Importance of Neonatal Period
Neonatal period defines the first 4 weeks of life after birth. Neonatal mortality rate is the number of deaths during the neonatal period per 1000 live births. Perinatal mortality rate is defined by the deaths of fetus and neonates during the period of 28 weeks of gestation to first week after birth per 1000 births. Birth weight is the major determinants of neonatal mortality and number of LEW infants is a major cause of high neonatal mortality and morbidity in developing countries. Clinical decision making in neonatal care has on occasion been taught with the use of pneumonics like the word "ART". The A in this case stands for anticipation, the R for recognition, and the T for treatment.
Seventy-three percent of the 10.6 million child deaths worldwide each year are the result of six causes: pneumonia, diarrhea, malaria, neonatal sepsis, preterm delivery and asphyxia at birth. Researchers at the Johns Hopkins Bloomberg School of Public Health and the World Health Organization (WHO) have developed the most accurate estimates to date of the causes of death of children under age 5.
According to the study, four communicable disease categories account for 54 percent of all child deaths globally. Pneumonia accounts for 19 percent of all child deaths, diarrhea 17 percent, malaria 8 percent and neonatal sepsis 10 percent. Under nutrition is an underlying cause in more than half of all deaths before age 5. More than 37 percent of all child deaths occur during the first 28 days of life, the neonatal period.
"In all regions of the world, deaths in the neonatal period, primarily due to preterm delivery, sepsis or pneumonia and birth asphyxia, should also be addressed. The new estimates of the causes of child deaths should be used to guide public-health policies and programs," he said.
Past medical history of mother: illness such as diabetes mellitus, hypertension, heart diseases, kidney diseases, or sickle cell diseases.Family history of hereditary diseases: Hereditary disorders of either side of the family, such as cystic fibrosis, haemophilia.
Past obstetric history: have all previous pregnancies, deliveries, and babies been normal'.' If not, why not? Full details of all abnormalities.
History of pregnancy: Date of last menstrual periods (LMP), results of ultrasound scan, if performed, amniocentesis. Illness during pregnancy (rubella). Complications like pre-eclampsia. Antepartum haemorrhage (APH), intra-uterine growth retardation (IUGR). polyhydramnios.
History of labour: Gestation at onset. Length of time membrane ruptured. Length of labor . Drugs used. Fetal heart irregularities. Fetal distress.
History of delivery: Spontaneous, assisted (force p, ventose), vertex, breech, or caesarean section (elective or emergency)
Resuscitation of the baby: Oxygen, bag and mask, intubation. Drugs given (naloxone, bicarbonate, others). Condition of infant as assessed by Apgar score.
Controlling for birth weight of the newborn, the researchers found that women who averaged less than six hours of sleep per night had significantly longer labors and were 4.5 times more likely to have cesarean deliveries than women who averaged seven or more hours of sleep. women who have less sleep or severely disrupted sleep in late pregnancy are significantly more likely to have longer labors and are more likely to have cesarean births.
Data reported that the required increase in breathing in response to reduced oxygen supply was lower in nicotine-exposed animals compared to the controls over their first nine days. This suggests that prenatal nicotine exposure reduces the ability of a neonatal animal to respond to low blood oxygen, which can lead to prolonged and possibly lethal apneas.This is important when the neonate has an 'apnea,' or cessation of breathing, when they are sleeping, because under these conditions the oxygen can be reduced dramatically.
Nearly 40 percent of all child deaths worldwide occur in the neonatal period, or the first month of life, and three quarters of those deaths occur within the first week of life.Some of the cost-effective measures identified by the researchers include providing tetanus vaccinations for pregnant women, delivering babies in a clean environment, exclusively breastfeeding infants, providing extra care for low-birth-weight babies and antibiotics for neonatal infection.
