This document discusses several common neonatal disorders classified by type. Birth injuries include caput succedaneum (edema of the scalp from pressure during labor), cephalhematoma (collection of blood under the skull from birth trauma), fractures, facial paralysis, and Erb's/Brachial palsy. Disorders related to physiological factors include hyperbilirubinemia, hemolytic disease of the newborn, and respiratory distress syndrome. Infectious disorders include sepsis and necrotizing enterocolitis. Disorders related to maternal conditions include infants of diabetic mothers. Specific details are provided on hemolytic disease of the newborn, respiratory distress syndrome, nursing care for injuries to the head, and Erb
This document discusses apnea of prematurity (AOP), which refers to cessation of breathing seen in premature infants due to immaturity of respiratory control systems. AOP is defined as absent breathing accompanied by bradycardia and desaturation. The risk is highest in infants born before 28 weeks gestation, with over 60% affected. Treatment involves identifying/treating underlying causes, caffeine therapy to increase breathing drive, and respiratory support like CPAP if needed. AOP generally resolves by 37 weeks but can persist longer in more premature infants. Prompt treatment is important to avoid hypoxia-related risks.
Assessment of Mother, Fetus and Newborn with.pptxdrshonarkar
This document provides an overview of assessing the mother, fetus, and newborn. Key points include:
1) Identifying high-risk pregnancies is important to monitor for complications and institute treatments. Conditions that increase risk include growth issues, congenital anomalies, prematurity, and maternal medical complications.
2) A newborn's transition to extrauterine life requires assessment of the delivery and mother's history to anticipate any issues. Routine newborn care includes eye prophylaxis, skin antisepsis, and vitamin K administration.
3) The Apgar score rapidly assesses a newborn's condition at 1 and 5 minutes. Low scores may indicate the need for resuscitation per the AB
Birth asphyxia occurs when a baby fails to breathe at birth and can lead to neonatal mortality. It is caused by factors that obstruct breathing such as meconium aspiration or complications during delivery. Symptoms may include abnormal skin tone, lack of crying, and low heart rate. Diagnosis involves assessing signs, using the Apgar score, and determining acid-base balance. Treatment involves clearing the airways, stimulating breathing, warming the baby, and providing ventilation and oxygen as needed. Nursing care focuses on resuscitation and monitoring for complications like brain damage or developmental delays. While immediate effects include acidosis and respiratory issues, long-term effects of severe asphyxia can be cerebral palsy, intellectual disability, or
Respiratory Distress Syndrome by DR FAITHFUL DANIEL.pptxDanielFaithful
Respiratory Distress Sydrome is a condition that affects the lungs of newborn infants predominantly. Not much is known about the condition in the tropics.
In this presentation Daniel Faithful Miebaka provides detailed review of the condition that has fatal potential.
This document discusses high risk newborns, including their classification based on size and age, etiology, characteristics, and management. Key points include:
- High risk newborns have a greater chance of mortality or morbidity due to conditions associated with birth and adjusting to life outside the womb.
- They are classified as low birth weight, very low birth weight, or extremely low birth weight based on size, or as preterm based on gestational age.
- Risk factors for preterm or low birth weight birth include socioeconomic status, infections, smoking, stress, etc.
- High risk newborns require careful management in the NICU to address their immature organ systems and
This document discusses apnea in infants and sudden infant death syndrome (SIDS). It defines apnea, describes the different types (obstructive, central, mixed), and potential causes. It outlines the clinical presentation of apnea and treatment options, including caffeine/theophylline. Though apnea is more common in preterm infants, it does not increase the risk of SIDS. The prognosis is generally good unless apnea is severe and refractory to treatment. SIDS is defined as the sudden unexpected death of an infant under 1 year that remains unexplained after autopsy. Risk factors include prematurity, sleeping in the prone position, and exposure to cigarette smoke. The exact pathophysiology of SIDS remains unknown.
1) Hydrocephalus is a condition where there is excess cerebrospinal fluid in the brain, causing increased pressure and head enlargement. It can be caused by issues with CSF production, flow, or absorption.
2) Symptoms in infants include rapid head growth, bulging fontanelles, vomiting, and irritability. Older children experience headaches, nausea, and personality changes.
3) Treatment involves surgical insertion of a shunt to drain CSF out of the brain and into other areas of the body like the abdomen. Nurses focus on monitoring the child closely after surgery for complications and teaching parents how to care for the child and the shunt long term.
Neonatal respiratory diseases can present as respiratory distress in newborns, characterized by tachypnea, grunting, chest wall indrawing, and cyanosis. Common causes include respiratory distress syndrome (lack of surfactant), pneumonia, meconium aspiration syndrome, and congenital diaphragmatic hernia. Respiratory distress syndrome is treated with supportive care like oxygen supplementation or CPAP, and may require mechanical ventilation. Pneumonia is usually treated with antibiotics and oxygen as needed. Meconium aspiration syndrome can cause lung injury and inflammation requiring oxygen, antibiotics, and steroids. Congenital diaphragmatic hernia presents with respiratory distress at birth due to lung compression, and is
This document discusses apnea of prematurity (AOP), which refers to cessation of breathing seen in premature infants due to immaturity of respiratory control systems. AOP is defined as absent breathing accompanied by bradycardia and desaturation. The risk is highest in infants born before 28 weeks gestation, with over 60% affected. Treatment involves identifying/treating underlying causes, caffeine therapy to increase breathing drive, and respiratory support like CPAP if needed. AOP generally resolves by 37 weeks but can persist longer in more premature infants. Prompt treatment is important to avoid hypoxia-related risks.
Assessment of Mother, Fetus and Newborn with.pptxdrshonarkar
This document provides an overview of assessing the mother, fetus, and newborn. Key points include:
1) Identifying high-risk pregnancies is important to monitor for complications and institute treatments. Conditions that increase risk include growth issues, congenital anomalies, prematurity, and maternal medical complications.
2) A newborn's transition to extrauterine life requires assessment of the delivery and mother's history to anticipate any issues. Routine newborn care includes eye prophylaxis, skin antisepsis, and vitamin K administration.
3) The Apgar score rapidly assesses a newborn's condition at 1 and 5 minutes. Low scores may indicate the need for resuscitation per the AB
Birth asphyxia occurs when a baby fails to breathe at birth and can lead to neonatal mortality. It is caused by factors that obstruct breathing such as meconium aspiration or complications during delivery. Symptoms may include abnormal skin tone, lack of crying, and low heart rate. Diagnosis involves assessing signs, using the Apgar score, and determining acid-base balance. Treatment involves clearing the airways, stimulating breathing, warming the baby, and providing ventilation and oxygen as needed. Nursing care focuses on resuscitation and monitoring for complications like brain damage or developmental delays. While immediate effects include acidosis and respiratory issues, long-term effects of severe asphyxia can be cerebral palsy, intellectual disability, or
Respiratory Distress Syndrome by DR FAITHFUL DANIEL.pptxDanielFaithful
Respiratory Distress Sydrome is a condition that affects the lungs of newborn infants predominantly. Not much is known about the condition in the tropics.
In this presentation Daniel Faithful Miebaka provides detailed review of the condition that has fatal potential.
