1.

Causes for Neonatal Sepsis, Newborn Sepsis, Neonatal Infection, Sepsis Treatment
Neonatal sepsis is a severe bacterial infection occurring in a newborn. Infants are particularly susceptible to infection due to their immature immune system and lack of immunity. Group B streptococcus is the most common bacteria that causes septicemiaand sepsis in newborns. This bacteria can gain entry via the placenta, in the birth canal or after delivery. However, a number of other infectious disease organisms can cause neonatal infections, like: E. coli herpes rubella syphilis listeriosis candidiasis chickenpox toxoplasmosis coxsackie virus cytomegalovirus rotavirus, enteroviruse human immunodeficiency virus

Late pregnancy and newborn screening for neonatal infections and early treatment has played a major role in reducing the number of cases of newborn sepsis. Infants with neonatal sepsis or infection may exhibit some of these symptoms: apnea shock diarrhea seizures jaundice vomiting cyanosis irritability skin rashes nasal flaring weak sucking rapid breathing low blood sugar slowed heart rate lethargic, inactive irregular heartbeat breathing difficulty

abdominal distention body temperature fluctuations ~ hypothermia

Neonatal meningitis, pneumonia, respiratory distress and conjunctivitis are possible complication concerns for a infection in newborn as well. Bacteria or virus infection can be the causer for newborn conjunctivitis. Antibiotic treatment is commenced immediately if bacteria is the suspected cause of your babys infection. With prompt sepsis treatment, many newborns completely recover from bacteria caused infection. Nonetheless, newborn sepsis is one of the leading causes for infant death.

2.

October 1, 2007 Table of Contents

Respiratory Distress in the Newborn

CHRISTIAN L. HERMANSEN, MD, and KEVIN N. LORAH, MD, Lancaster General Hospital, Lancaster, Pennsylvania
Am Fam Physician.2007Oct1;76(7):987-994.

The most common etiology of neonatal respiratory distress is transient tachypnea of the newborn; this is triggered by excessive lung fluid, and symptoms usually resolve spontaneously. Respiratory distress syndrome can occur in premature infants as a result of surfactant deficiency and underdeveloped lung anatomy. Intervention with oxygenation, ventilation, and surfactant replacement is often necessary. Prenatal administration of corticosteroids between 24 and 34 weeks' gestation reduces the risk of respiratory distress syndrome of the newborn when the risk of preterm delivery is high. Meconium aspiration syndrome is thought to occur in utero as a result of fetal distress by hypoxia. The incidence is not reduced by use of amnio-infusion before delivery nor by suctioning of the infant during delivery. Treatment options are resuscitation, oxygenation, surfactant replacement, and ventilation. Other etiologies of respiratory distress include pneumonia, sepsis, pneumothorax, persistent pulmonary hypertension, and congenital malformations; treatment is disease specific. Initial evaluation for persistent or severe respiratory distress may include complete blood count with differential, chest radiography, and pulse oximetry.

The clinical presentation of respiratory distress in the newborn includes apnea, cyanosis, grunting, inspiratory stridor, nasal flaring, poor feeding, and tachypnea (more than 60 breaths per minute). There may also be retractions in the intercostal, subcostal, or supracostal spaces. Respiratory distress occurs in approximately 7 percent of infants,1 and preparation is crucial for physicians providing neonatal care. Most cases are caused by transient tachypnea of the newborn, respiratory distress syndrome, or meconium aspiration syndrome, but various other causes are possible (Table 1).

Transient Tachypnea of the Newborn

Transient tachypnea of the newborn is the most common cause of neonatal respiratory distress, constituting more than 40 percent of cases.1 A benign condition, it occurs when residual pulmonary fluid remains in fetal lung tissue after delivery. Prostaglandins released after delivery dilate lymphatic vessels to remove lung fluid as pulmonary circulation increases with the first breath. When fluid persists despite these mechanisms, transient tachypnea of the newborn can result. Risk factors include maternal asthma,2male sex, macrosomia, maternal diabetes,3 and cesarean delivery.4 The clinical presentation includes tachypnea immediately after birth or within two hours, with other predictable signs of respiratory distress. Symptoms can last from a few hours to two days. Chest radiography shows diffuse parenchymal infiltrates, a wet silhouette around the heart, or intralobar fluid accumulation5

3.Pneumonia - Causes
Pneumonia is most commonly caused by an infection, usually a bacterial infection. However, many different bacteria, viruses and (rarely) fungi cause pneumonia; the germ depends on where the pneumonia began. For example, the germs that cause pneumonia caught in hospitals are different to those that cause pneumonia caught in the community.

