![Page 1: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/1.jpg)
Richard A. Polin M.D. Professor of Pediatrics
Director of the Division of Neonatology [email protected]
S. David Rubenstein M.D. Professor of Clinical Pediatrics
THE PRETERM NEONATE
![Page 2: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/2.jpg)
![Page 3: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/3.jpg)
![Page 4: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/4.jpg)
![Page 5: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/5.jpg)
![Page 6: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/6.jpg)
Maximus R.• Born to a 32 year old primagravida at 35 weeks• Fetal distress (bradycardia) during labor• C-section-meconium noted at membrane rupture• Apgar scores 1 and 6 ( at 1 and 5 minutes)• Persistent hypoxia despite FiO2 1.0 (pO2 >700)• IPPV initiated without significant increase in pO2• pH 7.30, pCO2 48, pO2 38, HCO3 22• Diagnosis: persistent fetal circulation
![Page 7: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/7.jpg)
Composition of Meconium
• Sloughed intestinal epithelial cells
• Swallowed amniotic debris (hair, vernix)
• Squamous epithelial cells
• Pancreatic lipases and proteases
• Bile acids and salts
• Sucus entericus
• White blood cells
![Page 8: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/8.jpg)
Maximus R.• Born to a 32 year old primagravida at 35 weeks• Fetal distress (bradycardia) during labor• C-section-meconium noted at membrane rupture• Apgar scores 1 and 6 ( at 1 and 5 minutes)• Persistent hypoxia despite FiO2 1.0 (pO2 >700)• IPPV initiated without significant increase in pO2• pH 7.30, pCO2 48, pO2 38, HCO3 22• Diagnosis: persistent fetal circulation
![Page 9: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/9.jpg)
Components of the Apgar Score____________Score__________________
Sign 0 1 2
Heart rate Absent <100 >100
Respiration Absent Irregular Good cry
Color Cyanotic Acrocyanosis Pink
Tone Limp Minimal Active
Reflex Absent Minimal Active
![Page 10: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/10.jpg)
Maximus R.• Born to a 32 year old primagravida at 35 weeks• Fetal distress (bradycardia) during labor• C-section-meconium noted at membrane rupture• Apgar scores 1 and 6 ( at 1 and 5 minutes)• Persistent hypoxia despite FiO2 1.0 (pO2 >700)• IPPV initiated without significant increase in pO2• pH 7.30, pCO2 48, pO2 38, HCO3 22• Diagnosis: persistent fetal circulation
![Page 11: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/11.jpg)
![Page 12: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/12.jpg)
![Page 13: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/13.jpg)
![Page 14: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/14.jpg)
![Page 15: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/15.jpg)
![Page 16: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/16.jpg)
![Page 17: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/17.jpg)
![Page 18: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/18.jpg)
![Page 19: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/19.jpg)
![Page 20: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/20.jpg)
![Page 21: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/21.jpg)
![Page 22: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/22.jpg)
![Page 23: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/23.jpg)
![Page 24: Richard A. Polin M.D. Professor of Pediatrics Director of the Division of Neonatology rap32@columbia.edu S. David Rubenstein M.D. Professor of Clinical](https://reader036.vdocuments.us/reader036/viewer/2022070415/56649d3e5503460f94a169f2/html5/thumbnails/24.jpg)