the newborn infant slides 3

8/8/2019 The Newborn Infant Slides 3

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The Newborn

Leah F. Fajutagana,M.D. MPH


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Question #1

Organogenesis is completed by :

a. 13th week of life

b. 12th week of life

c. 10th week of life

d. 14th week of life


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Question #2

In utero, the link between mother and fetus isthrough:

a)Placental circulation onlyb)Umbilical vessels( artery and vein)

c)Placental circulation and umbilical vessels

d)Umbilical vein only


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Question #3

The oxygenated blood that passes through theumbilical veins, hepatic veins, inferior venacava, and shunted to the foramen ovale into theleft ventricle and ascending aorta supplies:

a)Lower half of the body

b)Brain and upper half of the body

c)both


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Circulatory System

In utero, the link between the mother and fetusis through the placental circulation andumbilical vessels.

Fetal circulation : 2 shunts

Patent foramen ovale-bet. two auricles/atrium

Patent ductus arteriosus- bet. Pulmonary arteryand aorta

Oxygenated blood passes through the umbilicalvein, ductus venosus in the liver, hepatic veins,


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Circulatory System

Inferior vena cava then reaches the right atrium

The right atrium receives unoxygenated bloodfrom the superior vena cava and oxygenated

blood from the inferior vena cava. Oxygenated blood in the right atrium, shunted

to the patent foramen ovale left atrium leftventricle ascending aorta to supply the brain

and upper half of the body.

Unoxygenated blood R ventricle Pulmonaryartery descending aorta lower of the body.


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Events when the infant is born:

Placental circulation stops soon as the cord isclamped respiration occurs infants lungs

expand pulmonary circulation is established. Pressure in the R atrium decreases patent

foramen ovale closes

Increase oxygenation causes muscular

constriction of patent ductus arteriosus hencethis shunt closes.

Adult type of circulation is established


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Respiratory System

The newborn infant has all the equipmentnecessary for respiration- lungs,chemoreceptors, and baroreceptors

In utero, lungs are unexpanded but notcollapsed, air spaces are filled with fluid

The fluid gushes out of mouth and nose duringNSD, fluid is replaced by air.

Full term newborn, may have pauses duringregular breathing

Premature's may shift from regular to apneicepisodes of 5-10 seconds


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Respiratory system

Surfactant - phospholipid substance produce byalveolar cells.

Lowers the surface tension of the alveolar liningepithelium preventing atelectasis.

Component: lecithin and sphingomyelin

High lecithin to sphingomyelin ratio indicates

lung maturity and lower ratio means lungs isless mature.


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Question #4

Swallowing movements of fetus is observed onwhat Age of gestation:

a) 13The week AOGb)12th week AOG

c) 15th week AOG

d)10th week AOG


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Gastrointestinal System

Swallowing is observed as early as 12th week ofgestation

No excretion via gastrointestinal tract occurs

unless the anal sphincter relaxes ffg a hypoxicepisode.

Epithelial debris accumulates in the SI and asthe liver starts to function,conjugated bilirubinfinds its way to the SI Meconium.

Meconium is black viscid substance composedof mucopolysaccharide and epithelial debris.


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Question #5

Urine is produced by the fetus at what AOG.

a)15th week AOG

b)16th

week AOGc)12th week AOG

d)13th week AOG


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Question #6

The 10% weight loss in newborn infants is dueto:

a) Diuresisb)Expulsion of meconium

c)Withholding of water and calories

d)All of the above


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Renal System

The kidneys produce urine as early as the 4thmonth of gestation

Renal function as measured by glomerularfiltration rate, tubular mass and resorption,renalplasma flow reach the adult levels about the 2nd year of life.

The newborn is unable to concentrate urineadequately, thus his urine is dilute


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Renal System

10% weight loss is observed during the 1st daysof life and regained after the 1st week of life.

Weight loss maybe due to: Diuresis, expulsionof meconium, and withholding of water andcalories- physiologic


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Question #7

Vaginal bleeding on the first few days of life ispathologic.

a)Trueb) False


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Endocrine System

Maternal estrogenic effects on both male andfemale newborn infants are manifested inhypertophied mammary tissue. Sometimessecretes milky discharge called witch milk.

Hymeneal tags and mucoid vaginal dischargewith vaginal bleeding may also be present.

Infant born to diabetic mother has hyperplasticislets of langerhans, result in excessive insulinproduction causing hyperglycemia.


