maternal diseases affecting newborn.pptx

maternal diseases affecting newborn.pptx

1. Maternal Disorders Affecting Fetus or Newborn Safwat M. Abdel-Aziz Assistant professor of pediatrics Assiut university

2. High risk neonates High risk neonates, as an outcome of high risk pregnancies and/or problematic pregnancies, are in need of close observations immediately after birth. High risk pregnancies are characterized by factors that increase the likelihood of abortion, fetal demise, preterm labor, IUGR, congenital malformations, and mental retardation. An active partnership between obstetric and neonatal teams should be developed for the management of high-risk pregnancies and newborns .

3. Factors Associated with High Risk Pregnancy 1- Maternal age: less than 18 years or more than 35 years old 2- Poverty 3-Social and behavioral factors: ► Low educational status ► Cigarette smoking ► Drug addiction ► Poor nutrition

4. 4- Obstetric factors: ► Previous cesarean section ► Multiple pregnancies ► Prior infertility ► Previous preterm birth ► Previous postterm birth ► Pre- eclampsia

5. 5- Medical conditions: ► Diabetes mellitus ► Hypertension ► Pregnancy induced hypertension (PIH) ► Congenital heart disease ► Auto-immune diseases ► Infections

6. Factors Associated with High Risk Delivery 1-Prolonged or precipitate labor 2- Instrumental (forceps/vacuum) delivery 3-Cesarean section 4-Analgesia 5-Signs in placenta, umbilical cord, amniotic membranes and amniotic fluid ( e.g.,placental pallor, edema, retro-placental hematoma, whitish nodules, meconium staining, or single umbilical artery)

7. Important maternal medical conditions and associated risk for fetus or neonate 1-Diabetes mellitus - Intrauterine fetal demise - RDS, hypoglycemia, polycythemia - Macrosomia , birth injury - Congenital anomalies 2- Thyroid disease Goiter, hypothyroidism, hyperthyroidism 3-Heart, lung disease IUGR, prematurity 4-Systemic lupus erythematosus Congenital heart block, rash, anemia, thrombo-cytopenia , neutropenia

8. 5-Renal disease IUGR, prematurity 6-Urinary tract infection Prematurity, sepsis 7-Hypertension (chronic or PIH ) IUGR, intrauterine fetal demise, asphyxia, prematurity 8-Anemia IUGR, asphyxia, prematurity, hydrops

9. 9- Rhesus or other blood group sensitization Fetal anemia, hydrops , neonatal jaundice 10-Iso-immune thrombocytopenia Thrombocytopenia and bleeding 11-Myasthenia gravis Transient neonatal myasthenia 12-Hyperparathyroidism Neonatal hypocalcemia

10. 13-Infections - Group β Streptococci, E.Coli Ascending cervical sepsis, pneumonia - Rubella virus Congenital rubella - Cytomegalovirus (CMV) Congenital CMV -Hepatitis B virus Neonatal hepatitis, chronic carrier - Hepatitis C virus Uncommon but possible neonatal hepatitis chronic carrier

11. Newborn Admission in Neonatal Care Units

12. Indications for Admission 1- Prematurity ≤34 weeks' gestation 2-Low Birth Weight (LBW) <1,800 gm 3-Cardiopulmonary problems: ► Central cyanosis ► Respiratory distress ► Apnea/ Bradycardia ► Meconium suctioned below the vocal cords

13. 4- Neurologic problems: ► Seizures ► Impaired consciousness ► Abnormal neonatal reflexes ► Severe hypotonia ► Low 5-minute Apgar score

14. 5-Gastrointestinal and genitourinary problems: ► Delayed passage of meconium beyond 48 hrs ► Bile stained vomiting, or other signs suggesting bowel obstruction ► Feeding problems severe enough to cause clinical concern ► Abdominal masses ► Delayed passage of urine beyond 24 hrs

15. 6- Hematologic problems: ► Pallor ► Polycythemia with venous hematocrit ≥65%, or 60-64% with clinical symptoms ► Petechiae and purpura 7-Hyperbilirubinemia requiring treatment 8-Neonatal infection (acquired or congenital)

16. 9-Metabolic problems: ► Hypoglycemia and IDM: inability to maintain a serum glucose concentration ≥45 mg/dl despite adequate feeding ► Dehydration ► Electrolyte disturbances

17. 10-Congenital malformation: Major malformations or minor malformations that need special care as: □ Chromosomal disorders ( trisomies 13, 18, and 21) □ Pierre Robin syndrome □ Osteogenesis imperfecta □ Asphyxiating thoracic dystrophy 11- Birth injuries

18. Thank you