This document discusses perinatal asphyxia, which is a lack of oxygen and blood flow to the fetus or newborn during delivery resulting in tissue injury. It can be caused by issues with the placenta, umbilical cord, prolonged compression of the fetal head during delivery, or other maternal or fetal conditions. Left untreated, perinatal asphyxia can damage multiple organs but particularly impacts the brain, kidneys, and heart. Management involves maintaining adequate oxygen and blood flow as well as controlling seizures. Hypothermia therapy, keeping the infant's core temperature at 33°C for 72 hours, may help reduce brain injury from severe asphyxia. While multisystem effects are common, failure to breathe
Neonatal problems
Neonatal jaundice
Pathophysiology and epidemiology
Visible at >85 μmol/L of bilirubin (BR). The BR is usually unconjugated, which is fat-soluble thus can enter tissue (and cross the blood-brain barrier), causing damage.
Common: affects 60% of term babies, and 80% of preterm.
Usually physiological: onset after the first 24h, with BR not exceeding 200 μmol/L. Due to liver immaturity and replacement of fetal Hb.
Early jaundice (onset <24h)
Causes:
Hemolytic disease: Rh incompatibility, ABO incompatibility (usually mild), G6PD deficiency, or spherocytosis. Make sure to ask about blood group and family history of hemolytic anaemia.
Congenital infection: Group B Strep, TORCH (Toxoplasmosis, Rubella, CMV, HSV).
Neonatal problems
Neonatal jaundice
Pathophysiology and epidemiology
Visible at >85 μmol/L of bilirubin (BR). The BR is usually unconjugated, which is fat-soluble thus can enter tissue (and cross the blood-brain barrier), causing damage.
Common: affects 60% of term babies, and 80% of preterm.
Usually physiological: onset after the first 24h, with BR not exceeding 200 μmol/L. Due to liver immaturity and replacement of fetal Hb.
Early jaundice (onset <24h)
Causes:
Hemolytic disease: Rh incompatibility, ABO incompatibility (usually mild), G6PD deficiency, or spherocytosis. Make sure to ask about blood group and family history of hemolytic anaemia.
Congenital infection: Group B Strep, TORCH (Toxoplasmosis, Rubella, CMV, HSV).
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
2. PERINATAL ASPHYXIA
Insult to the fetus / Newborn
Lack of oxygen (Hypoxia)
Lack of perfusion (Ischemia)
Effect of hypoxia & Ischemia are inseparable
Both contribute to tissue injury
10. ETHIOLOGY
I - MATERNAL CAUSES: (conditions
leading to imperfect oxygenation
of maternal blood)
Severe anemia, Hemorrhage &
shock, Respiratory failure, and heart
failure.
Eclamptic seizure, pneumonia, and
pulmonary edema.
11. ETHIOLOGY
II- PLACENTAL CAUSES:
Placental compression: interfering with its
circulation as in tonically contracted uterus,
prolonged labour after rupture of the
membranes or as a method of control of
bleeding in placenta previa.
Placental separation as in accidental
hemorrhage.
Placental insufficiency e.g. extensive
degeneration, multiple infarcts & abnormally
small placenta.
12. ETHIOLOGY
III- CAUSES IN THE UMBILICAL CORD:
Obstruction of the circulation, which may be
due to:
Tight nucal cord
True knots
Prolapsed cord
Compression of the vessels by hematoma of
the cord
Rupture of vasa praevia.
13. ETIOLOGY ( cont…)
IV-PROLONGED COMPRESSION OF THE FETAL
HEAD:
This will cause edema and ischemia, which
interfere with the blood supply of the medulla
leading to depression of the respiratory center.
Prolonged compression may be due to:
Contracted pelvis (C/P disproportion).
Rigid perineum.
Intracranial hemorrhage.
Forceps application for a long time.
Depressed fracture
14. FACTORS
Mat. Oxygenation
Blood flow
mother to
placenta
Blood flow
placenta to
fetus
Gas Exchange
across placenta
or fetal tissue
Fetal O2 Req.
