Wesleyan University –Philippines

Cabanatuan City
College of Nursing

NCM 109- Care of Mother and Child at

Risk or with Problems
(Acute and Chronic)-LECTURE
MIDTERM PERIOD
WEEK 9
NEWBORN PRIORITIES IN THE FIRST DAYS OF LIFE
 THEY INCLUDE;
 1. initiation and maintenance of respirations
 Resuscitation
 Airway (primary apnea/secondary apnea)
 Laryngoscopes
 Lung expansion
 Drug therapy(narcotics)
 Ventilation maintenance
 2.establishment of extra uterine circulation
 3.maintenance of fluid and electrolyte balance
 4.control of body temperature
 Radiant heat sources
 Incubators
 Skin to skin care
 5.intake of adequate nutrition
 6.establishment of waste elimination
 7.prevention of infection
 8.establishment of newborn-parent/caregiver relationship
 9.institution of developmental care or care that balances physiologic
needs and stimulation for optimal development
 Follow up of the high risk infant at home
 High –risk infants and child maltreatment
The Newborn At Risk Because Of Altered
Gestational Age Or Birth Weight
 AGA- APPROPRIATE FOR GESTATIONAL AGE
 (fall between 10th and 90th percentiles of weight for their gestational age)
 SGA- SMALL FOR GESTATIONAL AGE
 Fall below 10th percentiles of weight for their gestational age
 LGA- LARGE FOR GESTATIONAL AGE
 Fall above 90th percentiles of weight for their gestational age
 LBW-LOW BIRTH WEIGHT (weighing less than 2500 g at birth)
 VLBW-VERY-LOW BIRTH WEIGHT (weighing less than 1500 g at birth)
 ELBW-EXTREMELY LOW BIRTH WEIGHT (weighing less than 1000 g at birth)
1.Problems related to maturity
a.Prematurity/The Preterm Infant:
A preterm infant is traditionally defined as a liv-born infant
born before the end of 37 weeks of gestation
Divided in terms of the degree of care needed:
a. Late preterm – born between 34 and 37 weeks
b. Early preterm –born between 24 and 34 weeks
Assessment: Signs or Prematurity: On gross inspection
Very small
Head is disproportionately large > 3 cm greater than the
chest size
Skin is ruddy- due to lack of subcutaneous fat beneath it-
veins easily seen
Neurologic Assessment
If < 33 weeks- sucking with coordinated swallowing and breathing will be
absent
Deep tendon reflexes such as Achilles tendon reflex is also diminished
Preterm infant is less active and rarely cries, if the infant will cry, the cry
is weak and high pitched
SUMMARY OF ASSESSMENT:
> The new Ballard score is commonly used to determine gestational
age, whether the baby is mature, premature or post mature
> Scores are given for 6 physical and 6 nerve and muscle
development
NEUROMUSCULAR MATURITY
1.Posture
• Mature - baby’s arms should be flexed or bent in
• Premature – baby’s arms are extended of flaccid
2. Square window
> Assess the wrist flexibility of the baby
Procedure: bend the hand all the way down until it hits the arm
• Mature- the examiner must be able to do it without resistance from
the baby
• Premature - the examiner cannot bend the baby’s hand even to 90
degrees
3. Arm recoil- holding the infant’s arms from being flexed and pull it
down
• Mature - the baby’s arms should recoil back
• Premature – the baby’s arms does not recoil
4. Popliteal angle- taking the infant’s leg and bringing it up in an angle,
• Mature – there is resistance is felt by the examiner, cannot bring the
leg more than 90 degrees
• Premature- if leg can be brought up even to baby’s face
5.Scarf sign – taking the baby’s arm and moving it across the baby’s chest
• Mature- if there is resistance felt by the examiner
• Premature – if the arm can be wrapped around the baby’s chest
6. Heal to ear – bending the knee
• Mature – there is resistance felt by the examiner
• Premature – if the leg can be brought all the way to the ear
PHYSICAL MATURITY ASSESSMENT
• 1.Skin texture
• Mature – thicken
• Premature-sticky and transparent
• Post mature-leathery and wrinkled
• 2.Lanugo
• Mature- very little lanugo
• Premature – abundant
• Very premature - absent
3.Plantar creases-found at the bottom of baby’s feet
• Mature- positive creases on the entire sole of the foot
• Premature – soles are smooth, no creases
4.Breast tissue
• Mature-areola: 5-10 mm in size
• Premature-areola are not perceptible
5.Eye opening and ear cartilages
Eyes: > Mature-eyes are opened
> Premature-eyes are shut
Ears: >Mature- if pinna is bended forward, it will recoil back very
quickly
> Premature – if pinna is bended forward, it will stay the
6.Genitalia
For male baby: Mature – pendulous testicles and with rugae
present and
little wrinkles on testicles
Premature – scrotum :flat and smooth
For Female baby: Mature- labia majora will cover the labia minora
and clitoris
Premature- prominent clitoris and flat labia

