PEDIA

Requirements:
Case Study
EBN

Start of notes
*Half a million of mothers die from complication

4 million babies die due to:

-prematurity
-infection
-cord prolapse
- asphyxia

Maternal death causes:

1. hypertensive disorders- leading cause
2. post partum hemorrhage- second leading cause
3. abortive outcomes - Third leading cause

Causes of neonatal death:

1. preterm- First cause
2. infection- 2nd
3. Asphyxia- third cause

Maternal death​ is the ​death​ of a woman while pregnant or within 42 days of termination of
pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or
aggravated by the pregnancy or its management but not from accidental or incidental causes.

*approx. 1, 484 maternal deaths - as of 2016

Top 3 region with highest number of deaths

1. CALABARZON / Region 4-A
2. central visayas/ region 7
3. NCR

LEAST NUMBER OF MATERNAL DEATHS (2016)

1. ARMM

2017 (124 deaths) VS 2016 (121 deaths)

CAUSES OF MATERNAL MORTALITY ( as of 2010)

1. complications related to pregnancy (660)
2. Hypertension complications (605)
3. PPH (298)
4. Aborted outcome (156)

Factors affecting Risk for Maternal death

• Frequency and spacing of births
• Nutrition level (maternal undernutrition)
• Stature and maternal age
• Appropriate medical and midwife support
• Access to emergency and intensive treatment if were necessary
• Lack of management capacity in the health system
• No political will and lack of management
• Majority of the deaths are preventable
• HIV infection increase threat

Main causes of maternal deaths

· Hypertensive disorders of pregnancy
· Post-partum hemorrhage
· Pregnancy with abortive outcomes
Main causes of neonatal deaths
· Prematurity or Pre-term
· Infection
· Asphyxia
Maternal mortality rates in the Philippines
· Flat mortality rate/reduction
Main Causes of maternal mortality
· Complications related to pregnancy occurring in the course of labor, delivery and
puerperium
· Hypertension complicating pregnancy, childbirth and puerperium
· Postpartum hemorrhage
· Pregnancy with abortive outcome

Causes of Maternal Death

· ​Labor complications
· ​Hypertension
· ​Postpartum hemorrhage
· ​Abortion

Highest maternal mortality rate

1.Region IVA
2.Central Visayas
3.NCR
Recorded as least maternal date
1.ARMM

Maternal Death
· Death of a woman while pregnant or within 42 days (period of puerperium) of termination
of pregnancy
· Irrespective of the duration and site of the pregnancy
· Should be related by pregnancy, not by accident or incidental causes.
Risk Factors
· Frequency and spacing of births
· Nutrition level (maternal undernutrition)
· Stature and maternal age
· Appropriate medical and midwife support
· Access to emergency and intensive treatment if were necessary
· Lack of management capacity in the health system
· No political will and lack of management
· Majority of the deaths are preventable
· HIV infection increase threat
Main Problem
>Majority of these deaths and disabilities are preventable, being mainly due to insufficient care
during pregnancy and delivery.
Infant Mortality rates in the Philippines
> Infant – More than 28 days, less than 1 year
> There is the decrease in the under five of child mortality
Different programs:
● Breastfeeding
● Unang Yakap
● Immunization
● Newborn Screening

Neonatal- 37%
Preterm – 28%
Pneumonia – 26%
Asphyxia – 23%

Infant death​- occured Before reaching age 1 or <1 year old, but more than or equal29 days.

