Neonate Terms
-antenatal: before birth
-postnatal: after birth
-perinatal: around the time of birth
-neonatal: first 28 days of
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Gestation
-term: 37-41 weeks
-post term: 41w+
-late preterm: 34-36 weeks
-mod preterm: 32-33 weeks
-very preterm: <32 weeks
-extremely preterm: <25 weeks
Trimesters
-Week 1- week 12: embryological phase
-wk 13-27: foetus phase
-week 28-birth: 3rd trimester
Weight terminology
-LGA: weight >90% at GA
-AGA: normal birth weight
-SGA: weight <10% at GA
-LBW & ELWB: <1000gm weight below defined limit at GA
What is a neo puff?
Flow dependent resusitator delivering breaths manually with accurate peak pressures (PIP) and end pressures (PEEP)
What is IUGR?
Poor maternal nutrition & lack of 02 supply to foetus
Foetal circulation
-Gas exchange occurs
-Foetal CVS highly 02 blood delivered to myocardium & brain
-Comprised of placenta, 2 umbilical arteries and 1 umbilical vein
-Foetus PA02 of 25-30mmHg
Foetal circulation steps
1. Foetal Hb maintains 02 delivery despite decreased partial pressures
2. Blood with increased 02 flows to vital organs
3. Foetus has decreased metabolic & 02 consumption and does not require energy to maintain thermoregulation
6 core principles of FCC
1. Listening & respecting
2. Flexibility
3. Sharing of info
4. Providing formal & informal support systems
5. Collaboration at all levels
6. Recognising & building strengths of individuals & families
Kangaroo care Principles
- prem infants held by mothers 24 hrs a day
-thermoregulatuon: baby's temp relies on mother
-regulates baby's resps & HR, decreased apenic episodes
Goals of developmental care
-infant goals: reduce stress, conserve energy, enhance recovery, promote growth and well-being
-family goals: support parents in caregiver role, enhance family emotional & social wellbeing
Risk factors for RDS
Premature infants increase risk for severe respiratory distress
RF include: low gestation, male, maternal diabetes, cesarean, PIH
Diagnosis of RDS
- increased RR
- subcostal & sternal retractions
-cyanosis
-grunting
-bilateral decrease in breath sojnds
Prevention of RDS
-antenatal steroids
-prevention of asphyxia
-CPAP
Management of RDS
-surfactant treatment
-CPAP/ mechanical ventilation
-nutrition
-AB's
-thermoregulation
- 02 & fluids
Neonatal liver at birth
- iron stores are dependent on maternal stores
- ready supply of glycogen
-vit k not available
-metabolises bilirubin
Jaundice definition
-manifestation of bilirubin in tissues of body
-appears after level of 5mg/dl
Types of Jaundice
-Pathological: visible <24hrs of age
-Physiological: 24hrs- 10 days of age
-Obstructive: >10 days of age
Pathological Jaundice cause
-Deposition of bilirubin in the dermal and subcutaneous tissues and the sclera
-Haemolytic disease: ABO incompatibility rH disease
Physiological Jaundice cause
-Mild increase in bilirubin (risk of brain damage with persistent high levels)
-increased bilirubin production
-impaired hepatic uptake & excretion of BR
-reabsorption of BR in small intestine
Late onset Jaundice cause
-idiopathic neonatal hepatis
-hep B
-bilary atresia
-bile duct stenosis
-galactosaemia
Treatment of Jaundice
-phototherapy, exchange transfusion
-light enhances bilirubin excretion
Hypoglycaemia complications
-congenital anomalies
-prematurity
-perinatal asphyxia
-RDS
-low iron stores
-hypercalcaemia & hyperbilirubinemia
Hypocalceamia definition
-evident 48-72 hours post birth
-severity and duration of maternal diabetes
-failure of IDM to gather hormone response
-increased levels of calicitonin & alternations in vit D metabolism
Neonatal abstinence syndrome
Behaviour & physiological signs & symptoms that are simulcast despite differences in properties of causative agents
2 types of NAS
1. Perinatal or maternal use of substances that result in withdrawal symptoms in newborn
2. Secondary to discontinuation of meds
Complications of NAS
-poor interuterine growth
-prematurity