Potential Problems:
1. Anemia of Prematurity – develop a normochromic,
normocytic anemia ( normal cells just few in number)
Signs: pale, lethargic and anorectic in appearance
Anemia occurs from a combination of immaturity of the
hematopoietic system (the effective production of red cells with an
elevated reticulocyte count may not begin until 32 weeks of
pregnancy) combined with destruction of RBC because of low level
of Vit E, a substance that protects RBC against oxidation
Mgt:
Extraction or drawing of blood should are coordinated to the fewest
possible and have a record of the blood loss for these tallied
Delaying cord clamping to allow a little more blood from the
placenta to enter the infant
2. Acute Bilirubin Encephalopathy (ABE)
> Destruction of brain cells by invasion of indirect or unconjugated
bilirubin – results from a high concentration of indirect bilirubin that
forms in the bloodstream from an excessive breakdown of RBC at
birth
Bilirubin is toxic to cells of the brain. If a baby
has severe jaundice, there's a risk of bilirubin
passing into the brain, a condition called acute
bilirubin encephalopathy.
Signs:
•Listlessness
•Difficulty waking
•High-pitched crying
•Poor sucking or feeding
Mgt:
Phototherapy
Exchange transfusion
3. Persistent Patent Ductus Arteriosus
Preterm infants’ lungs are noncompliant due to lack of
surfactant, making it hard for the infant to move blood from
the pulmonary artery into the lungs- can lead to pulmonary
artery hypertension that can interfere to closure of the ductus
arteriosus.
Mgt:
Indomethacin or ibuprofen for term infant to cause closure of a
patent ductus arteriosus-making ventilation more efficient
Should be used with utmost care among premature infant- can
cause adverse effect- decreased renal function, decreased
platelet count (can cause severe bleeding) and gastric irritation.
Monitor urine output, and observe bleeding at injection site, it
the medication is prescribed.
Common Long Term Problems Associated with Premature Birth
Hearing problems
Vision loss or blindness
Learning disabilities
Physical disabilities
Delayed growth and poor coordination
Behavioral and psychological problems
Biggest Problem:
A.Respiratory Function
Lungs of preterm infants (more than 6 weeks early) lack adequate surfactant
• Lungs are non compliant (lungs don’t expand easily; hard to breathe in)
• Prone to atelectasis (collapse of alveoli)
• Increased energy required to breathe (breathing is difficult)
Poor cough/gag reflex
Narrow respiratory passages
Weak respiratory muscles
*ASSESS FOR RESPIRATORY DISTRESS: (HYPOXEMIA)
Signs:
>RR > 60 or < 30 per minute > crackles, rhonci,
wheezing
Tachycardia (early sign) > stridor
Bradycardia (late sign) > see-saw respirations
Apneic episodes >2o minutes > central cyanosis
Retractions, labored breathing
Nasal flaring
grunting
NURSING DIAGNOSES:
Ineffective Airway Clearance
Risk for Aspiration
Ineffective Breathing Pattern
Impaired Spontaneous Ventilation
Impaired Gas Exchange
OUTCOME EVALUATION:
Newborn initiates breathing at birth after resuscitation
Maintains normal newborn respirations of 30-60 breaths per
minute free of assisted ventilation
Exhibits oxygen saturation levels of at least 95% as evidenced
by pulse oximtetry
NURSING INTERVENTION:
1. Administer Oxygen
The need for O2 administration is determined by signs of
respiratory distress. Arterial Oxygen Pressure (PaO2) of ,
60mmHg and oxygen saturation (SaO2) of < 92%
O2 is administered by hood, nasal cannula, positive-pressure
mask or endotracheal tube
O2 should not be free flowing in the incubator because the
amount cannot be controlled
O2 needs to be warmed and humidified to prevent cold
stress and moisten airway
2. Maintain patent airway/breathing pattern
