Abstract:most common diseases of neonates which causes discomfort to the newborn.How can we assess the crying baby.The most common diseases are preterm birth,hemolytic diseases of newborns,infant respiratory distress syndrome,neonatal jaundice,broncho pulmonary dysplasia,neonatal infection,neonatal sepsis,perinatal asphyxia.
Neonatal mortality rate: it refers to the number of deaths occurring at less than 28days after the birth per thousand live births. This accounts for 67%of the infant death. 50%of the neonatal death can be attributed to low birth waight, acute perinatal asphyxia, congenital anomalies,perinatal infections, difficult labour,respiratory distress syndrome and gastroenteritis.
INTRODUCTION
Neonatology means knowledge of the human newborn, Neonatal period starts from the 7th day of life to 28th day of life.
The first 24hours of life is a very significant and a highly vulnerable time due to critical transition from intra uterine to extra uterine life.
Crying is a normal physiological behaviour in young infants. At 6 to 8 weeks age a baby cries on average 2-3times/24hours.infant with colic are well and thriving.
Assessment of a crying infant:
Crying develops in the early weeks of life and peaks around 6 to 8 weeks of age. Colic is the term used to describe infants who cry excessively for no apparent reason during the first three months of life. Colic is one of the most distressing problems of infancy. It is distressing for the infant, the parents, and for the health care provider. The cause of colic is not well understood, but it resolves in most infants by three to four months of age. Even though it usually goes away on its own, it can be helpful to learn more about colic in order to gain a better understanding of this difficult stage of baby's life.Usually worse in late afternoon or evening but may occur at any time.may last for several hours.
Infant may draw up legs as if in pain ,but there is no evidence that is colic is attributable to an intestinal problems or wind.it usually improves by 3 to 4 months of age. Colic is defined as "excessive crying." An infant with colic usually cries for more than three hours per day on more than three days per week.
Colic is extremely common and occurs in up to 40 percent of all infants. It usually starts sometime between the third and sixth week after birth and ends when a baby is three to four months of age. Colic occurs with equal frequency in the following groups:
●Males and females
●Breast- and bottle-fed infants
●Full-term and preterm infants
●The first and second child (and other siblings as well)
Common non pathological causes of crying include,
⦁ Excessive tiredness – suspect if the infants total sleep duration per 24hours falls more than an hour short of the average for their age.
Average sleep requirements: At birth -16 hours
At 2-3months- 15hours.
A 6 week old baby generally becomes tired after being awake for 1.5hours.
⦁ Hunger – this is more likely if a mother repors her baby has frequent feeds(<3hourly),poor weight gain and inadequate milk supply.
⦁ Gastro –oesophageal reflex disease may exist if there is frequent vomiting or if the body has feeding difficulties.
⦁ Lactose overload/malabsorption- primary lactose intolerance is extremely rare,suspect if there is frothy watery diarrhea with perianal excoriation.
Most common diseases of neonates
-hemolytic diseases of newborn
-infant respiratory distress syndrome
-neonatal jaundice
-broncho pulmonary dysplasia
-neonatal infection
-neonatal sepsis
-perinatal asphyxia
-necrotizing entrocolitis
-meconium aspiration syndrome
Hemolytic disease of newborn:its also known as erythroblastosis fetalis,isoimmunization,or blood group incompatibility,occurs when fetal red blood cells,which possess an antigen that the mother lacks,cross the placenta into the maternal circulation,where they stimulate antibody production.the antibodies return to the fetal circulation and result in RBC destruction.
Infant respiratory distress syndrome: its also known as hyaline membrane disease,is inadequate pulmonary surfactant due to preterm birth .the manifestation of disease are caused by the resultant diffuse alveolar atlectasis,odema,and cell injury.
Risk factors-prematurity,maternal diabetismellitus,and genetic factors,thoracic malformations
Infants delivered before labour starts do not benefit from the adrenergic and steroid hormones released during labour,which increase surfactant production and release.assessment of fetal lung maturity –prenatal prediction of lung maturity can be made by testing amniotic fluid obtained by amniocentesis.