-foetal distress
-still birth
-malformations
Common substances that cause NAS
-opiates
-alcohol
-tobacco
-benzodiaz
-SSRI's
-amphetamines
-cocoaine
-marijuana
Finnegqn definition
Measures baby withdrawal symptoms: commended 2 hrs after birth & 4-6hourly
Necrotising enterocolitis definition
Necrotic bowel: occurs in formula fed LBW babies
Nutrition in preterm
-growth
-resistance against infection
-neuro & cognitive development
-decrease morbidity
Limitations to neonate nutrition
-Minimal nutrient stoes
-functional immaturity
-diminished suck swallow coordination
-gastrointestinal immaturity
World BF charter five principles
-Human Right
-Healthy for babies
-Empowers Women
-Nature's way
Human Milk Formula Properties
-Increases protein, energy, calcium & phosphorus
-Decreases volume
-Increases calories & weight gain
Nutritional requirements for neonates
-Vit A, D & C
-Iron
-Folic acid
-Calcium & phosphate
Maternal risk factors for prematurity
-previous prem birth
-twins/triplets
-smoking/narcotics
-poor nutrition
-infections or diabetes
Preterm infant characteristics
-<2500gms
-plethoric skin
-surface veins
-weak cry
Thermoregulation complications in ELBW
-lack brown fat stores
-high body surface area to body weight ratio
-non-keratinised skin
-lack glycogen supply
RDS risk in ELBW babies
-surfactant deficiency resulting in alveoli collapse
-air leak syndromes
-CLD
-bronchopulmonary dysplasia
-ROP
Neonatal Sepsis Definition
-Body's inflammatory response to infection by injuring own tissues & organs
-occur in 1-8 per 1000 live births
-preterm at risk due to immunodeficiency
Intrauterine Environment Definition
Protects fetus from pathogens-cells are exchanged through placenta
Extrauterine Environment Definition
Birth canal is not sterile and therefore exposed to a verity of microorganisms after delivery
Maternal risk factors for sepsis
-Dehydration
-Fever & stress
-UTI in delivery (chorio)
-peripartum infection
Foetal risk factors for sepsis
-Prolonged rupture of foetal membranes
-Break in amniotic sac
Common sepsis microorganisms
-GB streopoccocus
-Escheria coli
-Coagulase-negative stephyloccucus
-Haemophyllis influenzae
-Listena monocytogenes
Signs of Sepsis
-Pallor
-Lethargy
-Jaundice
-Fever
-Hypothermia/ temp instability
-hypo/hyperglycemia
Risk factors for Neonate Respiratory Failure
-Antenatal stress
-congenital anomalies
-multiple gestations
-immaturity of immune system
Risk factors for neuro conditions in neonates
-O2 deprivation
-Infant Jaundice
-Physical trauma
-Infection
IVH definition
-Bleeding into the ventricles of the brain
-Germinal matrix (fragile capillaries) in prem babies
-Prem brain lacks ability to autoregulate cerebral BP
-More common in babies with RDS (unstable BP)
IVH Grading System
Grade 1: hemorrhage confined to germinal matrix
Grade 2: extension of hemorrhage into lateral ventricles without hydrocephalus
-Grade 3: Ventricular hemorrhage with presence of associated hydrocephalus
-Grade 4: Parenchymal hemorrhage
Neonatal Seizures Definition
-paroxysmal EEG activity with motor changes & autonomic/behavioural clinical signs
-include effects on respiration, HR & BP
Seizure Management Steps
1st: phenoburbitone
2nd: phenytonin
3rd: midazolam infusion
Therapeutic hypothermia Definition
-Reduces cerebral metabolism & ATP consumption to down regulate many intracerebral metabolic processes
-Limits damage of acute injury
-<35degrees to impair normal metabolic, muscular & cerebral function
High flow NP 02 Defintion
-provides 02 & CPAP to babies with resps distress
-2L/kg/min until pressure of 2-8cm of water is achieved
CPAP & Bubble CPAP definition
CPAP
-decreases resp effort
-prevents alveolar collapse (conserves energy)
Bubble
-maintains lung vol during expiration
-humidified
Basics of neonatal ventilation
-Appropriate oxygenation (affected by several factors): FI02, MAP & area of diffusion across gas exchange surface
-Appropriate ventilation: amount of C02 exchange at alveolar level [Show Less]