Neonatology Book

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Neonatal Advanced Life Support

Aka: Neonatal Advanced Life Support, Newborn Resuscitation, Resuscitation of the Newborn, Advanced Life Support for Newborns, NALS, NRP
  1. See Also
    1. Neonatal Distress Causes
    2. Neonatal Respiratory Distress
    3. Newborn History
    4. Newborn Exam
  2. Epidemiology
    1. Five million neonatal deaths per year worldwide
      1. Birth Asphyxia accounts for 19% of neonatal deaths
    2. Newborns requiring respiratory assistance at birth: 10%
    3. Newborns requiring extensive Resuscitation at birth: 1%
    4. Early Resuscitation is key (intervene at primary apnea)
      1. Primary apnea (initial) responds to simple measures
        1. See Neonatal Airway Assessment
      2. Secondary apnea requires PPV and other interventions
        1. Does not respond to continued stimulation
        2. Associated with prolonged Resuscitation
        3. Associated with poorer outcomes
        4. Associated with decreased Heart Rate and BP
  3. Transition from fetal circulation at birth
    1. Alveolar fluid is absorbed by lung
    2. Umbilical vessels are clamped
      1. Increases systemic Blood Pressure
    3. Pulmonary circulation increases
      1. Pulmonary vessel vasodilation
      2. Ductus arteriosus vasoconstriction
  4. Approach
    1. Initial questions to consider
      1. Is the newborn clear of meconium?
      2. Is the newborn breathing or crying?
      3. Does the newborn have good muscle tone?
      4. Is the skin pink centrally?
      5. Is this baby consistent with term gestation?
    2. Consider Neonatal Distress Causes
    3. Step by step assessment
      1. Neonatal Airway Assessment
        1. Includes general measures performed for all infants
        2. Includes warming, suctioning, drying, stimulation
      2. Neonatal Breathing Assessment
        1. Positive Pressure Ventilation for apnea
      3. Neonatal Circulation Assessment
        1. Positive Pressure Ventilation for Heart Rate <100
        2. Chest Compressions for Heart Rate <60
        3. Epinephrine for persistent Heart Rate <60
      4. Neonatal Perfusion Assessment
        1. Free flow Oxygen at 100% for central cyanosis
  5. References
    1. (1995) World Health Report, WHO
    2. Kattwinkel (2000) Neonatal Resuscitation, AAP-AHA

Neuropilin-1 (C0100804)

Definition (MSH) Dimeric cell surface receptor involved in angiogenesis (NEOVASCULARIZATION, PHYSIOLOGICAL) and axonal guidance. Neuropilin-1 is a 140-kDa transmembrane protein that binds CLASS 3 SEMAPHORINS, and several other growth factors. Neuropilin-1 forms complexes with plexins or VEGF RECEPTORS, and binding affinity and specificity are determined by the composition of the neuropilin dimer and the identity of other receptors complexed with it. Neuropilin-1 is expressed in distinct patterns during neural development, complementary to those described for NEUROPILIN-2.
Definition (NCI) Encoded by human NRP1 Gene (Neuropilin Family), Neuropilin 1 contains 1 MAM, 2 F5/8 type C, and 2 CUB domains. Found in embryonic nervous system, and adult heart, placenta lung, liver, skeletal muscle, kidney, and pancreas, type I membrane-bound 923-aa 103-kDa (precursor) isoform 1, expressed by blood vessels, acts as a receptor in cardiovascular development, angiogenesis, formation of neuronal circuits, and organogenesis. Binding to semaphorin 3A, PLGF-2, VEGF-165, and VEGF-B, Isoform 1 appears to mediate chemorepulsion by semaphorins, to increase VEGF-165 binding to KDR, and to regulate VEGF-induced angiogenesis. Expressed in hepatocytes and kidney distal/proximal tubules, secreted 644-aa isoform 2 may bind semaphorins and induce apoptosis by sequestering VEGF-165; it has an adverse effect on blood vessel integrity. Expression of isoforms 1 and 2 does not seem to overlap. (NCI)
Concepts Amino Acid, Peptide, or Protein (T116) , Receptor (T192)
MSH D039942
English A5 Antigen, NEUROPILIN 001, Neuropilin 1, Neuropilin-1, Npn 1 Protein, Npn-1 Protein, NRP, NRP1, NRP1 Protein, Sema III Receptor, Semaphorin III Receptor, Vascular Endothelial Cell Growth Factor 165 Receptor, VEGF165R
Parent Concepts Neuropilins (C0287275), Receptors, Cell Surface (C0034800)
Sources MSH , MTH, NCI
Derived from the NIH UMLS (Unified Medical Language System)


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