Position the infant in a side-lying or prone position- to facilitate
drainage of secretions, mucous, regurgitated feedings
Frequently change infant’s position
If the baby needs to lay supine, place a small roll under the
shoulders, to straighten the airway, elevate the head part of the
bed, and turn the infant’s head to the side.
B.Thermoregulation
Causes:
Skin is thin > heat more easily lost from
Little insulating subcutaneous fat internal organ to skin
Blood vessels close to skin surface > poor mechanism for body
temp.
Large skin surface area regulation during 1st days of
life
Methods of Heat Loss:
a. Convection – is the flow of heat from the body surface to cooler
surrounding air
b. Conduction – is the transfer of body heat to a cooler solid object in
contact with the baby.
Example: baby is placed on a cold counter or on the cold base of a
warming unit
c. Radiation – is the transfer of body heat to a cooler solid object not in
contact with the baby.
Example: air conditioner
d. Evaporation- is loss of heat through conversion of a liquid to a vapor
Rationale:
 Infant’s temperature falls almost immediately to below normal because
of heat loss and immature regulating mechanisms
 Temperature of delivery rooms – 68 F (21 C to 22 C)
 Newborns are wet-they lose a great deal of heat as the amniotic fluid
on their skin evaporates.
Signs of Inadequate Thermoregulation
Hypoglycemia and respiratory distress may be the first signs
that the infant’s temperature is low
Poor feeding or tolerance
Lethargy
Irritability
Poor muscle tone
Cool skin temp
Mottled skin
NURSING DIAGNOSES:
Ineffective Thermoregulation
Risk for Injury (Cold Stress)
Risk for Imbalanced Body Temperature
Risk for Unstable Blood Glucose Level
Risk for neonatal Jaundice
Risk for Thermal Injury
OUTCOME EVALUATION
Infant’s temperature is maintained at 97.6 degrees F (36.5
degrees C) axillary
NURSING INTERVENTIONS:
Provide a neutral thermal environment.
Place infant in radiant warmer or isolette with portholes closed
Monitor temperature continuously by skin probe and axillary
temperature
Prevent evaporation. Keep infant dry
Prevent drafts (convection), keep portholes closed, transparent
plastic blanket over the radiant warmer bed, blankets or hats
when out of the incubator, used warmed oxygen
Prevent conductive heat loss; keep hands warm, warm
stethoscope, padding surfaces with warmed blankets
c. Nutrition
Causes:
Lacks nutrient stores
Does not absorb nutrients well
Lacks coordination in sucking and swallowing
Fatigues easily
NURSING DIAGNOSES:
Imbalanced Nutrition Less than Body Requirements
Impaired Swallowing
Ineffective Infant Feeding Pattern
Ineffective Breastfeeding
Risk for Aspiration
Risk for Unstable Blood Glucose
Risk for Electrolyte Imbalance
NURSING INTERVENTIONS: Maintain Nutrition
• Methods of Feeding:
parenteral(Intravenous)
Enteral (uses GI tract
Bottle Feeding
Breast feeding
• Needs specific knowledge of infant’s physiologic characteristics,
the infant’s particular needs and methods of feeding
• At least 32 weeks gestation for oral feeds (coordination of sucking
and swallowing)
• Observe coughing, gagging, vomiting, cyanosis, changes in heart
rate or respirations, apnea
1.Parenteral
Some route other than through the GI tract, such as by
subcutaneous, intramuscular, or intravenous injection
TPN
Sugar, vitamins, minerals, and other nutrients IV
Monitor IV site
Observe strict aseptic technique in cleaning IV sites
Weigh daily:
• Same scale
• Monitor I & O
Signs of Being ready to Nipple feed: strong sucking, swallowing,
gag reflexes present)
Rooting
Sucking on a gavage tube or pacifier
Presence of gag reflex
Respiratory rate , 60 breaths per minute
Start by giving infant a pacifier when gavage feeding (to associate
comfort of fullness with sucking and to prepare for nipple feeding)

