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- 1. Newborn Short case Dr.P.Nagasree Prof and HOD Department of pediatrics
- 2. Birth history . General examination Systemic examination Maternal history
- 4. Maternal history Age Weight Height Immunization status Obsterstric formula Birth spacing Blood group and typing Chronic diseases
- 5. Age of mother Young primi <16 years •Low birth weight •Prematurity •Perinatal death
- 6. Age of mother • Elderly gravida >40 years • Hypertension • Diabetes • Intrauterine growth retardation • Congenital malformations
- 7. Age of mother • The risk of downs syndrome increases with the mothers age • 25 years 1in 1250 • 31 years 1in 1000 • 35 years 1in 400 • 40 years 1in 100
- 8. Maternal weight • Low BMI <17kg/m2 is associated with Perinatal death, Prematurity and SGA. • High BMI >35 kg/m2 associated with PROM,Preterm delivery • Weight gain in pregnancy varies greatly. Most pregnant women gain between 10kg and 12.5kg .
- 9. • Mothers with a small stature Less than 145–150 cm have a higher risk of prolonged or labour due to Cephalopelvic disproportion. Maternal height
- 10. Gravida. Term births. Premature births. Abortions. Living G4. T1. P1. A2. L2 4 pregnancies, 1 term birth, 1 premature birth, 2 abortions, 2living children Preterm: < 37 weeks Term: 37- 42 weeks Post term: >42 weeks Abortion as pregnancy terminated prior to 20 weeks gestation or a fetus born weighing < 500 grams. Problems during antenatal and postnatal period of the previous pregnancies should be noted Obstetric formula
- 11. Immunization status of Mother • R-vac is given to prevent congenital rubella syndrome • MR 1st dose at 9 - 12 months 2nd dose 16-24 months. If missed up to the age of 12-13 years. • Indications of Rvac. All girls at puberty (12 above) All woman of child bearing age and if missed Post delivery • Rubella vaccine should not be given to pregnant woman. • Pregnancy must be avoided for 28 days following R vac
- 12. Birth spacing • Healthy spacing of 3- 5 years between births is an effective way to prevent maternal and child mortality and morbidity. • If spacing is less - Nutritional and micronutrient deficiency – preterm birth or IUGR
- 13. Maternal blood group and type Rh Negative mothers with Rh positive fetus – Rh iso immunization H/o abortions and Anti D immunoglobulins after abortion or delivery
- 14. Maternal condition Effects on pregnancy Effect on infant Anemia Preterm labour low birth weight Diabetes Preeclampsia,polyhydro mnios , preterm delivery, fetal death Infant of diabetic mother SLE Spontaneous abortion Complete heart block Phenyl ketonuria MR,Microcephaly,CHD UTI Preterm labour Preterm related complications Smoking Abruptio placenta, still birth, LBW,Cleft lip , palate MR, growth retardation, hyperactive child Alcohol Fetal alcohol syndrome
- 15. Fetal alcohol syndrome Abnormal facies CNS abnormalities Growth retardation Irritability, jitteriness, and developmental delays in infancy Short palpebral fissures, a thin upper lip and a smooth philtrum.
- 17. Antenatal history 01 Antenatal visits 02 Dating scan 03 Iron folic acid supplementation 04 Quickening 05 Fever with rash 06 Teratogenic drugs 07 Radiation exposure 08 Pregnancy induced complications
- 18. Antenatal visits • Monthly visit during first 2 trimesters 1-28 weeks.- 7 visits • Fortnightly visit between 28-36 weeks- 4 visits • Weekly after 36 weeks till delivery I. e 38-40 weeks.- 2 to 4 visits Total – 13 to 15 visits
- 19. • A dating scan is done between 8 and 12 weeks of pregnancy • Best for assessing gestational age and EDD. • Diagnose Multiple gestation and • Rules our anovulatory pregnancy (non viable fetus) • Rules out ectopic pregnancy Dating scan
- 20. Iron supplementation Iron supplementation decreases the maternal and fetal anemia.
