Neonatal Problems PDF

NEONATAL PROBLEMS :Definition Problems that occur during the neonatal period.(1st 4 weeks of life) The 1st week of life– part of the perinatal period –is.an important time in the neonatal period Neonatal period is critical due to transition from.intra to extra uterine life Most of the probl...

NEONATAL PROBLEMS :Definition Problems that occur during the neonatal period.(1st 4 weeks of life) The 1st week of life– part of the perinatal period –is.an important time in the neonatal period Neonatal period is critical due to transition from.intra to extra uterine life Most of the problems are related to poor adaptation following birth due to asphyxia, prematurity, congenital anomalies, or adverse effect.of delivery  FETAL CIRCULATION ORDINARY CARE OF THE NEWBORN The newborn needs assistance to: 1\ Establish respiration. 2\ Maintain normal body temperature. 3\ Obtain adequate nutrition. 4\ Avoid contact with infection.  ASSESSMENT OF THE NEWBORN Every newborn should be assessed immediately after delivery-1st minute- and then after 5, 10, 15 &20 minutes according to.his\her condition :Apgar score is adopted for assessment  Apgar2Score Score* Criteria Mnemonic 0 1 2 Color Appearance All blue, Pink body, All pink pale blue extremities Heart rate Pulse Absent < 100 beats/ > 100 beats/min min Reflex response to nasal Grimace None Grimace Sneeze, cough catheter/tactile stimulation Muscle tone Activity Limp Some flexion Active of extremities Respiration Respiration Absent Irregular, Good, crying slow *A total score of 7–10 at 5 min is considered normal; 4–6, intermediate; and 0–3, low.  High risk newborn: Is the newborn in whom immediate or late problems are expected. Should be under close observation during pregnancy. Delivery should be attended by a person concerned with newborns. Active management might be needed immediately after delivery or later. It might be due to: 1\ Genetic factors. 2\ Maternal factors. 3\ Obstetric factors. 4\ fetal factors.  PRENATAL DIAGNOSIS: When is it used? Methods: History Ultrasound Doppler Emberioscopy &fetoscopy Amniocentesis Fetal urine analysis Percutaneous umbilical blood sampling Fetal tissue analysis Maternal serum Fetal heart rate monitoring  Manifestation of disease in the newborn: Cyanosis: respiratory or cardiac Convulsions Lethargy Irritability Failure to feed well Fever Hypothermia Periods of apnea Jaundice Vomiting \ diarrhea Abdominal distension Failure to move a limb  ASPHYXIA Definition: Asphyxia neonatorum, also called birth or newborn asphyxiaAsphyxia neonatorum, also called birth or newborn asphyxia, is defined as a failure to start regular respiration within a minute of birth. Asphyxia neonatorum is a neonatal Asphyxia neonatorum is a neonatal emergency as it may lead to hypoxia (lowering of oxygen supply to the brain and tissues) and possible brain damage or death if not correctly managed.  Causes: 1\Fetal hypoxia: Placental insufficiency Low oxygenation of maternal blood eg. anaesthesia Low perfusion due to maternal hypotension Inadequate uterine relaxation e.g. Excessive oxytocin Umbilical cord knotting or compression. Chronic fetal hypoxia may cause IUGR without signs of fetal distress, further  2\After birth: Severe anemia eg. HDN Shock eg.IVH or severe infection Central depression eg. Narcosis or trauma Severe congenital cyanotic heart disease or other congenital anomalies  Pathophysiology: Hypoxia--- bradycardia--- hypotension--- acidosis Maintenance of vital organs by increasing perfusion transiently by increased shunt through the ductus venosus, ductus arteriosus and foramen ovale  Pathologicaly: Congestion --- increased capillary permeability--- fluid leak--- coagulation necrosis--- cell death. Fetal hypoxia--- intrauterine gasping--- aspiration of amniotic fluid or meconium. After birth: chronic + acute hypoxic ischemic injury lead to neuronal necrosis of the cortex and interventricular hemorrhage, which lead to cortical cell death.  Clinical manifestations: Fetal hypoxia: IUGR Fetal bradycardia Fetal scalp blood sample show low PH So immediate delivery may be indicated to avoid fetal death & CNS damage. At delivery: meconium stained amniotic fluid.  After birth: Low Apgar score- usually the infant needs intensive resuscitation. Hypertonia and seizures may develop within the 1st 24 hours. Other systems might be involved: congestive heart failure & cardiogenic shock, pulmonary hypertension, GIT perforation &NEC, or haematuria.  Management: Before delivery: good monitoring and decide when to deliver the infant Delivery should be attended by who is responsible for the care of the newborn :After delivery Algorithm for resuscitation of neonates  Prognosis: The prognosis for asphyxia neonatorum depends on how long the new born is unable to breathe. For example, clinical studies show that the outcome of babies with low five-minute Apgar scores is significantly better than those with the same scores at 10 minutes. With prolonged asphyxia, brain, heart, kidney, and lung damage can result and also death, if the asphyxiation lasts longer than 10 minutes.  Long-term complications include: Cerebral palsy, epilepsy, mental retardation & behavioral disorders  Prevention: Anticipation is the key to prevent asphyxia neonatorum. It is important to identify fetuses that are likely to be at risk of asphyxia and to closely monitor such high-risk pregnancies. High-risk mothers should always give birth in hospitals with neonatal intensive care units where appropriate facilities are available to treat asphyxia neonatorum.  BIRTH INJURY Definition: Mechanical and anoxic trauma occurs to the newborn during labor and delivery. Its incidence increases with deficient obstetric care.  Predisposing factors: Large infant Prematurity Cephalopelvic disproportion Prolonged labor Abnormal presentation It causes anxiety and questioning from parents. Some injuries may seem mild initially but later result in severe illness or sequale. Cranial injuries: 1\Caput succedaneum: diffuse ecchymotic edema of the soft tissues involve the presenting part- vertex or face- It resolves spontaneously within the 1st week of life. 2\Erythema, abrasions,ecchymosis &wounds: May occur with forceps delivery, vigorous manipulation and premature delivery. Treatment accordingly. 3\ Subconjuctival & retinal hemorrhage: Resolve spontaneously. 4\Cephalohematoma: Subperiosteal hemorrhage. Always confined to one cranial bone May be associated with skull fracture. Usually resolve spontaneously within 1-3 months, but sometimes causes: a) Severe blood loss- blood transfusion b) Hyperbilrubinemia- phototherapy.  Skull fractures: May result from instrumental delivery or with difficult delivery. Usually asymptomatic unless associated with intracranial injury.  Intracranial (intraventricular) hemorrhage: Causes: Mechanical trauma. Anoxia & asphyxia. Bleeding disorder. Congenital vascular anomaly. It may occur in premature infants without apparent trauma.  Clinical manifestations: 80- 90% of the cases have the problem between the 1st and 3rd day of life. Symptoms include: Lethargy, poor muscle tone, absent or diminished Moro reflex, apnea, poor feeding, pallor, cyanosis, muscle twitching, high pitched cry, blugging fontanel, convulsions and shock.  Diagnosis: History and clinical manifestations Cranial ultrasound through anterior fontanel CT scan CSF examination- LP  Prognosis: Depends on the grade of bleeding and the weight of the infant, generally: Death. Hydrocephalus. Cerebral palsy: motor- mental. Epilepsy. Behavioral disorders.  Management: Supportive for shock, anemia and seizures. Prevention: Good antenatal and obstetric care  Erbs palsy: Paralysis of an upper limb due to brachial plexus injury. Fractures: Humerus, femur.