Pedia at Risk Lecture 1
Pedia at Risk Lecture 1
Pedia at Risk Lecture 1
PREMATURE NEWBORN
Risk Factors:
A. Respiratory System
- Poorly developed lungs/respiratory muscles
- Decreased surfactant> alveoli produce
surfactant
- Difficulty of breathing with apnea and cyanosis
- Poorly/unstable chest walls
- Poor gag/cough reflex
C. Digestive System
- Poor sucking and swallowing> refer pt to
pediatrician to avoid aspiration to order OGT
feeding
- Small stomach
D. Liver Function
- Decreased vitamin K
- Decreased hemoglobin and blood production
- Poor bilirubin conjugation
- Poor sugar storage and release
Glucuronyl transferase
E. Nervous System
- Centers of vital functions are poorly developed
- Poor reflexes
- Low response to stimuli
- Poor muscle tone
POTENTIAL COMPLICATIONS
1. Anemia of prematurity
- Normochromic, normocytic anemia (normal
cells, just few in number)
- Low reticulocyte count
- Immature hematopoietic system combined with
destruction of RBC’s (the effective production of
red cells with an elevated reticulocyte count
may not begin until 32 weeks of pregnancy)
- Excessive blood drawing
2. Kernicterus
- Destruction of brain cells by invasion of indirect
7. Retinopathy of prematurity
bilirubin.
8. Necrotizing enterocolitis
Risk Factors:
• Physical appearance
• Length of pregnancy
• Ultrasound
• Nonstress testing
- Placental function
• Checking the amount of amniotic fluid
Assessment finding
• Perinatal asphyxia
• Hypoglycemia
• Meconium aspiration
• Polycythemia vera
• Thermal regulation problems
• Hypothermia
TYPES OF IUGR
1. Symmetrical
- Cause occurs early in pregnancy
- Head circumference, abdominal
circumference, fetal length, and postnatal
weight all reduced/small.
- Is based on the cross-sectional evaluation and 2. Asymmetrical
this term has been used for those neonates - Cause occurs later in pregnancy
whose birth weight is less than the 10th - Abdominal circumference and weight
percentile for that particular age. reduced/small but other measurement normal.
Causes:
Epidemiology
• Prematurity
• Male gender
• Familial predisposition
• Cesarean section without labor
• Perinatal asphyxia
• Caucasian race
• Infant of diabetic mother
- is released from the lung cells and spreads 1. Tachypnea (>60 breathe/min)
across the tissue that surrounds alveoli. This 2. Intercostal and subcostal retractions
substance lowers surface tension, which keeps 3. Nasal flaring
the alveoli from collapsing after exhalation and 4. Grunting
makes breathing easy. 5. Cyanosis in room air
- Is a complex mixture of phospholipids, neutral
lipids and proteins. Its major constituents are Other Manifestations:
dipalmitoylphosphatidylcholine (DPPC or
lecithin), phosphatidylglycerol, cholesterol and • Hypotension
apoproteins. • Acidosis
• Hyperkalemia
• Low lung volumes and a bilateral, reticular
graular pattern (ground glass appearance)
- Management: Application of positive airway
pressure
Complications:
• Air leaks
• Intracranial hemorrhage
Management:
Prevention/Treatment
1. Antenatal Glucocorticoids
- Accelerate fetal lung maturity by increasing
formation and release of surfactant and
maturing the lung morphologically.
- Administration of glucocorticoids at least 24 to
48hrs (and no more than 7 days) before
preterm delivery decreases both incidence
and severity of RDS.
- They are most effective before 34 weeks.
However, antenatal steroids should still be
considered when therapy is less than 24hrs
before anticipated delivery because a
Katelinne Alba Dabucol
NCM 109 COMCA RISK (PEDIA)
reduction in neonatal mortality and RDS can still
occur in this time frame.
- ANTENATAL STEROIDS also reduce the TRANSIENT TACHPNEA OF THE NEWBORN
incidence of intraventricular hemorrhage.
TTN
2. EXOGENOUS SURFACTANT
- Is a therapeutic option for newborn with acute - Is characterized by mild to moderate respiratory
respiratory distress disorder. distress that gradually improves during the first
- Two approaches have been used for 48-72 hours of life.
surfactant delivery: - Results from the delayed clearance of fetal lung
1. Prophylactic fluid and is more commonly observed in NBs with
2. Rescue treatment history of maternal diabetes and those born via
Cesarean section
Prophylactic administration involves giving surfactant - Wet lungs
after birth, as soon as the infant has been stabilized. - Type II respiratory distress syndrome
5. Antibiotic Therapy
- The clinical and radiographic features of
pneumonia may be indistinguishable from RDS
at birth.
- As a result, all infants with RDS should have blood
cultures and CBC drawn, and should receive
empiric antibiotic therapy (Ampicillin and
Gentamicin)
- Generally, antibiotics may be discontinued if the
blood culture has no growth after 48 hours,
unless prenatal history or clinical scenario
warrants extended treatment. Risk Factors
• Precipitous delivery
• Prematurity
• Male sex
Diagnosis
Manifestations:
Treatment
• Supplemental oxygen
• Blood tests
• Continuous positive airway pressure
• IV (intravenous) fluid
• Tube Feeding
Meconium Aspiration
Syndrome
Meconium