2.Oral Feeding
Breast milk: preferred
Bottlefeed: soft premature nipple; high calorie formulas (24kcal/oz)
Feed slowly with frequent stops to burp and allow the infant
to rest
Place the baby on right side after feeding for one hour with
head elevated 30 degrees to facilitate the emptying of the
stomach into small intestine.

A premature infant can be released from the hospital once

they can:
1. breast-feed or bottle – feed
2. Breathe without support
3. Maintain body temperature and body weight
b. Postmaturity/Post term
A post term infant is one born after the 41st week of a pregnancy
If stayed in the uterus past week 41, the fetus is at special risk because the
placenta appears to function effectively for only 40 weeks
After this time, the placenta seems to lose its ability to carry nutrients
effectively to the fetus and the fetus begins to lose weight (postterm
syndrome)
Effects on the fetus:
Characteristics of SGA (Small Gestational Age)
• dry, cracked almost leatherlike skin from lack of fluid
• Absence of vernix
• Fingernails will have grown well beyond the end of the fingertips
• Shows more alertness like a 2 week old baby than a newborn
Assessment thru Diagnostic Exam:
UTZ- to measure the biparietal diameter of the fetus
Nonstress test or biophysical profile-to see if the placenta is still
functioning well
Mgt:
Cesarean Birth-if placental functioning is compromised
What to Expect from the Newborn
Difficulty establishing respirations
Polycythemia- due to decreased oxygenation in the final weeks
Increased hematocrit level- due to polycythemia and dehydration
that lowered the circulating plasma level
Hypoglycemia in the first hour of life- due to fetal consumption of
stored glucose for nourishment in the last weeks of intrauterine
life
Subcutaneous fat level are low- due to usage in utero, leading to hypothermia
Mgt:
1. Administer immediate care of the newborn
2. Allow woman to spend enough time with her newborn
3. Follow up care until school age to track their developmental abilities