Bacterial pneumonia
The most common cause of pneumonia in adults is a bacterium called Streptococcus pneumoniae. This form of pneumonia is sometimes called pneumococcal pneumonia. Less commonly, other types of bacteria can cause pneumonia, including: Haemophilus influenzae Staphylococcus aureus Mycoplasma pneumoniae (outbreaks tend to occur every four to seven years, more commonly in children and young people) And rarely, the following bacteria can cause pneumonia: Chlamydophila psittaci: this causes a rare form of pneumonia called psittacosis, which can be passed on to people from infected birds such as parrots, parakeets, pigeons, canaries and budgies (this condition is also called parrot fever or parrot disease) Chlamydophila pneumoniae Legionella pneumophila: this causes Legionnaires' disease, an

uncommon form of pneumonia

Viral pneumonia
Viruses can also cause pneumonia, most commonly the respiratory syncytial virus (RSV), and sometimes the flu (influenza) type A or B virus. Viruses are a common cause of pneumonia in young children.

Aspiration pneumonia
Rarely, pneumonia can be caused by breathing in: vomit a foreign object, such as a peanut a harmful substance, such as smoke or a chemical The object or substance inhaled causes irritation in the lungs or damages them. This is called aspiration pneumonia.

Fungal pneumonia
In the UK, pneumonia caused by fungal infection of the lungs is rare in people who are normally healthy. It more often affects people whose immune systems are weakened (see People at risk, top right box). Fungal pneumonia can rarely affect people who travel to places where these infections are more commonly found, such as some parts of the US, Mexico, South America and Africa. The medical names for fungal pneumonia include histoplasmosis, coccidioidomycosis and blastomycosis.

4What causes congenital pneumonia `?

The list of organisms which can cause pneumonia is very large, and includes nearly every class of infecting organism: viruses, bacteria, bacteria-like organisms, fungi, and parasites (including certain worms). Different organisms are more frequently encountered by different age groups. Further, other characteristics of an individual may place him or her at greater risk for infection by particular types of organisms: * Viruses cause the majority of pneumonias in young children (especially respiratory syncytial virus, parainfluenza and influenza viruses, and adenovirus). * Adults are more frequently infected with bacteria (such as Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus). * Pneumonia in older children and young adults is often caused by the bacteria-like Mycoplasma pneumoniae (the cause of what is often referred to as "walking" pneumonia).

* Pneumocystis carinii is an extremely important cause of pneumonia in patients with immune problems (such as patients being treated for cancer with chemotherapy, or patients with AIDS. Classically considered a parasite, it appears to be more related to fungi. * People who have reason to come into contact with bird droppings, such as poultry workers, are at risk for pneumonia caused by the organism Chlamydia psittaci. * A very large, serious outbreak of pneumonia occurred in 1976, when many people attending an American Legion convention were infected by a previously unknown organism. Subsequently named Legionella pneumophila, it causes what is now called "Legionnaire's disease." The organism was traced to air conditioning units in the convention's hotel.

5.

. Congenital Malformations Of The Heart

Congenital Malformations Of The Heart

MISPLACEMENTS of the heart are of rare occurrence, and the more important of them are merely part of a general malformation of the body. The heart may be transposed, that is to say, placed in a position on the right side of the chest corresponding with that which it normally occupies on the left. With this there is usually transposition of the viscera, but it sometimes occurs alone. Again, the heart may occupy the middle line, as it does in early foetal life. It may be placed outside the thorax altogether (Ectopia cordis), but in this case there are other congenital malformations, and that of the heart only forms a part. Malformations Of The Pericardium Absence of the pericardium is a rare congenital malformation, and is mostly associated with ectopia cordis. There are, however, cases of absence of the pericardium in persons otherwise well formed. The sac may be entirely absent or there may be traces of it at the base. Diverticulum of the pericardium is an unusual malformation. It occurs in the form of a sac with a narrow neck, which communicates with the pericardium. When distended the sac is about the size of a pigeon's egg. (See cases by Bristowe, Path, trans., xx., 101, and by author in Catalogue of Western Infirmary Museum). Malformations Of The Heart And Great Vessels These for the most part represent survivals of foetal conditions. The heart at an early period consists of two cavities, an auricle and a ventricle. The simple auricle receives the two ventse cavae, and the ventricle gives origin to the common arterial trunk. The ventricle, the auricle, and the common arterial trunk subsequently undergo subdivision each into two. This separation in the ventricle begins near the apex; the septum gradually rises towards the base, its completion at the base being delayed after the rest of the septum has been formed. Kokitansky distinguishes two parts in the ventricular septum, namely, an anterior (septum anterius) which divides the orifices of the aorta and pulmonary artery, and a posterior (septum