0-28 neonate
29-1 infancy
1-3 toddler
3-6 pre school
6 to 12 School age
12 to 20 Adolescent

Top 3 regions with highest number of infant deaths

1. CALABARZON
2. NCR
3. CENTRAL LUZON

Least infant deaths

82,000 Filipino Children die annualy

Ph is one of the 42 countires that account 90% under the age of 5 years old death

Top 3 Leading causes​:

-Pneumonia
-bacterial sepsis
-Respiratory Distress of the Newborn

Maternal and Child Health Indicators​:

- MMR (Maternal Mortality Rate)- number of maternal death per 1000 live birth

- IMR (Infant Mortality Rate)- Number of childre less than one year of age/ live of birth x 1000

-NMR (Neonatal Mortality Rate) -Number of death of children under 28 days

- Under 5 mortality rate- Number of death of children between birth and exactly 5 year

How do we measure? ​ (Computation)

Formula:
(# of maternal death/# of live birth) x (100,000)

​How do we assess​? (Mortality rates) Assement for mortality

- Very slow decline of MMR in past 20 years
-Maternal deaths account for 14% of deaths among women of reproductive age
-Maternal death triggers other adverse consequences in families: orphans, loss of family care
provider
-17 infants die per 1,000 live births within first 28 days of life
-Mostly within first week after birth
-Half die during the 1st 2 days

Predisposing factors for maternal and neonatal death

1. Young age at marriage & first pregnancy
2. Domestic violence and gender inequality
3.Poor maternal health
4. Poor hygiene during and after delivery
5. Lack of/poor newborn care
6. The three delays:
1. Delay to seek medical care
● Failure to see the danger signs)
● Lack of money
● unwanted pregnancy
● fear of being ill treated?
2. Delay of reaching the facility
● Distance of home from facility
● lack of awareness of existing services
● lack of community support
3. Delay of receiving appropriate and adequate care at health facility
● Lack of man pwoer
● Less resources
● Shortage or lack of equipment

DOH programs for childcare

1. Essential new born care
2. new born screening
3. immunization program
4.Breastfeeding program/ infant feeding
5. IMCI

HIgher-risk newborn
---------------------------------------------------------------
QUIZ ON MONDAY (then everyday quizzes)
Different diseases and disorders in pediatric
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Gestational age​- A measure of the age of a pregnancy which is taken from the beginning of
the woman's last menstrual period (LMP), or the corresponding age of the gestation as
estimated by a more accurate method if available.

Problems with gestational weight:

SGA - Small for gestational age
LGA- Large for gestational age

Acute condition OF NEWBORN

RDS (Respiratory Distress Sydrome)
MEConium AsPiratIon SyNdromE
SEPSIS
HYPERBILIRUBINEMIA
A. Nursing Care of the High-Risk Newborn to Maturity
1. ​Problems related to Maturity
a. Prematurity
b. Postmaturity

2. ​Problems related to gestational weight

a. Small for Gestational Age (SGA)
b. Large for Gestational Age (LGA)

3. ​Acute conditions of the neonates such a​s:

a. Respiratory distress syndrome
b. Meconium aspiration syndrome
c. Sepsis
d. Hyperbilirubinemia

B.COMMON HEALTH PROBLEMS THAT DEVELOP DURING INFANCY:

b.1. Colic
b.2. Sudden infant death syndrome
b.3. Cleft palate
b.4. Imperforate anus
b.5. Intussusception
b.6. Hirchsprung's disease
b.7. Failure to thrive
b.8. Otitis Media
b.9. Meningitis
b.10. Hydrocephalus
b.11. Febrile seizures
b.12. Spina bifida
b.13. Trisomy 21
b.14. Autism/ADHD

C.HEALTH PROBLEMS COMMON IN TODDLERS

1. Burns
2. Poisoning
3. Child Abuse
4. Cerebral Palsy

D.HEALTH PROBLEMS COMMON IN PRESCHOOLER

1. Leukemia
2. Wilm’s Tumor (Nephroblastoma)
3. Asthma
4. Urinary Tract Infection (UTI)
E. HEALTH PROBLEMS MOST COMMON IN SCHOOL AGED CHILDREN
1. Diabetes Mellitus
2. Rheumatic Fever
3. Rheumatoid Arthritis
4. Scabies
5. Pediculosis
6. Impetigo

F.HEALTH PROBLEMS COMMON IN ADOLESCENT

1. Amenorrhea
2. Dysmenorrhea
3. Accidents (trauma/injury)
4. Scoliosis
5. Bone Tumors
6. Obesity
7. Anorexia Nervosa
8. Substance abuse
9. STD
10. Suicide

Newborn​ Regardless of the gestational age or birth weight, who has a

greater- than- average chance of morbidity or mortality because of
conditions or circumstances superimposed on the normal course of
events associated with birth and adjustments to extrauterine life.

