Post on 03-Jun-2018
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Common Disorders andCommon Disorders andManagement in NewbornManagement in Newborn
YunYun CaoCao
ChildrenChildren s Hospital ofs Hospital of FudanFudan UniversityUniversityShanghai, ChinaShanghai, China
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Respiratory DisordersRespiratory Disorders
Apnea of Apnea of prematurityprematurity (AOP)(AOP) Respiratory distress syndrome (RDS)Respiratory distress syndrome (RDS) TransientTransient TachypneaTachypnea of the Newbornof the Newborn
(TTN)(TTN)
MeconiumMeconium aspiration syndrome (MAS)aspiration syndrome (MAS) Chronic lung disease (CLD)Chronic lung disease (CLD)
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Apnea of Preterm Infant Apnea of Preterm Infant
Apnea Apnea Cessation of breathingCessation of breathing
Pathologic ApneaPathologic Apnea Respiratory pauses > 20Respiratory pauses > 20 secssecs any pause accompanied byany pause accompanied by bradycardiabradycardia oror
significantsignificant desaturationdesaturation
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Periodic BreathingPeriodic Breathing
A type of central apnea A type of central apnea Brief pauses in breathing ofBrief pauses in breathing of 1010 Repeat itself for several cyclesRepeat itself for several cycles Significant immaturity of respiratorySignificant immaturity of respiratory
control and a variant of apneacontrol and a variant of apnea
Many preterm infants demonstrateMany preterm infants demonstrate 2020 --30% of total sleep time30% of total sleep time A normal A normal maturativematurative processprocess
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EpidemiologyEpidemiology
Most prevalent in premature infantsMost prevalent in premature infantsprior to 36 weeksprior to 36 weeks gestationgestation
5959 -- 78% of all preterm infants78% of all preterm infants with increasing gestational agewith increasing gestational age > 50% of infants 50% of infants
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Majority of AOP resolve by 37 weeksMajority of AOP resolve by 37 weeks postconceptionalpostconceptional ageage
Persists longer withPersists longer with GAGA
Most infants reach respiratory maturityMost infants reach respiratory maturityby 42by 42 -- 44 weeks CGA44 weeks CGA
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TreatmentsTreatments
StimulationStimulation CPAPCPAP IntubationIntubation Medication:Medication:
CaffeineCaffeineMethylxanthinesMethylxanthines
TheophyllineTheophyllineDoxapramDoxapram
OxygenOxygen
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Application Application
Apnea and Apnea and bradycardiabradycardia is a commonis a commonproblemproblem Adverse Adverse neurodevelopmentalneurodevelopmental outcomeoutcome
may result from more frequent andmay result from more frequent andsignificantsignificant desaturations/bradycardiasdesaturations/bradycardias
Long term effects on infant is less clearLong term effects on infant is less clearand under investigationand under investigation
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Respiratory Distress SyndromeRespiratory Distress Syndrome
Primary cause of respiratory disorders andPrimary cause of respiratory disorders anddeaths in the newborndeaths in the newborn Most frequently occurs in premature infantsMost frequently occurs in premature infants
15% of all low birth weight infants (
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RDSRDS Incidence higher & more severe in:Incidence higher & more severe in:
MalesMales Asphyxia Asphyxia Maternal DiabetesMaternal Diabetes
Second born twinSecond born twin Familial predispositionFamilial predisposition Maternal hypotensionMaternal hypotension
C/S without labour C/S without labour Hydrops fetalisHydrops fetalis 3rd Trimester bleeds3rd Trimester bleeds
2626 --28 wks gestation age (50% incidence)28 wks gestation age (50% incidence)
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RDSRDS
Caused by lack of pulmonaryCaused by lack of pulmonarysurfactantsurfactant
Leads to progressive atelectasisLeads to progressive atelectasis Loss of functional residual capacityLoss of functional residual capacity VentilationVentilation -- perfusion imbalanceperfusion imbalance Also called Also called Hyaline MembraneHyaline Membrane
DiseaseDisease
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Pulmonary SurfactantPulmonary Surfactant Complex material containing different lipidsComplex material containing different lipids
and proteinsand proteins