posterius) which comes between the two auriculo-ventricular openings. The undefended space (pars membranacea) is at the union of the anterior and posterior septa, and will be the last part to close. This portion of the septum remains throughout life devoid of muscular tissue, being composed of the two layers of endocardium from the two ventricles. It is situated at the base of the septum, just beneath the aortic valve. There is sometimes a minute aperture persisting in adult life. The common arterial trunk begins to show signs of division by a septum about the time that the inter-ventricular septum is approaching the base. A septum passing from both sides of the artery meets and divides the vessel into what are subsequently the pulmonary artery and the aorta. These are so adjusted as to connect with the right and left ventricles respectively. The division of the nitrides does not begin till the ventricular septum is nearly completed, namely, about the ninth week, and after being fully formed the septum remains partially open during the whole of intra-uterine life. The foetal circulation, so far as the heart and great vessels are concerned, differs from that of the adult chiefly in two respects, namely, in the existence of the foramen ovale and in the patency of the ductus arteriosus. The Foramen ovale forming a communication between the two auricles closes more or less completely at birth. The Ductus arteriosus connects the pulmonary artery with the descending aorta, and in the foetus it conveys most of the blood going to the abdomen and lower limbs, as well as that to the umbilical arteries. The left ventricle and aortic arch thus supply in the foetus the upper part of the body and the upper limbs, whilst the right ventricle and pulmonary artery through the ductus arteriosus supply the lower parts. There is a small part of the aorta between the origin of the subclavian artery and the opening of the ductus arteriosus, which is thus almost out of use in the foetus. It is called the Isthmus aortae, and is important in connection with subsequent lesions. Consistently with the larger amount of work thrown on the right ventricle in the foetus as compared with the adult, the wall of this ventricle is similar in thickness to that of the left ventricle. Causation Of Malformations Of The Heart A large proportion of cases of malformation are related to narrowness or Stenosis of the pulmonary artery. This has been variously ascribed to inflammation during foetal life, and defective formation of the parts in the ftus. By some (Peacock, Meyer) inflammation occurring in early foetal life has been assigned as the cause of the stenosis. We shall see afterwards that inflammation of the endocardium frequently leads to valvular lesions, which result in obstruction of the orifices. In the adult it mostly occurs in the valves of the left side of the heart, and this is usually ascribed to the fact that the systemic arteries are liable to greater variations in blood-pressure and greater strain than the pulmonary vessels. In the foetus it is otherwise; a much larger proportion of the circulation is dependent on the right ventricle, the abdominal aorta and umbilical arteries being fed by this ventricle. The umbilical arteries, again, are, from their position, exposed to variations in pressure, and this may tell on the pulmonary artery at its origin.

