Newborn Problems and complications .pptx

new born problems

1. OVERVIEW OF THE PROBLEMS OF THE NEWBORN PRESENTER: Paulin Robinson Moussa FACILITATOR: Prof.K.Manji

2. Introduction Problems in newborns may develop; Before birth while the fetus is growing During labor and delivery After birth About 10% of newborns need special care after birth due to prematurity, problems with the transition from fetal to newborn life, low blood sugar, DIB, Infections or other abnormalities .

3. Convulsions The commonest causes of neonatal convulsions include: Hypoxic ischaemic encephalopathy. (As a result of perinatal asphyxia: lack of oxygen to vital organs before, during or immediately after birth) 2. Central nervous system infection 3. Hypoglycaemia 4. Hypocalcemia

4. Hypoglycemia Inadequate glycogenolysis Inadequate glycogen stores (prematurity, intrauterine growth restriction) Increased glucose consumption Hyperinsulinemia (Infant of Diabetic Mother (IDM))

5. Respiratory Distress in the Neonate Preterm infants are at risk of respiratory distress syndrome due to surfactant deficiency. Clinical features usually include Respiratory Distress Syndrome: surfactant deficiency Transient tachypnea of the Newborn: retained fetal lung fluid Meconium Aspiration Syndrome Congenital pneumonia Persistent pulmonary hypertension Space occupying lesions: pneumothorax, chylothorax , pleural effusion, congenital diaphragmatic hernia, CCAM

6. Bacterial infection. Signs of bacterial infection are Inability to feed well Unconscious Fast breathing Raised temperature Convulsions

7. TORCH infections: Incidence is 0.5-2.5%; many infants are asymptomatic at delivery T oxoplasma gondii, “ O ther”: syphilis , R ubella C ytomegalovirus (most common) H erpes

8. Polycythemia Is defined as a venous hematocrit ≥ 65% or an abnormal elevation of the circulating RBC mass . Complications associated with hyper viscosity Plethora, slow capillary fill time Respiratory distress Hypoglycemia Irritability, lethargy

9. Cyanosis, heart murmur, and cardiomegaly Seizures and strokes Renal vein thrombosis Hyperbilirubinemia

10. Hyperbilirubinemia Types Physiologic vs Pathologic Causes Increased red cell breakdown Delayed/abnormal conjugation Abnormal excretion Increased enterohepatic circulation

11. Bowel Obstruction in the Neonate Emesis: Bilious emesis suggests a lesion distal to ampulla of Vater Sporadic emesis suggests partial obstruction, malrotation, duplications, or annular pancreas Failure to pass meconium Symptoms start soon after birth with high lesions or with complete obstruction.

12. Causes of Obstruction in the Newborn Atresia Stenosis Meconium ileus Anorectal malformations Volvulus Annular pancreas Peritoneal bands Hirschsprung

13. Duodenal Atresia 70% of neonates have other anomalies: Down syndrome, annular pancreas, cardiac malformation, multiple atresias Clinical presentations Upper abdominal swelling Early vomiting of large amounts,which may be greenish No urination after first few voidings No bowel movements after first few meconium stools

14. Malrotation with volvulus Malrotation can lead to; volvulus Complete obstruction Vascular compromises (gangrene of the gut, peritonitis, sepsis, and shock) Infants present with emesis, bowel distention, Intermittent emesis with incomplete obstruction.

15. Hirschprung’s Disease Lower bowel obstruction: agenesis of ganglion cells Rectal lesion extending in varying degree; in 80-90% patients no extension beyond sigmoid colon Associated w/ Downs (15%)syndrome Delayed meconium passage (>24-48 hrs) in 90% of patients (meconium ileus) Clinical findings: Abdominal distention, emesis, obstipation

16. Birth Injuries Cephalohematoma Caput succedaneum Subgaleal hematoma Erb’s palsy Klumpke’s palsy Clavicular fracture Phrenic nerve injury with diaphragmatic paralysis

17. Cardiac/Murmurs Can be congenital or develop later on in life, a heart murmur isn’t a diseases but murmurs may indicate an underlying heart diseases. Two types of heart murmurs; innocent and abnormal murmurs Can be innocent murmurs when blood flows more rapidly than normal through the heart

18. Cardiac/Murmurs continue… Abnormal heart murmurs in newborn is when babies are born with structural problems of the heart (congenital heart defects) Common heart defects are: Holes in the heart/cardiac shunts Heart valve abnormalities(stenosis , regurgitation) Other causes, Infections: valve calcification, endocarditis, rheumatic fever

19. Other congenital anomalies Cleft lip and palate Omphalocele Myelomeningocele, commonest site is lumbar region Congenital dislocation of the hip Club foot

20. References WHO. Pocket Book of Hospital care for children: Guidelines for the Management of Common Childhood Illnesses. 2 nd edition. 2013. .Stanford’s newborn nursery site: http://newborns.stanford.edu/PhotoGallery/Heart.html Kliegman : Nelson Texbook of pediatrics, seventh edition.Elsevier Ltd 2015.