Produced in Type II GranularProduced in Type II Granular PneumocytesPneumocytes ininthe alveoli and secreted into the air surfacethe alveoli and secreted into the air surface
Decreases surface tension and establishesDecreases surface tension and establishesstable respiratory interface and lung volumestable respiratory interface and lung volume
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Surfactant DeficiencySurfactant Deficiency
Surfactant production starts only inSurfactant production starts only inlate pregnancylate pregnancy
Insufficient amount of surfactantInsufficient amount of surfactant
causes collapse of the alveoli, loss ofcauses collapse of the alveoli, loss oflung volume due to the abnormallylung volume due to the abnormallyhigh surface tensionhigh surface tension
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Normal Alveolar Normal Alveolar RDSRDS
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RDSRDS -- TreatmentsTreatments RDSRDS -- is a self is a self --limiting diseaselimiting disease -- it usuallyit usually
subsides within 72 hourssubsides within 72 hours
Treatments includeTreatments include Antenatal Antenatal steroidssteroids SurfactantSurfactant Oxygen therapyOxygen therapy CPAP / IntubationCPAP / Intubation Maintaining normal acid/base balance, pHMaintaining normal acid/base balance, pH Neutral thermal environmentNeutral thermal environment
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TransientTransient TachypneaTachypnea of theof theNewbornNewborn
Results from slow absorption ofResults from slow absorption oflung fluidlung fluid
C/SC/S Mild respiratory distressMild respiratory distress
Peaks at about 36 hours of lifePeaks at about 36 hours of life Resolve spontaneouslyResolve spontaneously
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MeconiumMeconium Aspiration Syndrome Aspiration Syndrome
1010 --20% of all deliveries have in20% of all deliveries have in uterouteropassage ofpassage of meconiummeconium MeconiumMeconium staining alone is not a goodstaining alone is not a good
marker of asphyxiamarker of asphyxia MeconiumMeconium --stained amniotic fluid (MSAF)stained amniotic fluid (MSAF)
is found all races and socioeconomicis found all races and socioeconomicstrata in humanstrata in human
The thicker the consistency of MSAF,The thicker the consistency of MSAF,the greater the likelihood of MASthe greater the likelihood of MAS
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Diffuse patchyDiffuse patchyinfiltrates throughoutinfiltrates throughoutthe lung fieldsthe lung fields
Air leak syndrome Air leak syndrome
Occurs in 41% of babiesOccurs in 41% of babieswith MASwith MAS
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ToTo Recognize Potential ProblemsRecognize Potential Problems withwithMeconiumMeconium -- Stained FluidStained Fluid
fetal distressfetal distress meconium aspirationmeconium aspiration multisystem hypoxicmultisystem hypoxic --ischemic injuryischemic injury
Effective communication with obstetriciansEffective communication with obstetricians
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To Recognize Predictor Risk Factorsof MAS
post maturity non reassuring fetal heart tracings
oligohydramnios need for suctioning of baby s trachea one minute Apgar score < 4 = neonatal
depression C/S delivery
Prevention
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To Describe the Benefits of EarlyIntrapartum Interventions
attendance at delivery: skilled personnel suctioning mouth & oropharynx
as soon as head delivered as soon as in resuscitation surface keep baby warm
Assessment at delivery A = airwaysB = breathingC = circulation
Apgar scores
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Treatment of MASTreatment of MAS
OxygenOxygen Ventilation (high frequency)Ventilation (high frequency)
Exogenous surfactantExogenous surfactant Inhaled nitric oxideInhaled nitric oxide
ECMOECMO
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Chronic lung disease (CLD)Chronic lung disease (CLD)
Most frequently occurs in very prematureMost frequently occurs in very prematureinfantsinfants Oxygen dependent > 28 days, > 36 wks postOxygen dependent > 28 days, > 36 wks post
conceptionconception Due toDue to -- pulmonary immaturitypulmonary immaturity
SurfactantSurfactant Lung injuryLung injury BarotraumaBarotrauma Inflammation (due to oxygen therapy)Inflammation (due to oxygen therapy) Genetic predispositionGenetic predisposition
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CLDCLD Treatments:Treatments:
Oxygen therapyOxygen therapy Fluid restrictions / diureticsFluid restrictions / diuretics Steroids, broncodilatorsSteroids, broncodilators
Outcome:Outcome:
Death often occurs within the 1st year of lifeDeath often occurs within the 1st year of lifedue to cardiorespiratory failure; sepsis; ordue to cardiorespiratory failure; sepsis; orrespiratory infectionsrespiratory infections
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Jaundice andJaundice and HyperbilirubinemiaHyperbilirubinemia
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JaundiceJaundice Most common NeonatalMost common Neonatal ProblemProblem
Occurs in 50Occurs in 50 --60% of newborns60% of newborns Duration varies byDuration varies by
Ethnic groupEthnic group AA/Caucasians AA/Caucasians earlier peak and earlier declineearlier peak and earlier decline Asians/native Americans Asians/native Americans later and higher peak andlater and higher peak and
later declinelater decline Methods of feedingMethods of feeding
BreastBreast bottlebottle
Gestational ageGestational age Maternal healthMaternal health Drug exposureDrug exposure
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Physiologic JaundicePhysiologic Jaundice Classic patternClassic pattern
Rise inRise in bilirubinbilirubin on day 3on day 3 Decline to normal by 10Decline to normal by 10 --12days12days
PhysiologyPhysiology
RBCsRBCs have shortened life spanhave shortened life span Erythrocyte precursors degrade post birthErythrocyte precursors degrade post birth IncreasedIncreased enterohepaticenterohepatic circulationcirculation
Relatively deficient hepatic transportRelatively deficient hepatic transportsystemsystem
Resultant retention ofResultant retention of unconjugatedunconjugated
hyperbilirubinemiahyperbilirubinemia
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Breastfeeding JaundiceBreastfeeding Jaundice
Abnormal Abnormal Early onset exaggeration of physiologicEarly onset exaggeration of physiologic
jaundice jaundice
Result of suboptimal frequency and volumeResult of suboptimal frequency and volumeof feedingof feeding Common to see weight loss and decreasedCommon to see weight loss and decreased
number of stoolsnumber of stools High levels ofHigh levels of bilirubinbilirubin inin meconiummeconium IncreasedIncreased enterohepaticenterohepatic circulationcirculation
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PreventionPrevention
Promote early frequent feedingPromote early frequent feeding Early frequent contactEarly frequent contact Check infant in first few days afterCheck infant in first few days after
discharge home or on day 4discharge home or on day 4 Ask about feeding/urine output Ask about feeding/urine output
WeighWeigh
Educate MothersEducate Mothers
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Signs that your baby is BREASTSigns that your baby is BREAST --FEEDING WELLFEEDING WELL
By 3-4 days of age your baby: Has 4Has 4 --5 wet diapers per day5 wet diapers per day Has 2Has 2 --3 BM per day (3 BM per day ( colour colour progressing toprogressing to
seedy mustard yellow)seedy mustard yellow) Breast feeds at least 8 times per 24 hBreast feeds at least 8 times per 24 h Is content after most feedingsIs content after most feedings
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BreastmilkBreastmilk JaundiceJaundice
NormalNormal
Late onset prolonged physiologicLate onset prolonged physiologic jaundice jaundice
Transitional and mature milk increasesTransitional and mature milk increasesintestinalintestinal bilirubinbilirubin absorptionabsorption Unidentified factor in milk interferesUnidentified factor in milk interferes
with conjugationwith conjugation May persist as long as 3 monthsMay persist as long as 3 months
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Natural HistoryNatural History
0
50
100
150
200
250
300
0 1 2 3 4 5 6 7 8 9 10
BreastFormula
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Pathologic JaundicePathologic Jaundice
Onset in the first 24hrs post birthOnset in the first 24hrs post birth
Rate of increase of 0.5mg/dL/hr Rate of increase of 0.5mg/dL/hr
ConjugatedConjugated hyperbilirubinemiahyperbilirubinemia
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Is Jaundice Pathological?Is Jaundice Pathological? ? If there is an underlying diseaseIf there is an underlying disease
processprocess Bruising/Bruising/ polycythemiapolycythemia ?? Inborn error of metabolismInborn error of metabolism Blood group incompatibilityBlood group incompatibility Infant starving?Infant starving? Infection?Infection?
