This edition of Cloherty and Stark’s Manual of Neonatal Care has been updated and revised to reflect the many changes in fetal, perinatal, and neonatal care that have occurred since the eighth edition.
In the Manual, we describe our current and practical approaches to evaluation and management of conditions encountered in the fetus and the newborn, as prac- ticed in high-volume clinical services that include contemporary prenatal and post- natal care of infants with routine as well as complex medical and surgical problems.
Although we base our practice on the best available evidence, we recognize that many areas of controversy exist, that there is often more than one approach to a problem, and that our knowledge continues to grow.
Our commitment to values, including clinical excellence, multidisciplinary collaboration, teamwork, and family-centered care, is evident throughout the book. Support of families is reflected in our chapters on breastfeeding, developmental care, bereavement, and decision making and ethical dilemmas.
To help guide our readers, we have a section of key points at the start of each chapter. Many individuals around the world contributed to advance the care of newborns. We especially recognize our teachers, colleagues, and trainees at Harvard, where the four editors trained in newborn medicine and practiced in the neonatal intensive care units (NICUs).
We are grateful to Clement Smith, Nicholas M. Nelson, and Mary Ellen Avery for their pioneering insights into newborn physiology and to all the former and current leaders and members of the Newborn Medicine Program at Harvard. This would have been an impossible task without the administrative assistance of Isabelle Smith. We also thank Wolters Kluwer. We dedicate this book to William D. Cochran for his commitment to the care of newborns in the Harvard teaching hospitals and to the personal support and advice he provided to so many, including the editors. We also acknowledge the contribu- tion of our founding editor, Dr. John P.
Cloherty, whose collaboration with current editor Dr. Ann R. Stark led to the first edition more than four decades ago and is ac- knowledged in the title of this edition.
Finally, we gratefully acknowledge the nurses, residents, fellows, parents, and babies who provide the inspiration for and measure the usefulness of the information contained in this volume.
GESTATIONAL AGE ASSESSMENT
Is important to both the obstetrician and pediatrician and must be made with a reasonable degree of precision.
Elective obstetric interventions such as chorionic villus sampling (CVS) and
amniocentesis must be timed appropriately.
When premature delivery is inev-itable, gestational age is important with regard to prognosis, the management of labor and delivery, and the initial neonatal treatment plan.
THE CLINICAL ESTIMATE
Of gestational age is usually made on the basis of the first day of the last menstrual period (LMP).
Accompanied by physical examination, auscultation of fetal heart sounds and maternal perception of fetal movement can also be helpful.
Is the most accurate method for estimating gestational age early in gestation, but as gestation advances, dating based on ultrasound alone may introduce error if there is fetal growth restriction (FGR).
Once estab-lished based on clinical and ultrasound criteria, the due date should not be changed later in gestation.
During the first trimester, fetal crown-rump length (CRL) can be an accurate predictor of gestational age.
After 14 weeks, measurements of the biparietal diameter (BPD), the head circumference (HC), abdominal circumference (AC), and the fetal femur length are used to estimate gestational age.
Strict criteria for measuring the cross-sectional images through the fetal head ensure accuracy.
If the due date by LMP dif-fers from the due date estimated by ultrasound, there are established criteria for changing the due date.
Table 1.1 lists the criteria for changing the due date based on the difference between the due date estimated by LMP and ultrasound.