This document discusses high risk newborns, including their classification based on size and age, etiology, characteristics, and management. Key points include:
- High risk newborns have a greater chance of mortality or morbidity due to conditions associated with birth and adjusting to life outside the womb.
- They are classified as low birth weight, very low birth weight, or extremely low birth weight based on size, or as preterm based on gestational age.
- Risk factors for preterm or low birth weight birth include socioeconomic status, infections, smoking, stress, etc.
- High risk newborns require careful management in the NICU to address their immature organ systems and
This document discusses apnea in infants and sudden infant death syndrome (SIDS). It defines apnea, describes the different types (obstructive, central, mixed), and potential causes. It outlines the clinical presentation of apnea and treatment options, including caffeine/theophylline. Though apnea is more common in preterm infants, it does not increase the risk of SIDS. The prognosis is generally good unless apnea is severe and refractory to treatment. SIDS is defined as the sudden unexpected death of an infant under 1 year that remains unexplained after autopsy. Risk factors include prematurity, sleeping in the prone position, and exposure to cigarette smoke. The exact pathophysiology of SIDS remains unknown.
1) Hydrocephalus is a condition where there is excess cerebrospinal fluid in the brain, causing increased pressure and head enlargement. It can be caused by issues with CSF production, flow, or absorption.
2) Symptoms in infants include rapid head growth, bulging fontanelles, vomiting, and irritability. Older children experience headaches, nausea, and personality changes.
3) Treatment involves surgical insertion of a shunt to drain CSF out of the brain and into other areas of the body like the abdomen. Nurses focus on monitoring the child closely after surgery for complications and teaching parents how to care for the child and the shunt long term.
Neonatal respiratory diseases can present as respiratory distress in newborns, characterized by tachypnea, grunting, chest wall indrawing, and cyanosis. Common causes include respiratory distress syndrome (lack of surfactant), pneumonia, meconium aspiration syndrome, and congenital diaphragmatic hernia. Respiratory distress syndrome is treated with supportive care like oxygen supplementation or CPAP, and may require mechanical ventilation. Pneumonia is usually treated with antibiotics and oxygen as needed. Meconium aspiration syndrome can cause lung injury and inflammation requiring oxygen, antibiotics, and steroids. Congenital diaphragmatic hernia presents with respiratory distress at birth due to lung compression, and is
Respiratory distress in neonates can be caused by pulmonary issues like respiratory distress syndrome, pneumonia, or transient tachypnea of the newborn, or non-pulmonary issues like cardiac problems, hypoglycemia, or central nervous system conditions. Early recognition and prompt treatment is essential to improve outcomes. Respiratory distress is characterized by tachypnea, chest retractions, and/or grunting. Causes and management should be considered based on gestational age, time of onset, and associated clinical features.
The document provides information on essential newborn care. It discusses components of essential newborn care including warmth, skin-to-skin contact, breastfeeding, cord care, eye care, vitamin K administration and immunization. It also discusses the Apgar score system used to evaluate newborns and outlines steps for newborn resuscitation. Additionally, it covers topics like high-risk newborns, respiratory distress syndrome, hypothermia, prematurity and low birth weight.
INTRODUCTION
A newborn, regardless of gestational age or birth weight, who has a greater than average chance of morbidity or mortality because of conditions or circumstances superimposed on the normal course of events associated with birth and the adjustment to extra uterine existence.
FACTORS – TO DEFINE HIGH RISK NEWBORN
DEMOGRAPHIC SOCIAL FACTORS:
Maternal age <16 or >40, unmarried, physical stress, socio-economic status.
PAST MEDICAL HISTORY:
Diabetes Mellitus, genetic disorder, hypertension
PREVIOUS PREGNANCY:
Intrauterine death, neonatal death, IUGR, congenital malformations.
PRESENT PREGNANCY:
Vaginal bleeding, PROM, multiple gestation, pre-eclampsia, abnormal USG findings.
LABOR: AND DELIVERY:
Obstructed labor, fetal distress, forceps delivery, meconium stained liquor.
NEONATE:
Birth weight <2000 or >4000, gestation <37 or >42.
DEFINITIONS
Low birth weight: Live born baby weighing 2500 gram or less at birth. (VLBW: <1500 gm, ELBW: 000 gm).
Preterm: When the infant is born before term i.e. before 38 weeks of gestation.
Premature: When the baby is born before 37 weeks of gestation.
Full term: When the infant is born between 38-42 weeks of gestation.
Post term: When the baby is born after 42 weeks of gestation.
HYPOTHERMIA
DEFINITION
It is a condition characterized by lowering of body temperature than 36℃.
TYPES OF HYPOTHERMIA
It can be classified according to causes and according to severity.
CLASSIFICATION BASED ON CAUSE:
Primary Hypothermia:
Seen immediately after delivery.
Normal term baby delivered into a warm environment may drop its rectal temperature by 1 – 2℃ shortly after birth and may not achieve a normal stable body temperature until the age of 4 – 8 hours.
In low birth weight baby, the decrease of body temperature may be much greater and more rapid unless special precautions are taken immediately after birth. (Loss at least 0.25℃./min).
Secondary Hypothermia:
This occurs due to factors other than those immediately associated with delivery.
Important contributory factors are: e.g. acute infection especially septicaemia.
CLASSIFICATION BASED ON SEVERITY:
According to severity:
Mild Hypothermia: <36℃.
Moderate Hypothermia: <35.5℃.
Severe Hypothermia: <35℃.
CLINICAL FEATURES
Decrease in body temperature measurement.
Cold skin on trunk and extremities.
Poor feeding in the form of poor suckling
Shallow respiration
Cyanosis
Decrease activity, e.g. weak cry.
FOUR MODALITIES OF HEAT LOSS IN NEONATES
Evaporation: Heat loss that resulted form expenditure of internal thermal energy to convert liquid on an exposed surface to gases, e.g. amniotic fluid, sweat.
Prevention: Carefully dry the neonates after delivery or after bathing.
Radiation: It occurred from body surface to relatively distant objects that are cooler than skin temperature.
Conduction: Heat loss occurred from direct contact between body surface and cooler solid object.
Prevention: Keep the baby out of drafts and close end of heat shield in in
Common neonatal disorders include birth injuries, physiological problems, and respiratory, sepsis, and seizure issues. Birth injuries can involve soft tissue, the head, or nerves. Physiological problems include hyperbilirubinemia, hypoglycemia, hypocalcemia, and hypothermia. Respiratory disorders include respiratory distress syndrome and meconium aspiration syndrome. Neonatal jaundice is usually physiological but can also be pathological, breastfeeding-related, or due to breast milk. It is assessed and managed through history, examination, tests, phototherapy or admission based on bilirubin levels.
This document discusses complications that can occur in neonates (newborns). It lists potential issues like preterm birth, low birth weight, respiratory distress syndrome, jaundice, infections and birth injuries. The document then provides details on several of these complications, including the signs and symptoms of preterm babies. It describes the physiology of preterm babies and their increased risks due to underdeveloped organ systems. Overall, the document outlines various medical issues that can affect neonates and provides information on managing preterm infants.