?If it causes neurological damage?If it causes neurological damage
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Blanching SkinBlanching Skin
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Maternal education: an alternative strategy forensuring safety with early newborn discharge
Chandran L, et al. Journal of Perinatal Education 1997
Discuss withcaller Repeatafter 2 days Call MD now
No concernsat this t ime
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BiliChek BiliChek
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Blood Brain Barrier andBlood Brain Barrier andBilirubinBilirubin EncephalopathyEncephalopathy
Prevents freePrevents free unconjunconj bilirubin from crossingbilirubin from crossing Less effective in premature infantsLess effective in premature infants Less effective in unwell infantsLess effective in unwell infants BilirubinBilirubin encephalopathyencephalopathy
HypotoniaHypotonia High pitched cryHigh pitched cry
SeizuresSeizures Long termLong term sequalaesequalae
Athetoid Athetoid CPCP SensoneuralSensoneural deafnessdeafness
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Necessary LabsNecessary Labs
Maternal ABO andMaternal ABO and RhRh typing andtyping and isoimmuneisoimmune Ab Ab screen/direct Coombsscreen/direct Coombs Neonate ABO andNeonate ABO and RhRh typingtyping BilirubinBilirubin panelpanel includes total and directincludes total and direct
RepeatRepeat bilibili q6q6 --12hrs12hrs Peripheral blood smearPeripheral blood smear hemolysishemolysis ?? CBCCBC anemic?anemic? ConsiderConsider reticulocytereticulocyte countcount Sepsis work up if suspicious for infectionSepsis work up if suspicious for infection
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TreatmentTreatment Consider Phototherapy while waitingConsider Phototherapy while waiting
for investigationsfor investigations OptimizeOptimize enteralenteral intakeintake
Options:Options: ObserveObserve PhototherapyPhototherapy Phototherapy and exchange transfusionPhototherapy and exchange transfusion
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New AAP Guidelines for StartingNew AAP Guidelines for Starting
PhototherapyPhototherapy
050
100
150
200
250
300
350400
0 1 2 3 Days
Term, wellConsider...
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New AAP Guidelines for ExchangeNew AAP Guidelines for Exchange
Transfusion: NoTransfusion: No hemolysishemolysis
0
100
200300
400
500
600
0 1 2 3 Days
Term, wellConsider PTExch if PT fail sExch!
Exchange transfusion + Intensive PTExchange transfusion + Intensive PTExchange only i f PT failsExchange only if PT fails
InvestigateInvestigate
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Guidelines for PT/ExchangeGuidelines for PT/Exchangetransfusion:transfusion: HemolysisHemolysis
0
100
200300
400
500
600
0 1 2 3 Days
Phototh/InvestPT if unwellExch if PT fail sExch!
