Patent ductus arteriosus is a condition in which the duct that channels blood between two main arteries does

not close after the baby is

born. In some cases, a drug called indomethacin can be given to close the duct. Surgery may be required if the duct does not close on its
own as the baby develops
***Research has shown that the risks of massaging preterm infants are minimal and that infants benefit from improved developmental
scores, more rapid weight gain, and earlier discharge from the hospital. An additional benefit of massage therapy is closer bonding
between the parents and their newborn child. Another method, called kangaroo care, entails placing a medically stable, diaper-clad
premature infant on a parent's chest for periods of time so that the parent and child are touching skin-to-skin. A 2002 study published in
Pediatrics found that both the parent and infant benefited from the practice: mothers reported lower rates of depression and more sensitivity
to the infant's needs, and the infants showed improved cognitive and motor development.
 21 weeks or less: 0 percent survival rate
 22 weeks: 0 to 10 percent survival rate
 23 weeks: 10 to 35 percent survival rate
 24 weeks: 40 to 70 percent survival rate
 25 weeks: 50 to 80 percent survival rate
 26 weeks: 80 to 90 percent survival rate
 27 weeks: greater than 90 percent survival rate
Apnea —The temporary absence of breathing. Sleep apnea consists of repeated episodes of temporary suspension of breathing during sleep.
Dubowitz exam —Standardized test that scores responses to 33 specific neurological stimuli to estimate an infant's neural development
and, hence,gestational age.
intraventricular hemorrhage (IVH) —A condition in which fragile blood vessels within the brain burst and bleed into the hollow
chambers (ventricles) of the brain and into the tissue surrounding them.
Jaundice —A condition in which the skin and whites of the eyes take on a yellowish color due to an increase of bilirubin (a compound
produced by the liver) in the blood. Also called icterus.
Necrotizing enterocolitis —A serious bacterial infection of the intestine that occurs primarily in sick or premature newborn infants. It can
cause death of intestinal tissue (necrosis) and may progress to blood poisoning (septicemia).
Respiratory distress syndrome (RDS) —Also known as hyaline membrane disease, this is a condition of premature infants in which the
lungs are imperfectly expanded due to a lack of a substance (surfactant) on the lungs that reduces tension.
Retinopathy of prematurity —A condition in which the blood vessels in a premature infant's eyes do not develop normally. It can, in
some cases, result in blindness.
Surfactant —A protective film secreted by the alveoli in the lungs that reduces the surface tension of lung fluids, allowing gas exchange
and helping maintain the elasticity of lung tissue. Surfactant is normally produced in the fetal lungs in the last months of pregnancy, which
helps the air sacs to open up at the time of birth so that the newborn infant can breathe freely. Premature infants may lack surfactant and are
more susceptible to respiratory problems without it
These incubators made of transparent plastic keep the premature infant warm, limit water loss and reduce chances of infection.
The present invention relates to an improved infant incubator.

The purpose of an infant incubator is to secure and improve the chances of survival of a premature or weakly infant. This is accomplished
by keeping the infant in an environment which is warm, moist and contains sufficient oxygen. A premature infant has a low body weight,
and thus a body temperature which is close to the ambient temperature. The premature infant is therefore very vulnerable to temperature
swings, and consequently major efforts have been made to develop incubators which maintain as constant a temperature as possible.

The incubators dominating today's market comprise a lower section housing equipment for adjusting the temperature and the composition of
the gas delivered to the premature infant. Placed on this lower section is an upper section made of a transparent material, through which
there are provided closable portholes to allow the premature infant to be cared for without removing the whole of the upper section. Inside
the incubator, the infant lies on a mattress which forms the dividing line between the upper and the lower section. The gas in the incubator
comprising air, possibly with the addition of extra oxygen and moisture, circulates up between the walls of the incubator and the mattress on
one side, and down into a corresponding opening on the opposite side of the incubator. To improve the flow pattern of the gas, an inner wall
is often provided in the upper section of the incubator, causing the gas to flow up and down between the outer shell and the inner wall in the
upper section of the incubator. Means for heating, humidifying and circulating the air flow are provided in the lower section of the
incubator. This means that a heating element and a fan are located in proximity to the premature infant. The heating element and fan may be
the source of some electromagnetic radiation, a radiation which at present is the subject of intense discussion with respect to whether it has
any effects on health. In addition, and more importantly, a fan of this kind cannot be entirely noise-free and is thus the source of an acoustic
nuisance for the tiny patient.