About fetal distress in pregnancy
Child cause fetal distress due to hypoxia there are maternal factors like cardiovascular hypothyroidisim acute bleeding . Fetal factors like cardiovascular dysfunction, deformity,, umbilical cord and placenta factors
This document discusses asphyxia of the newborn, including definitions, causes, signs and symptoms, complications, and treatment. Asphyxia is defined as ineffective respiration in a newborn due to oxygen deprivation during labor or delivery. Causes include issues with the placenta, umbilical cord, maternal health conditions, and difficult delivery. Signs range from mild transient symptoms to more severe outcomes like coma or multi-organ failure. Treatment focuses on resuscitation of the airway, breathing, and circulation (ABC approach). Asphyxia can lead to complications such as hypoxic-ischemic encephalopathy and birth trauma.
This document discusses the management of preterm neonates and complications of prematurity. It begins by defining key terms like preterm birth, low birth weight neonates, and classifications of gestational age. It then describes common complications of prematurity like respiratory distress syndrome, jaundice, intraventricular hemorrhage, and retinopathy of prematurity. The document outlines the management of preterm neonates, including immediate postnatal care, respiratory support, thermoregulation, and nutrition. It emphasizes the importance of minimizing handling, monitoring vital signs, treating infections, and providing supplements. The prognosis is generally good if infants survive the initial risks, though long term complications can include cerebral palsy and developmental delays.
The document outlines the key components of a routine newborn assessment, including establishing a historical database, physical examination, and evaluating for any signs of distress, trauma, or abnormalities. The examination follows a structured process, beginning with observation, then assessing the skin, vital signs, reflexes, measurements, and examining specific body systems like respiratory, cardiovascular, abdominal, genitourinary, and musculoskeletal. The goals are to determine gestational age, evaluate growth and development, and identify any health issues in the newborn.
The document provides information about assessing and caring for a normal newborn infant. It defines a normal newborn, outlines objectives for understanding newborn characteristics and care, and describes how to assess vital signs, measurements, physical characteristics including the skin, head, chest and extremities. It also details reflexes, physical and behavioral assessment using the Ballard score, and immediate newborn care processes such as clearing the airway, cord clamping and cutting, identification, and establishing breastfeeding. The goal is for learners to understand how to evaluate a newborn and provide appropriate initial care.
This document provides information on various fetal assessment measures that can be performed during pregnancy. It discusses evaluating fetal growth through fundal height measurements and Leopold's maneuvers. It also describes biochemical tests that can be done including maternal serum alpha-fetoprotein, triple screen, estriol levels, and acetylcholine esterase. Invasive procedures for assessing the fetus such as amniocentesis and chorionic villus sampling are explained. The aims, indications, procedures, and risks of these various fetal monitoring techniques are outlined in the document.
Neonatal sepsis occurs when pathogenic organisms enter the bloodstream of newborns, potentially causing infections like septicemia, pneumonia, and meningitis. It accounts for 15-47.7% of neonatal deaths worldwide. Symptoms develop within 3 days (early onset) or after 3 days (late onset) and include pallor, apnea, bulging fontanel, and poor feeding. Escherichia coli, Staphylococcus aureus and Klebsiella are common causes. Diagnosis involves sepsis screening and CSF analysis. Treatment requires appropriate antibiotics based on culture and supportive care like IV fluids and oxygen. Outcomes depend on the infant's weight and maturity as well as the causative organism and treatment
Pre-term, Small for gestational age and Post-term InfantLipi Mondal
Due to high risk of pregnancy there are several adverse outcome or poor perinatal outcome we can see.... So most commonly adverse out come should be known by health care providers.
This document provides an overview of newborn resuscitation including the basic physiologic changes at birth, resuscitation equipment and personnel, and the steps involved in resuscitation. It discusses anticipation of need, preparation, initial steps of providing warmth, clearing the airway, and stimulation. It then covers subsequent steps such as positive pressure ventilation, chest compressions, and administration of drugs if needed. Key points include using room air rather than 100% oxygen for positive pressure ventilation, and emphasizing adequate ventilation before initiating chest compressions if the heart rate is low.
This document discusses the physiologic challenges faced by premature and high-risk newborns. It describes classifications of high-risk newborns based on gestational age and birth weight. The major physiologic challenges for premature infants are then discussed, including respiratory, thermoregulation, digestive, and renal systems. Specific nursing interventions are provided to address the needs in each of these areas for preterm infants. Several common disorders seen in the NICU are also outlined such as respiratory distress syndrome, hyperbilirubinemia, and necrotizing enterocolitis.
This document discusses neonatal jaundice and prematurity. It defines neonatal jaundice as a yellowing of the skin due to high bilirubin levels. It notes that jaundice can be physiologic or pathologic. It also discusses the causes, signs, management including phototherapy and exchange transfusion, and complications of jaundice like kernicterus. The document also defines and describes prematurity, the characteristics of premature infants, causes of preterm birth, and problems they often face like respiratory distress and temperature instability. It emphasizes the importance of thermal management for premature neonates.
Hydrocephalus
introduction
Hydrocephalus, also known years ago as “water on the brain”, is a condition where the circulation system of the body’s cerebrospinal fluid (CSF) is not functioning properly. The CSF accumulates in the brain and causes intracranial pressure. A shunt is usually placed to equalize the flow of CSF, which requires surgery. The diagnosis and surgery can be very frightening for the parents as well as the child
definition
Hydrocephalus is a condition characterized by an excess of cerebrospinal fluid (CSF) within the ventricular and subarachnoid spaces of the cranial cavity
INCIDENCE
It is found in 1-3 of every 1000 born children in world wide
Classification
Non communicating. In the non communicating type of congenital hydrocephalus, an obstruction occurs in the free circulation of CSF.
Communicating. In the communicating type of hydrocephalus, no obstruction of the free flow of the CSF exists between the ventricles and the spinal theca; rather, the condition is caused by defective absorption of CSF, thus causing increased pressure on the brain or spinal cord.
CAUSES
Obstruction. The most common problem is a partial obstruction of the normal flow of CSF, either from one ventricle to another or from the ventricles to other spaces around the brain.
Poor absorption. Less common is a problem with the mechanisms that enable the blood vessels to absorb CSF; this is often related to inflammation of brain tissues from disease or injury.
Overproduction. Rarely, the mechanisms for producing CSF create more than normal and more quickly than it can be absorbed.
PATHOPHYSIOLOGY
CLINICAL MANIFESTATION
Poor feeding. The infant with hydrocephalus has trouble in feeding due to the difficulty of his condition.
Large head. An excessively large head at birth is suggestive of hydrocephalus.
Bulging of the anterior fontanelles. The anterior fontanelle becomes tense and bulging, the skull enlarges in all diameters, and the scalp becomes shiny and its veins dilate.
Setting sun sign. If pressure continues to increase without intervention, the eyes appear to be pushed downward slightly with the sclera visible above the iris- the so-called setting sun sign.
High-pitched cry. The intracranial pressure may increase and the infant’s cry could become high-pitched.
Irritability. Irritability is also caused by an increase in the intracranial pressure.
