Neonatal Medicine Fetal Assessment Gestational Age: obstetrical - PDF document

6/29/2011 Neonatal Medicine • Fetal Assessment • Gestational Age: obstetrical interventions Pediatrics • –amniocentesis, c ‐ section, inevitable premature delivery delivery • LMP, quickening, first fetal heart tones, Fernando Vega, MD • Physical exam, • Ultrasound HIHIM 409 – 1 st trimester: crown ‐ rump – 2 nd and 3 rd trimester: BPD Neonatal Medicine Neonatal Medicine • Functional maturity • Specific Fetal diseases • Fetal Growth – Alpha ‐ fetoprotein (AFP) – maternal and fetal • IUGR – Anencephaly, congenital nephrosis, duodenal atresia, Hydrocephalus • encephalocele, esophageal atresia, fetal blood • macrosomia contamination, fetal death, gastroschisis, hydrocephalus, , , g , y p , • • Fetal well being Fetal well being Myelomeiningocele, Necrosis of fetal liver 2 o to HSV • Lungs infection, Nuchal bleb, omphalocele, Rh isoimmune • Fetal movement disease, sacroccygeal teratoma, spontaneous abortion, • Non stress test – Trisomy 13, Turner’s syndrome, Twins, urinary obstruction • Fetal activity is accompanied by a reflex acceleration of • Amniotic fluid: liquid and cellular elements. fetal heart rate ‐ a reflex present by 32 • Percutaneous umbilical blood sampling weeks of gest. Neonatal Medicine Neonatal Medicine • Timing of delivery • Labor and Delivery – Fetal well being – Stages of Labor: – Maternal well being • 1 st ,is from onset of labor to 10 cm dilation • 2 nd ,passage through the birth canal 2 ,passage through the birth canal • 3 rd ,from delivery of baby to passage of placenta – Fetal well being • Fetal heart monitors 1

6/29/2011 Neonatal Medicine Neonatal Medicine • Physiologic changes during transition from fetal to neonatal life. – Expansion of lungs – Air exchange Air exchange – Termination of right to left circulatory shunt Neonatal Medicine Neonatal Medicine Resuscitation in the Delivery room: High risk infants that need an experienced resuscitator • Fetal distress: abnormalities in heart rate, scalp pH<7.20 • Thick meconium in amniotic fluid • Prematurity <36wks, postmaturity>42wks • Low BW <2.0kg, high BW >4.5kg Low BW <2 0kg high BW >4 5kg • Detected congenital anomalies Multiple births • • Abn presentation • Cord prolapse • Significant vaginal bleeding • Midforcepts delivery • Prolonged, difficult unusual labor Neonatal Medicine Neonatal Medicine • Respiratory distress APGAR SCORE 0 1 2 • Apgar score <6 at 5 minutes Heart Rate absent <100bpm >100 bpm • Signs of maternal infection Respiratory effort Respiratory effort absent absent slow (irreg) slow (irreg) Good crying Good crying • Prolonged rupture Muscle tone Limp some flexion of Active motion • Foul smelling amniotic fluid extremities Reflex irritability No response Grimace Cough or snz Maternal diabetes, Rh sensitization, PIH, • Color Blue, Paile Pink body, blue All pink extrmities Add up five numbers to get a final score 2

6/29/2011 Neonatal Medicine Neonatal Medicine • Normal newborn • Caridorespiratory system: color, respiratory rate, heart sounds, rate, pulses • • Abdomen • History: family, maternal, paternal, pregnancy, • GU/Rectum perinatal • Skin • Physical exam Ph i l • Extremities, Spine, Joints Signs of gestational age • Head neck mouth • Neuro Congenital Anomalies • Neuromuscular maturity: Posture.square window,arm Successful Transition to Air breathing recoil, popliteal angle, scarf sign, heel to ear. Impact of labor, delivery • Physical maturity: skin,m lanugo, plantar creases, breast, ear, genitals Signs of infection or metabolic diseases Neonatal Medicine Neonatal Medicine • Problem newborn • • Respiratory Tract Disorders • Respiratory distress • Transition to Pulmonary Respiration • • Congenital heart disease • Apnea • • RDS • RDS Birth trauma • • TTNB • • Orthopedic problems • Meconium apiration • • Pulmonary Hemorrhage • Metabolic problems • Digestive System Disorders Hypoglycemia • • Hyperglycemia • Meconium Ileus in Cystic Fibrosis • Dermatological problems Neonatal Medicine Infant Care • Breast feeding, benefits • Baby bottle tooth decay • Neonatal Necrotizing Enterocolitis • Solids • Jaundice of the Newborn • Formula • Formula • Blood Disorders • Elimination • Anemia • Developmental Milestones • Hemolytic Disease of the Newborn • Day/Night routine • Hemorrhage in the Newborn • Child Abuse 3

6/29/2011 The Older Older Child Pediatric Infectious Disease • Allergic Disorders • Fever • Allergic Rhinitis • URI’s • Asthma • Otitis Media • Atopic Dermatitis • Gastroenteritis • Urticaria ‐ Angioedema • Pneumonia • Anaphylaxis • Menningitis • Adverse reaction to Foods • Sepsis Pediatric Rheumatology Pediatric Oncology – Leukemia • Juvenile Rheumatoid Arthritis • White cell proliferation in blood – Arthritis may not be evident early in the course of the – Lymphoma disease • White cell tumors – High fevers, rashes, markedly elevated white blood cell – Wilm’s Tumor counts, and anemia = thought to be leukemia or Kawasaki’s • Kidney malignancy • Vasculitis – Neuroblastoma • Malignancy of Sympathetic ganglion cells – Henoch Schoenlein Purpura – Retinoblastoma – Kawasaki’s • Retina malignancy Pediatric Nephrology Pediatric Neurology • UTI’s in children • Seizures in Childhood • Evaluation of Hematuria • Headaches • Evaluation of Proteinuria 4