Summary
Samenvatting neonatologie Dr. Allegaert
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- Institution
Neonatale adaptatie De eerste levensweek Neonatale stabilisatie Congenitale infecties Intra-uteriene, perinatale en neonatale virale infecties Neonatale pijn
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Neonatologie K. Allegaert – fase 1 (examen januari) www.embryology.chNeonatologie
Inhoudsopgave
Neonatale adaptatie..........................................................................................................................2
1 Transitie geboorte: van foetus naar pasgeborene...........................................................................2
1 Transitie: ademhaling......................................................................................................................2
Ademhalingsproblemen.................................................................................................................2
Ademlast bij de pasgeborene: klinische tekens.............................................................................2
Structurele longontwikkeling.........................................................................................................2
Surfactant......................................................................................................................................3
1. Hyaliene membraanziekte (prematuur).....................................................................................3
2. Transiet tachypnea (voldragen pasgeborenen)..........................................................................3
3. (Meconium) Aspiratie Syndroom...............................................................................................3
4. Pulmonale hypoplasie (longhypoplasie).....................................................................................3
5. Pneumothorax & luchtleksyndroom..........................................................................................3
6. Congenitale neonatale pneumonie............................................................................................3
7. Luchtwegobstructie syndroom..................................................................................................3
8. Persisterende pulmonale hypertensie.......................................................................................3
Hernia diafragmatica......................................................................................................................3
2 Transitie: circulatie..........................................................................................................................4
Embryology: foetale vs neonatale circulatie.......................................................................................5
Het foetale circulatiesysteem.............................................................................................................5
3 Apgar score > 7 = oké......................................................................................................................6
4 Te vroeg, te laat, op tijd?.................................................................................................................6
5 Te licht, te zwaar, normaal gewicht? (p50 = gemiddelde)...............................................................6
6 Onderzoek neonatus door de kinderarts.........................................................................................6
De eerste levensweek.......................................................................................................................6
Identificatie v.d. probleemneonatus...................................................................................................6
8,10,12%: gewichtsverlies door verdamping.................................................................................8
Cardiale zaken................................................................................................................................9
Streptococcal disease prevention..................................................................................................9
Waarom screenen we?.......................................................................................................................9
Neonatale stabilisatie......................................................................................................................10
Apgar test.........................................................................................................................................10
Reanimatie.......................................................................................................................................10
Reanimatie van een pasgeborene................................................................................................11
Congenitale infecties.......................................................................................................................12
Intra-uteriene, perinatale en neonatale virale infecties...................................................................13
Neonatale pijn.................................................................................................................................13
Pijn bij pasgeborene (problemen bij pijn).........................................................................................13
Verschil in pijn..................................................................................................................................14
Behandeling van pijn bij jonge kinderen...........................................................................................14
Mogelijkheden voor de niet-kritische zieke pasgeborene.................................................................14
Borstvoeding....................................................................................................................................14
Geneesmiddelen bij pasgeborenen?.................................................................................................14
Extra’s..............................................................................................................................................14
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, Neonatologie K. Allegaert – fase 1 (examen januari) www.embryology.ch
Neonatale adaptatie
1 Transitie geboorte: van foetus naar pasgeborene
Na 6 weken neemt het gewicht met 50% toe.
60 – 65 000 geboorten per jaar in Vlaanderen
1-2% intensieve zorgen
1-2% aangeboren afwijking
6-7% te vroeggeboren -> NIC afdeling
10-20% extra zorgen of ondersteuning nodig
20% keizersnede
1 Transitie: ademhaling
Ademhalingsproblemen
Normaal 20-40 ademhalingen per minuut, +- 100 bpm
Slechte longen zijn stijf, borstkas = kraakbeen
Baby’s ademen alleen door neus
Hypoglycemie = kost IQ punten
CPAP = druk zetten op long, zodat hij niet zou dichtvallen
Ademlast bij de pasgeborene: klinische tekens
1. Tachypneu
2. Retractie
3. Neusvleugelen
4. Cyanose = blauw zien = door te weinig zuurstof in bloed
Centrale: lage saturatie, lippen blauw
Perifere: handen (rechterhand) & voeten blauw
5. Kreunen: baby doet stembanden toe, zodat de lucht in de longen blijft, zo zou de long
niet dichtvallen -> longen onrijp.
6. Slecht drinkgedrag / 7. te stil zijn
Pneumonie = longontsteking
Apneu = stoppen met ademhaling
Bij prematuur: koffie goed voor ademhaling
Ademhaling
Hartfrequentie
Saturatie (R hand)
Structurele longontwikkeling
Embryonaal : 0-7 w
Pseudoglandulair: 8-16 w
Canaliculair: 17-26 w
Sacculair: 24-35 w
Alveolair: 36 w-5 j
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