Projectile vomiting. An increase in the intracranial pressure can cause projectile vomiting
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conclusions
The document discusses topics related to obstetrics including the prenatal period, assessment and management of obstetric patients, complications during pregnancy and delivery, abnormal delivery situations, and maternal complications of labor and delivery. It provides details on the anatomy, physiology, development, and common issues that can arise at each stage of pregnancy, labor, delivery, and the postpartum period. Management guidelines are presented for emergency situations that may be encountered with obstetric patients in the prehospital setting.
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).
This document discusses teams and teamwork. It defines a team as a group committed to producing a result through cooperation and communication. Benefits of teamwork include quick solutions, improved productivity, diversity of ideas, and better decisions. The stages of team development include forming, storming, norming, performing, and adjourning. Effective communication is vital for team success and includes supporting ideas, listening, and giving feedback. The closing thought emphasizes that the strength of each individual member lies in the team.
The document describes a structured teaching programme on cord blood banking among staff nurses. It presents a conceptual framework based on a general system theory model that shows demographic variables and source of information as inputs, a pre-interventional knowledge assessment and teaching intervention as the throughput, and knowledge assessment outcomes as either an increase in knowledge or no change as the outputs. The goal is to increase nurses' knowledge about cord blood banking through this teaching programme.
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Respiratory distress in neonates can be caused by pulmonary issues like respiratory distress syndrome, pneumonia, or transient tachypnea of the newborn, or non-pulmonary issues like cardiac problems, hypoglycemia, or central nervous system conditions. Early recognition and prompt treatment is essential to improve outcomes. Respiratory distress is characterized by tachypnea, chest retractions, and/or grunting. Causes and management should be considered based on gestational age, time of onset, and associated clinical features.
The document provides information on essential newborn care. It discusses components of essential newborn care including warmth, skin-to-skin contact, breastfeeding, cord care, eye care, vitamin K administration and immunization. It also discusses the Apgar score system used to evaluate newborns and outlines steps for newborn resuscitation. Additionally, it covers topics like high-risk newborns, respiratory distress syndrome, hypothermia, prematurity and low birth weight.
INTRODUCTION
A newborn, regardless of gestational age or birth weight, who has a greater than average chance of morbidity or mortality because of conditions or circumstances superimposed on the normal course of events associated with birth and the adjustment to extra uterine existence.
FACTORS – TO DEFINE HIGH RISK NEWBORN
DEMOGRAPHIC SOCIAL FACTORS:
Maternal age <16 or >40, unmarried, physical stress, socio-economic status.
PAST MEDICAL HISTORY:
Diabetes Mellitus, genetic disorder, hypertension
PREVIOUS PREGNANCY:
Intrauterine death, neonatal death, IUGR, congenital malformations.
PRESENT PREGNANCY:
Vaginal bleeding, PROM, multiple gestation, pre-eclampsia, abnormal USG findings.
LABOR: AND DELIVERY:
Obstructed labor, fetal distress, forceps delivery, meconium stained liquor.
NEONATE:
Birth weight <2000 or >4000, gestation <37 or >42.
DEFINITIONS
Low birth weight: Live born baby weighing 2500 gram or less at birth. (VLBW: <1500 gm, ELBW: 000 gm).
Preterm: When the infant is born before term i.e. before 38 weeks of gestation.
Premature: When the baby is born before 37 weeks of gestation.
Full term: When the infant is born between 38-42 weeks of gestation.
Post term: When the baby is born after 42 weeks of gestation.
HYPOTHERMIA
DEFINITION
It is a condition characterized by lowering of body temperature than 36℃.
TYPES OF HYPOTHERMIA
It can be classified according to causes and according to severity.
CLASSIFICATION BASED ON CAUSE:
Primary Hypothermia:
Seen immediately after delivery.
Normal term baby delivered into a warm environment may drop its rectal temperature by 1 – 2℃ shortly after birth and may not achieve a normal stable body temperature until the age of 4 – 8 hours.
In low birth weight baby, the decrease of body temperature may be much greater and more rapid unless special precautions are taken immediately after birth. (Loss at least 0.25℃./min).
Secondary Hypothermia:
This occurs due to factors other than those immediately associated with delivery.
Important contributory factors are: e.g. acute infection especially septicaemia.
CLASSIFICATION BASED ON SEVERITY:
According to severity:
Mild Hypothermia: <36℃.
Moderate Hypothermia: <35.5℃.
Severe Hypothermia: <35℃.
CLINICAL FEATURES
Decrease in body temperature measurement.
Cold skin on trunk and extremities.
Poor feeding in the form of poor suckling
Shallow respiration
Cyanosis
Decrease activity, e.g. weak cry.
FOUR MODALITIES OF HEAT LOSS IN NEONATES
Evaporation: Heat loss that resulted form expenditure of internal thermal energy to convert liquid on an exposed surface to gases, e.g. amniotic fluid, sweat.
Prevention: Carefully dry the neonates after delivery or after bathing.
Radiation: It occurred from body surface to relatively distant objects that are cooler than skin temperature.
Conduction: Heat loss occurred from direct contact between body surface and cooler solid object.
Prevention: Keep the baby out of drafts and close end of heat shield in in
Common neonatal disorders include birth injuries, physiological problems, and respiratory, sepsis, and seizure issues. Birth injuries can involve soft tissue, the head, or nerves. Physiological problems include hyperbilirubinemia, hypoglycemia, hypocalcemia, and hypothermia. Respiratory disorders include respiratory distress syndrome and meconium aspiration syndrome. Neonatal jaundice is usually physiological but can also be pathological, breastfeeding-related, or due to breast milk. It is assessed and managed through history, examination, tests, phototherapy or admission based on bilirubin levels.
This document discusses complications that can occur in neonates (newborns). It lists potential issues like preterm birth, low birth weight, respiratory distress syndrome, jaundice, infections and birth injuries. The document then provides details on several of these complications, including the signs and symptoms of preterm babies. It describes the physiology of preterm babies and their increased risks due to underdeveloped organ systems. Overall, the document outlines various medical issues that can affect neonates and provides information on managing preterm infants.
About fetal distress in pregnancy
Child cause fetal distress due to hypoxia there are maternal factors like cardiovascular hypothyroidisim acute bleeding . Fetal factors like cardiovascular dysfunction, deformity,, umbilical cord and placenta factors
This document discusses asphyxia of the newborn, including definitions, causes, signs and symptoms, complications, and treatment. Asphyxia is defined as ineffective respiration in a newborn due to oxygen deprivation during labor or delivery. Causes include issues with the placenta, umbilical cord, maternal health conditions, and difficult delivery. Signs range from mild transient symptoms to more severe outcomes like coma or multi-organ failure. Treatment focuses on resuscitation of the airway, breathing, and circulation (ABC approach). Asphyxia can lead to complications such as hypoxic-ischemic encephalopathy and birth trauma.
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The document outlines the key components of a routine newborn assessment, including establishing a historical database, physical examination, and evaluating for any signs of distress, trauma, or abnormalities. The examination follows a structured process, beginning with observation, then assessing the skin, vital signs, reflexes, measurements, and examining specific body systems like respiratory, cardiovascular, abdominal, genitourinary, and musculoskeletal. The goals are to determine gestational age, evaluate growth and development, and identify any health issues in the newborn.
