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NEWBORN

NEWBORN. DR SWATI PRASHANT MD Paediatrics www.paediatrics4all.com drprashantw@gmail.com Index Medical College,Indore,MP,India. Introduction. Newborn period encompasses the first 4 weeks of extra uterine life .

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NEWBORN

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  1. NEWBORN DR SWATI PRASHANT MD Paediatrics www.paediatrics4all.com drprashantw@gmail.com Index Medical College,Indore,MP,India

  2. by dr swati prashant,MD. paediatrics4all.com

  3. Introduction • Newborn period encompasses the first 4 weeks of extra uterine life . • There is a transition from intrauterine to extra uterine life , which requires many biochemical and physiologic changes. • After clamping of cord , following changes occur in the newborn . by dr swati prashant,MD. paediatrics4all.com

  4. Functional Changes • Pulmonary function is activated for CO2---O2 exchange . • GIT starts functioning for food absorption. • Renal functions activate to excrete waste and maintain chemical homeostasis. • Hepatic functions activate to neutralise & excreting toxic substances . • CVS ---changes in pressures occur. by dr swati prashant,MD. paediatrics4all.com

  5. Changes ,co. • Immune system gets activated to protect against infections . • A normal newborn adapts well to these changes. • If in this transition period there is any insult to the newborn in the form of • ----1)Birth asphyxia • ---2)Prematurity by dr swati prashant,MD. paediatrics4all.com

  6. changes-- • 3)Life threatening congenital anomalies • 4)Infections , bleeding , and any other adverse effects of delivery, • Then the newborn infant lands up in problem. by dr swati prashant,MD. paediatrics4all.com

  7. LOW BIRTH WEIGHT NEWBORN • Defn.----Live born infants delivered weighing < 2.5 kgs. At birth are termed as LBW babies. • 2 types 1)newborn with wt. <2.5 kg ,born before 37 wks. Of gestation (preterm ). • 2)newborn wt <2.5 kg but born at term or post term (IUGR ,SGA , SFD ). • VLBW---wt<1.5kgs • ELBW---Wt<1kgs. by dr swati prashant,MD. paediatrics4all.com

  8. Preterm baby by dr swati prashant,MD. paediatrics4all.com

  9. PREMATURITY • 10-15 % of Indian babies are born preterm i.e <37 wks. Of gestation. • They are anatomically and functionally immature therefore causing high mortality. • The exact mechanism initiating normal labor are not clearly understood. by dr swati prashant,MD. paediatrics4all.com

  10. Causes of prematurity • 1)FETAL ---a) fetal distress (cord round the neck ) • b)Multiple pregnancies. • c)Congenital malformations • d)erythroblastosis fetalis. • 2)Placental----Placenta previa • placental dysfunction • Abruptio placentae. by dr swati prashant,MD. paediatrics4all.com

  11. Prematurity causes co. • 3)Maternal---a)PET,HT • b)Incompetant of cervix • c)Uterine abnormalities in mother. • --d)maternal infections • e)TORCH • f)Medical illness—DM ,Heart disease , renal disease, by dr swati prashant,MD. paediatrics4all.com

  12. prematurity co. • g)Drug abuse , smoking. • 4)Other causes ----poly hydramnios, PROM , Iatrogenic , trauma , extreme age of mother, sexual activity. by dr swati prashant,MD. paediatrics4all.com

  13. Assessment of newborn • Assessment of gestational age is done by • 1)physical maturity • 2)neuromuscular maturity. • (New Ballard score ) • Physical maturity in preterm • How do they look by dr swati prashant,MD. paediatrics4all.com

  14. Preterm assesment • 1) They are small in size ,wt. <2.5 kg. , length <47 cm. • 2) Head is relatively large with large fontanel &wide sutures. • 3) Face small , with minimal buccal pad of fat. • 4)Ears soft , flat with ear cartilage having less recoil . • 5)Skin is thin , pink , shiny , oedematous. • 6)little subcut . Fat . • 7)Breast nodule is<5 mm. wide . by dr swati prashant,MD. paediatrics4all.com

  15. Features • 8)Testes– not descended in scrotum. Scrotum has less rugosities. • 9)In females –labia majora is widely seperated exposing the labia minora & clitoris . 10) Sole creases are not well formed. 11) General activity is poor , NNR are poor . 12) Mild hypotonia. by dr swati prashant,MD. paediatrics4all.com