Exchange transfusion + Intensive PT
Investigate & Rx
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Recommendation Prior to the discharge of every newborn, there should
be a process and protocol in place for assessing therisk for development of significant hyperbilirubinemiain all newborns nurseries
There should be a systematic approach to theassessment of all infants before discharge for thisrisk and program and follow up should be in place ifthe infant develops jaundice
All newborn infants who are visibly jaundiced, near(between 35 37 weeks) and full (>38 weeks) termshould have a bilirubin level determined
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Recommendation,cont.
Infants, although not visibly jaundiced but with two
or more risk factors should have at least onebilirubin level preformed prior to discharge
Serum bilirubin may be done on either capillary or
venous blood sample Infants with severe or prolonged jaundice should
have further investigations including an analysis ofthe conjugated component of the bilirubin
A Transcutaneous Bilirubin measurement may beused if available as a screening device
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Follow Up TSB that needs photo therapy should mandate an
investigation for cause
History, physical examination, lab tests, etc. etc.
ecommend tion
Adequate follow-up should be ensured for all infantswho are jaundiced.
Infants under phototherapy should be investigated
for determination of the cause of jaundice.
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Prolonged JaundiceProlonged Jaundice
Common in breast fed infants; ? 20%Common in breast fed infants; ? 20%
VERY common in premature breast fedVERY common in premature breast fedinfantsinfants .? >30%.? >30%
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Does Prolonged JaundiceDoes Prolonged JaundiceRequire Investigation?Require Investigation?
PathologicalPathological vsvs physiological?physiological? Breast fed?Breast fed?
Feeding well?Feeding well? Thriving?Thriving? TSH screen negative?TSH screen negative?
No investigation needed until 2No investigation needed until 2 --3 weeks3 weeks
l d d
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Prolonged Persistent JaundiceProlonged Persistent Jaundice(>2 weeks) Investigations(>2 weeks) Investigations
PathologicalPathological vsvs physiological?physiological? Breast fed?Breast fed? Feeding well?Feeding well? Thriving?Thriving? TSH screen negative?TSH screen negative?
Blood for split bilirubinCheck urine for wbcs, urobilinogen
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Neonatal InfectionNeonatal Infection
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Global Impact (1)Global Impact (1) Infection associated with 7Infection associated with 7 --54% of early54% of early
neonatal deathneonatal death Infection associated with 30Infection associated with 30 --73% of late73% of late
neonatal deathneonatal death Neonatal sepsis in hospital 5Neonatal sepsis in hospital 5 --6 per 10006 per 1000
livebirthslivebirths Neonatal meningitis 0.7Neonatal meningitis 0.7 1 .0 per 10001 .0 per 1000livebirthslivebirths
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Global Impact (2)Global Impact (2)
Acute respiratory infectionAcute respiratory infection 800,000800,000deaths per annumdeaths per annum
Neonatal tetanusNeonatal tetanus 438,000 per annum,438,000 per annum,
372,000 died372,000 died OmphalitisOmphalitis 22--54 per 1000 livebirths54 per 1000 livebirths
with 0with 0 --15% died15% died DiarrheaDiarrhea responsible for 1responsible for 1 --12% of12% of
neonatal deathsneonatal deaths
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Neonatal SepsisNeonatal Sepsis
Illness with positive blood culture inIllness with positive blood culture infirst 30 days of lifefirst 30 days of life
Early onset sepsisEarly onset sepsis
Late onset sepsisLate onset sepsis
l l f
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Clinical Signs: NonspecificClinical Signs: Nonspecific
HyperthermiaHyperthermia 55%55%
Jaundice 35%Jaundice 35% RespiratoryRespiratory
distressdistress 33%33%
Anorexia 28% Anorexia 28% Vomiting 25%Vomiting 25% Apnea 22% Apnea 22% Abdominal Abdominal