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Endocrine System

Infants are usually fat and have facies cushingoid

The pituitary- adrenal axis and thyroid glandfunction separately from that of the mother.


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Question #8

A violent startle reaction of an infant whensudden noise or movements occur in theenvironment.

a) Moro reflex

b)Righting reflex

c)Tonic reflex

d)Rooting reflex


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Central Nervous System

Rapid growth of the brain is usually observedduring the last half of fetal life with a peak nearor at the time of birth, then decreases over thefirst year of life.

All limbs are in flexion, the hands are closedand thumbs are adducted.

During the waking state, the infant manifestsgeneralized muscular activity.

Any sudden noise/ vigorous movement aroundmay evoke violent startle reaction- Moro reflex


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Central Nervous System

Important Specific Reactions:

Moro reflex, grasp reaction, swimming reflex,tonic and righting reflexes

Reflexes associated with feeding: sucking,rooting,and tongue retrusion reflex

Hunger/ or discomfort from any cause, infantcries and increases his motor activity.

After feeding, if kept dry and warm, he is quiteand relaxed.

Cerebral cortex participates very little at this

stage.


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Question #9

Which of the ffg blood picture is true at birth:

a) Hemoglobin value is low

b) Hemoglobin value is highc)Predominance of lymphocytes

d)Segmenters normal


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Hematologic System

At birth, infant has high hgb 15-20g/dl due torelative hypoxia in utero causing stimulation ofthe bone marrow.

Blood volume is from 80-90ml/kg- depend onearly clamping of the umbilical cord (


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Hematologic System

Lymphocytic predominance is attained as theinfant grows older.

Hgb start to drop on the third day of

life( physiologic anemia), 10-12g/dl is reachedon the 2nd- 3rd month of life.

Physiologic anemia is due to:

Relative dec. in bone marrow erythropoieticactivity, relative inc. in the rate of hemolysis,and hemodilution due to the rapid expansionof bld volume.


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Immunologic System

Newborn infant- completely developed

if challenged by antigenic stimuli can produceantibodies.

Abs present in the newborn infant are maternalin origin: 7S or IgG antibodies

Antibodies in cord blood =/ > maternal blood

are: Tetanus antitoxin, diphtheria antitoxin, smallpox

agglutinins, antistreptolysin, toxoplasma Abs,and Rh antiblocking Abs


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Immunologic System

19 s gamma globulins specific for protectingagainst gram (-) and some gram (+) organismsdo not cross the placental barrier.

Infants prone to gm (-) infections


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Question #10

The main source of energy of a newborn is/ are

a)Brown adipose tissue

b)White adipose tissuec)White and brown adipose tissue

d)None of the above


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Thermoregulation

Newborn infant is homoiotherm ( stable T )

Infants maintain deep body temp. constant bet.

36-37 0C. Factors that affect thermoregulation:

Chemical thermoregulation

Physical thermoregulation Thermal stimulation


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Thermoregulation

1.Chemical thermoregulation: 2 response

Shivering thermogenesis- heat productionaccompanied by electrical activity of skeletalmuscle

Non-shivering thermogenesis- without visibleor electrical muscular activity

Newborn has both white and brown adiposetissue, utilize for non shivering thermogenesis.

Brown adipose tissue more effective supplier ofheat


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Thermoregulation

2. Physical thermoregulation defines themechanism of heat loss from the body core to thesurface, from the surface to the environment.

3. Thermal insulation heat exchange bet thebody and environment.

Internal thermal insulation -subcutaneous fat

layer, skin blood flow External thermal insulation- clothing and

incubator temp.


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Thermoregulation

Cold environment, more energy utilized for heatproduction and increase oxygen consumption.

Normal fetal heart tone (term) 120-160/min Fetal bradycardia (120/min) are signs of fetaldistress

Hypoxia is the most common cause of fetaldistress

Fetus: Assessment of Growth


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Fetus: Assessment of Growth,Maturity and well being

12th week of life- intrauterine assessment

X-ray and UTZ

periodic determination of bi parietal diameter Fetal size and implantation

Measurement of fetal head and amountamniotic fluid

Estimation of gestational age

Fetus: assessment of Growth


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Fetus: assessment of Growth ,Maturity and well being

Lung maturity- analysis of the amount ofsurfactant in the amniotic fluid

Placental maturity index- determined by thedegree of calcification (by UTZ)