Moreover, when a porthole is opened in the upper section, the circulating air will draw the colder air of the surroundings with it into the
incubator, which may cause the temperature in such an incubator to fall by about 2°C when a door is open for more than 10 minutes. A
temperature drop of this kind may at first seem to be insignificant, but is most unfortunate for the extraordinarily vulnerable premature
infant who has little energy to burn and low heat capacity. The doors must be opened from time to time to care for and carry out test
procedures on the premature infant. Moreover, it is desirable that the premature infant should not be completely isolated from the
surroundings since, just as other infants, the premature infant needs body contact - even if nothing more than the touch of a friendly hand.
The portholes in the incubator may therefore remain open for many periods of more than 10 minute.

Normal ductus arteriosus closure

In the developing fetus, the ductus arteriosus (DA) is the vascular connection between the pulmonary artery and the aortic arch that allows
most of the blood from the right ventricle to bypass the fetus' fluid-filled compressed lungs. During fetal development, this shunt protects
the right ventricle from pumping against the high resistance in the lungs, which can lead to right ventricular failure if the DA closes in-
utero.

When the newborn takes its first breath, the lungs open and pulmonary vascular resistance decreases. After birth, the lungs release
bradykinin to constrict the smooth muscle wall of the DA and reduce bloodflow through the DA as it narrows and completely closes,
usually within the first few weeks of life. In most newborns with a patent ductus arteriosus the blood flow is reversed from that of in utero
flow, ie. the blood flow is from the higher pressure aorta to the now lower pressure pulmonary arteries.

In normal newborns, the DA is substantially closed within 12-24 hours after birth, and is completely sealed after three weeks. The primary
stimulus for the closure of the ductus is the increase in neonatal blood oxygen content. Withdrawal from maternal circulating prostaglandins
also contributes to ductal closure. The residual scar tissue from the fibrotic remnants of DA, called the ligamentum arteriosum, remains in
the normal adult heart.

Patent ductus arteriosus

Patent ductus arteriosus, or PDA, is a heart condition that is normal but reverses soon after birth. In a persistent PDA, there is an irregular
transmission of blood between two of the most important arteries in close proximity to the heart, the aorta and the pulmonary artery.
Although the ductus arteriosus normally seals off within a few days, in PDA, the newborn's ductus arteriosus does not close but remains
patent. PDA is common in neonates with persistent respiratory problems such as hypoxia, and has a high occurrence in premature children.
In hypoxic newborns, too little oxygen reaches the lungs to produce sufficient levels of bradykinin and subsequent closing of the DA.
Premature children are more likely to be hypoxic and thus have PDA because of their underdeveloped heart and lungs.

A patent ductus arteriosus allows a portion of the oxygenated blood from the left heart to flow back to the lungs by flowing from the aorta
(which has higher pressure) to the pulmonary artery. If this shunt is substantial, the neonate becomes short of breath: the additional fluid
returning to the lungs increases lung pressure to the point that the neonate has greater difficulty inflating the lungs. This uses more calories
than normal and often interferes with feeding in infancy. This condition, as a constellation of findings, is called congestive heart failure.

In some cases, such as in transposition of the great vessels (the pulmonary artery and the aorta), a PDA may need to remain open. In this
cardiovascular condition, the PDA is the only way that oxygenated blood can mix with deoxygenated blood. In these cases, prostaglandins
are used to keep the patent ductus arteriosus open.

A heart problem that occurs soon after birth in some babies. In patent ductus arteriosus (PDA), there is an abnormal circulation of blood
between two of the major arteries near the heart. Before birth, the two major arteries – the aorta and the pulmonary artery – are normally
connected by a blood vessel called the ductus arteriosus, which is an essential part of the fetal circulation. After birth, the vessel is supposed
to close within a few days as part of the normal changes occurring in the baby's circulation. In some babies, however, the ductus arteriosus
remains open (patent). This opening allows blood to flow directly from the aorta into the pulmonary artery, which can put a strain on the
heart and increase the blood pressure in the lung arteries.
A PDA is a type of congenital heart defect. A congenital heart defect is any type of heart problem that is present at birth.

