Semester 2.2, theme 8
Week 29 yellow child
Understand the transition from fetal to neonatal life
, understand the birth weight and gestational age classification
know about the assessment of maturation
Pulmonary maturation can be assessed via surfactant in the
amniotic fluid. A neurological exam is done to assess maturity of
the nervous system. Vital signs are also measured. Furthermore
the spine is examined for hair tufts and the skin is checked for
cyanosis. Acrocyanosis, can be present, but is not necessarily
bad, if the rest of the body is pink.
* cyanosis is i.c.o. >5g unsaturated Hb
Maturation is also checked via the skin:
- lanugo (thin hair)
- vernix caseosa (fatty white substance)
both absent, or less present in a full-term baby
understand neonatal respiratory problems
Respiratory distress syndrome (RDS)
- DEFICIENT SURFACTANT!! (secreted by T2 pneumocytes), mostly secreted in week 34-36
Risk factors: prematurity, maternal diabetes, hypothermia, asphyxia, male secs, 2 nd born of twins, C-section
Symptoms: atelectasis, low FRC, respiratory distress, perfusion but no ventilation (shunt), chest wall retractions,
cyanosis, nasal flaring
Treatment: intratracheal exogenous surfactant (corticosteroids for prevention)
Complications: - PDA (hypoxemia prevents closure of ductus)
- pneumothorax (alveoli rupture near pleural cavity)
- bronchopulmonary dysplasia (damage to neonatal lungs due to O2 needs and increased P after ventilation)
- retinopathy of prematurity (due to acute effects of O2 toxicity on developing bloodvessels)
Transient tachypnoea of the newborn: self-limited condition characterized by tachypnoea, mild retractions, hypoxia
due to retained lung fluid or slow resorption of the fluid (more seen in C-section)
, Meconium aspiration: most commonly during first breaths of air after birth air trapping, obstruction atelectasis
pneumonitis can appear
to prevent aspiration: before complete birth it is emptied from oropharynx via suction
Primary pulmonary hypertension: if not cardiac or pulmonary diseases are present. Most in post term / term infants
oft with right-left shunt via foramen ovale (too high P in pulmonary artery)
Apnea of prematurity: most commonly a combination of obstructive (still chest movements) and central (no airflow
and respiratory effort) apnea.
Treatment = O2, methylxanthines (minute ventilation + better CO2 sensitivity, more diaphragmatic activity)
understand neonatal feeding problems and necrotizing enterocolitis
Necrotizing enterocolitis (NEC): severe intestinal damage and necrosis
Risks: PREMATURITY (limited immune system, less GI hormones, enzymes and
abnormal regulation of bloodstream)
Symptoms: abdominal distention, vomiting, rectal bleeding, unstable
temperature, apnea, bradycardia, shock
Complication: intestinal perforation
Indications: ileus, pneumatosis intestinalis (air in intestinal wall),
pneumoperitoneum
Diagnosis: X-ray
Treatment: stop enteral feeding, start parenteral feeding, broad-spectrum
antibiotics, 25-50% surgery (remove necrotic bowel
laparoscopically)
know about the mechanism behind neonatal jaundice and bilirubin
metabolism
Week 29 yellow child
Understand the transition from fetal to neonatal life
, understand the birth weight and gestational age classification
know about the assessment of maturation
Pulmonary maturation can be assessed via surfactant in the
amniotic fluid. A neurological exam is done to assess maturity of
the nervous system. Vital signs are also measured. Furthermore
the spine is examined for hair tufts and the skin is checked for
cyanosis. Acrocyanosis, can be present, but is not necessarily
bad, if the rest of the body is pink.
* cyanosis is i.c.o. >5g unsaturated Hb
Maturation is also checked via the skin:
- lanugo (thin hair)
- vernix caseosa (fatty white substance)
both absent, or less present in a full-term baby
understand neonatal respiratory problems
Respiratory distress syndrome (RDS)
- DEFICIENT SURFACTANT!! (secreted by T2 pneumocytes), mostly secreted in week 34-36
Risk factors: prematurity, maternal diabetes, hypothermia, asphyxia, male secs, 2 nd born of twins, C-section
Symptoms: atelectasis, low FRC, respiratory distress, perfusion but no ventilation (shunt), chest wall retractions,
cyanosis, nasal flaring
Treatment: intratracheal exogenous surfactant (corticosteroids for prevention)
Complications: - PDA (hypoxemia prevents closure of ductus)
- pneumothorax (alveoli rupture near pleural cavity)
- bronchopulmonary dysplasia (damage to neonatal lungs due to O2 needs and increased P after ventilation)
- retinopathy of prematurity (due to acute effects of O2 toxicity on developing bloodvessels)
Transient tachypnoea of the newborn: self-limited condition characterized by tachypnoea, mild retractions, hypoxia
due to retained lung fluid or slow resorption of the fluid (more seen in C-section)
, Meconium aspiration: most commonly during first breaths of air after birth air trapping, obstruction atelectasis
pneumonitis can appear
to prevent aspiration: before complete birth it is emptied from oropharynx via suction
Primary pulmonary hypertension: if not cardiac or pulmonary diseases are present. Most in post term / term infants
oft with right-left shunt via foramen ovale (too high P in pulmonary artery)
Apnea of prematurity: most commonly a combination of obstructive (still chest movements) and central (no airflow
and respiratory effort) apnea.
Treatment = O2, methylxanthines (minute ventilation + better CO2 sensitivity, more diaphragmatic activity)
understand neonatal feeding problems and necrotizing enterocolitis
Necrotizing enterocolitis (NEC): severe intestinal damage and necrosis
Risks: PREMATURITY (limited immune system, less GI hormones, enzymes and
abnormal regulation of bloodstream)
Symptoms: abdominal distention, vomiting, rectal bleeding, unstable
temperature, apnea, bradycardia, shock
Complication: intestinal perforation
Indications: ileus, pneumatosis intestinalis (air in intestinal wall),
pneumoperitoneum
Diagnosis: X-ray
Treatment: stop enteral feeding, start parenteral feeding, broad-spectrum
antibiotics, 25-50% surgery (remove necrotic bowel
laparoscopically)
know about the mechanism behind neonatal jaundice and bilirubin
metabolism
