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Neonates

Neonates. Dr.I.Lakshminarayana. Structure. Normal new born Adaptation to extra uterine life Nutrition Maintaining temperature Common neonatal problems Neonatal examination Case discussion. Anthropometry. Term 37-42 weeks Pre term < 37 weeks Post term >42 weeks

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Neonates

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  1. Neonates Dr.I.Lakshminarayana

  2. Structure • Normal new born • Adaptation to extra uterine life • Nutrition • Maintaining temperature • Common neonatal problems • Neonatal examination • Case discussion

  3. Anthropometry • Term 37-42 weeks • Pre term < 37 weeks • Post term >42 weeks • Normal birth weight 2.5- 4 kg (average 3.5 kg/7.5 pounds) • Low birth weight <10th centile • ELBW <0.4th centile • Head circumference average 35 cm • Length 50 cm

  4. Normal to lose weight 5-7% in first ten days • From then on babies gain 15 g/day

  5. The transition-Respiratory • In utero fetal lung is filled with fluid 25ml/kg • Compression of chest wall during delivery • Chemoreceptor stimulation causes a gasp (<6sec) Sensory stimulation Clamping cord will increase the systemic pressure and reduce pulmonary pressure.

  6. Transition-cardiovascular • UV through ductus venosus to IVC • IVC • RA RV,PA,Aor Thro FO To LA

  7. Changes in circulation at birth • Cord is clamped, collapse of veins and ductus venosus, increase in sytemic pressure • Ist breath lungs expand, vasodilation, pulmonary vascular resistance falls by 80%,increase in LA pressure, closure of FO • Ductus arteriosus closes owing to rise in Pao2 by 12 hours

  8. Nutrition • Breast is best • Advantages of breast feeding- Protects against respiratory/gastrointestinal infections • Increases response to immunisation • Reduces risk of NEC • Reduces incidence of allergy and atopy • Increases cognitive development

  9. Nutritional requirement • Term babies require 100kcal/kg/day • Breast milk provides 70kcal/100ml • 1.3 gm protein,4.1 gm fat,7.2 gm carbohydrates

  10. Breast milk composition • Fat –supply energy, build cell membranes, LCPUFA, EFA help in cognitive development and improved retinal function • Carbohydrates – Lactose converted to lactic acid by lacto bacillis protects gut • Protein – Whey based easily absorbed, antibodies, lactoferrin, enzymes

  11. Maintaining temperature • Cold can kill • Ideal temperature close to 37 • Heat loss can occur due to large surface area for a small body mass • Heat loss occurs by conduction, convection, evaporation and radiation • Heat production- hydrolysis of triglycerides in brown fat using oxygen

  12. Clinical effects of hypothermia • Reduced surfactant synthesis • Reduced surfactant efficiency • Hypoglycemia • Increased oxygen requirement • Increased utilisation of calorie reserves • Increased postnatal weight loss

  13. Common neonatal problems • Benign

  14. Birth Marks

  15. Rash

  16. Other problems • Feeding • Hypoglycemia • Jaundice

  17. Jaundice • Know basic physiology of bilirubin metabolism • Day 1 jaundice always pathalogical commonest cause being blood group incompatability • Prolonged jaundice>14 days think could this be obstructive • High bilirubin levels cause kernicterus

  18. Problems that need immediate attention Respiratory TTN, RDS, Meconium aspiration, congenital pneumonia, CDH Infection GBS, Staphylococci ,E.Coli, Listeria Cardiac causes Duct dependant systemic /pulmonary circulation

  19. Congenital anomalies of gut – duodenal atresia, anal atresia,NEC in preterm infants.

  20. New born examination • History –mother’s medical ,antenatal history, FH of heart disease, DDH • Explore parental concerns , feeding • Check weight, HC, length and plot on chart • Detailed head to toe examination with infant undressed with particular emphasis in picking up birth trauma and congenital abnormalities • Examine eyes , hips

  21. Case discussion • 32 hour old baby referred by midwife for jaundice • What questions would you ask the mother? • How will you manage this baby? • How will you monitor treatment?

  22. 3 week old baby referred for prolonged jaundice • What are the likely causes • What condition you would like to rule out? • What investigations would you perform?

  23. You are the FY1 in neonates. You are called by the midwife to review a baby who is 15 minutes old. She is concerned that the baby is grunting. • What are the initial questions you will ask the midwife? • What are the causes of respiratory distress in babies? • What are the investigations you will request? • How will you manage this baby?

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