Complications of prematurity
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A short presentation including a fictitious case study on prematurity. Focusing on the causes of prematurity, acute complications, chronic complications and bronchopulmonary dysplasia.
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prematurity
This document discusses prematurity and its complications. It defines prematurity as a live birth before 37 weeks gestation. The incidence in Pakistan is estimated at 11-13%. Causes of prematurity include maternal, uterine, fetal and other factors such as infections and socioeconomic status. Complications of prematurity can be immediate such as respiratory issues, intraventricular hemorrhage, and infections, or long term such as cerebral palsy and developmental delays. Management involves proper delivery room care, maintaining temperature and fluids, screening for complications, proper feeding and supplementation. Outcomes depend on gestational age and birth weight, with survival rates increasing with advances in neonatal intensive care.
Prematurity
This document discusses prematurity and the management of preterm infants. It defines prematurity as birth before 37 weeks gestation. It describes the problems that can occur in preterm infants relating to immaturity of organ systems, including respiratory issues, temperature regulation difficulties, neurological impairments, and metabolic concerns like hypoglycemia. The document outlines assessment and management approaches for various initial problems in the preterm newborn as well as long term issues involving development, medical complications, and social factors. Mortality and morbidity rates are provided based on gestational age and birth weight.
Meconium aspiration syndrome_
Meconium aspiration syndrome (MAS) is a respiratory distress in infants born through meconium stained amniotic fluid. It occurs in 5% of infants delivered through meconium stained fluid and is caused by mechanical obstruction and chemical pneumonitis from inhaled meconium. Clinical features include respiratory distress, cyanosis, and chest retractions. Diagnosis is confirmed by chest x-ray showing infiltrates and management involves ventilatory support, surfactant therapy, inhaled nitric oxide, and potentially extracorporeal membrane oxygenation. With aggressive treatment, mortality from MAS has decreased to less than 5%.
Prematurity and its complication
This document discusses prematurity and its complications. It defines prematurity as infants born before 37 weeks gestation according to the WHO. Prematurity is classified based on gestational age as extremely, very, or moderate to late preterm. It can also be classified based on birth weight as low, very low, or extremely low. Risk factors include socioeconomic status, previous prematurity, and maternal health conditions. Causes include fetal, uterine, maternal, and iatrogenic factors. Clinical presentation includes weak reflexes and poor muscle tone. Complications involve respiratory, cardiovascular, gastrointestinal, metabolic, central nervous system, renal, and infectious issues. Long term complications may include developmental delays. Care after birth focuses on stabilization, monitoring,
Prematurity Pediatrics
This document discusses prematurity and intrauterine growth retardation (IUGR). Prematurity is defined as birth before 37 weeks gestation. IUGR refers to poor growth in the womb. Both conditions increase neonatal morbidity and mortality. The document outlines classifications of prematurity and IUGR. It also discusses their incidence, causes, assessment, associated diseases in low birthweight infants, and care of preterm infants. Proper care includes thermal control, oxygen therapy, fluid management, nutrition, and infection prevention. Long term outcomes depend on gestational age and birthweight, with more prematurity and lower weight correlating to worse outcomes.
Prematurity
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High risk infant new
This document discusses factors that define high risk newborns and their management and follow up. It identifies demographic, medical history, pregnancy, delivery, and neonatal factors that increase morbidity and mortality risks. It outlines assessments and interventions needed for different at-risk groups, including extra care to prevent hypothermia, hypoglycemia, and infection. High risk newborns require intensive care and multidisciplinary follow up after discharge to screen for developmental delays and other issues. The goal is early identification and intervention to optimize outcomes.
Antenatal Corticosteroids
This document summarizes guidelines on the use of antenatal corticosteroids. It states that a single course of antenatal corticosteroids between 24-34 weeks of gestation significantly reduces neonatal death, respiratory distress syndrome, and intraventricular hemorrhage, with no known benefits or harms for the mother. It provides guidance on appropriate patients, timing, dosage, and considerations for particular clinical contexts. Repeating courses weekly is not recommended due to potential effects on growth, though a second course may be considered in limited circumstances.
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prematurity
This document discusses prematurity and its complications. It defines prematurity as a live birth before 37 weeks gestation. The incidence in Pakistan is estimated at 11-13%. Causes of prematurity include maternal, uterine, fetal and other factors such as infections and socioeconomic status. Complications of prematurity can be immediate such as respiratory issues, intraventricular hemorrhage, and infections, or long term such as cerebral palsy and developmental delays. Management involves proper delivery room care, maintaining temperature and fluids, screening for complications, proper feeding and supplementation. Outcomes depend on gestational age and birth weight, with survival rates increasing with advances in neonatal intensive care.
Prematurity
This document discusses prematurity and the management of preterm infants. It defines prematurity as birth before 37 weeks gestation. It describes the problems that can occur in preterm infants relating to immaturity of organ systems, including respiratory issues, temperature regulation difficulties, neurological impairments, and metabolic concerns like hypoglycemia. The document outlines assessment and management approaches for various initial problems in the preterm newborn as well as long term issues involving development, medical complications, and social factors. Mortality and morbidity rates are provided based on gestational age and birth weight.
