problems in the newborn

8/8/2019 Problems in the Newborn

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1. Hyperbilirubinemia2. Respiratory Distress3. Cleft Lip/Palate4. Hydrocephalus

5. Spina Bifida6. Down Syndrome7. Talipes Equinovarus8. Infant of a Diabetic Mom9. Infant of an HIV Positive Mom10. Infant of a Substance-Abusing Mom11. Phynylketonuria



Definition:An excess bilirubin in the blood, maybe RTPhysiologic Jaundice or Pathologic Jaundice

Pathologic jaundice ² may lead to KernicterusCommon Cause: Rh Incompatibility

Management:A. Medical ² PhototherapyB. Surgical ² Exchange Transfusion

BT ́ Oµ, Rh (-) Blood is usedComplications: Hyper/Hypovolemia, infection,Arrhythmias, Air

embolism

Insert pic



2 types:a. Respiratory Distress Syndrome (RDS)

- associated w/ preterm infants &surfactant deficiency

b. Transient tachypnea of the Newborn (TTN)- near term infants- results from failure to clear the airway oflung fluids & mucus or aspiration ofamniotic fluid- respiratory difficulties follows few hoursafter birth



Medical Management:

- determine type of Respiratory Distress thenbegin tx

RDSa. Mild RDS ² increased, humidified O2 concentrationb. Mod RDS ² continuous positive airways pressurec. Severe RDS ² Mechanical Ventilator

TTN4 days treatment of Ambient O2 of 30-50% then

decreases



Concern : Feeding

Special Considerations:1. Special Nipples & feeding devices

2. Held in upright position3. Frequent burping necessary4. Sleeping ² in side lying position



Excess cerebrospinal fluid in thecerebral ventricles, causes the infant·shead to be enlarged

Interventions:Head CircumferenceMeasured daily

Fontanels checked if flator bulgingInfant·s position changedfrequently



3 Types of Spina Bifida (Neural Tube Defects)1. Spina Bifida Occulta

- failure of the vertebral arch to close. There is adimple at the back which may have a tuft of hair.NO CARE required

2. Meningocele- saclike protrusion along the vertabral column filledw/ cerebrospinal fluid & meninges. Surgeryrequired, no long term effects

3. Myelomeningocele- saclike protrusion along the vertabral column filledw/ cerebrospinal fluid, meninges, nerve roots andspinal cord. Paralysis at some level after surgicalrepair



Considerations:- Protrusion covered with sterile saline

dressing

- Care taken when changing position- Sac must be kept free from

contamination by urine and stool-

Head Circumference is measured andfontanels checked for bulging(hydrocephalus often develops)



A chromosomal abnormality alsocalled Trisomy 21 resulting to severemental retardation



AKA Clubfoot ² a congenital deformityin which the foot and ankle are twistedinward and cannot be moved to amidline position



Transmission rate from mom ² infant = 28-35%Occur through:1. Placenta2. Maternal Blood

3. Secretions during labor and birth4. Breastmilk after birth

Every infant have HIV antibodies fromplacenta. By 8-15 mos, uninfected infantslost maternal antibodies

3-6 mos ² lymphoid insterstitial pneumonitis isa criterion for dx



Infant is a substance abuser at birthWithdrawal symptoms seen after the

cord is cut usually within the first24-48H after birth or not until 4-5days of age.The severity of withdrawalsymptoms depends on the substancebeing abused and the time andamount of last dose



Complications:Withdrawal

Respiratory DistressCongenital AnomaliesJaundiceBehaviour Problems

Growth Retardation

Management:Medical ² mgt of complicationsPharmacological ² Phenobarbital or tincture of

opium to control withdrawal symptomsDiazepam(Valium) ² to control seizures inROH-dependent infant



- An inborn error of metabolism inwhich the infant has deficiency ofthe enzyme required to digest the

amono acid phenylalanine- Result to severe mental retardation

Test done after ingestion ofBreastmilk of formula within 24H

problems in the newborn

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