  16. Physiological handicaps causing problems • 1)Immaturity of CNS---poor sucking , feeding ,Ivh ,hypoxia. • 2)R S– POOR SURFACTANT, poor blood flow , small alveoli , cough reflexes poor, • 3)GIT—GER ,immaturity of Liver. • 4) Renal functions---immature , GFR • 5)Temperature regulation—prone for hypothermia. by dr swati prashant,MD. paediatrics4all.com

  17. Problems with preterm co. • 6)CVS—Ductus closure delayed , • 7)Metabolic disturbances-- • hYpoglycemia , hypocalcaemia , hypoproteinemia , hypoxia etc. • 8)Infections • 9)nutritional deficiency • Because of all these problems preterm develop complications . by dr swati prashant,MD. paediatrics4all.com

  18. Complications • 1)Hypothermia , • 2)RS– HMD , Pneumonia , Apnea. • 3)CVS---PDA , HT , • 4) Hemat.—anemia , Hges . , DIC , • 5)GIT & LIVER ---NEC , hyperbil . • 6)Metabolic • 7)CNS---HIE , IVH , SEIZURES , ROP , kernictrus, • 8)Renal by dr swati prashant,MD. paediatrics4all.com

  19. IUGR • CAUSES--- • 1)Maternal—short stature , drg abuse , young adol. ,maternal illness , nutrition . • 2)Fetal----Twins , cong . Malfor. , TORCH , • 3)Placental---infarcts , infections , APH . by dr swati prashant,MD. paediatrics4all.com

  20. Problems of IUGR • Birth asphyxia , MAS , Hypothermia , hypoglycemia , infections , polycythemia , congenital malformations are common . by dr swati prashant,MD. paediatrics4all.com

  21. CARE OF LBW INFANTS • 1)Maintain temperature • 2)APGAR • 3)Skin and eye care • 4)I/V fluids • 5)monitor ---feeds ,wt , urine output , vital signs . • 6)early detection of complications and T/t. • 7)feeding. by dr swati prashant,MD. paediatrics4all.com

  22. FEEDING OF LBW • LBW Infants may show difficulties in feeding depending on their maturity and vigour . • This is because of poor sucking ,small capacity of stomach causing abd . Distention , and sluggish gut motility due to autonomic immaturity , GER , poor cough reflex . by dr swati prashant,MD. paediatrics4all.com

  23. FEEDING by dr swati prashant,MD. paediatrics4all.com

  24. Fluid Requirements in LBW(ml / kg) by dr swati prashant,MD. paediatrics4all.com

  25. Nutrition required • Caloric Requirement – 80 - 100kcal /kg • CHO Requirement ----10-12 gm/100ml • Proteins -----2.5 – 3 gms /100 ml • Fats -----4 gms /100 ml • Water ----125-180 ml • Vit.A—1000-1500 IU • Vit .D—400IU /d • Vit K—0.5-1 mg stat • Vit E—1 25IU/D • Vit. C—40-50 mg • B1-1000µg , B12—3-5 µg, FA—50 µg . by dr swati prashant,MD. paediatrics4all.com

  26. Nutrition contd. • Calcium--100 mg/kg • Iron 2-4 mg /kg • ZINC 0.5 mg • Human milk can be fortified with HMF to enhance the caloric value • Oral vitamins are started when enteral feeding reaches 150 ml/kg. by dr swati prashant,MD. paediatrics4all.com

  27. Monitoring • Temperature • Tolerance to feeds • Growth---wt . Daily, length &Hd . Circum .—wkly. • Others—sugar , Anemia ,ostopenia. • Activity. by dr swati prashant,MD. paediatrics4all.com

  28. Causes of poor growth with adequate Feeding • Inadequate protein intake. • Chronic cold stress. • Anemia • Metabolic acidosis • Infections—UTI , Fungal. • PDA by dr swati prashant,MD. paediatrics4all.com

  29. BREAST FEEDING • Give exclusively B/F for 6 months . • Benefits Of B/F • Lactose---6-7 gm /dl ,galactose helps forming galactcerebrosides—good for Brain. Lactose absorbs Calcium,lactobacilli formed. • Proteins---0.9—1 gm/dl---low ,as baby cannot metabolize high protein load. Taurine , Cysteine---------good for neurotransmission. by dr swati prashant,MD. paediatrics4all.com

  30. Breast feeding • Breast milk is rich in fats • PUFA present are good for myelinaton. • Water & electrolytes are sufficient. • Immunological superiority • Other benefits . by dr swati prashant,MD. paediatrics4all.com

  31. Thank you all • OUR other websites • Paediatrics4all.com • Pharmacology4students.com • Psm4students.com • Microbiology4students.com

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