Fetal distress can be assess through cardiacrhythms and fetal movements

Fetus: assessment of growth


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Fetus: assessment of growth,maturity and well being

Biochemical test for monitoring fetal well being

1.Non- stress test (NST)

2.Oxytocin challenge Test (OCT) Fetus is challenged with maternal oxytocin drip to

produce 3 uterine contraction every ten minutes

3 late decelerations suggests fetus at risk

Fetal Assessmnet growth


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Fetal Assessmnet, growth,maturity and well being

High Risks factors:

1.Maternal

2.Fetal3.Placental

Maternal infections

1.TORCHES, diabetes, toxemia, thyroid disorders

Congenital malformations

2.Ingestion of teratogenic drugs- malformation ordeath

Fetus: Assessment of Growth


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Fetus: Assessment of Growth ,maturity, and well being

Heroin and alcohol- withdrawal and growthretardation

Maternal age and poor obstetric history Fetal factors:

Erythroblastosis fetalis, error of metabolism, sexlinked disorders, gladular dysfunction, lung

maturity, growth retardation, prematurity,malpresentation and hypoxia

Fetus: Assessment of growth


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Fetus: Assessment of growth,Maturity, and well being

Placental factors;

Placental insufficiency, cord and amniotic fluidabnormality( meconium staining, oligo and

polyhyramnios

Q ti #11


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Question #11

A newborn was noted pale, with a heart rate of


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Question #12

A newborn was delivered cyanotic, with fairmuscle tone,doesn't cough or sneeze onsuctioning, HR >100, and irregular respiration.

What is the best management?

a)Assisted ventilation

b)Tracheal intubation

c)O2 by mask

d) Slapping of the sole

Q ti # 13


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Question # 13

Babies with an Apgar score of 7 at one minuteis considered:

a)Moderately depressed

b)Severely depressed

c)Vigorous

d)Needs resuscitation

M t f th N b


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Management of the Newborn

Initial care

Clinical Appraisal

Resuscitation Temperature regulation

Physical examination

I iti l C


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Initial Care

Done in the delivery room or where the deliverytook place with good lighting conditions.

First objective is the establishment of a clearairway

Gentle suctioning of secretions from the mouth,then the pharynx, and nose

The nose is suctioned last to avoid suddeninspiratory gasp which may result in theaspiration of the amniotic fluid in the mouth.

Clinical Appraisal


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Clinical Appraisal

The evaluation of the baby's condition is notedright after birth, with the first gasp, cry andonset of sustained respiration.

Clearing of the newborn airway start as soon asthe head is delivered.

APGAR SCORE


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APGAR SCOREsign 0 1 2

A- appearance(color)

Blue; pale Body pinkExtremities blue

Completely pink

P-Pulse(HR) absent Below 100 Over 100

G- Grimace No respone grimace Cry, cough or sneeze

A- Activity(muscle tone)

limp Some flexion of extremities

Active motion

R- respiration absent Slow; irregular Good strong cry

APGAR SCORE


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APGAR SCORE

Recorded at 1 minute and 5 minutes One minute scoring gives the index of necessity

of resuscitation

Five minute -valuable in predicting mortality andneurologic deficit of infant at one year old

Scores: one minute

7-10 vigorous 4-6 moderately depressed, assisted

ventilation

0-3 severely depressed, tracheal intubation,

oxygen administration

APGAR score


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APGAR score

HEART RATE is the most important parameter

nHR bet 100-160/ min

HR < 100- usually asphyxiated- newborn need

assistance HR >160 indicates distress

Respiratory rate

Muscle tone Reflex irritability

color

Temperature Regulation


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Temperature Regulation

The baby should be dried and wrapped in ablanket soon after birth.

The fall in temperature in a newborn is about 2-3 degrees celcius after birth

The heat losses/ unit body weight in newborn is4x that of an adult due to its greater surface

area in relation to the body weight. Prematures are more affected

Physical Examination


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Physical Examination

2 Stages Initial Examination

Detailed Examination

Initial Examination1.Color- persistent cyanosis after sustained

respiration and given high conc. of oxygen indicate failure of the ductus to close, high

pulmonary resistance or preductalcoarctation.

Deeply asphyxiated babies are pale due tosevere cutaneous vasoconstriction.

Initial Examination


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Initial Examination

Pallor is also prominent in erythroblastosis andfetomaternal and feto-fetal transfusion.