The document provides information about assessing and caring for a normal newborn infant. It defines a normal newborn, outlines objectives for understanding newborn characteristics and care, and describes how to assess vital signs, measurements, physical characteristics including the skin, head, chest and extremities. It also details reflexes, physical and behavioral assessment using the Ballard score, and immediate newborn care processes such as clearing the airway, cord clamping and cutting, identification, and establishing breastfeeding. The goal is for learners to understand how to evaluate a newborn and provide appropriate initial care.
This document provides information on various fetal assessment measures that can be performed during pregnancy. It discusses evaluating fetal growth through fundal height measurements and Leopold's maneuvers. It also describes biochemical tests that can be done including maternal serum alpha-fetoprotein, triple screen, estriol levels, and acetylcholine esterase. Invasive procedures for assessing the fetus such as amniocentesis and chorionic villus sampling are explained. The aims, indications, procedures, and risks of these various fetal monitoring techniques are outlined in the document.
Neonatal sepsis occurs when pathogenic organisms enter the bloodstream of newborns, potentially causing infections like septicemia, pneumonia, and meningitis. It accounts for 15-47.7% of neonatal deaths worldwide. Symptoms develop within 3 days (early onset) or after 3 days (late onset) and include pallor, apnea, bulging fontanel, and poor feeding. Escherichia coli, Staphylococcus aureus and Klebsiella are common causes. Diagnosis involves sepsis screening and CSF analysis. Treatment requires appropriate antibiotics based on culture and supportive care like IV fluids and oxygen. Outcomes depend on the infant's weight and maturity as well as the causative organism and treatment
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Due to high risk of pregnancy there are several adverse outcome or poor perinatal outcome we can see.... So most commonly adverse out come should be known by health care providers.
This document provides an overview of newborn resuscitation including the basic physiologic changes at birth, resuscitation equipment and personnel, and the steps involved in resuscitation. It discusses anticipation of need, preparation, initial steps of providing warmth, clearing the airway, and stimulation. It then covers subsequent steps such as positive pressure ventilation, chest compressions, and administration of drugs if needed. Key points include using room air rather than 100% oxygen for positive pressure ventilation, and emphasizing adequate ventilation before initiating chest compressions if the heart rate is low.
This document discusses the physiologic challenges faced by premature and high-risk newborns. It describes classifications of high-risk newborns based on gestational age and birth weight. The major physiologic challenges for premature infants are then discussed, including respiratory, thermoregulation, digestive, and renal systems. Specific nursing interventions are provided to address the needs in each of these areas for preterm infants. Several common disorders seen in the NICU are also outlined such as respiratory distress syndrome, hyperbilirubinemia, and necrotizing enterocolitis.
This document discusses neonatal jaundice and prematurity. It defines neonatal jaundice as a yellowing of the skin due to high bilirubin levels. It notes that jaundice can be physiologic or pathologic. It also discusses the causes, signs, management including phototherapy and exchange transfusion, and complications of jaundice like kernicterus. The document also defines and describes prematurity, the characteristics of premature infants, causes of preterm birth, and problems they often face like respiratory distress and temperature instability. It emphasizes the importance of thermal management for premature neonates.
Hydrocephalus
introduction
Hydrocephalus, also known years ago as “water on the brain”, is a condition where the circulation system of the body’s cerebrospinal fluid (CSF) is not functioning properly. The CSF accumulates in the brain and causes intracranial pressure. A shunt is usually placed to equalize the flow of CSF, which requires surgery. The diagnosis and surgery can be very frightening for the parents as well as the child
definition
Hydrocephalus is a condition characterized by an excess of cerebrospinal fluid (CSF) within the ventricular and subarachnoid spaces of the cranial cavity
INCIDENCE
It is found in 1-3 of every 1000 born children in world wide
Classification
Non communicating. In the non communicating type of congenital hydrocephalus, an obstruction occurs in the free circulation of CSF.
Communicating. In the communicating type of hydrocephalus, no obstruction of the free flow of the CSF exists between the ventricles and the spinal theca; rather, the condition is caused by defective absorption of CSF, thus causing increased pressure on the brain or spinal cord.
CAUSES
Obstruction. The most common problem is a partial obstruction of the normal flow of CSF, either from one ventricle to another or from the ventricles to other spaces around the brain.
Poor absorption. Less common is a problem with the mechanisms that enable the blood vessels to absorb CSF; this is often related to inflammation of brain tissues from disease or injury.
Overproduction. Rarely, the mechanisms for producing CSF create more than normal and more quickly than it can be absorbed.
PATHOPHYSIOLOGY
CLINICAL MANIFESTATION
Poor feeding. The infant with hydrocephalus has trouble in feeding due to the difficulty of his condition.
Large head. An excessively large head at birth is suggestive of hydrocephalus.
Bulging of the anterior fontanelles. The anterior fontanelle becomes tense and bulging, the skull enlarges in all diameters, and the scalp becomes shiny and its veins dilate.
Setting sun sign. If pressure continues to increase without intervention, the eyes appear to be pushed downward slightly with the sclera visible above the iris- the so-called setting sun sign.
High-pitched cry. The intracranial pressure may increase and the infant’s cry could become high-pitched.
Irritability. Irritability is also caused by an increase in the intracranial pressure.
Projectile vomiting. An increase in the intracranial pressure can cause projectile vomiting
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conclusions
The document discusses topics related to obstetrics including the prenatal period, assessment and management of obstetric patients, complications during pregnancy and delivery, abnormal delivery situations, and maternal complications of labor and delivery. It provides details on the anatomy, physiology, development, and common issues that can arise at each stage of pregnancy, labor, delivery, and the postpartum period. Management guidelines are presented for emergency situations that may be encountered with obstetric patients in the prehospital setting.
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).
Similar to commonneonataldisorders-160915052933.pdf (20)
This document discusses teams and teamwork. It defines a team as a group committed to producing a result through cooperation and communication. Benefits of teamwork include quick solutions, improved productivity, diversity of ideas, and better decisions. The stages of team development include forming, storming, norming, performing, and adjourning. Effective communication is vital for team success and includes supporting ideas, listening, and giving feedback. The closing thought emphasizes that the strength of each individual member lies in the team.
The document describes a structured teaching programme on cord blood banking among staff nurses. It presents a conceptual framework based on a general system theory model that shows demographic variables and source of information as inputs, a pre-interventional knowledge assessment and teaching intervention as the throughput, and knowledge assessment outcomes as either an increase in knowledge or no change as the outputs. The goal is to increase nurses' knowledge about cord blood banking through this teaching programme.
This document discusses human resource management and recruitment. It defines human resource management as planning, organizing, directing, and controlling various human resource functions like recruitment, training, performance evaluation, compensation, and retention to satisfy organizational and individual needs.
It then discusses the objectives, components and importance of recruitment. The key recruitment steps mentioned are planning, searching, screening, evaluation and control. Internal sources include promotions, referrals and external sources involve advertisements, consultants, campus recruitment. Factors affecting recruitment are organization size, employment conditions, growth rate, compensation offered.
