newborn infant
Post on 21-Feb-2017
8 Views
Preview:
TRANSCRIPT
Slide 1
NEWBORN INFANT-DR. AKIF A.B
NORMAL NEWBORNLength : 45-55cm
Head circumference : 34cm
Chest circumference :31cm
Upper to lower segment ratio : 1.7 to 1.9
Heart rate : 120-140 per minute
Respiratory rate :35-40/min
Attitude : flexion
Urine and meconium is passed within 24hrs
NORMAL NEWBORNSystolic murmur may be present - Peripheral cyanosis(acrocyanosis) may be present.
Note: Peripheral cyanosis is normal but not central cyanosis. Central cyanosis is always pathological
Normal Clinical ProblemsIn NewbornThere are few clinical problems which occur in newborn which are absolutely normal and gets compensated with time and doesnt require any treatmentMilia
Erythema toxicum
Mongolian spots
Peeling of skin
Subconjunctival haemorrhage
Breast engorgement7) Epstein pearl
8) Vaginal bleed
9) Hymenal tags
MILIA
Miliaare tiny white bumps that appear across ababy'snose, chin or cheeks.
Milia are common innewbornsbut can occur at any age.
You can't preventmilia.
no treatment is needed because they usually disappear on their own in a few weeks or months.
ERYTHEMA TOXICUM
Mongolian SpotsMongolian spotsare very common in any part of the body of dark-skinnedbabies most commonly at presacral region - They are flat, gray-blue in color (almost looking like a bruise), and can be small or large.
- They are caused by some pigment that didn't make it to the top layer when baby'sskin was being formed.
- Disappears spontaneously before 1st bday
Breast engorgement & Vaginal bleedingSeen on 3rd to 7th day of life
due to withdrawal of maternal hormones
SKIN PEELING
Epstein Pearls
NEONATAL REFLEXESRooting Reflex/suckling/swallowing reflex
Moros reflex
Palmar grasp
Crossed extensor reflex
Asymmetric tonic neck reflexes
Parachute reflex
Landau reflex
symmetric tonic neck reflexes
Appears after birthPresent since birth
Rooting/suckling/swallowing reflex
Moro Reflex
Moro reflex is present since birth
disappears by 6th month
Unilateral Moro reflex : 1) erbs palsy
2) fracture of humerus / clavicle
3) shoulder dislocation
4) Spastic Hemiplegia
- Exaggarated moro reflex : Brain damage
Watch video of asymmetric tonic neck reflex by clicking on this link https://www.youtube.com/watch?v=UWqafotPxTg
Appears at 4-6months and disappears at 8-12 months
PARACHUTE REFLEX
NEWBORN INFANT
Q. Earliest reflex to appear
Ans. Rooting ReflexRooting reflex appears at 32 wks of gestation
Q. Reflex which persists throughout life ??
Ans. Parachute ReflexParachute reflex appears at around 9th month and persists throughout life.
Q. Last reflex to appear ??
Ans. Landau ReflexLandau reflex appaears at 10th month and disappears by 24 months
Q. Newborn babies are able to breath and suck at the same time because of ??
Ans. High placed Larynx Infant's larynx is positioned high in the neck oppositeC3 or C4 (vocal cord level ) at rest and reaches C1 orC2 during swallowing. This high posit ion allows theepiglottis to meet soft palate and make a nasopharyngealchannel for nasal breathing during suckling. Themilk feed passes separately over the dorsum of tongueand the side of epiglottis, thus allowing breathing andfeeding to go on simultaneously.
Neonatal SeizuresMC type= Subtle Seizures
Best prognosis = clonic type
Worst prognosis = Myoclonic type
Etiology wise , best prognosis = Hypocalcemia
MC cause of Neonatal Seiures = Hypoxic Ischemic Encephalopathy ( Bad Prognosis)
MC cause of day 2 Seizure= Sub arachnoid Haemorrhage
Hypoglycemia can lead to seizures more commonly during Day 1 of Life
Hypocalcemia can lead to Seizures more commonly during day 2
Infant of Diabetic MotherMacrosomic baby
prone to Respiratory distress Syndrome since Insulin decreases Surfactant levels
prolongs neonatal jaundice
leads to Polycythaemia sluggish flow Renal Vein thrombosis
MC congenital defect = VSD > Anencephaly
Most specific = Sacral agenesis
MC complication during delivery = Shoulder Dystocia
Q. Reflex which never reappears ??
Ans. Moro Reflex
Hypothermia in neonatesShiverring mechanism is absent in Newborns
Newborns are more prone for hypothermia because of large surface area
Heat generation is by : 1) peripheral vasoconstriction
2) Non shivering thermogenesis in brown fat by adrenaline
Brown fat is located at : 1) Nape of neck
2) interscapullary region
3) around adrenal gland & Kidney
4) axillary region
Neonatal Seizures
8. Not ass. With neonatal jaundice 8. Prolongs neonatal jaundice since it contains blood
9. Edematous swelling of scalp 9. Subperiosteal swelling
Neonatal Head Injury
Neonatal Seizures
Congenital hypertrophic pyloric stenosisSymptoms doesnt appear at birth
Symptoms appear at 3rd week of life
Non bilious vomiting since obstruction is above the opening of common bile duct at 2nd part of duodenum
4) Usage of erythromycin during neonatal phase is associated with CHPS
5) Hypochloremic hypokalemic metabolic alkalosis
6) Investigation of choice : USG
7) Radiological diagnosis : pyloric thickness >4mm and pyloric length >14mm
8) Barium study : string sign /double tract sign
9) Rx: Ramstedts myomectomy operation
Congenital hypertrophic pyloric stenosis
Congenital hypertrophic pyloric stenosis
Congenital hypertrophic pyloric stenosis
Necrotising EnterocolitisSingle most important risk factor = Prematurity
Bells Staging
Neonatal Seizures
Very ImportantTo make it easy refer next slide
NECStage 1a : systemic features + GI Symptoms + Occult blood in stools = Rx : NPO + Antibiotics*3days
Stage 1b : systemic features + GI Symptoms + Gross blood in stool= Rx : NPO + Antibiotics*3days
Stage 2a : same as 1b + absent bowel sounds + Pneumatosis intestinalis = Rx : NPO + Antibiotics*7-10days
Stage 2b: same as 2b but increase in severity + x-ray showing Portal venous air = Rx : NPO + Antibiotics*10-14days
Stage 3a: same as above but increase severity + Peritonitis+X-Ray showing Ascites = Rx : NPO + Antibiotics+ supportive
Stage 3b: same as above + Pneumoperitoneum= Surgery
Q. 30wks,1.2kg,3b NEC on ventilator, TOC ??
Ans. Peritoneal Lavage You must be thinking answer as Surgery since it is mentioned 3b type NEC
BUT you should see that baby is on ventilator and is hence unfit for Surgery,
Hence, best management is Lavage
NEC
PneumoperitoneumPneumatosis intestinalis
Neonatal Seizures
top related