2.Problems related to gestational weight

a. The Small for Gestational Age Infant:
An infant is SGA if the birth weight is below the 10th percentile on an
intrauterine growth curve for that age
Infant may be born: Preterm: before week 38 of gestation
Term: between week 38 and 42
Post term: past 42 weeks
SGA infants: small for their age due to intrauterine growth
restrictions (IUGR) or failed to grow
Causes:
woman’s nutrition during pregnancy plays a vital role in fetal
growth, lack of adequate nutrition may be a major reason to IUGR
Adolescents – eating only to meet their own nutritional needs
Chromosomal abnormality- placenta is supplying the infants needs
during intrauterine life but the infant is not utilizing it properly
Common cause: placental issue/problem: either the placenta did
not obtain sufficient nutrients from the uterine arteries or
inefficient at transporting nutrients to the fetus
Women with systemic diseases
Assessment: Thru Physical Assessment : Inspection of the infant
after birth
Appearance: below average weight, length, and head circumference
Overall wasted appearance: poor skin turgor, with large head
because the rest of the body is small
Skull sutures widely separated
Hair dull and lusterless
Small liver- can cause difficulty regulating glucose, protein and
bilirubin
Sunken abdomen
Dry umbilical cord and stained yellow
Better neurologic responses
With sole creases, ear cartilage well developed
Alert and active
Laboratory Findings:
Blood test: high hematocrit: due to lack of fluid
Increased RBC (polycythemia) due to anoxia during intrauterine life
which stimulated excess development can lead to increased blood
viscosity that puts extra work on the infant’s heart because it is more
difficult to circulate thick blood- acrocyanosis( blue hands and feet)
If polycythemia is increased- can lead to blockage of the blood vessels
and thrombus formation
Mgt: exchange transfusion is necessary to dilute the blood
2nd problem of polycythemia is hyperbilirubinemia – so many RBC to
breakdown and can cause release of bilirubin
Decrease glycogen stores- can cause hypoglycemia
Mgt: IV glucose to sustain blood sugar until the infant can suck well
enough to take sufficient feedings
b. Large For Gestational Age Infant
An infant is LGA if the birth weight is above the 90 th percentile on an
intrauterine growth chart for that gestational age
Can seemingly healthy upon birth but often reveals immature
development
Causes:
Overproduction of nutrients and growth hormone in utero
Woman is obese
Woman is diabetic
Assessment : Physical Assessment thru Inspection
woman’s uterus appears to be unusually large for the date of pregnancy
UTZ-
Non stress test or biophysical profile to assess if the placenta can sustain a
large fetus
Amniocentesis- to assess the fetal lung maturity
Mgt:
If the fetal size is not detected during pregnancy, it may be
recognized during labor when the baby appears too large
Assessment: Thru Physical Assessment : Inspection of the infant
after birth
Appearance:
• Immature reflexes
• Low score on gestational age examine relations to size
• May have extensive bruising or broken clavicle or Erb Duchenne
paralysis from trauma to the cervical nerves in order for the
shoulders to be born vaginally
• Capput succedaneum, cephalohematoma or molding due to large
head exposing to more than enough pressure during delivery
Cardiovascular Dysfunction
 polycythemia may occur as the fetus attempts to oxygenate more
than the average amount of body tissue
Observe for hyperbilirubinemia due to absorption of blood from
bruising and breakdown of the extra RBC created by polycythemia
Assess HR
If with cyanosis- due to poor heart
Hypoglycemia
Observe for the first hour of life because infants who are too large
require large amounts of nutritional stores to sustain their weight
If the mother has diabetes, the infant might have an increased
glucose level causing for the infant to produce elevated levels of
insulin
3.Acute conditions of the neonates:
a.Respiratory Distress Syndrome (RDS)
before: known as hyaline membrane disease
Common among premature infants
There is hyaline (fibrous) membrane formed from an exudate of an infant’s
blood that begins to line the terminal bronchioles, alveolar ducts and
alveoli causing problems in the exchange of O2 and carbon dioxide
Cause: low level of surfactant
Assessment:
Infants have difficulty initiating respirations at birth
After resuscitation, infants appear to have periods of hours or a day when
it she don’t have symptoms because of an initial release of surfactant
Infant may aspirate meconium either in utero or with the
first breath at birth.
Meconium can cause severe respiratory distress : tachypnea,
retractions, and grunting)
Mgt:
Oxygen administration
Therapeutic Mgt:
• Amnioinfusion- to dilute the amount of meconium in the
amniotic fluid
c.Sepsis
Causes of neonatal sepsis

•The most common causes of neonatal sepsis are Group B

streptococcus and Escherichia coli bacteria

Bacterial agents:
•Listeria monocytogenes
•Staphylococcus aureus
•Enterococcus
•Other gram-negative bacteria such asKlebsiellaandEnterobacter
•Coagulase-negative staphylococci (CoNS
Non-bacterial agents
•Herpes simplex virus (HSV)
•Enterovirus and parechovirus
•Candida
•Early-onset sepsis (either before seven days of age or in
the first 72 hours of life; exact definitions vary) is usually
associated with vertical transmission. This means the
infant likely acquired the infection just before or during the
birthing process.
•In some cases, infection ascends the mother’s birth
canal (1); the risk of this is higher if the mother has
experienced PROM

