This document discusses apnea of prematurity, which is more common in preterm infants and involves cessation of breathing. It defines apnea and describes the different types - obstructive, central, and mixed. Potential causes are discussed along with clinical manifestations. Treatment typically involves cardiorespiratory monitoring, stimulation, caffeine/theophylline, CPAP, or doxapram. Prognosis is generally good unless apnea is severe and refractory. The document also discusses SIDS and notes that while preterm infants are at higher risk, apnea of prematurity itself is not a risk factor.
Health Assessment of the Newborn
The newborn requires thorough skilled observation to ensure a satisfactory adjustment to extra uterine life.
Health assessment of newborn after delivery can be divided into:
1. Initial Assessment
2. Transitional Assessment
3. Assessment of gestational age
4. Behavioural asessment
5. Systemic physical examination
Initial Assessment:
Initial assessment is done by using the APGAR scoring system.
APGAR score: It is method use to assess the newborn’s immediate adjustment to extra uterine life.
• The score based on five signs
1. Appearance (colour)
2. Pulse (Heart rate)
3. Grimace (Reflex irritability )
4. Activity (Muscle tone)
5. Respiratory rate
• Each item is given a score 0, 1, or 2
• 0-3 severe distress
• 4-6 moderate difficulty
• 7-10 no difficulty adjusting to life
• Evaluations of all five categories are made on 1-5 min after birth.
APGAR score:
Sign 0 1 2
Appearance (colour) Blue or pale Body pink, Extrimities Blue Completely Pink
Pulse (Heart rate) Absent Slow (<100 /> 100/m
Grimace (Reflex irritability ) No response Grimace Cough Or Sneeze
Activity(Muscle tone Limp Some flexion Active movement
Respiratory rate Absent Slow, Irregular Good, Crying
Other initial assessment are-
• Stabilization
• Measuring weight.
Transitional Assessment during the period of reactivity
First period of reactivity (6- 8 hours after birth):
During the first 30 minutes the newborn is very alert, cries vigorously, may suck a first greedily, and appears very interested in the environment. Physiologically the respiratory rate can be as high as 80 breaths/ min, crackles may be heard, heart rate may reach 180 beats/min, bowel sound are active, mucus secretions are increased and temperature may decrease slightly.
Second period of reactivity:
Began when the newborn awake from the deep sleep, it lasts about 2-5 hours. The newborn is alert and responsive, heart and respiratory rate are increased, gastric and respiratory secretions are increased, and passage of meconium commonly occurs.
Following this stage is a period of stabilization of physiologic systems & vacillating patern of sleep & activity.
Health Assessment of the Newborn
The newborn requires thorough skilled observation to ensure a satisfactory adjustment to extra uterine life.
Health assessment of newborn after delivery can be divided into:
1. Initial Assessment
2. Transitional Assessment
3. Assessment of gestational age
4. Behavioural asessment
5. Systemic physical examination
Initial Assessment:
Initial assessment is done by using the APGAR scoring system.
APGAR score: It is method use to assess the newborn’s immediate adjustment to extra uterine life.
• The score based on five signs
1. Appearance (colour)
2. Pulse (Heart rate)
3. Grimace (Reflex irritability )
4. Activity (Muscle tone)
5. Respiratory rate
• Each item is given a score 0, 1, or 2
• 0-3 severe distress
• 4-6 moderate difficulty
• 7-10 no difficulty adjusting to life
• Evaluations of all five categories are made on 1-5 min after birth.
APGAR score:
Sign 0 1 2
Appearance (colour) Blue or pale Body pink, Extrimities Blue Completely Pink
Pulse (Heart rate) Absent Slow (<100 /> 100/m
Grimace (Reflex irritability ) No response Grimace Cough Or Sneeze
Activity(Muscle tone Limp Some flexion Active movement
Respiratory rate Absent Slow, Irregular Good, Crying
Other initial assessment are-
• Stabilization
• Measuring weight.
Transitional Assessment during the period of reactivity
First period of reactivity (6- 8 hours after birth):
During the first 30 minutes the newborn is very alert, cries vigorously, may suck a first greedily, and appears very interested in the environment. Physiologically the respiratory rate can be as high as 80 breaths/ min, crackles may be heard, heart rate may reach 180 beats/min, bowel sound are active, mucus secretions are increased and temperature may decrease slightly.
