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NEONATOLOGY

Definitions :

A newborn baby from birth to age 28 days . : Neonate

if born after 37 (full term) A baby at term : Term baby

weeks gestation and before 42 weeks gestation.

delivered infant Live born : baby (Premature) Preterm

before 37 w eeks from the first day of the last menstrual
period. Those born before 28 weeks of gestation are
called (extreme prematurity).

born after 42 weeks gestation . An infant : Post term

:). W. B. Low birth weight ( L
An infant whose birth weight is 25 00 g. or less .
Not all preterm infants are L.B.W. and not all L.B.W.
infants are preterm.

: (V.L.B.W.) Very low birth weight

Birth weight is 1500 g. or less .

:). W. B. L. h weight (E Extremely low birt

Birth weight is 1000 g. or less .

: small for date or (S.G.A.) Small for gestational age

Birth weight is below the 10 th. percentile for gestation .

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:). A. G. Large for gestational age (L

. percentile for age .th 90 the Birth weight is greater than

: rate tal mortality Neona

The number of d eath s of infants in the period from birth
to 28 days of life and is expressed per 1000 of live births.

:). U. C.I. (N Unit are Intensive C Neonatal

The provision of life support systems such as assisted
ventilation , monitoring of heart rate ,respirato ry rate ,
blood gases , & total pare nteral nutrition (T .P.N .).
.

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: (N.B.B.) Examination of the Newborn Baby

- All newborns should be examined at least twice; one soon
after birth , and the other on the fifth day . The question to be
answered” is the infant normal ? In the first examination ,
you are rest ricted to elicit gross physical abnormalities , even
mild anom alies should be explained to parents to allay
anxiety . The baby should be kept warm during the
examination .
- A normal newborn should pass stool within 48 -72 hours
and urine within 24 hours after birth.
- General examination : The infant should cry lustily at
birth; weak cry may indicate severe respiratory distress ,
sepsis , hypot onia or birth asphyxia , while a high pitched cry
(cerebral cry or shrill) may indicate increased intracr anial
pressure .

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- A co nstant low pitched inspiratory stridor is heard in
cong enital lary ngomalacia which resolves by 12 -18
months.
. cold and hot weather, is seen in polycythemia Plethora -

The skin is covered by a greasy material secreted by

epithelial cells called vernix caseosa which protects the skin
from the effect of the amniotic fluid.
.

- Occasionally , one half of the body may ap pear red and the

other half is pa le (harlequin color change) which is usually
. transient and of unknown significance

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- Cyanosis :Central cyanosis is pathological and peripheral
or a crocyanosis is normal ( more in th e preterm babies ).

-Milia : Small sebaceous cysts , pinpoint in size , whitish

spots seen on the nose , cheeks and forehead , it disappears in
a few weeks spont aneously , it is a normal finding.

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-Erythema toxicum neonatorum : red blotchy , macular

patches with a white center seen all over the body ,
sparing the soles and palms . It affects 50% of full term
infants, less common in preterm infants. Pustules may be
seen in the center containing eosinophils .
T hey usually appear on the first few days and disappear
. spontaneously

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- Mongolian spots : blue , gray , flat , macular lesions seen

normally over the sacrum, sometimes on th e upper back ,
legs , hands and rarely on the face .
T hey may be solitary , numerous or patchy .
They are seen in colored chi ldren much more than whites.
They usually fade during the first few years of li fe .
. be misdiagnosed as bruises They may

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-

- Occipito -Frontal Circumference ( O .F.C .):
Average head circumfere nce at birth is 35cm .
-Weight : average weight 3 .5 kg , neonates lose 5 -10%
birth weight in the first few days of life and regained by
by10days.

Lengt h: average length of the newborn baby is 51cm. -
Fontanelle s: -
The average diameter of the anterior fontanelle is 3 cm , it
closes at 9 -18 mont hs. T he posterior fontan el le measures
about the tip of the finger usually closes by 3 months of age .

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-Examination of the eyes :

Ede ma of the upper eye lids is a result of birth process .
C onjunctival and scleral hemorrhages are commonly see n
and disappear by time .
L ook for cataract and glaucoma (m egalo cornea).
- Epstein pearls : are cysts containing keratin located on the
. soft and hard palate

-Capillary hemangioma :

is commonly seen on the upper eye lids and forehead ,
it disappears in the first year.

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The breasts might be large in both sexes , this is caused by

maternal hormones and is usu ally evident on day 2 or 3 of
life , they may persist for a month .
M ilk may be expressed from it by parents (witches milk) ,
this habit should be avoided because it may lead to abscess
(neonatal mastitis) .