This document defines and describes different types of variables that are commonly used in research. It begins by explaining that observations or participants can have characteristics that are either constants (the same for all) or variables (differ between participants). The main types of variables discussed are independent variables (factors being studied for their effects) and dependent variables (outcomes being measured). Other variable types covered include moderator variables, quantitative vs qualitative variables, and continuous vs discontinuous variables. Demographic variables are also defined as characteristics used to describe research samples.
This document defines key terms and concepts used in research. It discusses variables, data, samples, populations, hypotheses, limitations, validity, reliability and more. Research involves systematically investigating questions through data collection and analysis in order to generate answers and suggest new questions for further study. Key aspects of research addressed include conceptual frameworks, operational definitions, sampling methods, and reliability and validity.
This document discusses research hypotheses. It defines a hypothesis as a tentative statement about the relationship between two or more variables. Hypotheses help translate research problems into predicted outcomes and include the variables and population being studied. Formulating hypotheses plays an important role in theory building. The document outlines the importance of hypotheses in providing objectivity, direction, and goals for research. It also discusses the characteristics of good hypotheses, such as being testable and consistent with existing knowledge. Sources of hypotheses include theoretical frameworks, previous research, and real-life experiences. The document concludes by describing different types of hypotheses like simple vs complex and directional vs non-directional.
This document discusses educational objectives and their formulation. It begins by outlining the objectives, contents and introduction to the topic. It then defines educational objectives, lists their characteristics as SMART and FOCUSED, and describes the three types - general, intermediate and instructional. Next, it explains Bloom's taxonomy of educational objectives, which categorizes them into cognitive, affective and psychomotor domains. For each domain, it provides the levels and examples of action verbs used to write objectives. The document concludes by assigning students to prepare objectives for a teaching plan and answering review questions.
This document discusses different types of tumors and cancer treatments. It explains that cancerous tumors can spread throughout the body while noncancerous tumors are rarely life-threatening. It then describes common cancer treatments like surgery to remove tumors, chemotherapy to kill fast-growing cells, radiation therapy to reduce cancer risks or make other treatments more effective, and hormone therapy for certain cancers that use hormones to grow. The document concludes that having a diagnosis and treatment plan for early-stage cancer will help achieve the goal of overcoming the disease.
Nutritional deficiencies in children can cause significant health problems. Protein deficiencies like marasmus and kwashiorkor result in wasting and edema. Vitamin deficiencies such as vitamins A, D, B1, B2 and niacin can cause conditions like rickets, beriberi, and pellagra. Children are especially vulnerable due to their high nutritional needs for growth. Proper nutrition is essential for normal development and long-term health.
Genetic, environmental, and prenatal factors all influence child growth and development. Genetic factors like a child's sex, race, and any genetic disorders can impact development. The prenatal environment, including maternal health, nutrition, infections, and substance use also affect fetal growth. After birth, postnatal factors like nutrition, illness, physical environment, socioeconomic status, and learning experiences further shape development. Growth and development are complex, multifactorial processes determined by an interaction of hereditary and environmental influences from conception onwards.
The document discusses key concepts related to child growth and development. It defines growth as the process of physical maturation resulting in an increase in size, while development refers to functional and physiological maturation and the progressive increase in skills and capacity. It outlines several principles of growth and development, including that it proceeds from head to tail, center to periphery, general to specific, and is continuous, sequential, and predictable. Development depends on maturation and learning and is influenced by heredity and environment.
This document discusses principles of education and the teaching-learning process. It begins by defining key terms like education, philosophy, and educational philosophies. It then examines several philosophies of education in detail, including naturalism, idealism, realism, and pragmatism. For each philosophy, it outlines the chief proponents, basic concepts, aims and principles of education, organization of education, curriculum, teaching methods, discipline approaches, and the role of the teacher. The document provides an overview of major educational philosophies to help understand principles that guide the teaching and learning process.
This document provides information on lesson planning for nursing students, including:
- The objectives, contents, introduction, definition, functions, significance, prerequisites, characteristics, steps, and format of lesson planning.
- Key aspects of effective lesson planning include setting clear objectives, selecting appropriate content, utilizing various teaching methods and assessment strategies, and ensuring active student participation.
- The document outlines the various sections that should be included in a lesson plan such as the cover page, basic lesson plan information, time allotment and teaching-learning activities for each objective, assessment strategies, assignment, and references.
The document provides information on essential newborn care including the 8 steps of essential newborn care such as drying the baby, assessing breathing, cord care, and warming the baby. It discusses principles like immediate drying, skin-to-skin contact, and delaying bathing and weighing. Components include neonatal resuscitation, thermal protection, infection prevention, and initiation of breastfeeding within 1 hour. Risk factors for low birth weight babies and prevention measures are outlined. Optimal infant feeding practices of exclusive breastfeeding for 6 months and introducing complementary foods at 6 months are also summarized.
1. The document defines the neonatal period as the time from birth to 4 weeks postnatal. During this period, newborns are observed and stabilized in the normal newborn nursery or on the maternity floor.
2. The roles of nurses and physicians in the normal newborn nursery include admission care like assessments, history taking, and ensuring identification; ongoing assessments using tools like the APGAR score; and providing routine neonatal care like maintaining temperature and establishing breastfeeding.
3. Physical examinations of newborns assess various body systems and features like reflexes, fontanels, skin characteristics, and vital signs to evaluate overall health and normalcy. Any abnormalities are noted.
The document summarizes a study that assessed the effectiveness of a structured teaching program on mothers' knowledge of preventing pediatric emergencies and providing first aid for children under 5. 50 mothers participated in the study. Their knowledge was tested before and after the teaching program using a 25 question survey. The results showed that after the program, none of the mothers had inadequate knowledge while all had adequate knowledge, indicating the program was effective. The study also found significant associations between mothers' knowledge and several demographic factors like age, education level, occupation, number of children, and information sources.
This document discusses the teaching-learning process in a nursing education context. It begins by outlining the objectives and aims of education, including the individual, social, and democratic aims. It then defines learning as a modification of behavior through experience according to various psychological views. The principles of learning include that it is progressive, motivated, universal, and goal-directed. Teaching is defined as aimed at changing another's behavior potential and includes stimulation, guidance and encouragement of learning. The nature of teaching is described as interactive, multi-level, and requiring planning and effective communication. Evaluation questions are provided to test understanding of the key topics.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
2. Classification of common
neonatal disorders
Birth injuries
Caput succedaneum
Cephalhematoma
Fractures
Facial paralysis
Erb’s/Brachial palsy
3. Classification of common
neonatal disorders(cont…)
Disorders related to physiological factors
Hyperbilirubinemia
Hemolytic disease of the newborn
Respiratory distress syndrome
7. Injuries to the head while
birth
S - Skin
C - Close connective tissue & cutaneous vessels
& nerves.
A - Aponeurosis (epicranial aponeurosis)
L - Loose connective tissue (scalping layer)
P - Periosteum of skull bones
8.
9. Injuries to the head
CAPUT SUCCEDANEUM
A caput succedaneum is an edema of the
scalp at the neonate’s presenting part of the
head
It often appears over the vertex of the
newborn’s head as a result of pressure against
the mother’s cervix during labor.