On the other hand, Rokitansky seeks to ascribe the frequency of defect of the pulmonary artery to deficiency in the original formation of the septum dividing the primary common arterial trunk. This is probably the more correct explanation, as there are seldom traces of inflammation visible in the endocardium at birth, and, besides, the lesion is not simply one of the valves, which inflammation produces, but frequently a real narrowing or defect in the artery, as if in the division of the primary arterial stem the greater part had been monopolized by the aorta. The stenosis of the pulmonary artery is commonly associated with defects in the septa, and these may be ascribed to a mechanical interference with the complete closure of the septa. Let us suppose that the common arterial trunk, instead of dividing in the normal way into pulmonary artery and aorta, does so imperfectly, and so there is a large aorta and a small pulmonary artery, or even an entire absence of the latter. In the case last mentioned the blood from the right ventricle, as well as that from the left, would pass into the aorta, and the constant recurrence of this passage of blood at each systole of the ventricle would prevent the closure of the septum at the base, and cause the aorta to take permanent origin from the right ventricle as well as from the left. On a similar principle the obstruction of the pulmonary artery will, by raising the pressure of the blood in the right auricle, interfere with the closure of the foramen ovale. Instead of stenosis of the pulmonary artery, we may have a similar condition of the aorta. The consequence of this will be defect of the septa and alterations in the circulation, the latter differently located to those already mentioned. Forms Of Malformation. 1. Defects Of The Septum Ventriculorum As already indicated, this usually goes along with defect of the great vessels. When the stenosis is in the pulmonary artery, as is mostly the case, it is chiefly the anterior part of the septum which is defective;while in the case of aortic stenosis it is the posterior (Rokitansky). The defect, if limited in extent, is usually in or near the undefended space (see Fig. 200). The defect may be so great as that there is virtually no septum, the ventricle being composed of a single cavity, or it may present various degrees of divergence from this extreme.

6Congenital abnormality
A congenital anomaly (congenital abnormality, congenital malformation, birth defect) is a condition which is present at the time of birth which varies from the standard presentation.[1] It is a type of congenital disorder which is primarily structural in nature.[2]

Types
A limb anomaly is called a dysmelia. These include all forms of limbs anomalies, such as amelia,ectrodactyly, phocomelia, polymelia, polydactyly, syndactyly, polysyndactyly, oligod

actyly, brachydactyly,achondroplasia, congenital aplasia or hypoplasia, amniotic band syndrome, and cleidocranial dysostosis. Congenital anomalies of the heart include patent ductus arteriosus, atrial septal defect, ventricular septal defect, and tetralogy of fallot. Helen Taussig has been a major force in research on congenital anomalies of the heart.[1] Congenital anomalies of the nervous system include neural tube defects such as spina bifida, meningocele, meningomyelocele, encephalocele andanencephaly. Other congenital anomalies of the nervous system include the Arnold-Chiari malformation, the Dandy-Walker malformation, hydrocephalus,microencephaly, megencephaly, lissencephaly, polymicrogyria, holoprosencephaly, and agenesis of the corpus callosum. Congenital anomalies of the gastrointestinal system include numerous forms of stenosis and atresia, and imperforate. [edit]Occurrence

rate

About 3% of newborns have a "major physical anomaly", meaning a physical anomaly that has cosmetic or functional significance.[3] Congenital anomalies involving the brain are the largest group at 10 per 1000 live births, compared to heart at 8 per 1000, kidneys at 4 per 1000, andlimbs at 1 per 1000. All other physical anomalies have a combined incidence of 6 per 1000 live births. Congenital anomalies of the heart have the highest risk of death in infancy, accounting for 28% of infant deaths due to congenital anomaly, whilechromosomal anomalies and respiratory anomalies each account for 15%, and brain anomalies about 12%. [edit]Causes The cause of 40-60% of congenital anomalies in humans is unknown. These are referred to as sporadic, a term that implies an unknown cause, random occurrence regardless of maternal living conditions,[4] and a low recurrence risk for future children. For 20-25% of anomalies there seems to be a "multifactorial" cause, meaning a complex interaction of multiple minor genetic anomalies with environmental risk factors. Another 10-13% of anomalies have a purely environmental cause (e.g. infections, illness, or drug abuse in the mother). Only 12-25% of anomalies have a purely genetic cause. Of these, the majority are chromosomal anomalies.[5] Genetic causes of congenital anomalies include inheritance of abnormal genes from the parents, as well as new mutations in one of the germ cells that gave rise to the fetus. Environmental causes of congenital anomalies are referred to as teratogenic. These are generally problems with the mother's environment. Teratogenscan include dietary deficiencies, toxins, or infections. For example, dietary deficiency of maternal folic acid is associated with spina bifida. Ingestion of harmful substances by the mother