Apnea of prematurity occurs in up to 85 percent of all prematurely born human infants, and obstructive sleep apnea occurs in 3 to 27 percent of all children.Researchers found that dopamine promotes attention, learning, memory and a variety of higher cognitive functions, the researchers believe repetitive apnea during neonatal development may be one factor leading to the development of attention deficit hyperactivity disorder (ADHD).
Autosomal recessive polycystic kidney disease (ARPKD) is one of the most common childhood diseases of the kidneys. ARPKD, also known as infantile PKD, affects one in 20,000 Americans. The disease results in the development of multiple fluid-filled cysts in the kidney, fibrosis in the liver and often poor lung development and neonatal death.Scientists have identified the gene causing an inherited form of childhood kidney disease associated with renal failure and neonatal death. The discovery may improve prospects for gene testing and diagnosis of this life-threatening disease.
Although much of the detail of intensive care has changed in the intervening 12 years since these children were born, we remain concerned about long term problems in very premature children who survive.A most recent study shown that children who are born very premature remain at risk of psychological and psychiatric problems into adolescence, despite neonatal intensive care.
Newborn animals grow rapidly, and they must develop new blood vessels fast enough to keep pace with that growth.Researchers at Washington University School of Medicine in St. Louis have found that a kind of immature cell that develops in the bone marrow and circulates in the blood contributes to the growth of new blood vessels during the neonatal period.This finding has important implications for tumor biology, gene therapy and the treatment of various congenital disorders.
Examination of Newborn:
The initial examination should be performed as soon as possible after delivery to detect abnormalities and to establish a baseline for subsequent examination. This examination should take place in the delivery room. A second and more detailed examination should be performed within 24 hours of birth. No infant should be discharge from the hospital without a Final examination,
Since certain abnormalities, particularly heart murmurs, often appear or disappear in the immediate neonatal period, or there may be evidence of disease that has just been acquired. Pulse, respiratory rate, temperature, weight, length, head circumference, and dimensions of any visible or palpable structural abnormality should be recorded.
Blood pressure is determined, if the neonate appears ill. Examining the newborn requires patience, gentleness, and procedural flexibility. If the infant is quiet and relaxed at the beginning of the examination, palpation of the abdomen or auscultation of the heart should be performed first before other more disturbing manipulations are done.
- General appearance: Pallor, jaundice or cyanosis. Features of syndromes like Down's syndrome, Turner's syndrome etc, is the baby appropriate for the period of gestation or small or large? Lanugo or evidence of postmaturity.
- Skin: Birth marks, meconium staining, cyanosis, subcutaneous bleeding etc.
- Head: Size, and tension of fontanelles, cephalhacmaloma or depressed fractures.
- head circumference, sternomastoid swelling.
- Face: Fades, jaws, harelip, ptosis or cataract, subconjunctival haemorrhage.
- Arms and hands: Proportions of arms or fingers, number of fingers, normal movements, Erb's palsy, palmar creases, edema.
- Chest: Distortion, recession, distress, respiratory rate, air entry, additional sounds, breast enlargement.
- Cardiovascular system: Apex,precordial impulse, quality of pulses (radiofemoral delay), heart sounds and murmurs.
- Abdomen: Palpate carefully for renal, bladder, liver, spleen and other masses.
- Genitalia: Look for ambiguous genitalia.
- Male : Testes (normal, undescended or maldescendcd), hernia or hydrocele. penis size, position of urethral orifice.
- Female: posterior vagina! skin tag is common, clitoromegaly, vaginal bleeding.
- Legs and feet: Proportions of legs and feet, club foot, femoral pulses.
- Back: Scoliosis, spina bifida, sacral pit, myelomeningocele.
- Mouth: Is there a cleft soft palate? Is saliva profuse (esophageal atresia)? Are Epstein's pearls present. Look for rooting and sucking reflexes.
- CNS: Are all four limbs moving normally? Is the baby alert and vigorous when
- awake or quiet? Is the cry normal? Are the moro and grasp reflexes symmetrical? Condition of rooting and sucking reflexes?
- Test for the congenital dislocation of the hip by Ortoloni's test.