testing if positive for proteinuria 2.

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N eng!. ] med2008;358:700-708. Ostrea em, odell gb. The influence of bicarbonate administration on blood ph in a "closed system". Clinical implications.] pediatr 1972;80:671-680. Perlman jm, risser r cardiopulmonary resuscitation in the delivery room. Associated clinical events. Arch pediatr adoksc med 1995;149:20-25. Saugstad od. Resuscitation of newborn infants with room air or oxygen. Semin neonatol 2001 ;6:233-239. Saugstad od, rootwelt t, aalen 0. Resuscitation of asphyxiated newborn infants with room air or oxygen. An international controlled trial. Pediatrics 1998;102:E1.

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All vlbw infants should be screened both in the neonatal period and again at 1 year of age (earlier if parental concerns are noted or if the infant has additional risk factors for hearing loss) (see chap. 65). There is also evidence that vlbw infants are at increased risk for auditory dyssynchrony (also called auditory neuropathy) and central auditory processing problems. 188 i follow-up care of very low birth weight infants e. Dental problems. Vlbw infants have been noted to have an increased incidence of enamel hypoplasia and discoloration. Long-term oral intubation in the neonatal period may result in palate and alveolar ridge deformation, affecting tooth development. Referral to a pediatric dentist in the first 18 months oflife is recommended, as is routine supplemental fluoride. Ill. Neurodevelopmental outcomes. Infants with intracranial hemorrhage, in particular parenchymal hemorrhage, or periventricular white matter injury are at increased risk for neuromotor and cognitive delay. Infants with white matter injury are also at increased risk for visuomotor problems, as well as visual field deficits. Among elbw infants with neonatal complications, including bpd, brain injury (defined on ultrasonographic imaging as intraparenchymal echodensity, periventricular leukomalacia, porencephalic cyst, or grade 3 or 4 intraventricular hemorrhage [nh]), and severe rop (threshold or stage 4 or 5 rop in one or both eyes), 88o/o had poor neurosensory outcomes at 18 months of age with either cerebral palsy, cognitive delay, severe hearing loss, or bilateral blindness. Infants with cerebellar hemorrhage are at increased risk for abnormal motor development, as well as cognitive, behavioral, functional, and social developmental problems. A. Neuromotor problems. The incidence of cerebral palsy is ?. O/o to 12o/o in vlbw infants and 11 o/o to 15o/o in elbw infants. The most common type of cerebral palsy is spastic diplegia. This correlates with the anatomic location of the corticospinal tracts in the periventricular white matter. Vlbw infants are also at risk for other types of abnormal motor development, including motor coordination problems and later problems with motor planning. 1. Both transient and long-term motor problems in infants require assessment and treatment by physical therapists and occupational therapists. These services are usually provided at home through local programs. Infants with sensorineural handicaps require coordination of appropriate clinical services and developmental programs. For older children, consultation with the schools and participation in an educational plan are important. 2. Early diagnosis and referral to a neurologist and orthopedic surgeon will prompt referral for appropriate early intervention services, such as physical and occupational therapy. Some infants with cerebral palsy are candidates for treatment with orthotics or other adaptive equipment.

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Some people donate blood for specific patients, providing what is commonly known as directed or designated blood. Directed donations have a small increase in rate of infectious disease transmission. The difference is minimal and parents often want to donate for their children. Transfusion of paternal rbcs or platelets is contraindicated if the neonate's plasma contains antibodies directed against antigens expressed on paternal erythrocytes or platelets, respectively. If a first-degree relative does donate blood, the cellular blood components must be irradiated since they are at increased risk for causing ta-gvhd. Ii. Packed red blood cells (rbc) a. General principlo. 1. Mechanism. Rbcs provide oxygen carrying capacity for patients whose blood lacks sufficient oxygen carrying capacity due to anemia, hemorrhage, or hemoglobinopathy. Transfusion for hemoglobinopathies is unusual in the neonatal period when most patients will have significant amounts of fetal hemoglobin. Several types of rbc units are available that vary in the preservatives added. Chemical additives delay storage damage to rbcs allowing for extended storage times. The types of units that are currently available in the united states are. A. Anticoagulant-pro;ervative solution units. These units contain approximately 250 ml of a concentrated solution ofrbcs. The average hematocrit of hematologic disorders i 53 1 these units is 70% to 80%. In addition, these units contain 62 mg of sodium, 222 mg of citrate, and 46 mg of phosphate. Three types of units are currently approved for use in the united states. These are. I. Cpd. This contains 773 mg of dextrose and has a 21-day shelflife. Ii. Cp2d. This contains 1,546 mg of dextrose and has a 21-day shelf life. Iii. Cpda-1.

This contains 965 mg of dextrose and 8.2 mg of adenine and has a 35-day shelf life. This is the most widdy used of the anticoagulant-preservative solution units. B. Additive solurlon units. Most rbc units used in the united states are additive units. Three additive solutions are currently approved for use in the united states.