(e.g., alcohol, mercury, or prescription drugs such as phenytoin) can cause recognizable combinations of birth defects. Several infections which a mother can contract during pregnancy can also be teratogenic. These are referred to as the TORCH infections. [edit]Teratogens The greatest risk of a malformation due to environmental exposure to a teratogen (terato = monster, gen = producing) between the third and eighth week ofgestation. Before this time, any damage to the embryo is likely to result in fatality, and the baby will not be born. After eight weeks, the fetus and its organs are more developed and less sensitive to teratogenic incidents. The type of congenital anomaly is also related to the time of exposure to a teratogen. For instance, the heart is susceptible from three to eight weeks, but the ear is susceptible from a slightly later time to about twelve weeks. Many common skin care ingredients can be absorbed through the skin in small amounts, where they can enter the bloodstream and pass into the fetus's circulation.[citation needed] Infection in the mother early in the third week may cause fetal cardiac damage. An infection in the eleventh week is less likely to damage the heart, but the baby may be born deaf. A common cause of congenital deafness of children in particular is a measles infection in the mother.

7Birth

asphyxia

Mula sa Wikipedia, ang libreng ensiklopidya

Intrauterine hypoxia (IH, and birth asphyxia) occur when the fetus is deprived of an adequate supply of oxygen. IH is used to describe inadequate oxygen availability during the gestation period, birth asphyxia (also referred to as perinatal asphyxia or Asphyxia neonatorum ) can result from inadequate supply of oxygen immediately prior to, during or just after delivery. There is considerable controversy over the diagnosis of birth asphyxia due to medicolegal reasons. Because of its lack of precision, the term is eschewed in modern obstetrics. IH may be due to a variety of reasons such as cord prolapse, cord occlusion, placental infarction and maternal smoking. Intrauterine growth restriction (IUGR) may cause or be the result of hypoxia. Birth asphyxia may result due to prolonged labor, breech deliveryin full-term infants; placental abruption, and maternal sedation in premature infants. Oxygen deprivation is the most common cause of perinatal brain injury. Intrauterine hypoxia and birth asphyxia can cause hypoxic ischemic encephalopathy which is cellular damage that occurs within the central nervous system (the brain and spinal cord) from inadequate oxygen. This results in an increased mortality rate, including an increased risk of Sudden infant death syndrome (SIDS). Oxygen deprivation in the fetus and neonate have been

implicated as either a primary or as a contributing risk factor in numerous neurological and neuropsychiatric disorders such as epilepsy, ADHD, eating disorders and cerebral palsy. " The problem of perinatal brain injury, in terms of the costs to society and to the affected individuals and their families, is extraordinary." (Yafeng Dong, PhD)

8Gastroenteritis
Gastroenteritis is a general, nonspecific term given to a variety of conditions causing inflammation of the stomach and intestinal tract. Its most notable sign is the sudden onset of frequent bowel movements with loose or liquid feces (diarrhea), associated with nausea and vomiting, as well as abdominal cramping, abdominal pain, weakness, and sometimes either fever or chills. Infectious gastroenteritis may be caused by viruses (50% to 70%), bacteria (15% to 20%), or parasites (10% to 15%) (Diskin). It occurs when microorganisms such as viruses, bacteria, or protozoa infect the stomach or intestines. Two of the most common viruses that cause infectious gastroenteritis are the rotavirus, which often affects travelers, babies, and young children, and is responsible for 12% of cases; and the norovirus (formerly known as the Norwalk virus), which affects older children and adults and is the most common cause of gastroenteritis in the US (Diskin). Bacteria that can cause gastroenteritis include staphylococci, clostridia, Bacillus cereus, Salmonella, Escherichia coli, Shigella, and vibrios (V. cholerae causes a severe type of gastroenteritis called cholera). Protozoa that can cause gastroenteritis include Entamoeba histolytica and Giardia. Infectious gastroenteritis is more common in individuals with compromised immune system or HIV infection/AIDS; they may develop gastrointestinal infections from the herpes simplex virus or cytomegalovirus, a virus that often causes no symptoms in a healthy person. Noninfectious gastroenteritis is usually due to food or shellfish intoxication (caused by bacterial toxins); medication,chemotherapy, or radiation therapy side effects; or underlying conditions such as ulcerative colitis, Crohn's disease, certain cancers, or AIDS. Its severity may vary from mild and inconvenient to severe and life-threatening. 9

Meconium aspiration syndrome

Meconium aspiration syndrome is a serious condition in which a newborn breathes a mixture of meconium and amniotic fluid into the lungs around the time of delivery. Causes Meconium is the term used for the early feces (stool) passed by a newborn soon after birth, before the baby has started to digest breast milk (or formula). In some cases, the baby passes stools (meconium) while still inside the uterus. This usually happens when babies are under stress because they are not getting enough blood and oxygen.