2.Respiration

Grunting with prolonged expiration is an earlysign of respiratory distress syndrome (RDS)

Diaphragmatic hernia- respiratory distress

appears after sustained respiration has beenestablished. Diminished breath sounds andscaphoid abdomen.

Initial examination


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Initial examination

3. Umbilical vessels and placenta

Presence of single umbilical artery- anomaliesfound in genito - urinary/ gastrointestinal

tracts, skeletal and cardiovascular and CNS. Placental exam done to detect infection and

placental insufficiency.

Question #14


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Question #14

A newborn was delivered via NSD, edema withecchymosis was noted on the head andborders are not well defined merging with the

rest of the tissues. The most likely diagnosis is:a)Cephalhematoma

b) Caput succedaneum

c)Craniotabesd)Cranial meningocele

Question #15


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Question #15

At birth, the liver is always palpable about 2-3cm below the right costal arch.

a)True

b)False

Question #16


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Question #16

The ffg are normally seen in newborn babies,except:

a) Milia

b)Erythema toxicum

c)Mongolian spots

d)Petechia

DETAILED EXAMINATION


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Measurements of weight, length, circumferenceof head, chest, and abdomen, cardiac andrespiratory rate and temperature.

1.Skin- babies are covered with vernixcaseosa, to protect the skin from maceration inutero.

Pinkish, smooth and elastic with fair amount ofsubcutaneous tissue.

Lanugo hair maybe present in the back,shoulders and upper arms.



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Preterm infants has less subcutaneous tissueand skin is almost transparent

Post term, has paler or dry and desquamatingskin; pallor/plethora noted.

Mottling of the skin occurs when the body isexposed to cold, due to instability of thecirculation

Mongolian spots- blue grey pigmented areas,seen in buttocks, back and extremities

Milia- small whitish papules which covers the

nose made up of sebaceous glands



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Erythema toxicum- small, firm, yellow-white 1-2mm papules topped by vesicles at the tip andsurrounded by patch of erythema.

2. Head- rounded if babies are born by cesarean

section, varying degrees of molding if delivered byNSD.

Caput succedaneum- edema w/or w/o ecchymosis,extend across the midline and across the suture line,

disappears after few days Cephalhematoma-due to subperiostial bleeding,

does not cross the suture line.



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Craniotabes- soft areas in the parietal bones,pingpong ball' when pressed;preterm infants

If persist beyond infancy, pathologic as seen in

Rickets and Osteogenesis imperfecta.

Cranial meningocele pulsating mass whichbecome more tense when the baby cries.

Fontanels- vary in size small or closed microcephaly /

craniocynostosis.

Tense fontanel- increase ICP

Detailed examination


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eta ed e a at o

Face- symmetrical Down syndrome- common facies seen at birth

Eyes: Subconjunctival hemorrhages, congenitalcataracts; fundoscopic exam prior to

discharge Ears: low set ears associated with chromosomal

disorders and renal anomalies; ear tags

Nose- patency; cleft palate; high palatine arch

Tongue- small; large seen in cretin; Tonguetie- short lingual frenulum

Neck- Laxity /webbing found in down syndromeand Turner; cystic hygroma;



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Chest- size, shape and movement shld benoted. RR= 40/min

Heart 120-140/min; slowing of HR- congenitalheart block, anoxia, intracrnial hemorrhage

Mammary glands- engorged, (+) witch milk

Abdomen- globular

Distention and vomiting after feeding- intestinalobstruction

Liver is palpable 2-3 cm below the R coastalarch



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Genitalia- hymen with prominent tags; clitoris large; labiaminora prominent than majora

Female- mucoid nonpurulent/ bloody vaginal

discharge Male- size of the penis and scrotum varies; hydrocele

may be present.

Extremities

Creases of the palms and sole should be examined forpeculiar lines like simian line in Down syndrome

Non development of distal portion- hemimelia



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Nondevelopment of proximal portion-phocomelia

