Lecture Notes on Newborn Babies (2016-2017) PDF

Lec.05 2016 - 2017 Pediatrics Newborn Babies Professor Numan Nafie Hameed Lec. 1 0 Professor Numan Nafie Hameed ‫د نعمان نافع الحمداني‬.‫ا‬ NEWNORN BABIES (NB) A pregnan...

Lec.05 2016 - 2017 Pediatrics Newborn Babies Professor Numan Nafie Hameed Lec. 1 0 Professor Numan Nafie Hameed ‫د نعمان نافع الحمداني‬.‫ا‬ NEWNORN BABIES (NB) A pregnant woman in her first trimester came for regular antenatal care visit. One of the followings cannot be used by the obstetrician during this visit to assess the gestational age: a. Date of last menstrual period b. Expected delivery date c. quickening (Date of first reported fetal activity and movement) d. First reported fetal heart sounds e. Abdominal Ultrasound examination A 750-g female experienced respiratory distress after a preterm delivery at 27 weeks’ gestation. Pregnancy was uncomplicated, but labor was abrupt and therefore the mother did not receive steroid or penicillin therapy. The baby required intubation and Mechanical Ventilation with 100% O. The possible causes of respiratory distress include all the 2 following except: a. Spontaneous Pneumothorax b. Transient tachypnea of newborn c. Lobar emphysema d. Group B streptococcal infection e. Respiratory distress syndrome Neonatal period: It is the first 4 weeks of human life (28 days). It is divided into: Early Neonatal period: is the first week of life (7 days) Late Neonatal period: > 7- 28 days of life Perinatal mortality rate (PMR): Is the number of still born babies after 20 weeks of gestation + number of deaths in the first week of life per 1000 total births. Neonatal mortality rate (NMR): Is the number of infants died during the first 28 days of life per 1000 live births. NB by gestational age is classified as PRETERM: NB delivered before 37 completed weeks (295 days). NB gestational age is assessed by: 1. History: LMP & EDD and quickening (Date of first reported fetal activity, usually occurs at 16-18 weeks) 2. Examination: Fundal height by obstetrician Examination and Expanded new Ballard score by Pediatrician 3. Investigations: First reported fetal heart sounds (10-12 weeks by Doppler ultrasound examination) and Ultrasound examination (very accurate if obtained before 20 weeks' of gestation). NB by birth weight on growth charts is classified as: Small for gestational age (SGA) Is NB with birth weight of < 10 th centile Appropriate for age (AGA) Is NB with birth weight between 10th -90th centiles Large for gestational age (LGA) Is NB with birth weight of > 90 th centile Full term neonates normally have the following: BW: Average 3.250 g (7.5 pounds), 95 % (2.500 – 4.250 g) Length: 50 cm, 95 % (46 – 56 cm) OFC 35 cm, 95 % (33 – 38 cm) Hb 14 – 22 g/ dl WBC 5000 - 20000 / cm3 BP 80/50 mm Hg RR 40 – 60 breaths/ minutes PR 120 – 160 beats / minutes 2 Urine passed within 24 hours of birth, max. 40 hours Meconium passed within 24 hours, max 48 hours, If > 48 hours, think of imperforated anus. Preterm neonates might normally have delayed passage of meconium longer than 48 hours. LOW BIRTH WEIGHT NEONATES (LBWN): They are neonates whose birth weight < 2500 grams. They represents 6-7 % of all births, but they accounts for 2/3 of all neonatal deaths. LBWN could be preterm, SGA, or both PRETERM NEONATES: Any neonate who was born before 37 weeks completed. Causes: 1. Maternal causes: maternal age 35 years, grand parity, smoking, poor housing, short stature, alcohol consumption, chronic maternal diseases like chronic HT, cyanotic CHD, chronic renal diseases, acute infections during pregnancy and drug abuse like cocaine. 2. Placental causes: placenta previa, abruption of placenta. 3. Uterine causes: Bicornuate uterus, cervical incompetence. 4. Fetal causes: Fetal distress, multiple gestations, erythroblastosis fetalis, congenital anomalies, and non-immune hydropis fetalis. 5. Others: Premature rupture of membranes, polyhydraminos, iatrogenic e.g. poorly timed C/S, trauma including surgery. PROBLEMS OR DISADVANTAGES OR COMPLICATIONS OF PREMATURITY: 1. Birth asphyxia and the need for resuscitation at birth (perinatal depression): due to immaturity of respiratory Centre, thin flail chest wall, and deficiency of surfactant. 3 2. Thermal instability (hypothermia or hyperthermia): Hypothermia may be due to large S.A compared to BWT, little or no subcutaneous fat, poor muscular activity, poor sweating mechanism, immature heat regulating centre in brain. So protect preterm neonates by putting him in plastic bag(