Once the meconium has passed into the surrounding amniotic fluid, the baby may breathe meconium into the lungs. This may happen while the baby is still in the uterus, or still covered by amniotic fluid after birth. The meconium can also block the infant's airways right after birth. This condition is called meconium aspiration. It can cause breathing difficulties due to swelling (inflammation) in the baby's lungs after birth. Risk factors that may cause stress on the baby before birth include: Decreased oxygen to the infant while in the uterus Diabetes in the pregnant mother Difficult delivery or long labor High blood pressure in the pregnant mother Passing the due date

10. Low birthweight

Babies born weighing less than 5 pounds, 8 ounces (2,500 grams) are considered low birthweight. Low-birthweight babies are at increased risk for serious health problems as newborns, lasting disabilities and even death. About 1 in every 12 babies in the United States is born with low birthweight (1). Advances in newborn medical care have greatly reduced the number of deaths associated with low birthweight. However, a small percentage of survivors develop mental retardation, learning problems, cerebral palsy and vision and hearing loss.

Why are babies born with low birthweight?

There are two main reasons why a baby may be born with low birthweight:

Premature birth: Babies born before 37 completed weeks of pregnancy are called

premature. About 67 percent of low-birthweight babies are premature (1). The earlier a baby is born, the less she is likely to weigh. Very low-birthweight babies (those who weigh less than 3 pounds, 5 ounces or 1,500 grams) have the highest risk for health problems. Some premature babies born near term do not have low birthweight, and they may have only mild or no health problems as newborns.

Fetal growth restriction: These babies are called growth-restricted, small-for-

gestational age or small-for-date. These babies may be full term, but they are underweight. Some of these babies are healthy, even though they are small. They may be small simply because their parents are smaller than average. Others have low birthweight because something slowed or halted their growth in the uterus. Some babies are both premature and growth-restricted. These babies are at high risk for health problems.

What causes low birthweight?

Preterm labor, labor that happens before 37 completed weeks of pregnancy, frequently results in the birth of a premature, low-birthweight baby. The causes of preterm labor are not thoroughly understood. However, we do know that women with these risk factors are at increased risk for delivering prematurely:

Had a premature baby in a previous pregnancy Are pregnant with twins, triplets or more Have certain abnormalities of the uterus or cervix

Other factors that may contribute to premature birth and/or fetal growth restriction include:

Birth defects: Babies with certain birth defects are more likely to be growth

restricted because genetic conditions and structural abnormalities may limit normal development (2, 3). Babies with birth defects also are more likely to be born prematurely (4).

Chronic health problems in the mother: Maternal high blood pressure, Smoking: Pregnant women who smoke cigarettes are nearly twice as likely to

diabetes, and heart, lung and kidney problems sometimes can reduce birthweight (2, 3). have a low-birthweight baby as women who do not smoke (5). Smoking slows fetal growth and increases the risk of premature delivery (5).

Alcohol and illicit drugs: Alcohol and illicit drugs can limit fetal growth and can

cause birth defects (2, 3). Some drugs, such as cocaine, also may increase the risk of premature delivery.

Infections in the mother: Certain infections, especially those involving the Infections in the fetus: Certain viral and parasitic infections, including

uterus, may increase the risk of preterm delivery (6). cytomegalovirus, rubella, chickenpox and toxoplasmosis, can slow fetal growth and cause birth defects (2, 3).

Placental problems: Placental problems can reduce flow of blood and nutrients to

the fetus, limiting growth. In some cases, a baby may need to be delivered early to prevent serious complications in mother and baby.

Inadequate maternal weight gain: Women who dont gain enough weight

during pregnancy increase their risk of having a low-birthweight baby (2, 6). Women of normal weight should usually gain 25 to 35 pounds during pregnancy.

Socioeconomic factors: Low income and lack of education are associated with

increased risk of having a low-birthweight baby, although the underlying reasons for this are not well understood. Black women and women under 17 and over 35 years of age also are at increased risk