Presented by Amarila and Arimado

• Defined as a live-born neonate born before the end of week 37

of gestation
• Late preterm born between 34 and 37 weeks
• Early preterm born between 24 and 34 weeks
• Most preterm newborns need intensive care from the moment
of birth to give them their best chance of survival because they
are more prone to hypoglycemia, infections and intracranial
hemorrhage
• Inadequate nutrition
• Smoking
• Alcohol use
• Use of assisted fertility methods such as in vitro
fertilization (IVF)
• Iatrogenic issues such as elective cesarean birth or
inducing labor before 39 weeks of pregnancy
• An infant is SGA (also called microsomia) if the birth
weight is below the 10% percentile on an intrauterine
growth curve for that age
• SGA infants are small for their age because they have
experienced intrauterine growth restriction (IUGR) or
failed to grow at the expected rate in utero
• Inadequate nutrition
• Placental issue
• Pregnant people with systemic diseases
• Pregnant people who smoke heavily or use opiates
• Sonography
• Biophysical profile includes nonstress test, placental
grading, amniotic fluid amount, and an ultrasound
examination
• High hematocrit level and increase in total number of red
blood cells (polycythemia)
• An infant is LGA (also termed macrosomia) if the birth
weight is above the 90th percentile on an intrauterine
growth chart for gestational age

• The baby appears deceptively healthy at birth because of

the weight, but a gestational age examination often
reveals immature development
• A postterm newborn is one born after the 41st week of a
pregnancy
• Newborns who stay in utero past week 41 are at special risk
because a placental functions most effectively for only 40
weeks
• Newborns with this syndrome demonstrate many of the
characteristics of the SGA infant: dry, cracked, almost
leathery skin from lack of fluid and an absence of vernix
• RDS occurs in babies born early (premature) whose lungs

are not fully developed

• It is formerly termed hyaline membrane disease

• The cause of RDS is a low level or absence of surfactant

since it does not form until the 34th week of gestation

• Respiratory Distress Syndrome (RDS) is primarily caused by a
lack of surfactant. This deficiency leads to a mismatch in the
way air and blood flow in the lungs. Due to insufficient
surfactant production or release, the air sacs (alveoli) get
blood supply but not enough ventilation. This results in low
oxygen levels, collapsed air sacs, reduced lung function, and
increased effort required for breathing.
• Chest X-ray
• Culture test of blood, cerebrospinal fluid, skin
• Administer oxygen
• Ventilation
• Surfactant replacement
• Additional Therapy: Nitric Oxide
• Extracorporeal membrane oxygenation (ECMO)
• A respiratory disorder that affects newborns, typically within
the first few hours of life. It is characterized by rapid breathing
(tachypnea) and increased respiratory effort.