Meconium aspiration syndrome_
Meconium aspiration syndrome (MAS) is a respiratory distress in infants born through meconium stained amniotic fluid. It occurs in 5% of infants delivered through meconium stained fluid and is caused by mechanical obstruction and chemical pneumonitis from inhaled meconium. Clinical features include respiratory distress, cyanosis, and chest retractions. Diagnosis is confirmed by chest x-ray showing infiltrates and management involves ventilatory support, surfactant therapy, inhaled nitric oxide, and potentially extracorporeal membrane oxygenation. With aggressive treatment, mortality from MAS has decreased to less than 5%.
Prematurity and its complication
This document discusses prematurity and its complications. It defines prematurity as infants born before 37 weeks gestation according to the WHO. Prematurity is classified based on gestational age as extremely, very, or moderate to late preterm. It can also be classified based on birth weight as low, very low, or extremely low. Risk factors include socioeconomic status, previous prematurity, and maternal health conditions. Causes include fetal, uterine, maternal, and iatrogenic factors. Clinical presentation includes weak reflexes and poor muscle tone. Complications involve respiratory, cardiovascular, gastrointestinal, metabolic, central nervous system, renal, and infectious issues. Long term complications may include developmental delays. Care after birth focuses on stabilization, monitoring,
Prematurity Pediatrics
This document discusses prematurity and intrauterine growth retardation (IUGR). Prematurity is defined as birth before 37 weeks gestation. IUGR refers to poor growth in the womb. Both conditions increase neonatal morbidity and mortality. The document outlines classifications of prematurity and IUGR. It also discusses their incidence, causes, assessment, associated diseases in low birthweight infants, and care of preterm infants. Proper care includes thermal control, oxygen therapy, fluid management, nutrition, and infection prevention. Long term outcomes depend on gestational age and birthweight, with more prematurity and lower weight correlating to worse outcomes.
Prematurity
Prematurity Management of Premature Babies. Golden Hour in NICU. Neonatal Intensive Care management of Preterm Babies.
High risk infant new
This document discusses factors that define high risk newborns and their management and follow up. It identifies demographic, medical history, pregnancy, delivery, and neonatal factors that increase morbidity and mortality risks. It outlines assessments and interventions needed for different at-risk groups, including extra care to prevent hypothermia, hypoglycemia, and infection. High risk newborns require intensive care and multidisciplinary follow up after discharge to screen for developmental delays and other issues. The goal is early identification and intervention to optimize outcomes.
Antenatal Corticosteroids
This document summarizes guidelines on the use of antenatal corticosteroids. It states that a single course of antenatal corticosteroids between 24-34 weeks of gestation significantly reduces neonatal death, respiratory distress syndrome, and intraventricular hemorrhage, with no known benefits or harms for the mother. It provides guidance on appropriate patients, timing, dosage, and considerations for particular clinical contexts. Repeating courses weekly is not recommended due to potential effects on growth, though a second course may be considered in limited circumstances.
Infant of diabetic mother
Gestational diabetes can cause complications in infants due to hyperglycemia transferring through the placenta. Infants of diabetic mothers (IDMs) are at risk for birth defects if hyperglycemia occurs early in pregnancy during organ development. Later hyperglycemia increases risks for macrosomia, hypoglycemia, and other issues. IDMs require careful monitoring and treatment of potential complications in the neonatal period such as hypoglycemia, hypocalcemia, respiratory distress, and cardiomyopathy. Long term, IDMs have increased risk of obesity, diabetes, and developmental or cognitive delays.
Preterm
This document defines a preterm neonate as any baby born before 37 weeks of gestation. It discusses the causes of preterm birth including health issues in the mother and multiple pregnancies. It describes the physical characteristics of preterm infants such as small size, thin skin, and underdeveloped organs. Complications of preterm birth are outlined involving the respiratory, cardiovascular, gastrointestinal and neurological systems. The management of preterm labor and care of preterm newborns is summarized including monitoring for common problems like infections, breathing issues, and nutritional deficiencies.
Prematurity
This document discusses prematurity and its management. It defines prematurity as infants born before 37 weeks gestation. The main causes of prematurity include fetal, placental, uterine and maternal factors. Key aspects of management include antenatal corticosteroids to aid lung development, careful temperature and fluid regulation, early nutrition including breastmilk, and monitoring for respiratory, cardiac and neurological complications which are common in premature infants. The goal of management is to provide supportive care until organs are developed enough for survival outside the womb.
Infant of a diabetic mother
This document discusses the infant of a diabetic mother. It begins with an introduction stating that diabetes is a common complication of pregnancy and risks to the infant have decreased but still exist. It then covers pathophysiology, epidemiology, complications, management, and prognosis. Key points include: fetal macrosomia is a risk; hypoglycemia is common due to hyperinsulinemia; other risks include hypocalcemia, hypomagnesemia, and congenital heart defects. Management involves monitoring glucose and electrolytes along with imaging tests. Treatment focuses on maintaining normal glucose during labor and delivery along with early breastfeeding to prevent hypoglycemia. Prognosis is generally good but neurodevelopmental risks exist if maternal glucose control was
Respiratory distress in newborn
A preterm newborn developed respiratory distress soon after birth, with signs including grunting and cyanosis. Evaluation found respiratory distress syndrome (RDS). The baby was treated with nasal CPAP, surfactant, and mechanical ventilation. RDS is caused by surfactant deficiency in premature infants, resulting in alveolar collapse and impaired gas exchange. Management includes respiratory support, surfactant replacement therapy, and care to prevent complications.
