This set of ppt displays a short description about IVH and Pulmonary hemorrhage its causes, grades, pathophysiology related to it, management and the prognosis in paediatric population.
This presentation discusses cranial hemorrhage in a newborn baby. We have included extracranial and intracranial bleed discussion in neonates. Intraventricular hemorrhage (IVH) is further discussed in details in terms of pathophysiology, management strategies and clinical studies related to it.
Hope this presentation is helpful for the knowledge and practice of medical students, pediatricians and neonatologists and helps in practical management of your NICU babies as well.
This presentation discusses cranial hemorrhage in a newborn baby. We have included extracranial and intracranial bleed discussion in neonates. Intraventricular hemorrhage (IVH) is further discussed in details in terms of pathophysiology, management strategies and clinical studies related to it.
Hope this presentation is helpful for the knowledge and practice of medical students, pediatricians and neonatologists and helps in practical management of your NICU babies as well.
Neonatal necrotizing enterocolitis
NEC is the most common life-threatening emergency of the gastrointestinal tract in the newborn period. The disease is characterized by various degrees of mucosal or transmural necrosis of the intestine. The cause of NEC remains unclear but is most likely multifactorial. The incidence of NEC is 1-5% of infants in neonatal intensive care units (NICUs). Both incidence and case fatality rates increase with decreasing birthweight and gestational age. Because very small, ill preterm infants are particularly susceptible to NEC, a rising incidence may reflect improved survival of this high-risk group of patients.
Clinical Manifestations
Infants with NEC have a variety of signs and symptoms and may have an insidious or sudden catastrophic onset (Table 96-1). The onset of NEC is usually in the 2nd or 3rd week of life but can be as late as 3 mo in VLBW infants. Age of onset is inversely related to gestational age. The 1st signs of impending disease may be nonspecific, including lethargy and temperature instability, or related to gastrointestinal pathology, such as abdominal distention and gastric retention. Obvious bloody stools are seen in 25% of patients. Because of nonspecific signs, sepsis may be suspected before NEC. The spectrum of illness is broad, ranging from mild disease with only guaiac-positive stools to severe illness with bowel perforation, peritonitis, systemic inflammatory response syndrome, shock, and death. Progression may be rapid, but it is unusual for the disease to progress from mild to severe after 72 hr.
Diagnosis
A very high index of suspicion in treating preterm at-risk infants is crucial. Plain abdominal radiographs are essential to make a diagnosis of NEC. The finding of pneumatosis intestinalis (air in the bowel wall) confirms the clinical suspicion of NEC and is diagnostic; 50-75% of patients have pneumatosis when treatment is started (Fig. 96-4). Portal venous gas is a sign of severe disease, and pneumoperitoneum indicates a perforation (Figs. 96-4 and 96-5). Hepatic ultrasonography may detect portal venous gas despite normal abdominal roentgenograms .
Management of hypoxic ischemic encephalopathy (HIE) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Management of hypoxic ischemic encephalopathy (HIE) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
This presentation aims at discussion of the pathophysiology , clinical presentation and management of the different types of intracranial bleeds in a neonate. Special emphasis has been laid on intraventricular hemorrhage. The germinal matrix bleed in a preterm is discussed in depth along with the various evidence based management protocols available. Radiological diagnosis of IVH in a preterm / term baby will be discussed in the upcoming presentations.
An impairment of the infants body function or structure due to adverse influences that occur at birth. Injuries to the infant may result from mechanical forces (i.e., compression, traction) during the birth process. 0.7% (Seven of every 1,000) births result in birth injuries, though most women give birth in modern hospitals surrounded by medical professionals. Birth injuries account for fewer than 2% of neonatal deaths. Infant mortality resulting from birth trauma fell from 64.2 to 7.5 deaths per 100,000 live births from 1970-1985. Birth injuries can be classified to Soft tissue injuries, Head and neck injuries, Facial injuries, Cranial nerve injuries, Spinal cord injuries, Peripheral Nerve injury, Fractures & Torticollis, Intra-abdominal injury. Proper management neccissates, early recognition of trauma, Careful physical and neurological evaluation, Establish whether additional injuries exist, Injury may result from resuscitation, Assess Symmetry of structure & function, Specific examination such as cranial nerve, joint range of motion, scalp/skull integrity.
Neonatal necrotizing enterocolitis
NEC is the most common life-threatening emergency of the gastrointestinal tract in the newborn period. The disease is characterized by various degrees of mucosal or transmural necrosis of the intestine. The cause of NEC remains unclear but is most likely multifactorial. The incidence of NEC is 1-5% of infants in neonatal intensive care units (NICUs). Both incidence and case fatality rates increase with decreasing birthweight and gestational age. Because very small, ill preterm infants are particularly susceptible to NEC, a rising incidence may reflect improved survival of this high-risk group of patients.