distension 17%distension 17%
HypothermiaHypothermia 15%15%
DiarrheaDiarrhea 11%11% Less frequentLess frequent
LethargyLethargy
Poor feedingPoor feeding Poor perfusionPoor perfusion Bloody stoolsBloody stools
Strategies to Reduce Neonatal Infections
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Strategies to Reduce Neonatal Infections
Antenatal Care Antenatal CareTetanus immunization,Tetanus immunization,
Management of STD, urinary infection, malaria, TBManagement of STD, urinary infection, malaria, TBIdentify pregnancy related maternal diseases andIdentify pregnancy related maternal diseases and
GBS carriersGBS carriers
Intrapartum/delivery care Intrapartum/delivery carePrevent prolonged laborPrevent prolonged laborOptimal management of complications: fever,Optimal management of complications: fever,PROM, puerperal sepsisPROM, puerperal sepsisClean delivery, cutting of cord and optimal cord careClean delivery, cutting of cord and optimal cord care
Breast feeding Breast feedingPromote early and exclusive breast feedingPromote early and exclusive breast feeding
Strategies to Reduce Neonatal Infections
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g
Gender issuesGender issuesPromote gender equalityPromote gender equalityEncourage education of girlsEncourage education of girls
Interventions to decrease incidence of LBW or Interventions to decrease incidence of LBW or prematurity prematurity
Delay childbearing in young adolescentsDelay childbearing in young adolescents
Promote maternal educationPromote maternal educationImprove maternal nutritionImprove maternal nutritionReduce tobacco useReduce tobacco use
Treatment of STD, Malaria treatment andTreatment of STD, Malaria treatment andprophylaxisprophylaxisLimit maternal work load during pregnancyLimit maternal work load during pregnancy
Maternal support to decrease stress/anxietyMaternal support to decrease stress/anxiety
Strategies to Reduce Neonatal InfectionsStrategies to Reduce Neonatal Infections
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Strategies to Reduce Neonatal InfectionsStrategies to Reduce Neonatal Infections
CommunityCommunity -- based intervention based interventionTrain birth attendants to identify problems in the newborn,Train birth attendants to identify problems in the newborn,
refer with serious problemsrefer with serious problemsPromote and support breast feedingPromote and support breast feeding
Maternal education regarding personal and domestic hygiene,Maternal education regarding personal and domestic hygiene,newborn care, and childhood immunizationnewborn care, and childhood immunization
Public health care followPublic health care follow --up after delivery, early diagnosis andup after delivery, early diagnosis andtreatment of newborn infection and mother, immunizationtreatment of newborn infection and mother, immunization
Early identification and improved treatment of neonates Early identification and improved treatment of neonateswith infectionwith infectionIntegrated approach to the sick infantIntegrated approach to the sick infant
Improve newborn care at all levelsImprove newborn care at all levels
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Infection ControlInfection Control
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Most common mode of transmissionMost common mode of transmissionof pathogens is via hands!of pathogens is via hands!
Infections acquired in healthcareInfections acquired in healthcare
Spread of antimicrobial resistanceSpread of antimicrobial resistance
So Why All Concern AboutSo Why All Concern AboutHand Hygiene?Hand Hygiene?
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Hand washing with antimicrobial soapHand washing with antimicrobial soapand water and water
Alcohol Alcohol --based hand rubbased hand rub
Hand HygieneHand Hygiene
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Indications for Hand HygieneIndications for Hand Hygiene
Before:Before: Direct contact with a patient and/or donningDirect contact with a patient and/or donning
glovesgloves
Guideline for Hand Hygiene in HealthGuideline for Hand Hygiene in Health --care Settings.care Settings.MMWR 2002MMWR 2002 ; vol. 51, no. RR; vol. 51, no. RR --16.16.