Birth injuries
This document discusses various types of birth injuries that can occur during labor and delivery. It begins by defining birth injuries and noting their prevalence. It then covers predisposing risk factors and provides a classification system for birth injuries involving soft tissue, the head/neck, facial structures, nerves, fractures, and internal organs. The remainder of the document delves into specific injury types like brachial plexus palsy, skull fractures, retinal hemorrhages, and clavicle fractures, describing their causes, signs/symptoms, diagnosis, and management.
Perinatal asphyxia in Neonatal
This document discusses perinatal asphyxia, also known as hypoxic-ischemic encephalopathy. It is caused by lack of oxygen and/or lack of blood flow to the fetus or newborn. This can result from factors like maternal hypertension, diabetes, or difficult labor. It commonly causes brain injury, heart and lung issues, and can lead to long term effects like cerebral palsy or intellectual disability. Diagnosis involves assessing for problems during pregnancy and labor. Treatment focuses on restoring oxygen and blood flow levels, controlling seizures, and addressing other systemic effects to prevent long term complications.
Apnea of prematurity
Apnea of prematurity is common in neonates born before 32 weeks gestation or weighing less than 1000g, with rates as high as 54% in infants born at 30-31 weeks and nearly 100% in infants born below 29 weeks or weighing less than 1000g. Apnea can be classified as central, obstructive, or mixed based on whether there is absence of respiratory effort or upper airway obstruction. Common causes include infection, neurological or cardiovascular issues, pulmonary problems, inborn errors of metabolism, metabolic or hematological conditions, gastrointestinal issues, problems with temperature regulation, and drugs. Evaluation may include investigations and treatment involves general measures as well as specific measures and emergency treatment if needed. Methylxanthines are commonly
Premature baby
Babies born before 37 weeks of gestation are considered premature. Premature babies often require care in a Neonatal Intensive Care Unit (NICU) as their organs are not fully developed. In the NICU, premature babies receive monitoring, respiratory support if needed, and are fed through tubes or IVs initially. Kangaroo care, where the baby is held skin to skin, helps with temperature regulation, breastfeeding, and weight gain. As the baby develops, parents can help with diaper changes, baths, and taking temperatures. The goal is for the baby to gain weight and develop enough to be able to eat and breathe on their own.
Thermoregulation in newborn
Thermal care is central to reducing morbidity and mortality in newborns. Thermoregulation is the ability to balance heat production and heat loss in order to maintain body temperature within a certain normal range. The average “normal” axillary temperature is considered to be 37°C
Meconium aspiration syndrome
Meconium aspiration syndrome (MAS) occurs when an infant aspirates meconium during delivery or birth, leading to respiratory distress. Risk factors include post-term pregnancy or conditions that cause fetal stress. Affected infants experience respiratory distress, often requiring oxygen therapy, CPAP, or mechanical ventilation. Complications can include air leaks, pulmonary hypertension, or long-term lung issues. Treatment focuses on clearing meconium from the airways, managing respiratory support and oxygen needs, and treating complications like infections or pulmonary hypertension. Prevention strategies center on monitoring high risk pregnancies and potentially inducing labor or performing C-sections before complications arise.
NEONATAL RESPIRATORY DISTRESS SYNDROME
Neonatal acute respiratory distress syndrome (RDS) is caused by surfactant deficiency in premature infants. Surfactant is produced in the lungs beginning at 24 weeks gestation and helps lower surface tension to prevent alveolar collapse. Preemies are at risk for RDS due to incomplete lung development and surfactant production. Treatment includes supportive care like CPAP, surfactant replacement therapy, and mechanical ventilation if needed. With treatment and lung maturation, symptoms typically improve within 3-5 days.
NEONATAL SEPSIS
This document provides information about neonatal sepsis, including its definition, classification, causes, risk factors, clinical features, diagnostic tests, management, and prevention. Some key points:
- Neonatal sepsis is a systemic bacterial infection occurring in newborns, defined as a positive blood culture within the first month of life. It is a major cause of neonatal mortality and morbidity.
- It can be classified as early-onset (before 72 hours of life) or late-onset (after 72 hours) sepsis. Early onset is usually caused by maternal genital tract bacteria, while late onset is caused by environmental and healthcare-associated bacteria.
- Risk factors include prematurity, prolonged rupture of membranes, chorio
Bronchopulmonary Dysplasia
This document discusses bronchopulmonary dysplasia (BPD), a chronic lung disease that occurs in premature infants requiring respiratory support. It covers the definition, risk factors, pathogenesis, clinical features, prevention, and treatment of BPD. The definition has evolved over time from relying solely on oxygen need at 28 days to incorporating factors like oxygen need, pressure support, and gestational age. BPD results from lung injury and disrupted lung development due to prematurity and respiratory support. Management aims to protect the lung from injury through gentle ventilation, optimal oxygen levels, and other strategies.
Neonatal thermoregulation
This document discusses the history and physiology of neonatal thermoregulation. It begins with the history of incubation from ancient Egypt and its application to premature infants in the 1800s. Key concepts discussed include the thermoneutral zone, factors affecting an infant's susceptibility to temperature changes, and the physiology of thermoregulation including brown adipose tissue. The document also covers the prevention, signs, and management of hypothermia in infants.