Clinical Manifestations
Infants with NEC have a variety of signs and symptoms and may have an insidious or sudden catastrophic onset (Table 96-1). The onset of NEC is usually in the 2nd or 3rd week of life but can be as late as 3 mo in VLBW infants. Age of onset is inversely related to gestational age. The 1st signs of impending disease may be nonspecific, including lethargy and temperature instability, or related to gastrointestinal pathology, such as abdominal distention and gastric retention. Obvious bloody stools are seen in 25% of patients. Because of nonspecific signs, sepsis may be suspected before NEC. The spectrum of illness is broad, ranging from mild disease with only guaiac-positive stools to severe illness with bowel perforation, peritonitis, systemic inflammatory response syndrome, shock, and death. Progression may be rapid, but it is unusual for the disease to progress from mild to severe after 72 hr.
Diagnosis
A very high index of suspicion in treating preterm at-risk infants is crucial. Plain abdominal radiographs are essential to make a diagnosis of NEC. The finding of pneumatosis intestinalis (air in the bowel wall) confirms the clinical suspicion of NEC and is diagnostic; 50-75% of patients have pneumatosis when treatment is started (Fig. 96-4). Portal venous gas is a sign of severe disease, and pneumoperitoneum indicates a perforation (Figs. 96-4 and 96-5). Hepatic ultrasonography may detect portal venous gas despite normal abdominal roentgenograms .
Management of hypoxic ischemic encephalopathy (HIE) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Management of hypoxic ischemic encephalopathy (HIE) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
This presentation aims at discussion of the pathophysiology , clinical presentation and management of the different types of intracranial bleeds in a neonate. Special emphasis has been laid on intraventricular hemorrhage. The germinal matrix bleed in a preterm is discussed in depth along with the various evidence based management protocols available. Radiological diagnosis of IVH in a preterm / term baby will be discussed in the upcoming presentations.
An impairment of the infants body function or structure due to adverse influences that occur at birth. Injuries to the infant may result from mechanical forces (i.e., compression, traction) during the birth process. 0.7% (Seven of every 1,000) births result in birth injuries, though most women give birth in modern hospitals surrounded by medical professionals. Birth injuries account for fewer than 2% of neonatal deaths. Infant mortality resulting from birth trauma fell from 64.2 to 7.5 deaths per 100,000 live births from 1970-1985. Birth injuries can be classified to Soft tissue injuries, Head and neck injuries, Facial injuries, Cranial nerve injuries, Spinal cord injuries, Peripheral Nerve injury, Fractures & Torticollis, Intra-abdominal injury. Proper management neccissates, early recognition of trauma, Careful physical and neurological evaluation, Establish whether additional injuries exist, Injury may result from resuscitation, Assess Symmetry of structure & function, Specific examination such as cranial nerve, joint range of motion, scalp/skull integrity.
congenital heart disease is a heart defect, it is caused by the exposure of teracogenic substances during pregnancy ,it may lead to the congenital defect .
Hydrocephalous is a serious disease of the central nervous system which has both congenital and aquired subtypes. the congenital variety affects the children and is a considerable burden especially is the developing countries. I tleads to long term morbidity and high rates of mortality
Intracranial hemorrhage (ICH) refers to acute bleeding inside skull or brain. It’s a life-threatening emergency.
An intracranial hematoma is a collection of blood within the skull, most commonly caused by rupture of a blood vessel within the brain or from trauma such as a car accident or fall. The blood collection can be within the brain tissue or underneath the skull, pressing on the brain.
Intracranial hemorrhage refers to any bleeding within the intracranial vault, including the brain parenchyma and surrounding meningeal spaces.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
2. Introduction
• Intraventricular hemorrhage (IVH) of the
newborn is bleeding into the fluid-filled areas
(ventricles) inside the brain.
• The condition occurs most often in babies that
are premature
3. Causes
IVH is more common in premature babies with:
• Respiratory distress syndrome
• Unstable blood pressure
• Other medical conditions at birth
Infants born more than 10 weeks early are at
highest risk for this type of bleeding.
4. Grades
1. Grade1:Isolated Germinal Matrix Hemorrhage-
restricted to subependymal region
2. Grade2:IVH without ventricular dilatation-
extension into the normal sized ventricles. Fills
<50% of the volume of ventriclres.
3. Grade3:IVH with ventricular dilatation-
extension into dilated ventricles
4. Grade4:IVH with Parenchymal Extension-
extension into the parenchyma. Blood clots can
form and block the flow of CSF leading to
Hydrocephalus.