Neonatal jaundice: Newborn appear jaundiced when it is >7mg/dl between 25% and 50% of all term newborns and a higher percentage of premature infants develop clinical jaundice.
causes of neonatal jaundice-
overproduction-fetomaternal blood group
-heriditary spherocytosis
-eliptocytosis,somatocytosis
-G6PD deficiency and drugs
-pyruvate kinase deficiency
-alpha thalassemia,beta thalassemia
-acquired hemolysis due to vit K
Undersecreation- metabolic and endocrine conditions
-gilbert disease,galactosemia
-hypothyroidism,lucy-driscoll syndrome
-prematurity,hypopitutarisam
-hypopituarisam,anencephaly
-obstructive disorders,biliary atresia
Bronchopulmonary dysplasia:
Is a form of chronic lung diseases that develops in preterm neonates treated with oxygen and positive pressure ventilation.infants born with bronchopulmonary dysplasia shows the symptoms of respiratory distress syndrome.
Neonatal infections:
Vertically transmitted(mother to child)viral infections of the fetus and newborn can generally divided into two major categories
Congenital infections-which are transmitted to the fetus in utero.
Perinatal infections- which are acquired intrapartum or in the postpartum period.congenital infections can have clinical manifestations that are apparent antenataly by ultrasonography or when the patient is born.classically the congenital infections are Toxoplasmosis,Rubella,Cytomegalo virus,Herpes simplex virus.where as perinatal infections may not become clinically apparent until after the firat few days or weeks of life .
Neonatal sepsis:
Bacterial sepsis and meningitis continue to be major causes of morbidity and mortality in newborns,particularly in low birth weight infants.several studies report the incidence of Early onset sepsis(EOS)to vary from one to four cases per 1000live births.the most common causative organism is Group B streptococcus.The clinical signs of EOS are usually apperent in the first hours of life.90% of infants are asymptomatic by 24hours of age .Respiratory distress is the most common presenting symptom.
Meconium aspiration syndrome:
Is the aspiration of stained amniotic fluid,which can occur before ,during,or immediately after birth.meconium is rarely found in the amniotic fluid prior to 34weeks of gestation,meconium aspiration primarily affects infants born at term and postterm.intra uterine distress can cause passage of meconium into the amniotic fluid.factors that promote the passage of meconium in utero include placental insufficiency,maternal hypertension,preeclampsia,oligohydramnios,infection and maternal drug abuse.
REFERENCES
1.Nelson text book of pediatrics,20th edition
2.oxford hand book of pediatrics.
3.Pearls in clinical pediatrics
4.Manual of neonatal care 7th edition
5.Rennie and Robertson’s text book of neonatology 5th edition.
6.www.uptodate.com
Neonatal mortality rate: it refers to the number of deaths occurring at less than 28days after the birth per thousand live births. This accounts for 67%of the infant death. 50%of the neonatal death can be attributed to low birth waight, acute perinatal asphyxia, congenital anomalies,perinatal infections, difficult labour,respiratory distress syndrome and gastroenteritis.
INTRODUCTION
Neonatology means knowledge of the human newborn, Neonatal period starts from the 7th day of life to 28th day of life.
The first 24hours of life is a very significant and a highly vulnerable time due to critical transition from intra uterine to extra uterine life.
Crying is a normal physiological behaviour in young infants. At 6 to 8 weeks age a baby cries on average 2-3times/24hours.infant with colic are well and thriving.
Assessment of a crying infant:
Crying develops in the early weeks of life and peaks around 6 to 8 weeks of age. Colic is the term used to describe infants who cry excessively for no apparent reason during the first three months of life. Colic is one of the most distressing problems of infancy. It is distressing for the infant, the parents, and for the health care provider. The cause of colic is not well understood, but it resolves in most infants by three to four months of age. Even though it usually goes away on its own, it can be helpful to learn more about colic in order to gain a better understanding of this difficult stage of baby's life.Usually worse in late afternoon or evening but may occur at any time.may last for several hours.
Infant may draw up legs as if in pain ,but there is no evidence that is colic is attributable to an intestinal problems or wind.it usually improves by 3 to 4 months of age. Colic is defined as "excessive crying." An infant with colic usually cries for more than three hours per day on more than three days per week.
Colic is extremely common and occurs in up to 40 percent of all infants. It usually starts sometime between the third and sixth week after birth and ends when a baby is three to four months of age. Colic occurs with equal frequency in the following groups:
●Males and females
●Breast- and bottle-fed infants
●Full-term and preterm infants
●The first and second child (and other siblings as well)
Common non pathological causes of crying include,
⦁ Excessive tiredness – suspect if the infants total sleep duration per 24hours falls more than an hour short of the average for their age.