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Indications for Hand HygieneIndications for Hand Hygiene After: After:
Contact with a patientContact with a patient s intact skins intact skin Contact with blood, body fluids, excretions,Contact with blood, body fluids, excretions,
secretions nonsecretions non --intact skin, mucousintact skin, mucous
membranes, wound dressings in whichmembranes, wound dressings in whichglove use is indicated.glove use is indicated. Removing glovesRemoving gloves
Removal of any personal protectiveRemoval of any personal protectiveequipmentequipment Contact with environmental surfaces in theContact with environmental surfaces in the
patientpatient s immediate environments immediate environment
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Asphyxia and Neonatal Asphyxia and Neonatal
HypoxicHypoxic --IschemicIschemicEncephalopathyEncephalopathy
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Hypoxia
Perinatal asphyxia, apnea, respiratory failure,
right to left shunt
Ischemia
Heart failure, Shock, maternal hypotension
Causes
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Onset of HIE
Timing of Insults PercentageTiming of Insults Percentage
Antepartum Antepartum 2020IntrapartumIntrapartum 3535
Antepartum Antepartum antepartumantepartum 3535Postnatal 10Postnatal 10
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History of hypoxia or ischemia Clinical features
Neuroimaging Electrodiagnostic techniques
Neuronal biochemistry
Diagnosis
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1. Monitoring of vital signs
NICU, CNS, respiration,cardiovascular,renal, GI, fluid
Management
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2. Maintenance of AdequateVentilation and Perfusion
Respiratory support, blood gas Avoidance of systemic hypotensionor hypertension
Avoidance of hyperviscosity
Management
Management
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3. Maintenance of Adequate Glucose
LevelsNormal level: 3.9-6.6 mmol/L
4. Control of SeizurePhenobarbital
5. Control of Brain swellingPrevention of fluid overloadMannitol
g
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6. Other Therapeutic ApproachesMild hypothemia
7. Follow-up and Rehabilitation
Management
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Feeding Preterm infantsFeeding Preterm infants
Beneficial Effect of Feeding HM toBeneficial Effect of Feeding HM to
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ggPreterm InfantsPreterm Infants
Improved later cognitive developmentImproved later cognitive development
Reduced risk of NEC, infection,Reduced risk of NEC, infection,
atopyatopy
Nutritional programming of laterNutritional programming of latercardiovascular diseasecardiovascular disease
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Breastfeeding Premature InfantsBreastfeeding Premature Infants
SkinSkin --toto --skinskin Maintaining milk supplyMaintaining milk supply NonNon --nutritive sucklingnutritive suckling Initiation of breastfeedingInitiation of breastfeeding
TestTest --weightingweighting Breast vs bottleBreast vs bottle
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Skin to Skin ContactSkin to Skin Contact
Temperature RegulationTemperature Regulation OxygenationOxygenation Control of BreathingControl of Breathing Behavioral StateBehavioral State Rates of InfectionRates of Infection Maternal Milk ProductionMaternal Milk Production Duration of LactationDuration of Lactation
Bioactive Factors in Human MilkBioactive Factors in Human Milk
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With Effects on GI TractWith Effects on GI Tract
Secretory IgASecretory IgA
LactoferrinLactoferrin Cytokines (ILCytokines (IL --10)10) Enzymes (PAFEnzymes (PAF -- acetylhydrolase)acetylhydrolase) Growth factors (EGF)Growth factors (EGF)
NucleotidesNucleotides
Antioxidants Antioxidants Nutrients:Nutrients: Glutamine, TaurineGlutamine, Taurine
Human Milk Fortifier Human Milk Fortifier
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HM provides adequate nutrition for termHM provides adequate nutrition for term
infantsinfants
HM contains insufficient quantities of someHM contains insufficient quantities of somenutrients to satisfy the rapid growth rate ofnutrients to satisfy the rapid growth rate ofpremature infantspremature infants
HM fortifiers provide additional nutrients:HM fortifiers provide additional nutrients:protein, Ca, P, carbohydrates, vitamins, traceprotein, Ca, P, carbohydrates, vitamins, traceelementselements
HM fortifiers have short term benefits onHM fortifiers have short term benefits ongrowth with absence of documented longgrowth with absence of documented longterm benefitsterm benefits
Cochrane review 2004
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