Induction of labor
This document discusses induction of labor. It begins by defining induction of labor and listing its objectives. It then covers the indications and contraindications for induction, including maternal and fetal indications. It describes methods of induction, including natural non-medical methods, mechanical methods like hygroscopic dilators and balloon catheters, surgical methods like membrane stripping and amniotomy, and pharmacological methods using prostaglandins, misoprostol, mifepristone, and oxytocin. It provides details on techniques and risks of different methods. It emphasizes monitoring during inductions and lists side effects of pharmacological agents. The overall document is a guide for health professionals on selecting and performing appropriate induction methods for individual patients.
Unstable lie
This document discusses unstable lie and version in pregnancy. It defines unstable lie as a condition where the fetal presentation constantly changes beyond 36 weeks of pregnancy when it should have stabilized. Causes include factors that prevent the presenting part from remaining fixed in the lower uterus. Complications include cord entanglement and increased risk of perinatal death. External cephalic version can be attempted to correct the malpresentation if there are no contraindications. Hospitalization is recommended at 37 weeks to monitor for premature rupture of membranes or cord prolapse. Elective c-section is often required, especially if complicating factors are present.
congenital pneumonia
1. Pneumonia is an inflammatory process in the lungs that can be caused by infection or other inflammatory conditions. It causes abnormalities in lung ventilation and gas exchange.
2. Congenital pneumonia specifically refers to pneumonia that is present at birth, usually caused by viral or bacterial infections transmitted from the mother. These infections can pose serious challenges to the immature newborn.
3. Pneumonia is a major cause of neonatal mortality worldwide. It requires prompt diagnosis and treatment including antibiotics, respiratory support, and careful management of cardiac and respiratory functions to prevent complications and ensure infant survival.
Developmentally supportive neonatal care
This document discusses developmentally supportive care in the NICU. It describes how the NICU environment has transitioned from a technology-oriented space that could overstimulate or deprive infants to one that aims to mimic the womb and support brain development. It outlines principles of developmentally supportive care like NICU design, positioning, handling infants, and parental participation. Interventions like kangaroo care, non-nutritive sucking, massage therapy, and multimodal stimulation are described that aim to properly stimulate infant senses and support physiology and behavior.
HIE
1) Hypoxic-ischemic encephalopathy (HIE) is brain injury caused by lack of oxygen and blood flow before, during, or after birth. It remains a serious condition that can cause death or long-term disabilities like cerebral palsy or intellectual impairment.
2) The document discusses the definition, risk factors, pathophysiology, clinical features based on the Sarnat staging system, diagnosis using imaging and EEG, and treatment approaches for HIE including supportive care, perfusion management, anti-seizure medications, and therapeutic hypothermia.
3) The goal of treatment is to prevent further brain injury by maintaining appropriate oxygenation, blood pressure, glucose levels, and treating seizures
Prolonged pregnancy
Prolonged pregnancy refers to gestation lasting 42 weeks or more. The cause is still unknown, but it may be related to changes in the fetal brain that initiate labor or a placental estrogen deficiency. As pregnancy progresses past 40 weeks, amniotic fluid levels decrease from 500-1000 ml to around 400 ml by 42-43 weeks. This decrease in amniotic fluid can lead to compression of the umbilical cord and reduced blood flow to the fetus, resulting in potential complications like meconium aspiration, hypoglycemia, or polycythemia in the fetus. If left untreated, this condition known as dysmaturity syndrome can occur in 1-2% of postmature fetuses and cause skin changes,
Postterm pregnancy & induction of labor
This document summarizes information about post-term pregnancy and induction of labor. It defines post-term pregnancy as beyond 42 weeks gestation, which increases risks of complications. Induction of labor is commonly recommended between 41-42 weeks to reduce risks. Common methods of induction include amniotomy, prostaglandins like misoprostol, and oxytocin infusion. Risks of induction include greater pain, uterine hyperstimulation, and potential need for C-section if induction fails. Accurate dating and fetal surveillance are important aspects of managing post-term pregnancies.
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Infant of diabetic mother
Gestational diabetes can cause complications in infants due to hyperglycemia transferring through the placenta. Infants of diabetic mothers (IDMs) are at risk for birth defects if hyperglycemia occurs early in pregnancy during organ development. Later hyperglycemia increases risks for macrosomia, hypoglycemia, and other issues. IDMs require careful monitoring and treatment of potential complications in the neonatal period such as hypoglycemia, hypocalcemia, respiratory distress, and cardiomyopathy. Long term, IDMs have increased risk of obesity, diabetes, and developmental or cognitive delays.
Preterm
This document defines a preterm neonate as any baby born before 37 weeks of gestation. It discusses the causes of preterm birth including health issues in the mother and multiple pregnancies. It describes the physical characteristics of preterm infants such as small size, thin skin, and underdeveloped organs. Complications of preterm birth are outlined involving the respiratory, cardiovascular, gastrointestinal and neurological systems. The management of preterm labor and care of preterm newborns is summarized including monitoring for common problems like infections, breathing issues, and nutritional deficiencies.
Prematurity
This document discusses prematurity and its management. It defines prematurity as infants born before 37 weeks gestation. The main causes of prematurity include fetal, placental, uterine and maternal factors. Key aspects of management include antenatal corticosteroids to aid lung development, careful temperature and fluid regulation, early nutrition including breastmilk, and monitoring for respiratory, cardiac and neurological complications which are common in premature infants. The goal of management is to provide supportive care until organs are developed enough for survival outside the womb.