- Hips : exam ine hips for dysplasia(dislocation).

- F emoral artery : palpate both femorals by the index
fingers in the mid inguinal region , their absence indicates
coarctation of the aorta .
- CNS : Neonates may sleep up to 20 hours out of 24 hours if
left undisturbed .
Check activity, primitive (neonatal) reflexes, convulsions or
apnea.

: LOW BIRTH WEIGHT BABIES

(Normal Birth Weight:2500 -4000g. )
Definition of L.B.W. : A birth weight less than 2. 5Kg.
They are 20 times more li kely to die than normal infants & it
can affect the life of the individual by increasing diseases like
diabetes mellitus , hypertension, and C .V . diseases .
LBW is an indicator of public health sta tus and is a cause of
70% of neonatal deaths.

Maternal causes of LBW:

1-Previous LBW
2-Poverty.
3-Low level of education.
4-No antenatal care.
5-Maternal age: <16 & >35 years.

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6-Unspaced pregnancy.
7-Smocking,alcohol,drugs.

RETARDATION(I.U.G.R.): INTRAUTERINE GROWTH

Definition:
Fetal growth below the 10 th.centile for gestational age
and ab dominal circumference is below 2.5 th centile .
So S .G .A . is a statistical definition , while IUGR is a
clinical definition (clinical evidence of malnutritio n).
CAUSES of IUGR:
Causes: etal a.F
1-Congenital infection s.
2-Chromosomal abnormalities.
3-Congenita l malformations.
4-Twin to twin transfusion.
Placental causes: b.
1-Chronic abrutpio placentae .
2-Placental insufficiency.
3-Placental infarction.
). cause he commonest (t Constitutional c.
The majority of cases are normal but small , and t he
diagnosis is made after delivery by exclusion.
Maternal causes: d.
1-Hypertension,D.M.,chronic illnesses.
2-Pre -eclampsia.
3-Malnutrition.
4-Smoking,alcohol,teratogens.
5-Short stature.

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Problems of IUGR :

Treatment of I.U.G.R. :
1-Give more calories.
2-Monitor blood sugar level 2 -4 hourly until it is stable.
3-Monitor serum calcium level.

Outcome of IUGR:

1-Most of t hem have normal growth in infancy and childhood.
2-Many are born prematurely.
3-Defective mental development .

Fetal death.-

-Temperature instability.
-Perinatal asphyxia (the most important
problem ).
Hypoglycemia, Hypocalcemia.-
Polycythemia.-
Congenital anomalies.-

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: PREMATURITY

The p roblems of prematurity are due to poor
adaptation to extra uterine life due to immaturity of
or gans:
Respiratory problems:
a-R .D .S.(respiratory distress syndrome).
b-Chronic lung disease: B .P.D .(bronch opulmonary
dysplasia).
c-Apnea .

Neurologic problems:

a-Hypoxic -ischemic encephalopathy (H.I.E.).
b-In traventricular hemorrhage (I.V.H.) .
c-Convulsions .
Cardiovascular complications :
a-Hypotensio n.
b-P.D .A .(patent ductus arteriosus).
Hematologic :
a-Anemia .
b-Hyperbilirubinemia .
c-Organ hemorrhage .
d-D .I.C .
Nutritional problems (especially in those born before
32 weeks of gestation).
G .I. problems (N .E .C . : necrotizing enterocolitis).
Metabolic :
Hypoglycemia , Hypoca lcemia.

Renal problems :low G .F.R .

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Temperature regulation e.g. hypothermia.

Ophthalmologic e.g. R .O .P.(retinopathy of prematurity).

MANAGEMENT OF THE PREMATURE INFANT :
1-Delivery: should be in a hospital well equipped with
resuscitation tools and highly experienced staff.
2-Neonata l management:
a-Thermal regulation either by overhead radiant warmer
or a n incubator. The accepte d skin temperature is
36 -36.5c.
b-Oxygen therapy and assisted ventilation.
c-Fluid and electrolytes therapy.
d-Nutrition : enteral, N .G . tube or pare nteral.
e-Management of hyperbilirubinemia .
f-Control of infection s.
LONG TERM PROBLEMS OF PREMATURITY :
1-Poor growth and development.
2-R.O.P.
3-B.P.D.
4-Increased rate of post neonatal illness es.
5-Increased frequency of congenital anomalies.

Immunizations :

The timing of immunizati ons of premature babies is
based on the infant's chronologic age, not on the
gestational age.
It may be advisable to delay administration of hepatitis B
va ccine until the infant weighs 2000 g. or more.
The full dose s of all immunizations should be given .

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رفعت المحاضرة من قبل: Ahmed monther Aljial
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