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NEONATOLOGY: MANAGEMENT, PROCEDURES, ON-CALL PROBLEMS, DISEASES, AND DRUGS - part 5

D-chuyển vị của các động mạch lớn là nguyên nhân tim mạch phổ biến nhất của tím tái trong năm đầu tiên của cuộc sống, với một tỷ lệ nam-nữ lệ 2:1. Động mạch chủ xuất phát từ tâm thất phải và động mạch phổi từ tâm thất trái, với kết quả mạch riêng biệt, hệ thống và phổi. Với sự chăm sóc trẻ sơ sinh hiện đại, | CHAPTER 49. No Urine Output in 48 Hours PROBLEM OUTLINE I. Problem. Urine output has been scant or absent for 24 h. Oliguria is defined as urine output 0.5-1 mL kg h. One hundred percent of healthy premature full-term and postterm infants will void by 24 h of age. II. Immediate questions A. Is the bladder palpable If a distended bladder is present it is usually palpable. A palpable bladder suggests there is urine in the bladder. Crede s maneuver manual compression of the bladder may initiate voiding especially in infants receiving medications causing muscle paralysis. B. Has bladder catheterization been performed This will determine whether urine is present in the bladder. It is more commonly done in more mature infants. C. What is the blood pressure Hypotension can cause decreased renal perfusion and urine output. D. Has the infant ever voided If the infant has never voided consider bilateral renal agenesis renovascular accident or obstruction. Table 49-1 shows the time after birth at which the first voiding occurs. III. Differential diagnosis. For a complete discussion of acute renal failure see Chapter 75. A. Prerenal causes inadequate renal perfusion 1. Sepsis. 2. Dehydration. 3. Hemorrhage. 4. Hypotension. 5. Asphyxia. 6. Hypokalemia. 7. Heart failure. 8. Medications. Certain medications eg indomethacin captopril and P-agonists if given to the mother before delivery can result in renal insufficiency. B. Intrinsic renal failure 1. Renal agenesis. 2. Hypoplastic dysplastic or cystic kidneys. 3. Pyelonephritis. 4. Vascular accident renal artery and vein thrombosis . 5. Nephritis. 6. Infections such as congenital syphilis cytomegalovirus toxoplasmosis and gram-negative infections. 7. Acute tubular necrosis secondary to shock dehydration and asphyxia. 8. Medications. Some nephrotoxic medications include tolazoline aminoglycosides indomethacin amphotericin a-adrenergic agents and acyclovir. C. Postrenal causes urine is formed but not voided 1. Neurogenic bladder .