Palpation of the femoral pulses should be done

for early detection ofCoarctation of Aorta Neurological examination

Muscle tone and reflexes should be tested

Moro, grasp, rooting and sucking reflexesshould be elicited

Nursing Care


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g

Routine newborn care

Vitamin K 1mg or 0.5 mg in preterm- to preventprothrombin defficiency

Erythromycin ophthalmic ointment- topreventophthalmia neonatorum

Cord care with 70% isoprophyl alcohol

Thermoregulation Breastfeeding- started as soon as baby can

suck

Physiologic process in thenewborn


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newborn

events Term Preterm

Anemia time 6-12 weeks 5-10 wks

Hgb 9.5-11gms 8-10 gms

Weight loss < /=10% of the BW 1

st

10 days 14-21 days

Jaundice Time 3-4 days 5-7 days

level 6-8mg/dl 10-12 mg/dl

Passage of

meconium

0-48 hrs 99% 95%

Passage of urine 0-24 hrs 95% 95%

24-48 hrs 100% 100%

Question #16


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All of the ffg are contributory factors inperinatal morbidity and mortality except:

a)Maternal age

b)Multiple pregnancies

c)Paternal age

d) Socioeconomic status

HIGH- RISK INFANTS


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1. Babies of low birth weight

Factors related to perinatal morbidity andmortality

Maternal age,race, marital status, past obstetrichistory, multiple pregnancies.

Premature babies born before the 37th week ofgestation, BW < 2500 g

Small for gestational age babies born term butBW


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2. Post-term infants

Babies delivered after 42 weeks of gestation

Babies have little vernix, absent lanugo hair, pale

skin usually dry and desquamating with fingernails are longer.

Common among babies born of toxemic mothers,mothers with renal dse, with chronic illness,elderly primigravid or mothers with placental

abnormalities.

HIGH RISKS INFANTS


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3. Multiple pregnancies or twinning Babies are delivered prematurely or small for

gestational age

Malformations are common in multiple

pregnancies.

Management:

Babies of low birth weight and other high risks

infants are placed in heated incubators tomaintain body temperature between 36-37oCwith humidity of 60-70% and oxygen flow of40%

HIGH RISKS INFANTS


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Heated bassinets are used with piped -inhumidified oxygen in a hood just to enough torelieve cyanosis and respiratory distress.

Feeding witheld for smaller infants for 2-3 daysto prevent fatigue and danger of aspiration.

Infants


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Infants who appear well are fed 4-6 hrs afterbirth.Sterile water or 5% glucose at 2-3 hrsinterval, given by gavage.

Initial volume 2-3 ml for infant 1000-1500,increase the amount by 2ml/feeding/day.Ideally, 120-140 cal/kg/day reached by the endof 2nd week.

Protein intake 4-5gms/kg/day

Ballard Maturationalassessment


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assessment

Commonly used technique of gestational ageassessment

2 Criteria:

Physical maturity- relies on anatomical changes

Neuromuscular relies on muscle tone

Assigns scores to various criteria, the sum is

extrapolated to the gestational age of the baby. Scoring relies on intrauterine changes that fetus

underwent during its maturation

Neuromuscular rating


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Posture- total body muscle tone is reflected in infantsposture at rest

Square window- wrist flexibility and resistance to

extensor stretching Arm recoil- paassive flexor tone of the biceps muscle

Popliteal anglematuration of passive flexor tone abovethe knee joint

Scarf sign- passive flexor about the shoulder girdle

Heel to ear passive flexor about the pelvic girdle

-

Ballard ScoringPhysical Maturity Rating


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Physical Maturity Rating

-1 0 1 2 3 4 5

SKIN

Sticky,friable

transparent

Gelatinous, red

translucent

Smoothpink,

visibleveins

Superficial peeling/

rash, fewveins

Crackingpale

areas

Parchment deep

crackingno veins

Leathery,cracked,

wrinkled

LANUGO none sparse abundant thinning Baldareas

Mostlybald

PLANTARSURFACE

Heel-toe40-50mm-150mmnocreases

Faint redmarks

Anteriortranversecreases

Creasesant. 2/3

Creasesoverentiresole

Ballard scoringPhysical Maturity Rating


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Physical Maturity Rating

-1 1 2 3 4 5

BREASTIMPERCEPTIBLE

BARELYIMPERCEPTIBLE

FLATAREOLANO BUD

STIPPLEDAREOLA1-2MMBUD

RISEDAREOLA3-4MM

Full areola5-10mm

EYE/EARLids fusedloosely-1Tightly- 2

Lids openpinna flatstaysfolded

sl. curvedpinna; soft,slow recoil

Wellcurvedpinna, softready torecoil

Formedand firminstantrecoil

Thickcartilageear stff

GENITALIA- MALE

Scrotum

flat,smooth

Scrotum

empty,faintruggae

Testes in

uppercanal, rareruggae

Testes

descending fewruggae

Testes

down goodruggae

Testes

pendulousdeepruggae

GENITALIA-FEMALE

Clitorisprominentlabia flat

Clitorisprominentsmall labia

minora

Clitorisprominentenlarging

minora

Majora andminora =prominent

Majoralargeminora

smll

Majoracoverminora and

clitoris

Maturity Rating


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SCORE WEEKS-10 20

-5 22

0 24

5 26

10 28

15 30

20 32

25 34

30 36

35 38

40 40

45 42

50 44

Maturity rating


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Example:

Neuromuscular maturity score = 13

Physical maturity score = 28------

total 41

AOG 40 weeks

Diagnosis: newborn


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Chart: Live term baby girl delivered via NSD,AS 9/9, BW 3 kg, 41 weeks by ballards,Appropriate for gestational age (AGA)

Question #17


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Which of the ffg is the most common site offatal and disabling injuries in the newbornduring delivery .

a)Spinal cord

b)Intracranial cavity

c)Nerve

d)abdominal

DISEASES OF THE NEWBORN


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Birth injuries

1.Intracranial injuries- most common site offatal and disabling injuries

S/S: cyanosis or pallor, apnea and respiratorydifficulty, poor response to stimuli, convulsion,bulging fontanel

Usually caused by difficult delivery

Prognosis: usually die on the 1st 72 hrs or survivebut develop cerebral palsy, epilepsy or mentaldefficiency

Mgt:: keep the baby warm, give O2, Vit K,Sodium phenobarbital

Do lumbar uncture

Birth injuries


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2. Spinal cord injuries

Cause by difficulty in the delivery of theshoulder in head presentation and head in

breech presentation Paralysis may occur due to compression of the

cord by edema and hemorrhage

3. Nerve injuries

May result with excessive tension on one side ofthe neck producing brachial palsy.

Nerve Injuries


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1. Erb- Duchenne paralysis

Injury to C5-C6, loss of function of biceps,deltoid, brachialis and brachioradialis

2. Klumpke's paralyis Injury to C7-C8, wrist and hand movement are

lost

3. Horner's Syndrome Injury to the sympathetic nerve fibers with

concomitant meiosis of the pupil and eyelidptosis of the same side

Birth Injuries


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4. Fractures

Involve the long bones or the clavicleassociated with difficult delivery

Mgt: immobilization of the affected extremity 5. Intra-abdominal injuries

Hemorrhages from the liver, adrenal glands and

spleen are encountered in breech extraction Mgt: blood transfusion and exploratory

laparotomy

Question #18


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All of the ffg pathogens are likely cause of earlyonset neonatal sepsis except

a)Group b streptococcus

b)Escherichia coli

c)Staphylococcus epidermidis

d)Hemophilus Influenza

Question #19


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Late onset neonatal sepsis in full term infants isassociated with which of the ffg?

a)75% rate of meningitis

b)Group B Streptococcus

c)Escherichia coli

d)Onset as late as 60 days of life

e)All of the above

Question #20


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The most common focus of infection of group bStreptococcal early onset disease of thenewborn is the

a)Lungs

b)Skin

c)Menibges

d)Urinary tract

INFECTIONS IN THE NEWBORN


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Predisposing factors:

1. maternal infections

UTI, Toxoplasma gondii, rubella,

cytomegalovirus, herpes, syphylis (TORCH) 2.Infections acquired after delivery

3. prematurity

Infections in the Newborn


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Routes of Entry:

1. Hematogenous- microorganism is carried intothe intervillous spaces of the placenta to the

fetal bloodstream 2. Ascent of the vaginal bacteria into the

amniotic cavity after rupture of the membrane

3.Ingestion/aspiration of infected fluid

4. direct contact with infected material in thebirth canal

Sepsis Neonatorum


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Common bacterial causes: E.coli, Klebsiellaaerobacter, proteus specie, pseudomonasaerogenosa, Group B streptococci.

Candida albicans, chlamydia Two types:

1.Early onset

2.Late onset

Sepsis Neonatorum


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Early onset- usually serious and progressivemultisystemic infection during the first week oflife.

Most cases there is a history of obstetricalcomplications like prematurity or low birthweight

Mortality is high

Late onset insidious and ecognized after thefirst week

Obstetric complication less characteristic

Clinical Manifestation:


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Maternal history can greatly help the diagnosisof infection.

S/S: Poor feeding, lethargy, hyporeflexia,,irritability, apnea, cyanosis, jaundice,abdominal distention, petechia, diarrhea andtemperature instability.