• This condition is considered transient because the symptoms

usually improve on their own without specific treatment within

a few days

• The cause of TTN is retained lung fluid

• Chest x-ray will reveal some fluid in the lung along with
hyperexpansion
• Blood gases may show some respiratory acidosis and
hypoxemia
• Some neonates will be prescribed a mild
glucocorticosteroid to reduce respiratory tract
inflammation
Meconium Aspiration
Syndrome
• Meconium present in fetal bowel as early as 10 weeks of
gestation.
• Release into amniotic fluid due to hypoxia or pressure on
buttocks (breech birth).
• Meconium staining in 10% to 20% of all births, with 2% to 4%
causing MAS.
• Occurs less frequently in Extremely Low Birth Weight (ELBW)
newborns.
• Meconium aspiration syndrome (MAS) occurs when a newborn
inhales thick meconium, causing airway obstruction,
inflammation, and respiratory distress by impairing lung
function and surfactant production.
• Meconium staining in amniotic fluid.
• Breech birth.
• Amnioinfusion
• Cesarean Birth
• Oxygen and Ventilation
• Antibiotic Therapy
• Surfactant Administration
• High Inspiratory Pressure
• Monitoring for Ductus Arteriosus
• Neutral Thermal Environment
• Chest Physiotherapy
• Nitric Oxide or ECMO
• prompt resuscitation
• continuous assessment for breathing difficulties
• oxygen support
• diagnostic test monitoring
• assistance with amnioinfusion or cesarean birth if needed
• maintaining a neutral environment for the baby's temperature
• educating parents about MAS and its treatment.
• Pulse Oximetry
• Blood Gases
• Chest X-ray
• A blood gas analysis shows low blood acidity,
decreased oxygen and increased carbon dioxide.
A chest X-ray may show patchy or streaky areas
on the lungs.
Apnea
• Cessation in respirations lasting over 20
seconds.
• May be accompanied by bradycardia
and/or cyanosis.
• In newborns, apnea (temporary cessation of breathing) can result from an
immature respiratory control center in the brain. The central respiratory
center may fail to provide consistent signals to initiate breathing, leading
to periodic breathing pauses. Immature lung reflexes and decreased
sensitivity to carbon dioxide levels also contribute, making newborns
more prone to apnea episodes. Additionally, factors such as prematurity,
infections, or neurological issues can further disrupt respiratory
regulation in newborns, increasing the risk of apnea.
• Premature birth
• Secondary stressors like infection, hyperbilirubinemia,
hypoglycemia, or hypothermia.
• Provide tactile stimulation (e.g., foot flicking)
• Positive-pressure ventilation and resuscitative
interventions
• Apnea monitors
• Respiratory support (CPAP or ventilator)
• Caffeine
• Closely observe newborns, especially premature ones
• Maintain a neutral thermal environment
• Use gentle handling
• Minimize nasopharyngeal irritation during suction
• Use indwelling nasogastric tubes
• Observe for pressure on the diaphragm after feeding.
• Avoid rectal temperatures in infants prone to apnea.
• Cautious burping to reduce diaphragm pressure.
• Discharge high-risk infants with monitoring devices for Sudden Infant Death
Syndrome (SIDS) risk.
• Apnea monitors recording respiratory movements are
valuable tools.
• No specific laboratory tests.
• Apnea has one or more of these signs: Not
breathing for 20 seconds or longer. Skin color
becomes blue or very pale (cyanosis) The heart
beats more slowly, less than 80 times in a minute.
Sudden Infant Death Syndrome

• Sudden unexplained death in infancy.

• Higher incidence in infants of adolescent parents, closely
spaced pregnancies, underweight, and preterm infants.
• Peak age of incidence is 2 to 4 months.
• Sudden Infant Death Syndrome (SIDS) has unclear causes but
involves issues with brainstem functions, arousal responses,
serotonin regulation, and environmental factors during sleep.
• Adolescent birthing parents, closely spaced pregnancies,
underweight, preterm infants.
• Infants with BPD (bronchopulmonary dysplasia), twins, Native
American or Alaskan Native infants, economically
disadvantaged Black infants, infants of narcotic-dependent
parents.
• Peak age of incidence is 2 to 4 months.
• Recommendations: back sleeping, firm sleep surface,
breastfeeding, room sharing without bed sharing, routine
immunizations, consideration of using a pacifier.
• Avoidance of soft bedding, overheating, exposure to tobacco
smoke, alcohol, and illicit drugs.
• AAP recommendations have led to a 50% to 60% decline in SIDS
incidence.
• Support parents in coping with sudden infant death.
• Provide counseling by trained professionals.
• Educate on safe sleep practices.
• Support parents in dealing with grief and somatic symptoms.
• Autopsy reports are essential for parents, assuring them
the death was unexplained and not their fault.
• Continuous apnea monitoring for subsequent infants born
into families with a history of SIDS, especially if parents
are anxious.
• Laboratory findings may not provide a definitive
diagnosis, but investigations often include a complete
autopsy, examination of the death scene, and reviewing
the infant's medical history.
Hemolytic Disease of the Newborn
(Hyperbilirubinemia)