If your baby has a PDA, but has an otherwise normal heart, the PDA may shrink and go away completely, or it may need to be treated to
close it. But, if your baby is born with certain types of heart defects that decrease blood flow from the heart to the lungs or the body,
medicine may be given to keep the ductus arteriosus open to maintain blood flow and oxygen levels until corrective surgery for the heart
defect(s) can be performed.

About 3,000 infants are diagnosed with PDA each year in the United States. It is more common in premature infants (babies born too early)
but does occur in full-term infants. Premature babies with PDA are more vulnerable to its effects. PDA is twice as common in girls as in
boys.

Respirations: a. At the moment of delivery, the newborn must switch from passive reception of oxygen to establishing and maintaining
ventilation by untried lungs. Not infrequently, the premature infant is incapable of this task, making resuscitation necessary. The respiratory
muscles are poorly developed, the chest wall lacks stability, and production of surfactant is reduced. Effective resuscitation must be
established to prevent the development of irreversible respiratory acidosis.

b. The infant should be positioned to allow for easy drainage of mucus from his mouth. Very small infants are placed on their side, whereas,
large infants are placed on their abdomen. The infant's head may be tilted down except when danger of increased intracranial pressure or
increased respiratory distress, which is due to his liver pressing on the diaphragm.

c. The best way to evaluate the baby's oxygen status is through arterial blood gases. Caution must be applied during the administration of
100% oxygen during resuscitation or to maintain respirations because it places the immature infant in danger of developing pulmonary
edema or retrolental fibroplasia.

MAINTENANCE OF BODY TEMPERATURE IN THE PREMATURE INFANT

The lack of subcutaneous fat and poor muscular development make the premature infant more susceptible to loss of body heat. The absent
or minimal flexion of extremities prevents the premature infant from self-positioning to decrease the amount of body surface requiring heat.
In the absent or poor reflex control of skin capillaries, there is no shivering to produce heat. Immediately after delivery the baby should be
placed under a radiant heat warmer. He must never be without provisions of external warmth at any time. It is good practice to keep the
baby's head covered because of the large amount of heat that is lost through the head. The body temperature of the infant should be
maintained at 98o F axillary.

Heart rate, measured by counting the heart beats/minute, is a net effect of the decelerating influence of the vagal (parasympathetic) fibers,
and the accelerating influence of the sympathetic fibers on the inherent rhythmicity of the heart's sinoatrial node. Under resting conditions,
the vagal effects vary with the respiratory cycle. During inspiration, vagal impulses reaching the heart decrease, producing an increase in
heart rate; during expiration, they increase, producing a decrease in heart rate. These rate changes are too brief to be detected via a pulse or
stethoscope, but can be measured by creating and analyzing the beat-to-beat variation via a time series power analysis.

Bp: BP fluctuation was greater for a longer proportion of measured time in infants in whom intraventricular hemorrhage did not develop
compared with those in whom it did develop P < .05). These findings do not support a causal relationship between BP fluctuation and
intraventricular hemorrhage within the range of coefficient of variation studied.

Prophylactic: A preventive measure. The word comes from the Greek for "an advance guard," an apt term for a measure taken to fend off a
disease or another unwanted consequence.

A prophylactic is a medication or a treatment designed and used to prevent a disease from occurring. For example, prophylactic antibiotics
may be used after a bout of rheumatic fever to prevent the subsequent development of Sydenham's chorea.

A prophylactic is also a drug or device, particularly a condom, for preventing pregnancy

Neonatal conjunctivitis, also known as ophthalmia neonatorum, is a form of bacterial conjunctivitis contracted by newborns during
delivery. The baby's eyes are contaminated during passage through the birth canal from a mother infected with either Neisseria
gonorrhoeae or Chlamydia trachomatis. Eyedrops containing erythromycin are typically used to prevent the condition.[1] If left untreated it
can cause blindness

Neonatal conjunctivitis by definition presents during the first month of life. It may be infectious or non infectious

Non infectious

Chemical irritants such as silver nitrate can cause chemical conjunctivitis, usually lasting 2–4 days. Thus, silver nitrate is no longer in
common use. In most countries neomycin and chloramphenicol eye drops are used instead.