Infant of a diabetic mother
This document discusses the infant of a diabetic mother. It begins with an introduction stating that diabetes is a common complication of pregnancy and risks to the infant have decreased but still exist. It then covers pathophysiology, epidemiology, complications, management, and prognosis. Key points include: fetal macrosomia is a risk; hypoglycemia is common due to hyperinsulinemia; other risks include hypocalcemia, hypomagnesemia, and congenital heart defects. Management involves monitoring glucose and electrolytes along with imaging tests. Treatment focuses on maintaining normal glucose during labor and delivery along with early breastfeeding to prevent hypoglycemia. Prognosis is generally good but neurodevelopmental risks exist if maternal glucose control was
Respiratory distress in newborn
A preterm newborn developed respiratory distress soon after birth, with signs including grunting and cyanosis. Evaluation found respiratory distress syndrome (RDS). The baby was treated with nasal CPAP, surfactant, and mechanical ventilation. RDS is caused by surfactant deficiency in premature infants, resulting in alveolar collapse and impaired gas exchange. Management includes respiratory support, surfactant replacement therapy, and care to prevent complications.
Birth injuries
This document discusses various types of birth injuries that can occur during labor and delivery. It begins by defining birth injuries and noting their prevalence. It then covers predisposing risk factors and provides a classification system for birth injuries involving soft tissue, the head/neck, facial structures, nerves, fractures, and internal organs. The remainder of the document delves into specific injury types like brachial plexus palsy, skull fractures, retinal hemorrhages, and clavicle fractures, describing their causes, signs/symptoms, diagnosis, and management.
Perinatal asphyxia in Neonatal
This document discusses perinatal asphyxia, also known as hypoxic-ischemic encephalopathy. It is caused by lack of oxygen and/or lack of blood flow to the fetus or newborn. This can result from factors like maternal hypertension, diabetes, or difficult labor. It commonly causes brain injury, heart and lung issues, and can lead to long term effects like cerebral palsy or intellectual disability. Diagnosis involves assessing for problems during pregnancy and labor. Treatment focuses on restoring oxygen and blood flow levels, controlling seizures, and addressing other systemic effects to prevent long term complications.
Apnea of prematurity
Apnea of prematurity is common in neonates born before 32 weeks gestation or weighing less than 1000g, with rates as high as 54% in infants born at 30-31 weeks and nearly 100% in infants born below 29 weeks or weighing less than 1000g. Apnea can be classified as central, obstructive, or mixed based on whether there is absence of respiratory effort or upper airway obstruction. Common causes include infection, neurological or cardiovascular issues, pulmonary problems, inborn errors of metabolism, metabolic or hematological conditions, gastrointestinal issues, problems with temperature regulation, and drugs. Evaluation may include investigations and treatment involves general measures as well as specific measures and emergency treatment if needed. Methylxanthines are commonly
Premature baby
Babies born before 37 weeks of gestation are considered premature. Premature babies often require care in a Neonatal Intensive Care Unit (NICU) as their organs are not fully developed. In the NICU, premature babies receive monitoring, respiratory support if needed, and are fed through tubes or IVs initially. Kangaroo care, where the baby is held skin to skin, helps with temperature regulation, breastfeeding, and weight gain. As the baby develops, parents can help with diaper changes, baths, and taking temperatures. The goal is for the baby to gain weight and develop enough to be able to eat and breathe on their own.
Thermoregulation in newborn
Thermal care is central to reducing morbidity and mortality in newborns. Thermoregulation is the ability to balance heat production and heat loss in order to maintain body temperature within a certain normal range. The average “normal” axillary temperature is considered to be 37°C
Meconium aspiration syndrome
Meconium aspiration syndrome (MAS) occurs when an infant aspirates meconium during delivery or birth, leading to respiratory distress. Risk factors include post-term pregnancy or conditions that cause fetal stress. Affected infants experience respiratory distress, often requiring oxygen therapy, CPAP, or mechanical ventilation. Complications can include air leaks, pulmonary hypertension, or long-term lung issues. Treatment focuses on clearing meconium from the airways, managing respiratory support and oxygen needs, and treating complications like infections or pulmonary hypertension. Prevention strategies center on monitoring high risk pregnancies and potentially inducing labor or performing C-sections before complications arise.
NEONATAL RESPIRATORY DISTRESS SYNDROME
Neonatal acute respiratory distress syndrome (RDS) is caused by surfactant deficiency in premature infants. Surfactant is produced in the lungs beginning at 24 weeks gestation and helps lower surface tension to prevent alveolar collapse. Preemies are at risk for RDS due to incomplete lung development and surfactant production. Treatment includes supportive care like CPAP, surfactant replacement therapy, and mechanical ventilation if needed. With treatment and lung maturation, symptoms typically improve within 3-5 days.
NEONATAL SEPSIS
This document provides information about neonatal sepsis, including its definition, classification, causes, risk factors, clinical features, diagnostic tests, management, and prevention. Some key points:
- Neonatal sepsis is a systemic bacterial infection occurring in newborns, defined as a positive blood culture within the first month of life. It is a major cause of neonatal mortality and morbidity.
- It can be classified as early-onset (before 72 hours of life) or late-onset (after 72 hours) sepsis. Early onset is usually caused by maternal genital tract bacteria, while late onset is caused by environmental and healthcare-associated bacteria.