• Hemolytic Disease of the Newborn (Hyperbilirubinemia)

involves the destruction of red blood cells, leading to
elevated bilirubin levels.
• Hemolytic disease of the newborn (HDN) involves the immune system
attacking the baby's red blood cells, leading to hemolysis. This releases
bilirubin, a yellow pigment, causing hyperbilirubinemia. The excess
bilirubin can cross the blood-brain barrier, potentially resulting in
neurotoxicity and jaundice. Severe cases may lead to kernicterus, a
condition with long-term neurological consequences. Rh or ABO
incompatibility between the mother and baby is a common trigger for
HDN.
• Rh incompatibility: Rh-negative birthing parent with Rh-positive
fetus.
• ABO incompatibility: Maternal blood type O with fetal blood
type A or B.
• The Initiation of Early feeding
• Phototherapy
• Exchange Transfusion
• Monitor for rising bilirubin levels and signs of hemolysis.
• Educate parents on the need for early feeding and potential
treatments.
• Ensure eye protection during phototherapy to prevent retinal
damage.
• Observe for vital signs stability post-exchange transfusion.
• Total serum bilirubin (TSB) levels measured through blood draw
or transcutaneous bilirubin (TCB) meter.
• Rh incompatibility assessed through anti-Rh titer, indirect
Coombs test, and direct Coombs test.
• In cord blood, a positive direct Coombs' test is
indicative of hemolytic disease of the newborn. The
test results are usually weakly positive or negative in
ABO-HDN, while strongly positive in Rh- HDN or HDN
caused by other IgG antibodies
The Newborn at Risk Because of a
Maternal Infection
• β-HEMOLYTIC, GROUP B STREPTOCOCCAL INFECTION
• OPHTHALMIA NEONATORUM
• HEPATITIS B VIRUS INFECTION
• GENERALIZED HERPESVIRUS INFECTION
• HIV INFECTION
β-HEMOLYTIC, GROUP B
STREPTOCOCCAL INFECTION

• Gram-positive B-hemolytic Streptococcal (GBS)

infection is a serious threat to newborns, originating
from the maternal genital tract.
• β-hemolytic, Group B Streptococcal (GBS) infection involves the release
of toxins that damage red blood cells, leading to β-hemolysis. GBS can
also produce enzymes that contribute to tissue destruction and
inflammation. Invasive infections may result in conditions such as sepsis,
pneumonia, or meningitis, particularly in newborns or individuals with
weakened immune systems.
• Universal screening at 35 to 37 weeks of gestation to identify
GBS colonization in pregnant individuals.
• Antibiotics like penicillin, cefazolin, clindamycin, or vancomycin
are effective against GBS.
• Emphasize the importance of handwashing to prevent GBS
spread.
• Provide support to parents, especially if the newborn survives
but faces neurological challenges.
• Universal screening for GBS in pregnant individuals at 35 to 37
weeks.
• Specialized GBS blood culture for newborns at risk, born after
prolonged rupture of membranes or if the birthing parent's
culture is GBS positive.
• Blood screening tests for newborns displaying signs of infection.
• GBS beta-hemolysis may be difficult to detect for
some strains, however, and can be observed only
when colonies are detached from the blood agar.
OPHTHALMIA NEONATORUM

• Ophthalmia neonatorum is an eye infection occurring at

birth or in the first month, primarily caused by Neisseria
gonorrhoeae and Chlamydia trachomatis.
• Ophthalmia neonatorum is neonatal conjunctivitis caused by
bacterial or viral infections during childbirth, often by Neisseria
gonorrhoeae or Chlamydia trachomatis. Inflammation leads to
redness, swelling, and discharge, emphasizing the need for
timely preventive measures.
• Contracted from vaginal secretions during birth.
• Prophylactic erythromycin ointment prevents gonococcal and
chlamydial conjunctivitis.
• Therapeutic management involves individualized therapy based
on cultured organism (ceftriaxone for gonococci, erythromycin
for chlamydia).
• Use universal and contact precautions when caring for the
newborn.
• Administer sterile saline solution lavage for eye discharge,
ensuring lateral direction to prevent contamination.
• Treat birthing parent for gonorrhea or chlamydia; sexual
contacts should also receive treatment.
• Culture from eye exudate identifies the causative organism.
• The eye discharge is initially copious, then
becomes purulent, and it is associated with
eyelid swelling.
HEPATITIS B VIRUS INFECTION

