Newborn Complications: Prematurity

• Newborn complications are health issues affecting infants within the first 28 days of life
• Complications stem from prematurity, birth trauma, genetic disorders, infections, and metabolic disturbances

Prematurity-Related Complications

• Prematurity occurs when birth happens before 37 weeks of gestation
• Premature infants face higher risks due to underdeveloped organ systems
• Respiratory distress syndrome (RDS) arises from surfactant deficiency, crucial for keeping lung air sacs open
• RDS causes breathing problems and may require oxygen or ventilation
• Bronchopulmonary dysplasia (BPD) is a chronic lung condition in premature infants needing extended oxygen
• BPD involves lung inflammation and scarring, causing long-term respiratory issues
• Necrotizing enterocolitis (NEC) is a severe intestinal condition mainly affecting premature infants
• NEC causes intestinal wall inflammation and damage, potentially leading to perforation and sepsis
• Intraventricular hemorrhage (IVH) is bleeding in the brain ventricles, more common in premature infants with fragile blood vessels
• IVH can lead to neurological damage and lasting disabilities
• Retinopathy of prematurity (ROP) is an eye condition in premature infants from abnormal retinal blood vessel development
• Severe ROP can cause vision loss or blindness

Birth Trauma

• Birth trauma involves injuries to the infant during delivery
• Injuries vary in severity and can affect different body parts
• Caput succedaneum is scalp swelling from pressure during vaginal birth
• It typically resolves in days without intervention
• Cephalohematoma is bleeding between the skull and periosteum from delivery pressure
• It takes longer to resolve than caput succedaneum and may increase jaundice risk
• Brachial plexus injury is nerve damage affecting the arm and hand, often during difficult deliveries
• Mild cases may recover spontaneously, while severe cases may need therapy or surgery
• Fractures, like clavicle fractures, can occur during delivery, especially in larger infants or difficult deliveries
• Most fractures heal without long-term issues

Infections

• Newborns are vulnerable to infections due to immature immune systems
• Infections can be congenital (before birth), occur during delivery, or after birth
• Sepsis is a life-threatening systemic infection in newborns, often bacterial
• Sepsis symptoms can be nonspecific, including fever, lethargy, and poor feeding
• Pneumonia is a lung infection caused by bacteria, viruses, or fungi
• Newborns can contract pneumonia during or after delivery
• Meningitis is an infection of the membranes around the brain and spinal cord
• If untreated promptly it can lead to severe neurological damage
• Congenital infections transmit from mother to fetus during pregnancy
• Examples include cytomegalovirus (CMV), toxoplasmosis, and syphilis
• These infections can cause birth defects, developmental delays, and organ damage

Metabolic Disorders

• Metabolic disorders are genetic conditions affecting nutrient processing or waste elimination
• These disorders can cause toxic buildup or essential compound deficiency
• Phenylketonuria (PKU) is a disorder where the body cannot break down phenylalanine
• Untreated PKU can lead to intellectual disability
• Congenital hypothyroidism is a condition of insufficient thyroid hormone production
• Untreated hypothyroidism can cause developmental delays and intellectual disability
• Galactosemia is a disorder where the body cannot metabolize galactose found in milk
• Unmanaged galactosemia can cause liver damage, developmental delays, and cataracts
• Maple syrup urine disease (MSUD) is a disorder where the body cannot break down specific amino acids
• Untreated MSUD can lead to neurological damage and death

Jaundice

• Jaundice is yellowing of the skin and eyes from bilirubin accumulation in the blood
• Bilirubin is a yellow pigment from red blood cell breakdown
• Physiological jaundice is common in newborns and typically resolves within a week
• It occurs due to high red blood cell breakdown and immature livers
• Breast milk jaundice can occur in breastfed infants due to factors interfering with bilirubin metabolism
• It typically resolves on its own but may require temporary cessation of breastfeeding in severe cases
• Pathological jaundice arises from underlying conditions like blood group incompatibility, infections, or liver disorders
• Severe jaundice can lead to kernicterus, a rare but serious condition of brain damage from bilirubin

Neonatal Abstinence Syndrome (NAS)

• NAS occurs when a newborn exposed to drugs in the womb experiences withdrawal
• NAS is often linked to opioid exposure but can occur with other substances
• NAS symptoms include irritability, tremors, poor feeding, and gastrointestinal issues
• NAS treatment involves supportive care and medication for withdrawal symptoms

Respiratory Complications

• Transient tachypnea of the newborn (TTN) is a common respiratory issue when fluid remains in the lungs after birth
• TTN is characterized by rapid breathing and usually resolves within 24-48 hours
• Meconium aspiration syndrome (MAS) occurs when a newborn inhales meconium before or during delivery
• MAS can cause breathing difficulties and lung inflammation
• Pneumothorax is a collapsed lung that can occur spontaneously or from medical interventions
• Pneumothorax can cause breathing difficulties and may require chest tube insertion