Average sleep requirements: At birth -16 hours
At 2-3months- 15hours.
A 6 week old baby generally becomes tired after being awake for 1.5hours.
⦁ Hunger – this is more likely if a mother repors her baby has frequent feeds(<3hourly),poor weight gain and inadequate milk supply.
⦁ Gastro –oesophageal reflex disease may exist if there is frequent vomiting or if the body has feeding difficulties.
⦁ Lactose overload/malabsorption- primary lactose intolerance is extremely rare,suspect if there is frothy watery diarrhea with perianal excoriation.
Most common diseases of neonates
-hemolytic diseases of newborn
-infant respiratory distress syndrome
-neonatal jaundice
-broncho pulmonary dysplasia
-neonatal infection
-neonatal sepsis
-perinatal asphyxia
-necrotizing entrocolitis
-meconium aspiration syndrome
Hemolytic disease of newborn:its also known as erythroblastosis fetalis,isoimmunization,or blood group incompatibility,occurs when fetal red blood cells,which possess an antigen that the mother lacks,cross the placenta into the maternal circulation,where they stimulate antibody production.the antibodies return to the fetal circulation and result in RBC destruction.
Infant respiratory distress syndrome: its also known as hyaline membrane disease,is inadequate pulmonary surfactant due to preterm birth .the manifestation of disease are caused by the resultant diffuse alveolar atlectasis,odema,and cell injury.
Risk factors-prematurity,maternal diabetismellitus,and genetic factors,thoracic malformations
Infants delivered before labour starts do not benefit from the adrenergic and steroid hormones released during labour,which increase surfactant production and release.assessment of fetal lung maturity –prenatal prediction of lung maturity can be made by testing amniotic fluid obtained by amniocentesis.
Neonatal jaundice: Newborn appear jaundiced when it is >7mg/dl between 25% and 50% of all term newborns and a higher percentage of premature infants develop clinical jaundice.
causes of neonatal jaundice-
overproduction-fetomaternal blood group
-heriditary spherocytosis
-eliptocytosis,somatocytosis
-G6PD deficiency and drugs
-pyruvate kinase deficiency
-alpha thalassemia,beta thalassemia
-acquired hemolysis due to vit K
Undersecreation- metabolic and endocrine conditions
-gilbert disease,galactosemia
-hypothyroidism,lucy-driscoll syndrome
-prematurity,hypopitutarisam
-hypopituarisam,anencephaly
-obstructive disorders,biliary atresia
Bronchopulmonary dysplasia:
Is a form of chronic lung diseases that develops in preterm neonates treated with oxygen and positive pressure ventilation.infants born with bronchopulmonary dysplasia shows the symptoms of respiratory distress syndrome.
Neonatal infections:
Vertically transmitted(mother to child)viral infections of the fetus and newborn can generally divided into two major categories
Congenital infections-which are transmitted to the fetus in utero.
Perinatal infections- which are acquired intrapartum or in the postpartum period.congenital infections can have clinical manifestations that are apparent antenataly by ultrasonography or when the patient is born.classically the congenital infections are Toxoplasmosis,Rubella,Cytomegalo virus,Herpes simplex virus.where as perinatal infections may not become clinically apparent until after the firat few days or weeks of life .
Neonatal sepsis:
Bacterial sepsis and meningitis continue to be major causes of morbidity and mortality in newborns,particularly in low birth weight infants.several studies report the incidence of Early onset sepsis(EOS)to vary from one to four cases per 1000live births.the most common causative organism is Group B streptococcus.The clinical signs of EOS are usually apperent in the first hours of life.90% of infants are asymptomatic by 24hours of age .Respiratory distress is the most common presenting symptom.
Meconium aspiration syndrome:
Is the aspiration of stained amniotic fluid,which can occur before ,during,or immediately after birth.meconium is rarely found in the amniotic fluid prior to 34weeks of gestation,meconium aspiration primarily affects infants born at term and postterm.intra uterine distress can cause passage of meconium into the amniotic fluid.factors that promote the passage of meconium in utero include placental insufficiency,maternal hypertension,preeclampsia,oligohydramnios,infection and maternal drug abuse.
REFERENCES
1.Nelson text book of pediatrics,20th edition
2.oxford hand book of pediatrics.
3.Pearls in clinical pediatrics
4.Manual of neonatal care 7th edition
5.Rennie and Robertson’s text book of neonatology 5th edition.
6.www.uptodate.com
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