5. Symptoms
There may be no symptoms. The most common
symptoms seen in premature infants include:
• Breathing pauses (apnea)
• Changes in blood pressure and heart rate
• Decreased muscle tone
• Decreased reflexes
• Excessive sleep
• Lethargy
• Weak suck
• Seizures and other abnormal movements
6. Diagnosis
• All babies born before 30 weeks should have
an ultrasound of the head to screen for IVH.
The test is done in the 1 to 2 weeks of life.
Babies born between 30 to 34 weeks may also
have ultrasound screening if they have
symptoms of the problem.
• A second screening ultrasound may be done
around the time the baby was originally
expected to be born (the due date).
7. Management
• There is no way to stop bleeding associated with
IVH.
• Effort is made to keep the infant stable and treat
any symptoms.
• For example, a blood transfusion may be given to
improve blood pressure and blood count.
• If fluid builds up to the point that there is concern
about pressure on the brain, a spinal tap may be
done to drain fluid and try to relieve pressure.
• If this helps, surgery may be needed to place a
tube (shunt) in the brain to drain fluid.
8. Prevention
• Pregnant women who are at high risk of
delivering early should be given corticosteroids.
These drugs can help reduce the baby's risk for
IVH.
• Women who are on medicines that affect
bleeding risks should get vitamin K before
delivery.
• Premature babies whose umbilical cords are not
clamped right away have less risk of IVH.
• Premature babies who are born in a hospital with
a NICU and do not have to be transported after
birth also have less risk of IVH.
9. Prognosis
• Depends on how premature the baby is and
the grade of the hemorrhage.
• Less than half of babies with lower-grade
bleeding have long term problems.
• Severe bleeding often leads to developmental
delays and problems controlling movement.
10. Journal information
• A study on Intraventricular Hemorrhage and
Neurodevelopmental Outcomes in Extreme
Preterm Infants revealed that Grade I–II IVH,
even with no documented white matter injury
or other late ultrasound abnormalities, is
associated with adverse neurodevelopmental
outcomes in extremely preterm infants.
12. Definition
• Pulmonary hemorrhage (P-Hem) is an acute,
catastrophic event characterized by discharge
of bloody fluid from the upper respiratory
tract or the endotracheal tube.
• P-Hem is usually massive, is associated with
bleeding in other sites, involves more than
one third of the lungs, and has a high
mortality rate.
13. Statistics
• The incidence of P-Hem is 1 in 1,000 live
births. P-Hem is present in 7 to 10% of
neonatal autopsies, but up to 80% of
autopsies of very preterm infants.
14. Etiology
• Prematurity is the factor most commonly associated with P-
Hem
• Factors that favor increased filtration of fluid from
pulmonary capillaries (e.g., low concentration of plasma
proteins, high alveolar surface tension, lung damage,
hypervolemia).
• Other associated factors are those that predispose to
perinatal asphyxia or bleeding disorders, including
o toxemia of pregnancy
o maternal cocaine use
o erythroblastosis fetalis
o breech delivery, hypothermia
o Infection
o Respiratory Distress Syndrome
o administration of exogenous surfactant (in some studies)
o ECMO.
16. Clinical features
• Oozing of bloody fluid from the nose and
mouth or endotracheal tube with
• Rapid worsening of the respiratory status
• Cyanosis
• Shock
• Bleeding may be noted from other sites
17. Diagnosis
• Radiographic findings range from patchy
infiltrates to complete opacification of lung
fields.
• Hematocrit of the P-Hem fluid is usually 15 to
20% less than blood
18. Management
• Tracheal suction
• Oxygen and positive pressure ventilation.
• To assist in decreasing P-Hem, mean airway
pressure should be increased, either by a
relatively high PEEP (i.e., 6 to 10 cmH2O) or by
high frequency ventilation.
• Correct underlying abnormalities, especially
disorders of coagulation.
• When blood loss is large, prompt blood
transfusion may be needed to maintain an
adequate circulating blood volume.
19. Journal information
• Pulmonary hemorrhage in premature infants after
treatment with synthetic surfactant: An autopsy evaluation
• This study says that Pulmonary hemorrhage was present in
55% of 159 infants undergoing autopsy
• the incidence was not different in infants treated with
surfactant or air placebo.
• Birth weight was inversely related to the incidence of
pulmonary hemorrhage in both groups.
• Pulmonary pathologic findings significantly associated with
pulmonary hemorrhage included pulmonary interstitial
emphysema and necrotizing laryngotracheitis in both
groups.
• In the surfactant group, patent ductus arteriosus,
intraventricular hemorrhage, and pneumothorax were
significantly more frequent among those who developed
pulmonary hemorrhage.