[edit] Infectious

Many different bacteria and viruses can cause conjunctivitis in the neonate. The two most feared causes are N. gonorrheae and Chlamydia
acquired from the birth canal during delivery.

Ophthalmia neonatorum due to gonococci (Neisseria gonorrhoeae) typically manifests in the first 5 days of life and is associated with
marked bilateral purulent discharge and local inflammation. In contrast, conjunctivitis secondary to infection with chlamydia (Chlamydia
trachomatis) produces conjunctivitis after day 3 of life, but may occur up to 2 weeks after delivery. The discharge is usually more watery in
nature (mucopurulent) and less inflammed. Babies infected with chlamydia may develop pneumonitis (chest infection) at a later stage
(range 2 weeks – 19 weeks after delivery). Infants with chlamydia pneumonitis should be treated with oral erythromycin for 10–14 days. [3]

Other agents causing Opthalmia neonatorum include Herpes simplex virus (HSV 2), Staphylococcus aureus, Streptococcus haemolyticus,
Streptococcus pneumoniae.

Signs & symptoms

1. Pain and tenderness in eyeball
2. Conjunctival discharge:purulent, mucoid or mucopurulent depending on the cause.
3. Conjunctiva shows hyperaemia and chemosis. Eye lids are usually swollen.
4. Corneal involvement (rare) may occur in herpes simplex opthalmia neonatorum.

Complications:

Untreated cases may develop corneal ulceration, which may perforate resulting in corneal opacification and Staphyloma formation.

Treatment:

A. Prophylaxis needs antenatal, natal and post natal care.

1. Antenatal measures include thorough care of mother and treatment of genital infections when suspected.
2. Natal measures are of utmost importance as mostly infection occurs during childbirth. Deliveries should be conducted
under hygienic conditions taking all asceptic measures. The newborn baby's closed lids should be thoroughly cleansed and dried.
3. Postnatal measures include:

1. Use of 1% tetracycline ointment or 0.5% erythromycin ointment or 1% silver nitrate solution (crede's method) into the eyes of babies
immediately after birth 2. Single injection of ceftriaxone 50 mg/kg IM or IV should be given to infants born to mothers with untreated
gonococcal infection. B. Curative treatment as a rule, conjunctival cytology samples and culture sensitivity swabs should be taken before
starting treatment

 Chemical ophthalmia neonatorum is a self-limiting condition and does not require any treatment.
 Gonococcal ophthalmia neonatorum needs prompt treatment to prevent complications. Topical therapy should include

1. Saline levarage hourly till the discharge is eliminated 2. Bacitracin eye ointment four times per day (Because of resistant strains topical
penicillin therapy is not reliable. However in cases with proved penicillin susceptibility, penicillin drops 5000 to 10000 units per ml should
be instilled every minute for half an hour, every five minutes for next half an hour and then half-hourly till infection is controlled) 3. If the
cornea is involved then atropine sulphate ointment should be applied. Systemic therapy: Neonates with gonococcal ophthalmia neonatorum
should be treated for seven days with one of the following regimens

Ceftriaxone 75–100 mg/kg/day IV or IM, QID

Cefotaxime 100–150 mg/kg/day IV or IM, 12 hourly

Ciprofloxacin 10–20 mg/kg/day or Norfloxacin 10 mg/kg/day

Crystalline benzyl penicillin G 50,000 units (for full-term normal weight babies) or 20,000 units (for premature or low weight babies) IM
twice daily for three days (if penicillin is susceptible)

 Other bacterial ophthalmia neonatorum should be treated by broad spectrum antibiotics drops and ointment for two
weeks.
 Neonatal inclusion conjunctivitis caused by Chlamydia trachomatis responds well to topical tetracycline 1% or
erythromycin 0.5% eye ointment QID for three weeks. However systemic erythromycin should also be given since the presence of
chlamydia agents in conjunctiva implies colonization of upper respiratory tract as well. Both parents should also be treated with systemic
erythromycin.
 Herpes simplex conjunctivitis is usually a self-limiting disease. Topical antiviral drugs control the infection more
effectively and may prevent

Vitamin K (K from "Koagulations-Vitamin" in German and Scandinavian languages[1]) denotes a group of lipophilic, hydrophobic vitamins
that are needed for the posttranslational modification of certain proteins, mostly required for blood coagulation. Chemically they are 2-
methyl-1,4-naphthoquinone derivatives.