16. NONE BRAIN ORGAN DAMAGE
PATHOPHYSIOLOGY
Acute asphyxia
Diving reflex
Shunting of blood
to brain adrenals
& heart
Away from
lungs, kidney
gut & skin
23. NEUROPATHOLOCIAL CHANGES
Pattern seen in term infants
Selective neuronal necrosis (Spastic CP)
Status Marmoratus (Chorea, Athetoid, Dystonia)
Parasagittal cerebral injury (Prox Spastic
Quadriparesis)
Focal and multifocal ischemic brain injury (sp.
Hemiparesis, cognitive defects, seizure)
Pattern predominant in preterm
Periventricular leukomalacia
24. PATHOLOGY
Cerebral O2
Substrate supply
Synaptic inactivation (Reversible)
Energy failure
Memb. pump failure
Further in perfusion
At cellular level
25.
26. CHANGES IN SUBSTRATE METABOLISM
AND NEURTRANSMITTERS
Hypoxic effect
Changes that are increased
An initial increase Cerebral blood
flow
Increase of glucose influx to brain
Increase in glycogenolysis (increase
cAMP)
Increase in glycolysis (increase
cAMP)
27. CHANGES IN SUBSTRATE METABOLISM
AND NEURTRANSMITTERS
Changed that are decreased
Decreased oxidative
phosphorylation
Eventual decrease brain glucose
Decreased phosphocreatinine
(PCr) and ATP
These changes are more pronouned
in the white matter compared to the
gray matter
30. 12/11/2022 30
PULMONARY EFFECTS
Increased pulmonary resistance
pulmonary hemorrhage
Pulmonary edema secondary to cardiac failure
Failure of surfactant production with secondary HMD
Meconium aspiration may be present.
31. Management of HIE
1. Maintain O2 and CO2 in normal ranges.
2. Hyperventilation not recommended and may be
detrimental.
3. Monitor arterial blood pressure because cerebra perfusion
pressure is dependent on MAP
4. Administer volume slowly: overall fluid restriction
5. Monitor electrolytes and glucose
6. Control seizures
7. HYPOTHERMIA THERAPY
32. HYPOTHERMIA THERAPY
Entry criteria
PH < 7.0
Base deficit 16mmole/l in 1st hour
APGAR score < 5 at 10 minutes.
Less than 6 hrs old.
Technique
Keep core temp at 33 *C for 72 hrs
Continuous EEG monitoring
Continue medical management
33. MULTISYSTEMIC EFFECTS
Seizures
Often resitant to anticonvulsant therapy in severe HIE
(possibly because of a lack of cortical inhibition Vs.
excesive cortical activity
50% are subtle, focal ,multifocal or myoclonic
Typically first noted at age 12 to 24 hrs and often
resolve by 5 to 7 days
Must also assess for other metabolic derangements
(eg; hypoglycemia, hypocalcemia,
hypomagnesemia)
Phenobarbital is the first line agent followed by
dilantin (may also consider lorazepam)
34. MULTISYSTEMIC EFFECTS
ACUTE ASPHYXIA
elicits diving reflex with preferred blood flow to the brain,
heart, and adrenal gland
CARDIAC MANIFESTATIONS
Transient myocardial ischemia, congestive heart failure,
left or right ventricular dysfunction, tricuspid
regurgitation murmur within the first 24 hrs
RENAL
Oliguria and possible acute tubular necrosis
PULMONARY
Pulmonary hypertension especially after MAS
35. PREDICTORS OF POOR
NEURO DEVELOPMENTAL OUTCOME
Failure to establish respiration by 5 minutes
Apgar 3 or less in 5 mts
Onset of Seizure in 12 hrs
Refractory convulsion
Inability to establish oral feed by 1 wk
Abnormal EEG & failure to normalise by 7 days
of life
Abnormal CT, MRI in neonatal period