The edema in caput succedaneum crosses the
suture lines
10. Injuries to the head
CAPUT SUCCEDANEUM
Causes
Mechanical trauma of the initial portion of
scalp pushing through a narrowed cervix
Prolonged or difficult delivery
Vacuum extraction
11. Injuries to the head
Cephalhematoma
It is a collection of blood between the
periosteum of a skull bone and the bone
itself. It occurs in one or both sides of the
head
The swelling with cephalhematoma is not
present at birth rather it develops within the
first 24 to 48 hours after birth.
Has clear edges that end at the suture lines
12. Injuries to the head
Cephalhematoma Causes
Rupture of a periostal capillary due to the
pressure of birth
Instrumental delivery
13. Injuries to the head
Nursing care management
It is directed toward assessment and
observation of the common scalp injuries and
vigilance in observing for possible associated
complications such as infection or acute
blood loss and hypovolemia.
Because of the visible injuries resolves
spontaneously, parents need reassurance of
their usual benign nature.
14. Fractured clavicle
Bone most frequently fractured during
delivery
Associated with CPD
Signs:
limited ROM,
crepitus,
cries of pain when arm is moved,
absent Moro reflex on Affected side
15. Fractured clavicle
Heals quickly, handle gently, immobilize arm,
eliciting scarf sign is contraindicated.
Any newborn that weighs more than 3855g
and is delivered vaginally should be evaluated
for a fractured clavicle.
16. Fractured clavicle
Nursing Management
Often no intervention is needed other than
maintaining proper alignment, careful
dressing and undressing of infant.
Supporting the patient from upper and lower
back other than from under the arms should
be practiced.
The parents should be involved in the care.
17. Facial paralysis:
From pressure on facial nerve
during delivery
Affected side unresponsive when
crying
Resolves in hours/days
NURSING MANAGEMENT-
a) Feedings may be given by gavage
in order to prevent aspiration
b) Since the eye on the effected side
cannot be closed completely, it is
covered with an eye shield to
prevent drying of the conjunctiva
and cornea.
18. Erb’s Palsy (Erb- Duchenne
Paralysis)
Associated with stretching
or pulling head away from
shoulder during delivery
Signs: Flaccid arm, elbow
extended, hand rotated
inward, Moro & grasp
reflexes absent on affected
side
Requires immobilization &
reposition q 2 to 3 hr.
19. Erb’s Palsy (Erb- Duchenne
Paralysis)
NURSING MANAGEMENT-
a) The goal is to prevent
contractures in the paralyzed
muscles.The arm should be
partially mobilized in a position of
maximum relaxation so that the
non-paralyzed muscles cannot
exert pull on the affected muscles.
b) By use of a splint or brace when
upper arm is paralyzed, the arm is
abducted 90 degrees and rotated
externally at the shoulder with the
elbow flexed so that the palm of
the hand is turned towards the
head.
20. Erb’s Palsy (Erb- Duchenne
Paralysis)
When any form of immobilization is used, the
fingers and the hand should be observed for
coldness and discoloration and the skin for
the signs of irritation.
21. Hemolytic disease of the
newborn
Rh +ve blood – D antigen
Rh -ve blood – lacks this D antigen
22. Hemolytic disease of the
newborn
When Rh-positive blood is infused into an Rh-
negative woman through error or when small
quantities (usually more than 1 mL) of Rh-
positive fetal blood containing D antigen
inherited from an Rh-positive father enter the
maternal circulation during pregnancy, with
spontaneous or induced abortion, or at
delivery, antibody formation against D
antigen
24. Hemolytic disease of the
newborn
“Why the fetus is affected in second delivery
and not in first delivery?”
25. Hemolytic disease of the
newborn
As the mixing of blood usually occurs at the
time of delivery so by the time antibodies are
formed the baby is already delivered.
26. Hemolytic disease of the
newborn
But what if the mixing of blood occurs before
the delivery? Lets say during some procedure
like amniocentesis or chorionic villi sampling?
Now will the fetus be at risk?
28. “But why fetus ain’t at risk
during 1st pregnancy even if the
blood is mixed before delivery?”
29. Hemolytic disease of the
newborn
The answer is because of the type of
antibodies formed during first and second
delivery.
30. Prevention of hemolytic
disease.
Prevention: Rhogham/Anti-
RhD in un-sensitized mothers
Treatment of a mother with
Anti-RhD antibodies prior to
and immediately after trauma
and delivery destroys Rh
antigen in the mother's
system from the fetus
31. Hemolytic disease of the
newborn
Diagnosis:
Indirect coombs test in mothers-antigen
direct coombs test in infants with Rh-ve
mothers-antibodies
32. Hemolytic disease of the
newborn
Treatment: IVIG is given in infants, exchange
transfusion and phototherapy.
33. Hemolytic disease of the
newborn
Nursing management:
1. Early recognistion of Jaundice
2. If an exchange transfusion is
required then the nurse
prepares the infant and family
and assists the physician.
3.The nurse documents the
blood volume exchange.
34. Hemolytic disease of the
newborn
4. Signs of blood
transfusion reaction are
need to be monitored.
5.Throughout the
procedure infant’s
thermoregulation need
to be monitored.
6. After the procedure the
nurse monitors the
umblical cord for any kind
of bleeding.
35. Neonate Respiratory distress
syndrome/ hyaline membrane
disease
RDS occurs primarily in premature infants;
its incidence is inversely related to gestational
age and birth weight.
It occurs in 60–80% of infants less than 28 wk of
gestational age,
In 15–30% of those between 32 and 36 wk,
In about 5% beyond 37 wk,
and rarely at term.
36. Neonate Respiratory distress
syndrome
The condition occurs due to lack of
pulmonary surfactant because of immaturity
of the lungs.
Surfactant helps in reducing the surface
tension of alveoli.
When surfactant active material is deficient in
the alveoli, there is alveolar collapse during
expiration
37. Neonate Respiratory distress
syndrome
The pulmonary immaturity of the fetal lungs
can be assessed by determination of
lecithin/sphingomyelin ratio in the amniotic
fluid
L/S ratio is 2 or more suggestive of adequet
lung maturity, while a ratio of less than 1.5 is
often associated with HMD
38. Neonate Respiratory distress
syndrome
Clinical features
This is characterized by a triad of tachypnea,
expiratory grunt and inspiratory retractions in
a preterm.
These symptoms may begin at birth or within
6 hours of birth.
There is a gradual worsening of retrations,
grunting and cyanosis.
39. Neonate Respiratory distress syndrome/ hyaline
membrane disease
Management
Premature labor should be arrested by
appropriate tocolytic therapy to gain
pulmonary maturity.
The induction of labor should be delayed
as far as the lung maturity is confirmed by
l/S ratio.
When premature labor below 34 weeks of
gestation is unavoidable, the mother
should be given betamethasone 12mg IM
every 24hrs for two days or
dexamethasone 6mg IM four doses at an
interval of 12hrs.
40. Neonate Respiratory distress
syndrome
The infant should be nursed in a
thermoneutral env and administered
oxygen through head box.