- 21. Folic acid • Folic acid supplementation prevents the neural tube defects in fetus. • NTD- 1.Spina bifida – Meningocele, Myelomeningocele ,Spina bifida occulta 2. Anencephaly ,3. encephalocele, 4. Iniencephaly • All women of childbearing age with no history of a previous pregnancy affected by an NTD - 0.4 mg of folic acid / day • Women with a previous pregnancy affected by an NTD - 4 mg of folic acid per day • Starting 1 month before pregnancy and the first 3 months of pregnancy .
- 22. NTD
- 23. Quickening • First perception of fetal movements at 16- 18 weeks - Quickening – absent in Spinal muscular atrophy • Deceased /absent movements – Fetal distress,Fetal demise. • Cardiff rule of 10 - A way to assess intrauterine well-being of fetus mother records fetal movement during her usual activities. There should be at least 10 movements within a 12- hour period; if fewer than 10 movements are perceived, further medical evaluation is needed.
- 24. Fever with rash – TORCHS • T – Toxoplasmosis • O - Other infections- Zika virus , Parvo virus B19 • R - Rubella • C – Cytomegalovirus,chicken pox,coxsackie B virus • H - Herpes simplex virus, HIV,Hepatitis B. • S- Syphilis .,
- 26. Congenital rubella syndrome CATARACT DEAFNESS PDA BLUE BERRY MUFFIN RASH
- 28. Congenital herpes Microcephaly, hydrocephalus, chorioretinitis and vesicular skin lesions.
- 29. Congenital syphilis Early syphilis < 2years Vesicular bullous lesions Snuffles Syphilitic rhinitis Late syphilis > 2years Hutchinson's triad
- 30. Exposure to Irradiation (The fetus radiation dose below 50 mGy is safe ) Radiation exposure Cataract Microcephaly, Mental retardation
- 31. Pregnancy induced complications Gestational diabetes Pregnancy induced hypertension Oligohydromnios Polyhydromnios
- 32. Infant of diabetic mother (IDM) • Macrosomia • Birth trauma • Perinatal asphyxia • Shoulder dystocia • CNS – NTD • Metabolic • Hypoglycemia , • Hypocalcemia, • Hypomagnesemia • RS- RDS • CHD- TGA, VSD, ASD, cardiomyopathy • GUS- Renal agenesis, • ureteral duplication • cystic kidneys • GIT- Duodenal atresia, anorectal atresia • Musculoskeletal- Hypoplastic femur • Functional – Lazy left colon syndrome
- 34. Polyhydrominos • Definition • Liquor amni > 2000ML, Normal – 600-800ml • AFI >24 cm Normal – 8-18 cm • Causes • Gestational diabetes ,RH isoimmunization • IU infections toxoplasma, rubella ,syphilis • Gastrointestinal disorders, such as duodenal atresia, esophageal atresia, gastroschisis, and diaphragmatic hernia.cleft palate • Brain and nervous system disorders such as anencephaly, Myelomeningocele
- 35. Oligohydrominos • Definition • Amniotic fluid index (AFI) of less than 5 cm or less than the 5th percentile, from late mid-trimester. • Causes • Rupture of amniotic membranes (ROM). • Renal agenesis, obstructive nephropathy • Chromosomal abnormality • Post-term gestation, IUGR
- 36. Natal History
- 37. Newborn Short case Dr.P.Nagasree Prof and HOD Department of pediatrics • Birth order :The baby born after two or three live children is prone to malnutrition, especially if the duration between the deliveries is less than 2 years. • PROM • Multiple pregnancy: The second twin is at a high risk of hypoxia, hypoglycemia and birth trauma, all of which could result in brain damage. • Mode of delivery: Natural birth /Cesarean section, the incidence of transient tachypnea of newborn is more in C/S babies • Place of delivery: hospital/home/any other Natal history
- 38. Newborn Short case Dr.P.Nagasree Prof and HOD Department of pediatrics • Person who conducted the delivery: qualified doctor or nurse/trained dai/ untrained person. • Gestational age: From mother LMP • Presentation: Cephalic, Breech, Shoulder, Footling • Birth weight: Appropriate /Small/Large for gestational age. • Perinatal asphyxia: Cried/did not cry soon after birth, if not, then details of resuscitation. • APGAR score: at 1, 5 and 10 minutes. • Liquor colour / Odor Natal history
