Persistent ductus arteriosus (PDA) connects aorta with main pulmonary artery (MPA) (or left pulmonary artery – LPA) and during fetal life serves as important right-left shunt => mixed blood flowing from the pulmonary artery to the descendant aorta and supplying the lower half of the body. PDA prenatally remains open due to low partial pressure…
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…
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…
Necrotizing enterocolitis (NEC) belongs to acute abdomen events (inflammatory subgroup). It is typical disease of extreme prematurity – incidence is inversely proportional to advancing gestational age (1-5% of newborns admitted to the neonatal intensive care unit). Mortality associated with NEC varies between 20-50%. Multifactorial basis of NEC makes it difficult to pinpoint single…
Late onset sepsis (LOS) is an infectious complication in newborns that have clinical presentation after the first 72 hours of life. Sometimes also called nosocomial due to pathogenesis – contact with mother, breastmilk, invasive procedures, hands of healthcare personnel. LOS episodes significantly contribute to neonatal mortality and morbidity rates and can have lifelong…
The intraventricular hemorrhage in the preterm infants usually originates in the germinal matrix (temporary developmental structure with significant vascular supply due to massive mitotic and metabolic activity). The structure is divided from the cerebral ventricles only by a thin layer of subependymal cells and disappears after 34 weeks of gestation – one…
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