Second period of reactivity:
Began when the newborn awake from the deep sleep, it lasts about 2-5 hours. The newborn is alert and responsive, heart and respiratory rate are increased, gastric and respiratory secretions are increased, and passage of meconium commonly occurs.
Following this stage is a period of stabilization of physiologic systems & vacillating patern of sleep & activity.
HIE has been one of the problems facing newborns due to birth asphyxia caused by variety of conditions during child birth or after childbirth, i hope the readers will learn something from the slides
Osa in children by DR shashidhar tatavarthySHASHIDHAR T B
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The prostate is an exocrine gland of the male mammalian reproductive system
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Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
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The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
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Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
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3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. PES Institute of Medical Sciences & Research
INTRODUCTION
• Apnea is more common in preterm infants.
Apnea of prematurity requires a specific
assessment and treatment.
• It is rare among full-term healthy infants and, if
present, usually indicates an underlying pathology
• Idiopathic apnea of prematurity occurs in the
absence of identifiable predisposing diseases.
• Apnea is a disorder of respiratory control and may
be: obstructive, central, or mixed.
3. PES Institute of Medical Sciences & Research
APNEA
• In infants Apnea is defined as Cessation of
breathing for longer than 20sec, or any
duration if accompanied by cyanosis and sinus
bradycardia
4. PES Institute of Medical Sciences & Research
Obstructive Apnea
• Characterized by absence of airflow but
persistent chest wall motion.
• Pharyngeal collapse may follow the negative
airway pressures generated during inspiration or it
may result from in coordination of the tongue and
other upper airway muscles involved in
maintaining airway patency.
• Pharyngeal instability, neck flexion
5. PES Institute of Medical Sciences & Research
Central Apnea
• Caused by decreased central nervous system
(CNS) stimuli to respiratory muscles.
• Both airflow and chest wall motion are absent.
• Gestational age is the most important determinant
of respiratory control, with the frequency of apnea
being inversely related to gestational age.
• The immaturity of the brainstem respiratory centers
is manifested by an attenuated response to carbon
dioxide and a paradoxical response to hypoxia that
results in apnea rather than the hyperventilation
observed after the 1st few mo of life.
6. PES Institute of Medical Sciences & Research
Mixed Apnea
• The most common pattern of idiopathic apnea in
preterm neonates (50-75%) of the cases
• Usually Obstructive apnea precedes Central apnea
• Short episodes of apnea are usually central,
whereas prolonged ones are often mixed.
• Apnea depends on the sleep state; its frequency
increases during active (rapid eye movement)
sleep.
7. PES Institute of Medical Sciences & Research
Potential Causes of Neonatal
Apnea and Bradycardia
Central nervous system Intraventricular haemorrhage,
drugs, seizures, hypoxic injury,
herniation, neuromuscular
disorders, Leigh syndrome,
brainstem infarction or anomalies
(e.g., olivopontocerebellar
atrophy), spinal cord injury after
general anaesthesia
Respiratory
Infectious
Pneumonia, obstructive airway
lesions, upper airway collapse,
atelectasis, extreme prematurity,
laryngeal reflex, phrenic nerve
paralysis, pneumothorax, hypoxia
Sepsis, meningitis (bacterial, fungal,
8. Oral feeding, bowel
movement, necrotizing
enterocolitis, intestinal
perforation
Metaboli
c
↓ Glucose, ↓ calcium, ↓/↑ sodium,
↑ ammonia, ↑ organic acids,
↑ ambient temperature,
hypothermia
Cardiovascul
ar
Hypotension, hypertension, heart
failure, anemia, hypovolemia, vagal
tone
Othe
r
Immaturity of respiratory center,
sleep state
Gastrointestin
al
9. PES Institute of Medical Sciences & Research
Clinical Manifestation
• The incidence of idiopathic apnea of prematurity
varies inversely with gestational age.
• The onset of idiopathic apnea can be during the 1st 1-
2 wk after birth but is often delayed if there is RDS
or other causes of respiratory distress.
• Apneic episodes have been noted to be as frequent on
day 1 as throughout the 1st wk in premature infants
without respiratory disease.
• The incidence of associated bradycardia increases
with the length of the preceding apnea and
correlates with the severity of hypoxia.