Preterm- 36Weeks-20Weeks
Full term-37-40 Weeks
Posterm - after 40-42 wks

preterm infants- weigh less than 5.5 pounds, 2.5 kgs

● APGAR
● Ballard
● Ulrasound
● Silverman-Anderson index- neonatal respiratory distress grading
● sonographic estimation of gestational age
● LMP
● Neurologic and physical findings

Etiology- root cause/ possible reasons

● Low socio economic level
● Lack of prenatal care
 ● Poor nutritional status
● multiple pregnancy
● Low BMI
● Previous early birth
● Race
● Abuse of substance
● age of mother younger than 18 and older than 35
● mental status of women
● first and beyond 4th pregnancy
● Closely space pregnancy no 6 month allowance, but pregnant.
● Early induction of labor
● Elective caesarean birth
● spontaneous surgical abortion
● abnormal amount of amniotic fluid

Ballard Scoring-​ neuromuscular and physical maturation of new borns

12 criterias: For physical maturation: (6) and 6 for neuro
neuromuscular:
1. posture
2. arm recoil
3. square window
4. scarf sign
5. popliteal angle
6. heel to ear
Physical
● skin
● Lanugo
● breast
● genitalia
● plantar surface
● eyes cartilage
APGAR Scoring should be done within 5 mins
7-10 = Good; Healthy
4-6 = Fair; Guarded; Close Observation
0-3 = Poor; Serious; Needs resuscitation
1 min
- Determines how well the baby tolerated the
birthing process
5 min
- Well the baby is doing outside the womb of the
mother
10 min
- If poor, repeat again after 10 min
* Do cpr if poor

Silverman Anderson Index- ​Grading respiratory distresss

Characteristics of a Preterm Infant

a. very small and appear scrawny
b. have a proportionately large head in relation to the body;
with scant hair
c. Skin - bright pink, smooth, and shiny, with small blood
vessels clearly visible underneath the thin epidermis
d. Fine lanugo - abundant over the body but is sparse, fine,
and fuzzy on the head
e. Ear cartilage - soft and pliable
f. Skin - bright pink, smooth, and shiny, with small blood
vessels clearly visible underneath the thin epidermis
g. Soles and palms - minimum creases
h. Bones of the skull and the ribs - feel soft
i. Eyes may be fused.
j. Sleeping for most of the time
k. Inactive and listless
l. Underdeveloped breast tissue
m. Male infants - few scrotal rugae, testes are undescended;
n. Females - labia minora and clitoris are prominent
o. Extremities - maintain an attitude of extension and remain
in any position in which they are placed
p. Unable to maintain body temperature, have limited ability
to excrete solutes in the urine, and have increased
susceptibility to infection.
q. A pliable thorax, immature lung tissue, and an immature
regulatory center
r. More susceptible to biochemical alterations
s. Higher extracellular water content
t. Preterm infants exchange fully half their extracellular fluid
volume every 24hours
u. Soft cranium - subject to characteristic unintentional
deformation, or "preemie head," caused by positioning
from one side to the other on a mattress
v. Head - looks disproportionately longer from front to back, is
flattened on both sides, and lacks the usual convexity
seen at the temporal and parietal areas.
w. Frequent repositioning of the infant and positioning on a
gel mattress can reduce or minimize cranial molding.

ACTIVITY:
Read advance of anemia in prematurity?
RDS
*summarize them
etiology
signs and symptoms
diagnostics
nursing diagnosis
preventive management
therapeutic m
nursing management
complications