Vitamin K1 is also known as phylloquinone or phytomenadione (also called phytonadione). Vitamin K2 (menaquinone, menatetrenone) is
normally produced by bacteria in the large intestine,[2] and dietary deficiency is extremely rare unless the intestines are heavily damaged, are
unable to absorb the molecule, or are subject to decreased production by normal flora, as seen in broad spectrum antibiotic use[3].

There are three synthetic forms of vitamin K, vitamins K3, K4, and K5, which are used in many areas including the pet food industry
(vitamin K3) and to inhibit fungal growth (vitamin K5) [4]

Vitamin K source

Vitamin K is a fat-soluble vitamin that plays an important role in blood clotting. The body can store fat-soluble vitamins in fatty
tissue.

Function:Vitamin K is known as the clotting vitamin, because without it blood would not clot. Some studies indicate that it
helps in maintaining strong bones in the elderly.

Food Sources:Vitamin K is found in cabbage, cauliflower, spinach and other green leafy vegetables, cereals, soybeans, and
other vegetables. Vitamin K is also made by the bacteria that line the gastrointestinal tract.

Side Effects:Vitamin K deficiency is very rare. It occurs when the body can't properly absorb the vitamin from the intestinal
tract. Vitamin K deficiency can also occur after long-term treatment with antibiotics.

Individuals with vitamin K deficiency are usually more likely to have bruising and bleeding

Infants

 0 - 6 months: 2.0 micrograms per day (mcg/day)

 7 - 12 months: 2.5 mcg/day

Fetal development

Lanugo grows on fetus

es as a normal part of gestation

but is usually shed and replaced by vellus hair at about 33 to 36 weeks of gestational age

. As the lanugo is shed from the skin, it is normal for the developing fetus to consume the hair with the fluid, since it drinks
from the amniotic fluid
 and urinates it back into its environment. Subsequently, the lanugo contributes to the newborn baby's meconium

. The presence of lanugo in newborns is a sign of premature birth

. In the premature baby, the outer layer of skin (the epidermis) may be very thin and not well attached to the lower level of skin
(the dermis). As a result, the baby may be at increased risk for the following problems:

dehydration and difficulties in maintaining body temperature (because the baby loses water and heat through the skin);infection
(because bacteria and other germs can more easily penetrate the skin); andbreakdown of the skin (particularly when tape is
applied and removed

NICU staff take special precautions to protect the baby's skin and prevent breakdown. Babies are always handled very gently.
They are usually bathed with warm water (not hot) and only when necessary. The baby's body may be covered with a sheet of
plastic that helps contain heat and reduces the amount of moisture lost from the skin. Special tape that is very gentle is used and
only when necessary.

Even more precautions are taken when the baby is very premature. The baby's skin is covered with a special ointment that helps
protect the skin from breakdown, serves as a barrier to germs, and reduces loss of heat and water. The staff may try to avoid
using tape but if they must, they use a protective barrier between the tape and the infant's skin.

Testes:It usually doesn't take much time for a premature baby's skin to get stronger. However, even the special measures described above
are not enough to prevent skin irritation and breakdown in some babies
The testis descends from the urogenital ridge to the scrotum in two phases: the first, transabdominal migration, appears to be dependent
on Mullerian Inhibiting Factor substance; and the second stage, inguinoscrotal descent, relies on androgens. A peritoneal extension, the
processus vaginalis, elongates into the gubernaculum, which in turn migrates into the scrotum. Between weeks 26 and 28 of gestation the
testis descends through the processus vaginalis in the inguinal canal to reach the scrotum by 35–40 weeks.