•Late-onset sepsis (after seven days or 72 hours,

depending on which definition you follow), can be
acquired either vertically (sometimes early colonization
takes awhile to evolve into a serious infection) or
horizontally
Risk factors for vertically-transmitted neonatal sepsis

Premature rupture of membranes (PROM)

Chorioamnionitis(infection of the placenta and fetal
membranes)
Group Bstrep (this is routinely tested for during
pregnancy) or another infection in the mother
The mother has a high temperature during birth
Preterm birth
Use of forceps during delivery
Use of electrodes for intrauterine monitoring
Hospital stay: Newborns who have long hospital stays
and/or extended catheterization are at higher risk of
acquiring sepsis due to a horizontally-transmitted
infection
Unsanitary hospital conditions can also increase the risk.
Signs and symptoms of neonatal sepsis

The early stage of sepsis development is also known

as “warm shock”.
The main symptoms are from a decrease in systemic
vascular resistance, due to vasodilation.
Prior to/during birth:
Fetal tachycardia (an abnormally fast heart rate) and
other signs of fetal distress
Meconium-stained amniotic fluid
In NEWBORN
•Low APGAR score(six or below)
•Temperature control issues (term infants are more likely to have a
fever, while preterm infants are more likely to have hypothermia)
•Lethargy or irritability
•Respiratory issues such as tachypnea and apnea
•Tachycardia or bradycardia
•Hypotension (low blood pressure)
•Perfusion problems
•Hypotonia(low muscle tone/floppiness
•Feeding issues
•Seizure
•Jaundice
•Hepatomegaly (liver enlargement)
•Vomiting
•Diarrhea or low frequency of bowel movements
•Distention of the abdomen
•Hypoglycemia(low blood sugar)
Diagnosis of neonatal sepsis
testing the baby’s blood to look for the presence of
bacteria or other pathogens.
Blood tests:
Cultures
C-reactive protein (CRP) and/or procalcitonin(PCT)
levels
Complete blood count (CBC)
Lumbar puncture (spinal tap)
Chest x-ray
Urine or stool culture tests
Outcomes of neonatal sepsis
Meningitis
Developmental delays
Cerebral palsy
Seizure disorder
Hearing loss

3 hour sepsis bundle

The3-hour recommendations, which must be carried out
within 3 hours from the first time sepsis is suspected,
are:
1) obtain a blood culture before antibiotics,
2) obtain a lactate level,
3) administer broad-spectrum antibiotics, and
4) administer 30 mL/kg of crystalloid fluid for hypotension
 D. HYPERBILIRUBINEMIA
Photherapy (light therapy)is a way of treating jaundice.
Special lights help break down the bilirubin in the baby's
skin so that it can be removed from his or her body. This
lowers the bilirubin level in the baby's blood.
e. Sudden infant death syndrome (SIDS)

Sudden infant death syndrome (SIDS) are deaths in infants

younger than 12 months of age that occur suddenly,
unexpectedly, and without obvious cause.
SIDS cannot be explained despite a thorough investigation,
including a complete autopsy, examination of the death scene,
and review of the clinical and social history.
SIDS is also commonly called as “crib death”.

