Post-Maturity

DEFINITION

Postmaturity is a condition where the baby was born after a gestation exceeds 42 weeks.

CAUSE

The cause of post-maturity is usually not known.

SYMPTOMS

Physical description of post-mature baby:

·         The length of age, but low body weight so that it looks thin, especially if the function of the placenta is decreased

·         Drying and flaking

·         Toenails and fingernails long

·         Little fat under the skin so the skin on the arms and legs seemed to sag

·         Fingernails and greenish colored cord if meconium (the baby's first stool) has come out into the amniotic fluid

Most of the pregnancies were slightly exceed the age of 41-42 weeks did not experience any problems. However, if it exceeds that time, there could be a variety of disorders, due to placental function often begins to decline. Placenta start can not provide sufficient nutrients to the fetus in the womb.

Complications that can occur in infants postmature:

·         Decrease in blood sugar levels, because the baby has a lot to lose fat and carbohydrate reserves.

·         Fetal distress, if the placenta can not provide enough oxygen, especially during childbirth. The fetus is also susceptible to injury to the brain and other organs due to lack of oxygen.

·         Meconium aspiration. Fetal distress conditions can cause the release of meconium (first stool issued by the fetus) into the amniotic fluid. In addition, the fetal distress can arise reflex to draw a deep breath. As a result, the amniotic fluid mixed with meconium into the lungs before the fetus is born. After birth, the newborn may have difficulty breathing due to the meconium aspiration.

DIAGNOSIS

Diagnosis is based on clinical picture and the estimated time of delivery.

TREATMENT

If the baby postmature not experience any problems at birth, the main treatment is to provide good nutrition so that newborns can pursue weight according to age.

For infants postmature decreasing oxygen levels and fetal distress may require resuscitation at birth. If there is meconium in the amniotic fluid and the baby looks letargis, then a small hose needs to be inserted into the airway to suck as much as possible who have inhaled meconium. If meconium has been entered into the lungs, then the baby may require the help of a tool to be able to breathe (ventilator).

Administration of glucose solution needed to prevent hypoglycemia in infants postmature, which can be intravenously or breastfeeding / formula that often.

PREVENTION

To prevent the various circumstances that may occur due to pregnancy more months, it can be done induction of labor if the pregnancy has reached the age of 41-42 weeks or more. Sometimes a cesarean section can be done to end a pregnancy.

REFERENCE

- K, Arthur E. postmaturity. Merck Manual Home Health Handbook. 2009.

- K, James W. Postmature Infant. The Merck Manual. 2012.

- M, Julie S. postterm Pregnancy and postmaturity. Merck Manual Handbook. 2013.

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Polycythemia in the Newborn

DEFINITION

Polycythemia is a condition where there is a concentration of red blood cells is very high.

CAUSE

Polycythemia is caused by the formation of excessive red blood cells by the bone marrow. The risk of polycythemia was found in babies:

- Postmature

- His mother suffered from high blood pressure (hypertension)

- His mother smoked

- His mother suffered from diabetes

- Living in the mountains

The cause of polycythemia:

- The presence of low oxygen levels in the blood (hypoxia)

- Barriers to growth while in the womb

- The presence of blood transfusion between twins (twin-to-twin transfusion)

- Infants receiving too much blood from the placenta during delivery. This could happen if the newborn is placed lower than the placenta for a few moments before the umbilical cord is clamped

SYMPTOMS

Polycythemia cause the blood to become thick and cause a reduction in blood flow velocity when the blood through small vessels. As a result, oxygen delivery to the tissues to be disturbed. If the disease is severe, it can form a blood clot in the blood vessels.

Newborns with severe polycythemia has a very red skin color or slightly blackish. Baby looks limp, weak suck reflexes, heart rate and respiratory rate faster, and can have seizures.

DIAGNOSIS

Diagnosis is based on symptoms and physical examination there. May be obtained for signs of breathing problems, kidney failure, and jaundice (yellow) in infants. On examination of blood obtained the number of red blood cells is too much (high hematocrit value).

TREATMENT

Usually in infants who are asymptomatic do not need treatment other than maintaining normal hydration. However, for infants who have symptoms, need transfusion partial change, namely by removing most of the baby's blood and replacing it with fluids through a vein in the same amount. Thus, the red blood cells remaining could be diluted and correct polycythemia.