Also known as cryptorchidism, undescended testes is a congenital condition characterized by testicles that do not extend to the
scrotum.

Description

In the fetus, the testes are in the abdomen. As development progresses they migrate downward through the groin and into the
scrotum. This event takes place late in fetal development, during the eighth month of gestation. Thirty percent of premature
boys have testes that have not yet made the full descent. Only 3–4% of full-term baby boys have undescended testes, and half
of those complete the journey by the age of three months. Eighty percent of all undescended testes cases naturally correct
themselves during the first year of life. Undescended testes that are not corrected can lead to sterility and an increased risk of
testicular cancer.
Diagnosis

The newborn examination always checks for testes in the scrotum. It they are not found, a search will be conducted, but not
necessarily right away. If the testes are present at all, they can be anywhere within a couple inches of the appropriate spot. In
most cases, the testes will drop into place later. In 5 percent of cases, one testis is completely absent. In 10 percent of cases, the
condition occurs on both sides. Presence of undescended testes is differentiated from absence of testicles by measuring the
amount of gonadotropin hormone in the blood.

Treatment

Once it is determined that the testes will not naturally descend, treatment options must be considered. Hormone therapy is a
possible treatment but does not have a very high success rate. Another treatment option is surgery. The procedure is called an
orchidopexy and is relatively simple once the testes are located. The surgery is usually performed when the boy is between one
and two years old.

Infants who have low muscle tone may benefit from physiotherapy. This is especially true when a child has poor posture and
poor body alignment. Infants who have low muscle tone may develop more serious problems as they get older. Addressing the
problem of low muscle tone in infants as soon as possible is the best idea.

Low muscle tone can be caused by genetics or traumatic birth experiences. Premature babies are more likely to develop low
muscle tone. Many lifestyle habits may contribute to low muscle tone also. Babies are often "movement deprived" and spend
far too much time in round-backed car seats and other inclined seats.

If you want your child to develop good posture you should begin when she is an infant. Let her spend time flat on her tummy
every day. This will lengthen the spine and strengthen her neck muscles.Your baby should spend time every day in a horizontal
position rather than always being in a seat that sits in an inclined position. If she can see her feet and hands she will begin to
play with them. This will develop her hand-eye coordination.

As your baby gets older make sure that she is sitting in a proper position in her highchair. The seat and back should be at right
angles and her feet should be flat on the ground or on a foot rest.When your child is sitting on the floor she should sit cross-
legged. This way her hips will turn inwards. A young child can sit on the edge of a flat pillow so that there will be a slight curve
in her lower back.Infants who have low muscle tone may improve with healthy lifestyle habits and the help of a
physiotherapist.

The premature infant differs from the immature fetus in the possession of viability, that is to say, he is capable of an
independent existence outside the mother's uterus, an existence, it must be added, which is not limited to a few hours, but is
potentially possible for months and years. Not only must his heart beat, his limbs move, and his lungs respire, but his digestive
organs must also be capable of a certain amount of functional activity, and his tissues be able to assimilate nourishment brought
to them through the alimentary canal. So much is certain; but when attempts are made to fix the uterine age at which viability
may be said to be acquired difficulties are at once encountered. it is not easy, for instance, exactly to estimate the uterine age of
any fetus; consequently, when one speaks of a premature infant born at the seventh month of pregnancy, one can only mean that
the maternal symptoms and the physical examination of the mother and the infant pointed to that as the most probable date.
Neither fetal size nor weight can be regarded as sure indications of fetal age, and the knowledge we possess of the chronology
of the development process is not exact enough to permit the drawing of accurate conclusions from them. Another difficulty
exists in the fact that the maternal health during pregnancy has an influence upon the viability of the infant; thus, the seven-
months fetus of a healthy mother may be altogether viable, whereas the seven-months fetus of a syphilitic mother may be
absolutely non-viable. The age of attainment of viability will, therefore, vary with the state of health of the parents. Even if the
exact uterine age of the premature infant could be determined with sufficient accuracy, there would still be the varying factor of
the infants vitality as influenced by the varying circumstances of intrauterine health; the viability of the child depends,
therefore, not only upon the number of months spent in the uterus, but also upon the character of the life of these months.