Contributing Factors

•Prematurity and low birth weight. Low birth weight, whether

resulting from premature birth or from other causes, is associated
with a maturational delay in the ability to turn the head to the face-
down position.
•Apnea.Regurgitation of gastric contents with acidic pH can cause
reflexive apnea with resultant hypoxia
•Infection.At the time of death, 30-50% of otherwise healthy infants have
an acute infection, such as gastroenteritis, otitis media, or, in particular,
upper respiratory tract infection (URTI); infantile botulism may be the
cause of 5-10% of sudden infant deaths.
•Breastfeeding.infants who are not breastfed are at increased risk for SIDS.
•Maternal smoking.Cigarette smoking during pregnancy is highly significant as a risk
factor in the pathogenesis of SIDS.
•Sleeping position and bedtime environment.According to Gilbert-Barnesset al,
unequivocal evidence indicates that a substantial number (by some estimates, as
many as 73.7%) of deaths from SIDS can be prevented by avoiding the prone sleeping
position, particularly on any type of soft bedding.
Clinical Manifestations
•Cyanosis. About 50-60% of infants manifests cyanosis.
•Breathing difficulties. Half of the infants who had SIDS experience
breathing difficulties before death.
•Abnormal limb movements. Although most of infants are
apparently healthy, many parents state that their babies “were not
themselves” in the
hours before death

Measures for an infant who experiences SIDS

Emergency care. For the infant found in cardiorespiratory arrest,
the first priority is life support via attention to the ABCs (Airway,
Breathing, Circulation) and other medical interventions as
appropriate; in the absence of postmortem lividity or other signs of
obvious death, infants must be transported to the hospital to ensure
full resuscitative attempts.
•Management of apnea. All infants presenting with nontrivial
apnea or apparent life-threatening event (ALTEs) associated with
cyanosis or alterations in mental status or tone should be
admitted.
•After death. If the infant is pronounced dead, inform the family
in a quiet environment. Refer to the child by name, not as “the
baby”; detailing resuscitative efforts before telling the parents of
the death is not helpful and may engender parents’ resentment;
specifically and directly, tell parents that their child has died; use
of words such as “dead” or “died” avoids the confusion that may
result from gentler terms.
MECONIUM ASPIRATION SYNDROME
 Meconium is the first feces, or stool, of the newborn.
 Meconium aspiration syndrome occurs when a newborn breathes a mixture of
meconium and amniotic fluid into the lungs around the time of delivery.
 SIGN AND SYMPTOMS
 1. difficulty in breathing
 2.tachypnea
 3.cyanosis
THERAPEUTIC MANAGEMENT
1. AMNIOINFUSION
2. OXYGEN THERAPY
3. ANTIBIOTIC THERAPY
4. CHEST PHYSIOTHERAPY
APPARENT LIFE THREATENING EVENT
(ALTE)
 Some infants have been discovered cyanotic and limp in their beds but have
survived after mouth-to-mouth resuscitation by parents
 Characterized by a noticeable color change, some degree of apnea and
decreased tone
 Cases of SIDS and monitoring for apnea signs
 CPR technique for parents and care giver
TWIN TO TWIN TRANSFUSION
 A phenomenon that can occur if twins are
monozygotic( share the same placenta) and
abnormal arteriovenous shunts occur that direct
more blood to one twin than the other
 The result of blood shift leads to anemia in the
donor twins and polycythemia in the receiving
twin.
 The donor can be pale and SGA while the
recipient is prone to hyperbilirubinemia.
 Can be identified by sonogram
OPTHALMIA NEONATORUM
 Eye infection that occurs at birth or during the first
month of life
 Causative agent: neisseria gonorrhea and chlamydia
trachomatis
 Contracted thru vaginal secretion
 Signs and symptoms: corneal ulceration and
destruction(opacity of cornea and severe vision
impairment)
 Conjuntiva become fiery red, with thick pus and appear
edematous.
 Bilateral in nature
 Prevention: erythromycin ointment
 Therapeutic management: antibiotic therapy, contact
precaution in cleaning the eyes
 FETAL ALCOHOL SPECTRUM DISORDER OR


FETAL ALCOHOL EXPOSURE
Alcohol crosses the placenta in the same
concentration as is present in the maternal
bloodstream
 Alcohol have a teratogenic effect
 Characteristics: prenatal and postnatal growth
restriction, cognitive challenges, microcepaly,
cerebral palsy, and distinctive facial feature of
a short palpebral fissure and thin upper lip.
 With weak sucking reflex
 Needs conscientious folowup
Thank you for listening!