- Risk factors include prematurity, prolonged rupture of membranes, chorio
Bronchopulmonary Dysplasia
This document discusses bronchopulmonary dysplasia (BPD), a chronic lung disease that occurs in premature infants requiring respiratory support. It covers the definition, risk factors, pathogenesis, clinical features, prevention, and treatment of BPD. The definition has evolved over time from relying solely on oxygen need at 28 days to incorporating factors like oxygen need, pressure support, and gestational age. BPD results from lung injury and disrupted lung development due to prematurity and respiratory support. Management aims to protect the lung from injury through gentle ventilation, optimal oxygen levels, and other strategies.
Neonatal thermoregulation
This document discusses the history and physiology of neonatal thermoregulation. It begins with the history of incubation from ancient Egypt and its application to premature infants in the 1800s. Key concepts discussed include the thermoneutral zone, factors affecting an infant's susceptibility to temperature changes, and the physiology of thermoregulation including brown adipose tissue. The document also covers the prevention, signs, and management of hypothermia in infants.
Induction of labor
This document discusses induction of labor. It begins by defining induction of labor and listing its objectives. It then covers the indications and contraindications for induction, including maternal and fetal indications. It describes methods of induction, including natural non-medical methods, mechanical methods like hygroscopic dilators and balloon catheters, surgical methods like membrane stripping and amniotomy, and pharmacological methods using prostaglandins, misoprostol, mifepristone, and oxytocin. It provides details on techniques and risks of different methods. It emphasizes monitoring during inductions and lists side effects of pharmacological agents. The overall document is a guide for health professionals on selecting and performing appropriate induction methods for individual patients.
Unstable lie
This document discusses unstable lie and version in pregnancy. It defines unstable lie as a condition where the fetal presentation constantly changes beyond 36 weeks of pregnancy when it should have stabilized. Causes include factors that prevent the presenting part from remaining fixed in the lower uterus. Complications include cord entanglement and increased risk of perinatal death. External cephalic version can be attempted to correct the malpresentation if there are no contraindications. Hospitalization is recommended at 37 weeks to monitor for premature rupture of membranes or cord prolapse. Elective c-section is often required, especially if complicating factors are present.
congenital pneumonia
1. Pneumonia is an inflammatory process in the lungs that can be caused by infection or other inflammatory conditions. It causes abnormalities in lung ventilation and gas exchange.
2. Congenital pneumonia specifically refers to pneumonia that is present at birth, usually caused by viral or bacterial infections transmitted from the mother. These infections can pose serious challenges to the immature newborn.
3. Pneumonia is a major cause of neonatal mortality worldwide. It requires prompt diagnosis and treatment including antibiotics, respiratory support, and careful management of cardiac and respiratory functions to prevent complications and ensure infant survival.
Developmentally supportive neonatal care
This document discusses developmentally supportive care in the NICU. It describes how the NICU environment has transitioned from a technology-oriented space that could overstimulate or deprive infants to one that aims to mimic the womb and support brain development. It outlines principles of developmentally supportive care like NICU design, positioning, handling infants, and parental participation. Interventions like kangaroo care, non-nutritive sucking, massage therapy, and multimodal stimulation are described that aim to properly stimulate infant senses and support physiology and behavior.
HIE
1) Hypoxic-ischemic encephalopathy (HIE) is brain injury caused by lack of oxygen and blood flow before, during, or after birth. It remains a serious condition that can cause death or long-term disabilities like cerebral palsy or intellectual impairment.
2) The document discusses the definition, risk factors, pathophysiology, clinical features based on the Sarnat staging system, diagnosis using imaging and EEG, and treatment approaches for HIE including supportive care, perfusion management, anti-seizure medications, and therapeutic hypothermia.
3) The goal of treatment is to prevent further brain injury by maintaining appropriate oxygenation, blood pressure, glucose levels, and treating seizures
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Prolonged pregnancy
Prolonged pregnancy refers to gestation lasting 42 weeks or more. The cause is still unknown, but it may be related to changes in the fetal brain that initiate labor or a placental estrogen deficiency. As pregnancy progresses past 40 weeks, amniotic fluid levels decrease from 500-1000 ml to around 400 ml by 42-43 weeks. This decrease in amniotic fluid can lead to compression of the umbilical cord and reduced blood flow to the fetus, resulting in potential complications like meconium aspiration, hypoglycemia, or polycythemia in the fetus. If left untreated, this condition known as dysmaturity syndrome can occur in 1-2% of postmature fetuses and cause skin changes,
Postterm pregnancy & induction of labor
This document summarizes information about post-term pregnancy and induction of labor. It defines post-term pregnancy as beyond 42 weeks gestation, which increases risks of complications. Induction of labor is commonly recommended between 41-42 weeks to reduce risks. Common methods of induction include amniotomy, prostaglandins like misoprostol, and oxytocin infusion. Risks of induction include greater pain, uterine hyperstimulation, and potential need for C-section if induction fails. Accurate dating and fetal surveillance are important aspects of managing post-term pregnancies.
preterm and postterm labour
This document provides information on preterm and post-term labor. It defines preterm labor as onset of labor before 37 weeks of gestation and discusses the main risk factors, diagnosis, and management. Diagnosis requires documentation of regular contractions and cervical changes. Tocolytics and steroids are used to delay delivery. For post-term labor, it defines this as pregnancy exceeding 42 weeks and notes the risks include macrosomia, dystocia, and complications of prolonged labor. Conservative management or induction is recommended depending on cervical status and fetal well-being.
