This document discusses neonatal neurology, including risks for brain injury and developmental delays in newborns. It covers topics like intraventricular hemorrhage, cerebral palsy, hypoxic ischemic encephalopathy, metabolic disorders, and treatments for various conditions. Assessment tools for evaluating the neurobehavioral development of newborns are also mentioned.

1. Dr Prakash.I

2.  Biological
 Genetic
 Metabolic
 Environmental
 No apparent risk
Double vulnerability

3.  IVH- PVH- WMD- PVL
 Factors contributing-
 Less cerebral autoregulation
 Alteration in cerebral blood flow and pressure

4.  1- Isolated GMB
 2- IVH without ventricular dilatation
 3- IVH with ventricular dilatation
 4- IVH with parenchymal hemorrhage

5.  CP
 Visual impairment
 Hearing impairment
 IQ
 Learning difficulties
 ADHD
 Social development/ Psychological problems
 Health outcomes

6.  Perinatal asphyxia
 Neonatal seizures
 45% survivors have NDD
 6-23% of CP due to asphyxia
 Athetoid/ Dyskinetic CP- acute perinatal HI
 Spastic tetraplegic CP- damage to gray and
white matter and cerebral atrophy
 Hemiplegic CP- focal cerebral infarction

7.  Stage 1- Mild
 Stage 2- Moderate
 Stage 3- Severe

8.  AGPAR score <_ 3 at > 5 mins
 Fetal HR <60 beats/ min
 Prolonged antenatal acidosis
 Seizures within 24- 48 hrs
 Need for PPV > 1 min or 1st
cry delayed >5 mins

10.  Selective head cooling
 Systemic hypothermia
 Magnesium Sulphate
 Antioxidants
 Calcium Channel blockers
 Hyperbaric Oxygen treatment

11.  30% risk of NDD
 Interrupts development of the maturing
nervous system
 High risk groups-
 HIE, Meningitis, Hypoglycaemia
 Low risk groups-
 Late hypocalcaemia
 Subarachnoid haemorrhage

12.  Parieto occipital white matter abnormalities
 Maternal conditions
 Diabetes
 Drugs
 Intrapartum glucose administration

13.  Neonatal problems
 Preterm
 IUGR
 Perinatal HI
 Hypothermia
 Infections
 Polycythemia
 Following exchange transfusion

14.  Bilirubin encephalopathy
 80% die in neonatal period
 Athetoid CP, tone abnormalities, lower IQs,
sensory neural hearing deficits
Classic perlstein’s tetrad of kernicterus-
extrapyramidal abnormalities, sensori neural
hearing loss, gaze abnormality, dental dysplasia

15.  1st
year- poor feeding, high pitched cry,
persistent ATNR, hypotonia, and increased
DTRs
 Athetosis- as early as 18 mths
 dysarthria, facial grimacing, drooling, difficulty
in chewing and swallowing

16.  Responsible for 5% of MR and GDD
 Accumulation of a n/ abn metabolite or
deficiency resulting from enzyme defect
 Present as acute/ chronic encephalopathy with
or without non- neuronal involvement,
seizures, movement disorders, muscle
weakness etc

17.  Apnea
 Meconium aspiration syndrome
 Persistent pulmonary hypertension of newborn
 Neonatal shock
 Neonatal sepsis

18.  Pain and analgesia
 Neonatal infant pain scale ( NIPS)
1.Pharmacological-
 Opiods ( Morphine, fentanyl, codeine)
 Non opiods (paracetamol, sucrose, midazolam)
 Anaesthetic agents ( EMLA, lidocaine,
ketamine, thiopental)

19. 2. Environmental
Minimising/clustering painful Ix
Decreased handling
Reducing ambient noise/ light
3. Behavioural
Gentle sensory stimulation
Oral sucrose
KMC

20.  Neonatal transport
 Perinatal steroids
 Mechanical ventilation

21.  Neonatal behavioral assessment scale (NBAS)
 Assessment of Preterm Infant’s behavior (APIB)
 Neurological Assessment of the Fullterm and
preterm newborn infant
 Morgan Neonatal Neurobehavioral examination
 Movement Assessment of infants
 Milani- Comparetti Motor Development Screening
Test