Neonatal Care and Intracranial Hemorrhage Quiz

Neonatal Problems

• Neonatal problems are issues that occur during the first four weeks of life.
• The first week of life is part of the perinatal period.
• This period is critical due to the transition from intrauterine to extrauterine life.
• Many problems arise from poor adaptation after birth, including asphyxia, prematurity, congenital anomalies, or complications during delivery.

Fetal Circulation

• Diagrams display the fetal circulatory system.
• Key features include the ductus arteriosus, foramen ovale, umbilical vein, and umbilical arteries.

Ordinary Care of the Newborn

• Newborns require assistance in several areas.
• Establishing respiration is essential.
• Maintaining normal body temperature is crucial.
• Ensuring adequate nutrition is necessary.
• Preventing infection is a priority.

Assessment of the Newborn

• Newborns should be assessed immediately after birth and then at 5, 10, 15, and 20 minutes, based on their condition.
• The Apgar score is used for assessment.

Apgar Score Criteria

• The Apgar score evaluates the newborn's condition, with categories including color, heart rate, reflex response, muscle tone, and respiration.
• Scores of 7-10 are considered normal at 5 minutes.
• Scores between 4-6 are intermediate, and 0-3 indicate low scores.

High-Risk Newborns

• High-risk newborns are those expected to experience immediate or future problems.
• These newborns should be closely monitored throughout pregnancy.
• Delivery should be attended by a medical professional experienced with newborns.
• Active management might be necessary immediately after or later.

Causes of Neonatal Problems

• Genetic factors may contribute to problems.
• Maternal factors also play a role.
• Obstetric factors can be involved.
• Fetal factors are also implicated.

Prenatal Diagnosis

• Methods for prenatal diagnosis include a history, ultrasound, Doppler studies, and procedures like amniocentesis, fetal urine analysis, percutaneous umbilical blood sampling, fetal tissue analysis and maternal serum analysis.
• Prenatal diagnosis occurs in situations with potential risks.
• Fetal heart rate monitoring is another diagnostic method used.

Manifestations of Disease in Newborns

• Manifestations of disease include cyanosis (either respiratory or cardiac in origin), convulsions, lethargy, lack of feeding desire, irritability, failure to thrive, fever, hypothermia, periods of apnea, jaundice, vomiting, diarrhea, abdominal distension, and failure to move a limb.

Asphyxia

• Asphyxia neonatorum is another term for birth or newborn asphyxia.
• A lack of regular respiration within a minute of birth defines this condition.
• This medical emergency is characterized by oxygen deprivation to the tissues, potentially leading to brain damage or death.

Asphyxia Neonatorum Causes

• Fetal hypoxia, resulting in placental insufficiency and low oxygen in maternal blood, often due to either anesthesia or maternal hypotension, contributes to the condition.
• Inadequate uterine relaxation associated with oxytocin use, or umbilical cord conditions like knotting or compression, may lead to asphyxia neonatorum.
• Post-birth factors contributing to the condition include shock or sepsis, central depression, and congenital heart conditions.

Pathophysiology of Asphyxia

• Initial responses include a drop in blood oxygen, heart rate, and blood pressure.
• Short-term shunting in the circulatory system can be vital for organ maintenance.

Pathological Effects of Asphyxia

• Hypoxia leads to tissue damage, including fluid leakage, coagulation necrosis, and cell death.
• Fetal hypoxia may trigger gasping and fluid/meconium aspiration.
• Chronic or acute hypoxia in newborns may affect brain tissue, leading to necrosis of brain cortex and interventricular hemorrhage.

Asphyxia Clinical Manifestations

• Intrauterine growth restriction (IUGR)
• Fetal bradycardia
• Fetal scalp blood samples with low pH
• Meconium-stained amniotic fluid at delivery.

Neonatal Aspphyxia Post-Birth

• Low Apgar scores suggest the infant needs intensive resuscitation.
• Hypertonia and seizures may develop soon after birth.
• Other systems might be impacted, such as the cardiovascular system, gastrointestinal system, and neurological system.

Asphyxia Management

• Before delivery, monitoring is essential to determine the best time for delivery.
• Delivery should only be performed by a skilled professional.
• Post-delivery, a newborn resuscitation algorithm should be implemented.

Newborn Resuscitation Algorithm

• A detailed infographic describes the steps for neonatal resuscitation, including assessment of respiration, heart rate, and color, interventions based on their health status and O2 supplementation or ventilation, and use of epinephrine if certain criteria are met.

Prognosis For Asphyxia

• Outcome depends on the duration of impaired breathing.
• Babies with poorly performing 5-minute Apgar scores have better outcomes and less severe issues compared to those performing poorly in 10 minutes of assessment.
• Prolonged asphyxia can lead to brain, heart, kidney, and lung damage, potentially resulting in death.

Long-Term Complications of Asphyxia

• Long-term complications include cerebral palsy, epilepsy, mental retardation, and behavioral disorders.

Preventing Asphyxia

• Recognizing high-risk fetuses and close monitoring of high-risk pregnancies is critical.
• Ideal delivery is handled by specialists knowledgeable in neonatal care.

Birth Injury

• Birth injuries result from mechanical or anoxic trauma during labor and delivery.
• Factors that increase the risk of injury include a large infant, prematurity, cephalopelvic disproportion, prolonged labor, and abnormal presentation during childbirth.
• These injuries may range in severity from mild to very serious, causing problems in later life, and require prompt evaluation and appropriate medical care.

Cranial Injuries Types

• Caput succedaneum: fluid-filled swelling on the scalp involving portions of the head.
• Erythema, abrasions, and ecchymosis/wounds: wounds of various types.
• Subconjuctival and retinal hemorrhages: bleeding from vessels beneath the eye and within the retina.
• Cephalohematoma: bleeding near the bones of the skull.
• Skull fracture: fracture of the skull bone from instrumental or difficult deliveries.
• Intracranial (intraventricular) hemorrhage: bleeding in the brain's tissues, most commonly from physical trauma, anoxia, or blood clotting disorders.

Intracranial Hemorrhage Manifestations

• Approximately 80-90% of cases present within the first three days of life.
• Manifestations include lethargy, weak muscle tone, absent or depressed Moro reflex, apnea, problems with feeding, pallor, cyanosis, muscle twitching, a high-pitched cry, bulging fontanelles, seizures, and shock.

Intracranial Hemorrhage Diagnosis

• History and clinical manifestations.
• Cranial ultrasound through the fontanelle.
• CT scan.
• CSF examination (LP).

Intracranial Hemorrhage Prognosis

• Prognosis depends on bleeding severity and the infant's weight.
• Potential outcomes include death, hydrocephalus, cerebral palsy, epilepsy, and behavioral disorders.

Intracranial Hemorrhage Management

• Supporting the infant for shock, anemia, and seizures.
• Preventing issues through appropriate prenatal and obstetric care.

Other Birth Injuries

• Erb's palsy: paralysis of an arm caused by brachial plexus injuries.
• Fractures of the bones of the arms and legs.