PRE TERM,LBW AND IUGR BABIES

PowerPoint Presentation: 

MANAGEMENT OF PRE TERM,LBW AND SGA BABY

PRE TERM,LBW AND IUGR BABIES: 

PRE TERM,LBW AND IUGR BABIES DEFINITION OF PREMATURITY GESTATIONAL AGE <37 COMPLETED WEEKS DEFINITION OF LOW BIRTH WEIGHT LBW- <2.5 KG VLBW 1 TO 1.5 KG EXTREMELY LBW <1 KG IUGR DEVIATION FROM AN EXPECTED FETAL GROWTH PATTERN SYMMETRIC SIZE OF HEAD,BODY WEIGHT AND LENGTH ARE EQUALLY REDUCED INSULT DURING EARLY GESTATION ASYMMETRIC SIZE OF HEAD PRESERVED INSULT DURING LATE GESTATIONAL PERIOD SGA <2SD OR < 10 th PERCENTILE

PowerPoint Presentation: 

LOW BIRTH WEIGHT AND IUGR

PHYSICAL CHARACTERISTICS OF PREMATURITY: 

PHYSICAL CHARACTERISTICS OF PREMATURITY FUZZY HAIR POOR ELASTIC RECOIL OF PINNA BREAST NODULES <5mm UNDESCENDED TESTES AND ABSENCE OF RUGOSITIES IN SCROTUM PROMINENT LABIA MAJORA AND CLITORIS ,LABIA MINORA VISIBLE PALMAR CREASE PRESENT ONLY IN ANT 1/3 LOSS OF SUBCUTANEOUS FAT PRESENCE OF LANUGO HAIRS

PROBLEMS OF PRETERM AND IUGR: 

PROBLEMS OF PRETERM AND IUGR PRETERM HYPOTHERMIA BIRTH ASPHXIA RESPIRATORY DISTRESS APNOEA OF PREMATURITY METABOLIC (HYPOGLYCEMIA AND HYPOCALCEMIA) HEMATOLOGICAL (ANEMIA AND HYPERBILIRUBINEMIA) BACTERIAL SEPSIS FEEDING PROBLEMS AND POOR WEIGHT GAIN IUGR PERINATAL ASPHYXIA MECONIUM ASPIRATION HYPOTHERMIA HYPOGLYCEMIA FEEDING INTOLERANCE POLYCYTHEMIA,GROWTH RETARDATION

MANAGEMENT : 

MANAGEMENT RESUSCITATION TEMPERATURE CONTROL FLUID AND ELECTROLYTE INFECTION JAUNDICE

RESUSCITATION: 

RESUSCITATION PROBLEMS PERINATAL ASPHYXIA IMMATURE LUNGS,BLOOD VESSELS LARGE SURFACE AREA,SMALL BLOOD VOLUME MANAGEMENT HIGH RISK RESUSCITATION,SMALL BAGS FOR PPV AVOID HYPOTHERMIA

PowerPoint Presentation: 

BIRTH TERM MECONIUM CRY TONE YES ROUTINE CARE NO WARMTH,AIRWAY,DRY,STIMULATE RESP,HR,COLOR BREATH,HR >100,PINK OBSERVATIONAL CARE CYAN O2 PINK PERSISTANT CYAN APNEIC,HR<100 PP V HR>100,PINK POST RESUS CARE HR<60 PPV + CHEST COMPRESSION HR<60 EPINEPHRINE AND/OR VOLUME EXPAND

TEMPERATURE CONTROL: 

TEMPERATURE CONTROL PROBLEMS HIGH BSA,REDUCED GLYCOGEN STORE LOW SC FAT MANAGEMENT WARM DELIVERY ROOM BATHING POSTPONED WARM RESUSCITATION APPROPRIATE CLOTHING IMMEDIATE CRYING MOTHER- BABY CO-BEDDING KMC WARM TRANSPORTATION BREAST FEEDING PROFESSIONAL ALERTNESS

FLUIDS AND ELECTROLYTES: 

FLUIDS AND ELECTROLYTES IN PRE TERM BABIES FLUID LOSS IS ABOUT 10%-15% OF BIRTH WEIGHT. WATER LOSS – KIDNEY, GIT, SKIN , RT. FLUID THERAPY BW >1500 g INFANTS ON IV FLUIDS NEED TO EXCRETE 15 mosm /kg/day AT URINE OSMOLALITY OF 300 mosm /kg/day – NEED TO PASS 50+20 ml/kg/day.

PowerPoint Presentation: 

BW <1500g FLUID LOSS IS MORE DUE TO INCREASED IWL. INITIAL FLUID SHOULD BE 80ml/kg/day. ON FIRST DAY 10% DEXTROSE ALONE GIVEN AT RATE OF 4-6 mg/kg/day. Na AND K SHOULD BE ADDED AFTER 48 HOURS. IN BABIES <1250g 7.5% DEXTROSE IS USED INSTEAD OF 10%.

DAILY FLUID REQUIREMENTS DURING FIRST WEEK OF LIFE: 

BIRTH WEIGHT DAY 1 (ml/kg/ day) DAY 2 (ml/kg/ day) DAY 3 (ml/kg/ day) DAY 4 (ml/kg/ day) DAY 5 (ml/kg/ day) DAY 6 (ml/kg/ day) DAY 7 + > (ml/kg/ day) < 1500 g 80 95 110 120 130 140 150 > 1500 g 60 75 90 105 120 135 150 DAILY FLUID REQUIREMENTS DURING FIRST WEEK OF LIFE

INFECTION: 

INFECTION PROBLEMS IMMATURE DEFENCE INVASIVE INTERVENTION MANAGEMENT ASEPSIS,HAND WASHING MINIMAL HANDLING ANTIBIOTICS DECREASING EXPOSURE TO COMMUNICABLE DISEASE

JAUNDICE: 

JAUNDICE PROBLEMS LARGE RBC VOLUME FOR BODY WEIGHT IMMATURE LIVER AND BLOOD BRAIN BARRIER CAUSES HEMOLYTIC : Rh INCOMPATIBILITY, ABO INCOMPATABILITY, G6PD DEFICIENCY, THALASSSEMIA, HEREDITARY SPHEROCYTOSIS NON-HEMOLYTIC : PREMATURITY, EXTRAVASATED BLOOD, INADEQUATE FEEDING, POLYCYTHEMIA, BREASTMILK JAUNDICE.

PowerPoint Presentation: 

BIRTH WEIGHT TOTAL SERUM BILIRUBIN (mg/dl) HEALTHY BABY SICK BABY PHOTOTHERAPY EXCHANGE TRANSFUSION PHOTOTHERAPY EXCHANGE TRANSFUSION < 1000 gm 5 – 7 11 – 13 4 – 6 10 – 12 1001 – 1500 gm 7 – 10 13 – 15 6 – 8 11 – 13 1501 – 2000 gm 10 – 12 15 – 18 8 – 10 13 – 15 2001 – 2500 gm 12 – 15 18 – 20 10 – 12 15 – 18

PowerPoint Presentation: 

THANK YOU……………….