10. PES Institute of Medical Sciences & Research
• Short apnoea episodes (10 sec) are rarely
associated with bradycardia, whereas
longerepisodes (>20 sec) have a higher incidence of
bradycardia.
• Bradycardia follows the apnea by 1-2 sec in more
than 95% of cases and is most often sinus, but on
occasion it can be nodal.
• Vagal responses and, rarely, heart block are causes
of bradycardia without apnea.
• Short oxygen desaturation episodes noted with
oxygen saturation monitoring are normal in neonates,
and treatment is not necessary.
11. PES Institute of Medical Sciences & Research
CHEYNE-STOKES
BREATHING
Also calledas“periodicbreathing”.
This condition was named after “John Cheyne & William
Stokes”,thephysicianswho first described itin19th century.
Characterized by alternate periods of tachypnea
andapnea.
Occurs as acompensationforchanging serum pO2 &
pCO2, and classically seen in damage to pons where
resp.centersare located.
12. PES Institute of Medical Sciences & Research
TREATMENT
• Infants at risk for apnea should get cardio
respiratory monitoring.
• Gentle tactile stimulation is often adequate therapy
for mild and intermittent episodes.
• The onset of apnea in a previously well preterm
neonate after the 2nd wk of life or in a term
infant at any time is a critical event that warrants
prompt investigation.
• Recurrent apnea of prematurity may be treated
with caffeine or theophylline.
• Methylxanthines increase central respiratory drive
by lowering the threshold of response to
hypercapnia as well as enhancing contractility of
the diaphragm and preventing diaphragmatic
13. PES Institute of Medical Sciences & Research
• Caffeine and theophylline are as effective, but
caffeine has fewer side effects (less tachycardia
and feeding intolerance).
• Loading doses of 5-7 mg/kg of theophylline
(orally) or aminophylline (intravenously) should
be followed by doses of 1-2 mg/kg given every 6-
12 hr by the oral or intravenous route.
• Loading doses of 20 mg/kg of caffeine citrate are
followed 24 hr later by maintenance doses of 5
mg/kg/24 hr qd, either orally or intravenously.
14. PES Institute of Medical Sciences & Research
• These doses should be monitored through
observation of vital signs and clinical
response/Serum drug determinations (therapeutic
levels: theophylline, 6-10 μg/mL; caffeine, 8-20
μg/mL) are optional because important side effects
of these medications are rare.
• Doxapram, known to be a potent respiratory
stimulant, acts predominantly on peripheral
chemoreceptors and is effective in neonates with
apnea of prematurity that is unresponsive to
methylxanthines.
15. PES Institute of Medical Sciences & Research
• Transfusion of packed red blood cells to reduce
the incidence of idiopathic apnea is reserved for
severely anemic infants.
• Nasal continuous positive airway pressure
(continuous positive airway pressure [CPAP], 3-5 cm
H2O) and high- flow humidification using nasal
cannula (1-2.5 L/min) are therapies for mixed or
obstructive apnea, but
CPAP is preferred because of its proven efficacy and
safety. The efficacy of CPAP is related to its ability to
splint the upper airway and prevent airway
obstruction.
16. PES Institute of Medical Sciences & Research
PROGNOSIS
• Apnea of prematurity does not alter an infant’s
prognosis unless it is severe, recurrent, and
refractory to therapy.
• The associated problems of intraventricular
hemorrhage (IVH), BPD, and retinopathy of
prematurity are critical in determining the
prognosis for Apneic infants.
• Apnea of prematurity usually resolves by 37 wk of
post conceptional age, although it may persist
beyond term gestation, particularly in extremely
preterm infants born at <28 wk of gestation, and
does not predict future episodes of sudden infant
death syndrome (SIDS).
17. PES Institute of Medical Sciences & Research
APNEAAND SUDDEN INFANT
DEATH SYNDROME
• Although preterm infants are at higher risk for
SIDS, apnea of prematurity is not a risk factor for
SIDS.
• The epidemiologic evidence that positioning the
babies to sleep on their backs reduces the rate of
SIDS deaths by more than 50% suggests that
position, and not prematurity, has been the primary
cause of SIDS.
• Avoidance of cigarette smoke exposure and of
overheating the infant are also important in the
prevention of SIDS.