An IV line should be established to
maintain fluid and electrolyte balance, for
correction of acidosis and administration
of drugs.
Intratracheal administration of surfactant
should be done
SPo2 should be monitored
If infant cant monitor Spo2 above 90
despite of giving oxygen via hood the
infant should be put on CPAP
41. Neonate Respiratory distress
syndrome
If CPAP is also ineffective then the
infant should be put on IPPV
Acid-base parameters should be
monitored
Unmonitored oxygen levels may lead
to retinopathy of prematurity to
oxygen toxicity.
42. Neonate Respiratory distress
syndrome
Antibiotics are given in case of
superadded infections
The management of HMD requires
supportive care by trained nurses and
the availability of high technology to
monitor and manage the hypoxia due
to ineffective ventilation.
43. Neonate Respiratory distress
syndrome/ hyaline membrane
disease
Nursing management
Effective ventilation and oxygen
therapy
Equipment should be ready and in
working condition
Oxygen must be warm and humidified
The condition of the infant can change in
a fraction of a second so it is vital for the
nurse to monitor neonate’s color, level of
activity and to note blood gas
measurements.
When o2 is given, tracheal and
nasopharengial suctioning and chest
physical therapy is required.
44. Neonate Respiratory distress
syndrome/ hyaline membrane
disease
Optimal environmental temperature:The
nurse has a important role in providing
regulation of surrounding temperature.
Adequate nutrition: proper gavage
feedings at proper intervals is necessary
nursing action.
Minimal handling of critically ill infants.
Use of aseptic techniques.
Infants should be positioned with head
elevated to decrease pressure on
diaphragm.
45. Necrotising Enterocolitis (NEC)
This is characterized by necrosis of intestinal
wall , is a serious life threatening condition
that is being diagnosed with increasing
frequency in premature infants.
46. Necrotising Enterocolitis (NEC)
Factors that place the infant at risk of this
disease include:
Perinatal asphyxia
Low apgar score
IRDS
Sepsis
Enteral feedings
Congenital cardiac disease
Relative ischemia of the intestinal tract that is due to
hypotension
Use of umbilical catheters
Exchange transfusion
47. Pathophysiology
Factors
Depletion of the normal
blood flow
Ischemia with a reduction
in the protective mucosa.
Intestinal enzymes further
destroy the mucosal layer
48. Bacteria increases in the
presence of carbohydrate in
the infants feeding and form
gas
Intestines become dilated,
become necrotic
Necrosis may involve the full
thickness of the intestinal
wall leading to ultimate
perforation
50. Necrotising Enterocolitis
(NEC
Nursing management
As soon as the diagnose of NEC is
made the oral feedings are
discontinued and peripheral IV
fluids are given to the infant.
Palpation of abdomen, abdominal
girth are checked daily
Bowel sound monitoring
TPN is to be started
51. Necrotising Enterocolitis
(NEC
I/v antibiotics are started to
against gram negative enteric
organisms
Rectal temperature is not taken
so as to prevent rectal
perforation
Affected infants are to be
placed in isolation
52. Necrotising Enterocolitis
(NEC
These infants are not diapered
because of the increased risk of
intra-abdominal pressure.
These infants are nursed on their
back as much as possible to
reduce the external pressure on
the abdomen
Postoperatively , as the suture
line is close to stoma so
measures should be taken to
avoid any infection to suture
line.
54. Neonatal Sepsis
Systemic bacterial infections of
newborn infants are termed as
neonatal sepsis
They are the most common cause of
neonatal deaths in Indianatal sepsis
This is a generic term which
incorporates neonatal septicemia,
pneumonia, meningitis and urinary
tract infections
55. Neonatal Sepsis
Neonatal sepsis can be divided into two
types
Early onset: this happens in first 72
hours of life
This is mainly due to organisms
present in:
the genital tract or
in the labor room or
in maternity operation
56. Neonatal Sepsis
Late-onset: this is caused by the
organisms thriving in exter
The infection is often transmitted
by the care givers.
57. Neonatal Sepsis
The predisposing causes of LOS are
:
Lack of breast feeding
Superficial infections
Aspiration of feeds
Disruption of skin integrity with
needle pricks and use of IV fluids
External env of homes or hospital.
58. Neonatal Sepsis
Clinical features:The manifestations
of neonatal sepsis are often vague
and nonspecific demanding high
index of suspicion for early
diagnosis.
Any altern in feeding patterns
Active baby suddenly becoming
lethargic
59. Hypothermia in preterms and fever in
term babies especially in association
with gram –positive infections and
meningitis.
Diarrhea, vomiting and abdominal
distention
Jaundice and hepatosplenomegaly
may be present
Episodes of apneic spells with
cyanosis may also be one of the sign.
61. Neonatal Sepsis
Nursing Management:
Hand washing and thorough
scrubbing with soap and water
upto elbows for at least 2mons,
gowning and change of shoes
are mandatory.
Rings, bangles and
wristwatches should be
removed
Strict hand washing for 20 secs
and use of antiseptic solution in
between handling babies.
62. Neonatal Sepsis
4. Babies should be fed
early and exclusively on
breast milk.
5. Careful attention should
be paid to hygiene of the
katori and spoon.
6.The umblical stump
should be left open. Local
application of spirit
reduces colonization.
63. Neonatal Sepsis
All procedures should
be done wearing mask.
Unnecessary needle
pricking should be
avoided.
Strict housekeeping
routines for washing ,
disinfection, cleaning of
cots/incubators should
be ensured .
64. Infants of diabetic mothers IDM
There has been
continuing
improvement in the
care of mothers with
diabetes mellitus and
their neonates,
resulting in a decline
in the morbidity and
mortality rates
65. Infants of diabetic mothers IDM
Clinical manifestations of IDM:
Large for gestational age
Very plump and full faced
Abundant vernix caseosa
Pleothora
Listlessness and lethargy
Large placenta and umblical
cord
Possibly meconium stained at
birth
66. Infants of diabetic mothers IDM
Therapeutic management
The most common management of IDMs
is careful monitoring of serum glucose
levels and observation for accompanying
complications such as RDS.
Studies confirm that maintaining blood
glucose level more than 50mg/dl in IDMs
with hypoglycemia prevent serious
neurological conditions.
Oral and IV backup may be titrated to
maintain adequate blood glucose levels.
67. Nursing care management
Early introduction of carbohydrate
feedings as appropriate
Serum glucose monitoring.
Because macrosomic infants are at
high risk for problems associated
with difficult delivery, they are
monitored for birth injuries.
There is some evidence that IDMs
have an increased risk of acquiring
type 2 DM during childhood or
early adulthood therefore a nurse
should also focus on healthy
lifestyle and prevention later in life
with IDMs.
68. References
WONG’S ESSENTIAL OF PAEDIATRIC
NURSING 8TH EDITION
NELSON’STEXTBOOK OF PEDITRICS
15TH EDITION
http://www.imedicine.com /display
topic
DOROT HY R.M.MARLOWAND
BARBARAA. REDDING’STEXTBOOK
OF PEDIATRIC NURSING 6TH EDITION
Www.wikipedia.org
Textbook of Indian academy of
pediatrics