Postdate pregnancy
- Induction of labor is recommended for post-term pregnancies (greater than 42 weeks) due to increased risks of complications. Risks increase further as pregnancy progresses beyond 42 weeks.
- For low-risk pregnancies between 41-42 weeks, induction can be considered but is not necessarily recommended since perinatal outcomes do not significantly differ from 40-41 weeks. The risks and benefits should be discussed with the patient.
- Fetal surveillance with non-stress tests and ultrasound amniotic fluid measurements twice weekly is recommended for pregnancies beyond 42 weeks declining induction. Delivery is recommended if any test results cause concern for the fetal environment.
Post- term pregnancy
This document discusses post-term pregnancy, which is defined as pregnancy extending beyond 42 weeks from the last menstrual period. Risks to the fetus include doubling of perinatal mortality and risks to the mother include increased risk of labor abnormalities and cesarean delivery. The preferred course of management is induction of labor between 41-42 weeks, as this is supported by evidence of reduced perinatal mortality, morbidity and cesarean section rates. Membrane sweeping can also be used to prevent post-term pregnancy by reducing the percentage of patients going past term.
Management-of-Postterm-Pregnancy
Management of postterm pregnancy involves balancing risks to the fetus and mother. Postterm is defined as past 42 weeks gestation. Accurately dating the pregnancy is important to avoid false diagnosis. Risks to the fetus include stillbirth, meconium aspiration, and macrosomia. Risks to the mother include dystocia and infection. Studies show inducing labor at 41 weeks reduces stillbirths without increasing C-sections. Methods of antenatal testing after 41 weeks are debated, though monitoring is recommended. While an unfavorable cervix was viewed as a risk factor for C-section, recent evidence suggests underlying issues may be more important. Further research is needed to determine the optimal time for induction to minimize risks
Prolonged pregnancy
This document discusses prolonged pregnancy, defined as continuing past 42 weeks of gestation. Risks to the fetus include stillbirth, distress, injuries from large size, and meconium-related issues. Maternal risks include anxiety, operative delivery, and infection. Management involves expectant monitoring with tests like CTG and ultrasound or inducing labor. Induction methods include membrane sweeping, amniotomy, prostaglandins like misoprostol, and oxytocin. Caesarean section is indicated if monitoring finds issues or induction fails. Guidelines recommend offering induction from 41 weeks onward.
post date pregnancy
This document discusses prolonged or postterm pregnancy, defined as lasting longer than 42 weeks. Key points include:
- The incidence of postterm pregnancy varies depending on whether it is determined by last menstrual period (LMP), ultrasound, or both, ranging from 7.5% to 1.1%.
- Most postterm pregnancies (87%) deliver spontaneously in the 42nd week. Risk of adverse events doubles compared to a term delivery.
- Accurate dating is important to determine postterm status, and an ultrasound dating more than 7 days different than LMP-based dating requires further evaluation.
- Causes of postterm pregnancy include errors in dating, primiparity, previous prolonged pregnancies
Post term pregnancy
A post-term pregnancy persists 42 weeks or more from the last menstrual period. It occurs in 5-10% of pregnancies and is more common in first-time mothers. Risks include placental insufficiency, low amniotic fluid levels, and difficult labor due to an oversized baby with a more calcified skull. Diagnosis involves assessing gestational age, ultrasound measurements of fetal size and amniotic fluid levels, and tests of placental function. Management seeks to induce labor if safe for vaginal delivery, or perform a Caesarean section if conditions are not suitable for induction or it fails.
Post term pregnancy
This document discusses post-term pregnancy, which is defined as a pregnancy extending beyond 42 weeks of gestation. Risks of post-term pregnancy include fetal complications like meconium aspiration and fetal distress as well as maternal risks such as increased need for instrumental or cesarean delivery. Diagnosis involves assessing factors like menstrual history, fundal height, and ultrasound evaluations. Management may involve expectant monitoring for low-risk cases or induction of labor for cases with complications or signs of fetal distress.
Post term pregnancy
Post-term pregnancy is defined as exceeding 40 weeks of gestation. It occurs in 5-10% of pregnancies, often due to inaccurate gestational age calculation. Both mother and baby are at increased risk of complications like dystocia, meconium aspiration, stillbirth. Management includes assessing gestational age accurately, monitoring the fetus, and inducing labor between 41-42 weeks to prevent risks of post-term pregnancy. Intrauterine fetal death is the death of a fetus before delivery. It can result from maternal, fetal or obstetric complications. Evaluation includes detailed history, examinations, and tests to determine the cause to help counsel patients and prevent future recurrence.
Preterm labour
Preterm labor is defined as the onset of labor before 37 weeks of gestation. It can be spontaneous or medically indicated and accounts for a majority of neonatal deaths and disabilities. Risk factors include multiple pregnancies, infections, cervical insufficiency, and genetic factors. Management involves tocolytic drugs to delay labor, corticosteroids to improve neonatal outcomes, and careful fetal monitoring during labor. Prematurity and its complications remain a major challenge in obstetrics.
Care of preterm babies
This document discusses the care of preterm babies. Key points include:
- Preterm babies are born before 37 weeks gestation and have low birth weight, immature organ systems, and are susceptible to complications.
- Care involves temperature regulation, appropriate feeding, monitoring for complications like respiratory distress and infections.