18. PES Institute of Medical Sciences & Research
• There is significant new information in recent
decades on sudden infant death syndrome (SIDS)
and apnea during early infancy
• The hypothesis that apnea is the pathophysiologic
precursor to SIDS was first proposed in 1972.
• The apnea theory has never been proven despite
extensive independent research in the several
decades after that report.and SIDS has not been
established
19. PES Institute of Medical Sciences & Research
A Task Force on Prolonged Infantile Apnea formed (
in 1980) to evaluate the evidence for the theory that
apnea is a precursor to SIDS, concluded in 1985 that
“a causal relationship between prolonged apnea and
SIDS has not been established
20. PES Institute of Medical Sciences & Research
SUDDEN INFANT DEATH
SYNDROME (SIDS)
• Sudden infant death syndrome (SIDS)is the sudden,
unexplained death of an infantyounger than one year
old.
• Some people call SIDS"crib death" because many
babieswho die of SIDSarefound in their
cribs.
• SIDS is defined as the sudden, unexpected death of
an infant less than 1 year of age that cannot be
explained despite a thorough investigation,
including a complete autopsy, examination of the
death scene, and review of the clinical and social
history.
21. PES Institute of Medical Sciences & Research
Epidemiology
• Incidence
• Despite a recent decline in incidence, SIDS
continues to be the leading cause of post neonatal
mortality in developed countries after excluding
perinatal event-related deaths
• Age-related demographics
• About two-thirds of SIDS deaths occur in infants
aged 2-4 months. Ninety percent of deaths occur
in children younger than 6 months, and 95% of
deaths occur in children younger than 8 months;
few occur in children younger than 1 month or
older than 8 months.
22. PES Institute of Medical Sciences & Research
• Sex-related demographics
• Approximately 60-70% of SIDS deaths occur in
males. Despite other notable changes in SIDS
epidemiology, the male-to-female ratio has
remained relatively unchanged in most population
studies.
23.
24.
25.
26. Risk
Factors;
Risk factors for SIDS (Derived from Malloy and Mac Dorman
(2005).
Maternal Factors Infantile Factors
Young age Male gender
Multiparity Low birth
weight Smoking during pregnancy Low birth length
Drug abuse during pregnancy Premature birth
Previous fetal death Blood type B
Anemia in pregnancy Low Apgar score
Placenta previa Low hematocrit at 48h
Premature rapture of membrane Not using a pacifier
Low social status Prone or side sleeping
28. PES Institute of Medical Sciences & Research
Pathophysiology
• Although multiple hypotheses have been proposed
as the pathophysiologic mechanisms responsible
for SIDS, none have been proven. The triple-risk
model, proposed by Filiano and Kinney, suggests
that SIDS represents an intersection of factors,
including the following :
-A vulnerable infant possessing intrinsic
abnormalities in cardio respiratory
control
-A critical period in the development of
homeostatic control mechanisms
29. PES Institute of Medical Sciences & Research
Prevention
• Primary Prevention
• Dissemination of advice on safe sleeping has
been one of the most effective health
interventions ever performed.
• According to the American Academy of
Pediatrics(AAP, 2011), the following were
given as preventive measures ofAOP:-
• Infants should be placed for sleep in a supine
position for every sleep.
• – Use a firm sleep surface. Pillows or sheepskin
should not be placed under a sleeping infant.
30. PES Institute of Medical Sciences & Research
•Room-sharing without bed-sharing is recommended.
•Keep soft objects and loose bedding out of the crib.
• Pregnant women should receive regular
prenatal care.
• Avoid smoke exposure during pregnancy and
after birth.
• Avoid alcohol and illicit drug use during
pregnancy and after birth.
•Breastfeeding.
31. PES Institute of Medical Sciences & Research
• Consider offering a pacifier at nap time and
bed time. Avoid overheating. Bedroom
temperature should be comfortable for a lightly
closed adult.
• Do not use home cardiorespiratory monitors as
a strategy for reducing the risk of SIDS.
• Infants should be immunized in
accordance with recommendations of
the AAP and CDC.
• Avoid commercial devices marketed to reduce
the risk of SIDS.
32. PES Institute of Medical Sciences & Research
B). Secondary Prevention
• Monitoring, although recently discouraged has been
the only secondary mechanism of preventing SIDS.
• The first indication comprises infants after an
apparent life- threatening event (ALTE) and infants
from families who had two or more sudden
unexpected infant deaths.