- 39. Newborn Short case Dr.P.Nagasree Prof and HOD Department of pediatrics • PROM is the rupture of gestational membranes prior to the onset of labor. When membrane rupture occurs before 37 weeks of gestation, it is referred to as preterm PROM -PPROM • Prolonged PROM > 18 hrs before delivery – risk for sepsis in newborn PROM- Premature rupture of membranes
- 40. Newborn Short case Dr.P.Nagasree Prof and HOD Department of pediatrics
- 41. Newborn Short case Dr.P.Nagasree Prof and HOD Department of pediatrics Abnormal presentation
- 42. Liquor amni • Colour • Odor- odorless normally , foul smelling in amnionitis Green– meconium stained Golden – Rh isoimmunization Saffron – postmaturity Dark coloured- concealed haemorrhage Dark brown - IUD
- 43. Newborn Short case Dr.P.Nagasree Prof and HOD Department of pediatrics
- 44. Newborn Short case Dr.P.Nagasree Prof and HOD Department of pediatrics
- 46. SGA SGA provides a measure of size and not a direct measure of antenatal growth quality. SGA are Genetically, constitutionally small baby IUGR reflects fetal distress, utreoplacental dysfunction and impaired growth velocity during intrauterine period
- 47. Newborn Short case Dr.P.Nagasree Prof and HOD Department of pediatrics IUGR Symmetrical IUGR Asymmertical IUGR 20-30% 70-80% PI ≥2.2 g/cm 3 PI <2.2 g/cm 3 Insult during early gestation Later part of gestation Brain growth affected Brain growth not affected TORCH Genetic disorders Chronic hypoxia Malnutrition Ponderal Index = Weight (grams)/Length (cm)3
- 48. LGA - Macrosomia • Maternal diabetes, • Maternal Obesity • Increased weight gain during pregnancy
- 49. Cord clamping timing importance • Delay in umbilical cord clamping for at least 30– 60 seconds after birth in vigorous term and preterm infants is advised • Delayed cord clamping decreases the anemia in newborn baby
- 51. Initial feed Initial meconium passage Timing of urination Inj vitamin k. NICU admission and events
- 52. Initial feed Initiate breastfeeding within the first hour of birth Breast crawl- when a newborn baby is placed on mothers abdomen immediately after birth baby crawl toward the mother's breast; the neonate locates the nipple and self- attaches Prelacteal feeds: These are feeds to a baby before putting the baby to breast. Putting the baby on prelacteal feeds like honey, sugar water, buffalo milk, increases the risk of infection and suppresses lactation.
- 53. Meconium passage • First meconium should be passed before 48 hrs of birth • Causes of delayed meconium passage • Hirschsprung disease • Malrotation of gut • Cystic fibrosis • Intestinal atresia • Anorectal malformations
- 54. First urination Should be within 24 hours after birth Causes of delayed urination • Acute renal failure -Renal agenesis, renal dysplasia, polycystic kidney disease • Spina bifida • Posterior urethral valves 13–21% of infants void in the delivery room.
- 55. Vitamin K • Within the first 6 hours post-birth and following initial stabilization and appropriate maternal / newborn interaction • To prevent a serious disease called haemorrhagic disease of the newborn (HDN) • Route: Intramuscular (IM) • Dose of vitamin K 0.5 mg for infants weighing ≤1,500 g 1.0 mg for infants weighing >1,500 g
- 56. Neonatal problems resulting in infant morbidity • HIE- Cerebral palsy • Kernicterus – Dyskinetic Cerebral palsy • Neonatal seizures – Epilepsy • ICH – Hydrocephalus • Cerebral infarct – Hemiplegic CP • Umbilical catheterization – EHPTN • Meningitis – MR • Preterm – growth retardation • IUGR- metabolic syndrome
- 57. THANK YOU Insert the Subtitle of Your Presentation
- 60. Scalp
- 61. Q/A Fontanelle •The anterior fontanelle is the largest of the six fontanelles, and it resembles a diamond-shape ranging in size from 0.6 cm to 3.6 cm with a mean of 2.1 cm closes by 18 to 24 months •The posterior fontanelle is triangular meassuring 0.5 to 0.7 cm at birth and completely closes within about six weeks after birth
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