- Feeding may begin with intravenous fluids or a nasogastric tube and progress to breastfeeding. Nutritional needs for protein, carbohydrates, fats, vitamins and minerals must be met.
- Ongoing monitoring of vital signs and development is needed to detect any issues and provide appropriate treatment and care. Immunizations should also be given according to schedule.
Preterm babies..............
This document discusses preterm and low birth weight infants. Key points include:
- Birth weight below 2,500g is considered low birth weight, which can be due to prematurity or restricted growth.
- Preterm infants are born before 38 weeks gestation and have increased risks due to anatomical and functional immaturity.
- Indian preterm rates are higher than Western countries. Prematurity is associated with numerous socioeconomic factors.
- Preterm infants require specialized care in the NICU to address physiological immaturity of organ systems and higher risks of complications like respiratory distress and infections.
- Growth, feeding tolerance, vital signs stability and weight gain are monitored as indicators of preterm infant health and readiness for
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Management of Preterm And Low Birth Weight
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Definitions
Prevalent
Etiology
Assessment of gestational age
Problems of prematurity
Management
Antenatal (Prevention)
Natal (Delivery room care)
Post natal (after birth care)
Prognosis
Discharge criteria
Definitions
Term?
Preterm?
Immature?
LBW? VLBW?ELBW? ILBW?
SGA?
IUGR?
Gestational Age
Full-term
infant born after 37 completed menstrual weeks of pregnancy
Preterm (or premature) infant
infant born before 37 completed weeks of gestation
Late preterm infant (a recently identified category)
infant born between 34 and 36 weeks gestation
Moderately preterm infant
infant born between 32 and 34 completed weeks of gestation
Very preterm infant/ Early preterm
infant born before 32 completed weeks of gestation
Immature < 28 weeks
ELGAN: Extremely Low Gestational Age Newborn < 26 weeks
Weight
Low birth weight (LBW)
infant who weighs less than 2,500 grams at delivery
Very low birth weight (VLBW)
infant who weighs less than 1,500 grams at delivery
Extremely low birth weight (ELBW)
infant who weighs less than 1,000 grams at delivery
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Complications of prematurity
- 1. Complications of prematurity Jessica Peter Roscoe
- 2. Contents... ➢Classifying prematurity ➢Case study ➢Causes ➢Acute complications ➢Chronic complications ➢Prevention
- 3. Classifying prematurity... ➢Delivery prior to 36 weeks, 6 days ➢Incidence of 8-10% ➢Varies with socio-economic status
- 4. Considering a fictitious case...
- 5. ➢Daniel, 16 months ➢23 + 6 ➢Ten weeks in NICU ➢On permanent oxygen with bronchopulmonary dysplasia ➢Developmental delay - adjusted age
- 6. Causes/predictors... ➢ Family history/previous preterm (Daniel) ➢ Placental factors ➢ Cervical factors ➢ Social factors ➢ Maternal illness ➢ Fetal factors ➢ Idiopathic ➢ Iatrogenic
- 7. Acute complications ➢ Death (7.2% of live births are preterm, only 53% of these children survive) ➢ Neurological problems ➢ Infections ➢ Respiratory problems ➢ Gastrointestinal problems ➢ Haematological problems
- 8. Chronic complications ➢Cognitive - Learning disabilities ➢Respiratory - Bronchopulmonary dysplasia ➢Movement - cerebral palsy ➢Eyes - retinopathy of prematurity ➢Behavioural/psychological problems
- 9. Bronchopulmonary dysplasia ➢Iatrogenic chronic lung disease ➢Ventilation & supplementary oxygen ➢Arrested lung development ➢Mild, moderate, severe ➢Some may need tracheostomy ➢Recurrent infections/hospital admissions
- 10. Daniels X-ray ➢ Hyperinflation ➢ Fibrosis ➢ Sometimes atelectasis ➢ Typically symptoms gradually resolve (severity dependent)
- 11. How do we prevent prematurity?
- 12. Prevention... ➢Antibiotics for infections ➢IVF limits ➢Cervical cerclage
- 13. Any Questions?
Editor's Notes
- I wanted to talk about something that might be relevant to our exams - some of this will be revision. So, complications of prematurity.
- The earliest premature baby to survive was James Gill in 1987 - weighed 0.9 ounces at birth, born 21 weeks, 5 days.
- Daniel, 16 months old. One of three children - his siblings 2 and 5 yo have severe disabilities. Born at 23 plus 6. Daniel is a good example of how babies can be born extremely prematurely yet still survive.
- Social factors include maternal stress, smoking, substance abuse and there is a link with poverty.
- The likelihood of survival increases by 9.5% for every week gestation after 24weeks. NEUROLOGICAL Problems - apnoea of prematurity, HIE, retinopathy, developmental delay, cerebral palsy INFECTIONS may be more severe as babys immune system is premature so they’re more susceptable to things like UTIs, pmeumonia. Respiratory problems - respiratory distress due to lack of surfactant. Gastrointestinal problems - premature babies are morelikely to get nec. enterocollitis and neonatal hypoglycaemia. HAEM PROBLEMS - anaemia of prematurity, neonatal jaundice - phototherapy disrupts bonding
- I just wanted to add a slide in about BPD as this is Daniels main health issue.
- Preventing pretermbirths is very difficult, things that are thought to help………… avoiding smoking, good nutrition,