Laboratory:

CBC- wbc >30,000/cu.mm or


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Mgt:

Early onset- gm (-) enteric bacilli and grp Bstrep are prevalent

Late onset Staph Aureus and hospitalacquired enteric bacilli like pseudomonas andserratia

DOC: Penicillin 100,000U/K/day q 12 combined

with aminoglycoside ( gentamycin 5-7mg/kg/day or amikacin 10-15 mg/kg/day q12.) given for 7-10 days

Jaundice in the Newborn


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The degree of jaundice is measured in terms ofbilirubin concentration.

Clinically: yellow color of the skin, mucousmembranes of the mouth and sclerae.

Etiology:

1.overproduction of bilirubin liver cells arenot able to cope with the increased load of

indirect bilirubin 2.Undersecretion of bilirubin- caused by

decrease conjugation of IB.

Over production of bilirubin


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Eg; Isoimmune hemolytic anemias arise fromblood group incompatibilities bet. fetus and themother w/c results in formation by the mother ofantibodies against her infants red cells.

Type O mother with type A or B infant, Type Ohas both Anti- A and Anti B agglutinins easilytraverse the placenta to fetal circulationresulting to hemolysis.

Occurs in rh (-)mother who has an rh (+) infant

Undersecretion of bilirubin


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Eg: Physiologic jaundice

Deficient in glucoronyl transferase activity in thefirst few days of life.

Jaundice on the 2nd or 3rd day of life andsubsides on the 5th day.

Phototherapy and exchangetransfusion


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BILIRUBIN LEVEL Bilirubin level

Birth weight Phototherapy Exchange transfusion


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Indirect bilirubin 20mg/dl

Double volume exchange transfusion using thepatent umbilical vein

Donors blood should match mothers blood toprevent heolytic reaction

If IB not rising rapidly: Phenobrbitaladministration and Phototherapy

Phenobarbital increasing glucoronyltransferase necessary for conjugation andincrease y transport protein

Management


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Phototherapy -reduce bilirubin throughphotoisomerization in intracanalicular andinterstitial spaces to soluble breakdown

products, excreted rapidly in bile and urine. Infant unclothed and exposed to ten 20 watt

daylight or blue fluorescent light at 30 inchesabove

Baby's eyes should be shielded, to avoid retinaldegeneration

Management


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Complictions of phototherapy:

1.Dehydration

2.Diarrhea

3.Bronze baby syndrome

4.thrombocytopenia

Breast milk Jaundice(Physiologic)


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Parameters Breastfeeding jaundice Breast milk jaundice

Onset 3rd-4th DOL Start to rise on 4th Dol,may reach 20-30mg/dl onday 14, then decreaseslowly, normal by 4--12

weeksPathophysiology Dec. milk intake increase

enterohepatic circulationDue to B- glucoronidasein breastmilk whichincrease entrerohepaticcirculation

Management Fluid and caloricsupplementation

Stop breastfeeding, rapiddec in bilirubin in 48 hrs

Kernicterus


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High level of indirect bilirubin above 15-20mg/dl Dangerous because its depositon in the basal

ganglia of the CNS occurs producing toxicity tothe brain.

S/s: lethargy, hypotonia and poor feeding

Mgt: double volume exchange transfusion usingthe umbilical vein, phototherapy, phenobarbital

5mg/kg/day Donors blood should match mothers blood to

prevent hemolytic reaction.

Hyaline Membrane Disease

60% of preterm infants


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60% of preterm infants


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CXR: diffuse reticogranular infiltrate throughoutthe lung field with typical air-filledtracheobronchial tree- air bronchogram

Mgt: Baby dried and keep warm

O2 by hood, Mechanical ventilation

Correction of the acid base balance

Apnea of the newborn


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Apnea of the new born-respiratory pause is prolonged,>20 seconds, HR decrease 80/min

Periodic breathing respiratory pause is shorter 5-10secs alternating with breathing movement.

Common among preterm infants;

Term infants apnea occur few hrs after birth- due toaccumulation of secretions around the oropharynx

Etiology unknown

May lead to CNS damage

Apnea of the newborn


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Management:

Physical stimulation

Theophylline LD 5mg/kg IV, MD 2mg/kgTID

oral Reduces apnea by increasing alveolar

ventilation through cntral stimulations.


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THANK YOU!GOOD LUCK TO EVERYONE

the newborn infant slides 3

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