2. 2
Tasks of the neonatologist
Prenatal diagnosed condition
Inform parents, preparation of necessary intervention
Labor Ward
Handling healthy
newborns
Neonatal sequalae treatment
2
3. 3
Newborn terminology
CLIV. Act of Care 1997 Chapter XII. section 216. d.
„Perinatal Death:
a) Mortality occurs intra uterus post the 24th gestational week or after the
fetus reached 30 cm length or 500 g weight,
b) If the death occurs 168 hours post delivery, irrespective of the growth
parameters of the newborn
3
Perinatal Mortality
Fetal Death Infant Death
4. 4
Terms of newborns
Mature newborn: 37. – 41 6/7. gestational week
weight: 3500-4500 gramm
length: 45-55 cm
head circumference 32-37 cm
Over-carried newborn: post 42 . week
SGA (small for gestational age) newborn
- weight below the 10th percentile
- weight below the average by 2 SD
LGA (large for gestational age) newborn:
- weight above the 90th percentile
- weight above the average by 2 SD
Premature birth : age <37 gestational week,
weight <2500 gramms
VLBW (very low birth weight) newborn - <1000 gramms
4
5. Neonatologist is required in the
labor ward
Conditions of the mother
toxaemia, chronic disorders, dependency (drug, alcohol, smoking)
Fetal Condition
multiples, age of fetus (premature or postmature), IUGR (intrauterin growth retardation),
fetal development condition, diagnosed fetal disorder (e.g.: hydrops-syndroma)
Labour and birth factors:
distochia, meconium stained fluid,early membrane rupture/noticeable odor, bleeding,
umbilical chord disorder, cesarean section
5
Known anamnesis may result in resuscitation in cases of:
Post the normal pregnancy
Newborn shows symptoms of
changing respiratory rate, cyanosis, meconium stained fluid, hydrops syndrome
Apgar test tube can’t get through, development disorders
Healthy newborn condition deteriorates
6. 6
Labor ward treatment
Newborn resuscitation
Apgar test and score
Umbilical cord clamp
Treatment of eyes
First informative test of newborn
Development control
- Dubowitz-score – 1977
- New Ballard-score – 1991
Sterility/Hygienic norms
6
7. 7
Equipment needed for resuscitation
Open incubator (radiant warmer), phonendoscop,
„Apgar clock”
Oxygen and breathing space with tube outlets
Suction and catheters
(both throat and tube suction)
Equipments for ventilation
(Neopuff, balloon, masks, laryngoscope, tubes)
Equipments for vein punctions
Drugs
Scissors, tape
10. 10
APGAR score
0 1 2
Pulse absent <100/min >100/min
Respiratory effort absent Irregular Intensive cry
Grimace
(reflex irritability)
Non-responsive Grimace Sneeze or cough
Activity
(Muscle tone)
Absent , limp
Some flexion of
extremities
Strong movement
Appearence
(skin colour)
Pale, blue Acrocyanosis Rosy
Assessment:
8-10 – good outcome
6-7 – endangered condition, NICU observation required
4-5 – average condition, NICU observation required
< 3 – serious asphyxia, life threatening condition
11. Injuries during delivery
Prevalence – 1-2%
Predetermining factors:
macrosomia, premature birth, distochia,
long birth period, breach position
Cephalhaematoma – most common
Other injuries: suffusion, skin injury
Clavicula fracture
Bone fracture
Nerve injury: Erb-Duchenne (C5-6), Klumpke (C7-8, Th1)
11
12. 12
Healthy newborn care on ward
First day of life
Detailed physical examination
Vitamin. K prophylaxis
HBsAg test result – if necessary
injection
Observation time
sucking and feeding
jaundice
care of the umbilical region
Day of discharge
Metabolic disease screening test
Hearing test screening
BCG injection
13. 13
Conditions of early discharge
Normal single pregnancy
37- 42. gestational week
Spontaneous vaginal delivery
Normal prae-,intra- and postpartum period
12 hours prior to discharge normal and stable
parameters
At least two successful feeds
No condition that would justify hospitalization
Metabolic test results
Suitable home conditions (home assessment)
Mother is capable of caring for the newborn
Within 48 hours if pediatrician (GP) undertakes
the general practice at home
14. 14
Problems at healthy newborns
Managed on normal neonatal ward:
Tremor
- Hypoglycemia – blood sugar below 1,8-2 mmol/l
- Hypocalcemia – SeCa level below1,7 mmol/l
Passage disturbances:
-regurgisting, vomiting
- Stool (meconium) problems if it within 24-36 hours recover
Omphalitis without feeding problems and deterioration of
general condition
Icterus – physiologic
enough fluid intake supply, blue-light therapy and observation
15. 15
Cases of Intensive Care
requirement
Post intubation or resuscitation
Cardiorespiratory disorders
Prior to 34. gestational week or below 2000 grams of
birthweight
Symptoms of anemia or shock
Central nervous system disorders
Serious development disorders
Feeding difficulties or reoccurring vomiting
Infection
Serious disturbances of ion homeostasis
Clinical icterus
16. 16
Tasks prior to transfer
Stabilization, checking clinical signs and vital
parameters till the ambulance arrive
Inform the staff of ambulance service and the host
hospital before transportation
Parents information
Preparing documentation
17. 17
Necessary data:
Data of perinatal period: mode of delivery, time of membrane
rupture, amniotic fluid condition, medicine usage during
delivery, analgesia
Data of newborn: birthweight, Apgar points, invasive
treatments, medicaments, infusions, ventilation support,
laboratory findings
Maternal anamnesis: birthdate, insurance number, blood
group, date of previous pregnancies, acute and chronic
diseases, family anamnesis, regular use of medicine/alcohol/
drug
Data of recent pregnancy: results of laboratory and
ultrasound and screening tests (e.g..: HBsAg !!)
18. 18
Intensive Care Placement
I. Infection suspicion
II. Development disorders
III. Respiratory condition
IV. Gastrointestinal condition
V. Icterus
VI. Haematologic disorders
VII. Others
- seizures - ion homeostasis disturbances
- injury through delivery - social problems