• Hepatitis B virus (HBV) transmission to newborns can

occur through contact with infected vaginal blood at birth
when the birthing parent is HBsAg+.
• Hepatitis B virus infects the liver, causing inflammation and cell
damage. The immune response contributes to liver
inflammation, potentially leading to fibrosis, cirrhosis, and an
increased risk of liver cancer. Symptoms include fatigue,
jaundice, and abdominal pain during the acute phase.
• Positive HBsAg status in the birthing parent.
• Newborn should be bathed promptly to remove HBV-infected
blood and secretions.
• Administer serum hepatitis B immune globulin (HBIG) to the
newborn.
• Vaccination against hepatitis B at birth for future protection.
• Gentle suctioning to prevent mucous membrane trauma and
HBV invasion.
• Parents can breastfeed after HBIG administration without risk.
• Identification of HBsAg in the birthing parent confirms the risk
of transmission.
• Positivity indicates recent infection with
hepatitis B virus (<6 mos). Its presence indicates
acute infection. IgM anti-HBc should be ordered
only when acute HBV infection is a concern.
GENERALIZED HERPESVIRUS
INFECTION

• Generalized herpesvirus infection, particularly herpes

simplex virus type 2 (HSV-2), is a risk for newborns.
• Generalized herpesvirus infection involves the virus entering the
body, typically through mucous membranes or breaks in the skin. Once
inside, the virus replicates in local cells, causing cell damage and
inflammation. Herpesviruses can establish latency, where the viral
DNA persists in host cells without causing active infection.
Periodically, the virus may reactivate, leading to recurrent episodes of
infection. The immune response plays a crucial role in controlling the
virus, but factors like stress or a weakened immune system can
contribute to reactivation and the spread of infection to other tissues.
• Multiple sexual partners and potential for active lesions in
birthing parents during labor.
• Antiviral drug, such as acyclovir (Zovirax), to inhibit viral DNA
synthesis.
• Antenatal antiviral prophylaxis to reduce viral shedding and
recurrence at birth.
• Cesarean birth recommended for birthing parents with active
herpetic vulvar lesions.
• Newborns with the infection should be separated in the
nursery.
• Assessment of herpes lesions on birthing parents' faces before
holding the newborn.
• Cultures from vesicles, nose, throat, anus, and umbilical cord.
• Blood serum analysis for IgM antibodies to confirm the
diagnosis.
• PCR tests for viral DNA, viral culture, and
serological tests measuring antibodies.
HIV INFECTION

• HIV infection and AIDS can result from placental

transfer or direct contact with maternal blood during
birth.
• HIV infects and destroys CD4 T cells, weakening the immune
system. The declining CD4 cell count makes the body
susceptible to infections and diseases. Untreated HIV can
progress to AIDS, marked by severe immune system impairment
and vulnerability to opportunistic infections and cancers.
• Exposure through blood, body secretions, sexual contact,
needle sharing, contaminated blood products, perinatal
transmission, and potentially through nonexclusive breast
or chestfeeding.
• Healthcare workers are at risk without universal
precautions.
• No cure for HIV; remains in the body for life.
• Antiretroviral therapy, cesarean delivery, antiretroviral
prophylaxis for infants, and avoidance of breastfeeding to
prevent perinatal transmission.
• Early identification of HIV during pregnancy is crucial for early
care initiation.
• Routine HIV testing for pregnant patients, administration of
antiretroviral therapy, planned cesarean delivery, antiretroviral
prophylaxis for infants, and counseling.
• HIV testing during pregnancy, viral load monitoring, CD4
count measurement.
• Expedited HIV antibody test if the birthing parent's HIV status
is unknown at labor or birth. Consultation with a pediatric HIV
specialist for the infant's care.
• An antigen/antibody test performed by a lab on
blood from a vein can usually detect HIV 18 to
45 days after exposure.