Neonatal definitions are important in relation to categorization of infants into segments that carry a certain risk of associated morbidities. Newborns can be stratified based on Birth weight (BW), Gestational age (GA) and their relationship: Gestational age preterm newborns (< 37+0) term newborn (37+0 to 41+6) postterm newborn (> 41+6)…
Perinatal asphyxia remains one of the most common indications for postnatal resuscitation. The necessary prerequisites for successful resuscitation are properly equipped rooms (delivery suite, neonatal wards with the right and functional equipment; warmed up to the temperature of 26 °C) with properly trained personnel. Ventilation (and circulation dysfunction) are indications to initiate resuscitation…
Preterm birth is defined as any birth before 37 completed weeks of gestation (37+0). It has been estimated to account for up to 11 % of all births. Preterm birth is a substantial cause of neonatal and pediatric morbidity and mortality. Prematurity is the single most important cause of death in the…
Apneas represent another important group of respiratory/ventilation dysfunctions in newborns (apart from perinatal asphyxia and respiratory distress syndrome). They are generally defined as a cessation of breathing movements and air flow for more than 20 seconds, thus often being accompanied by desaturation and bradycardia. Spontaneous breathing causes water in lungs to be resorbed into blood and…
Postnatal adaptation is a complex process that involves multiple adaptive changes within several organ systems. For successful transition from intrauterine to extrauterine environment, relatively rapid conversion to air breathing and blood flow changes (especially in pulmonary vascular system) must occur simultaneously. Spontaneous breathing causes water in lungs to be resorbed into blood and lymphatic vessels,…
We should attempt to maintain normoxemic oxygenation in order to prevent hypoxic injury (mainly in the cerebral tissue). On the other hand, oxygen should be carefully titrated to newborns, especially preterm, due to the negative effects associated with its overuse (reactive oxygen species = ROS). Hyperoxia induces the production of oxygen radicals that subsequently trigger…
Retinopathy of prematurity (ROP) is a vasoproliferative disorder (fibrovascular proliferation) of developing retina in preterm infants. It is characterised by disorganized growth of abnormal new blood vessels (=> hemorrhage) and fibrous tissue ( => contracted scar tissue causing retinal detachment). Incidence of ROP is inversely proportional to the gestational age (general ROP screening…
Persistent pulmonary hypertension of newborns (PPHN) is characterized by postnatally persistent vasoconstriction of the pulmonary arteries, causing increased pulmonary arterial resistance. As a consequence, right-left shunting (extra-pulmonary shunts) occurs through foramen ovale apertum (FOA) and patent ductus arteriosus (PDA) with resultant hypoxemia. Also, pulmonary arteries in neonates are more prone to vasoconstriction than in adults. There is primary (impaired development…
Hyperbilirubinemia is defined as serum bilirubin concentration > 25 μmol/l. However, clinical presentation (jaundice (icterus) – yellowish colouring of the skin, sclera and mucosa) is apparent in newborns usually around hyperbilirubinemia of 80-100 μmol/l. It is one of the most common clinical and laboratory findings in both term and preterm infants (antenatally, placenta is responsible for…
The basic classification of neonatal anemia includes the following items: hemorrhagic anemia => blood loss (antenatal – perinatal – postnatal) hemolytic anemia (congenital vs. acquired) => increased destruction aplastic anemia => decreased production anemia of prematurity => specific to preterm infants Erythropoiesis Hemoglobin production begins around the third week of pregnancy in the cytoplasm…
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