REFERENCE

- K, Arthur E. Polycythemia in the Newborn. Merck Manual Handbook. 2009.

- L, Kimberly G. hyperviscosity - Newborn. Medline Plus. 2011.

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Pneumothorax

DEFINITION

Pneumothorax is the accumulation of air that occurs between the lungs and the chest wall, rembesnya result of air from the lungs, which can cause the lungs to become depressed and collapse.

CAUSE

The lungs and the chest wall is elastic, so that one can draw and exhaling. Pneumothorax occurs when there is a small air bags (alveoli) in the lungs of infants broke, so the air out into the cavity between the lungs and the chest wall (the pleural cavity).

Pneumothorax occurs most often in newborns with impaired lung elasticity, for example on:

·         Respiratory distress syndrome, the most common cause of pneumothorax in preterm infants. This is caused by a lack of surfactant that helps the lungs stay open, so that the alveoli can not develop easily. In addition, the baby is often aided by a respirator (ventilator), which can sometimes make the alveoli rupture and pneumothorax occurred.

·         Meconium aspiration syndrome (the baby's stool was first issued). If meconium is inhaled into the respiratory tract, it can cause respiratory problems in infants.

In rare cases, a healthy baby could experience pneumothorax while he was inhaling the first time after birth. This happens because the pressure needed to expand the lungs for the first time.

SYMPTOMS

Many infants with pneumothorax do not have symptoms. But if there is, symptoms may include:

·         bluish skin color

·         rapid respiratory rate

·         flared nostrils while breathing

·         baby becomes restless and fussy

·         sound coarse breath sounds

·         the retraction of the muscles of the abdomen and chest

DIAGNOSIS

Pneumothorax is suspected in newborns with pulmonary disorders or newborns who uses a respirator (eg CPAP or ventilator) experienced a worsening in breathing, drop in blood pressure, or both.

On physical examination, breath sounds in the lungs are exposed is reduced. In premature infants, can be done on the chest irradiation (transilluminasi) in a dark room. If there is a pneumothorax will appear as the brightest regions. Chest x-rays performed to confirm the diagnosis.

TREATMENT

No treatment is needed for newborns who are asymptomatic. Newborns at term with mild symptoms can be placed in a special crib given oxygen, so the baby breathe air that contains more oxygen than normal air.

However, if your baby has difficulty in breathing or if the oxygen levels in the blood decreases, the air must be removed from the chest cavity. Air spending is done by using a special needle.

For babies who are experiencing great difficulty in breathing or using breathing aids, it can be installed special plastic hose into the chest cavity to remove the air therein. This hose can usually be removed after a few days.

REFERENCE

- K, Arthur E. pneumothorax in newborns. Merck Manual Home Health Handbook. 2009.

- L, Kimberly G. pneumothorax - Infant. Medline Plus. 2012.

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Perinatal Tuberculosis

DEFINITION

Tuberculosis is an infection caused by the bacterium Mycobacterium tuberculosis. Tuberculosis infection can attack various organs, especially the lungs.

CAUSE

The cause of tuberculosis is Mycobacterium tuberculosis.

Babies can contract tuberculosis (TB) through a variety of ways:

·         The spread of infection through palsenta, when the baby is still in the womb

·         Inhaling or swallowing infected amniotic fluid during delivery

·         Inhaling contaminated air after the baby is born. Transmission can be of anyone infected with TB bacteria, such as family members or caregivers of infants infected tuberculosis

Approximately 50% of children born to mothers with active pulmonary tuberculosis will develop the disease during the first year after birth if the child is not given prophylactic medication or vaccine BCG.

SYMPTOMS

Clinical symptoms of tuberculosis in newborns is not specific, but is usually characterized by disturbances in various organs. Newborns can seem acute or chronic pain, and may experience:

- fever

- Looked sleepy

- Not strong suck

- respiratory disorders

- Failed to thrive (no weight gain)

- Enlarged liver and spleen because these organs filter tuberculosis bacteria that cause activation of white blood cells

DIAGNOSIS

Diagnosis is based on symptoms and physical examination.

In pregnant women are routinely conducted tuberculin test. A positive result should be followed by a chest X-ray examination. The tuberculin test is often performed on infants whose mothers gave a positive test result.

If a tuberculosis is suspected, it is necessary to culture of secretions from the respiratory tract, gastric fluid, and urine. Additionally, if required can also be done puncture and cerebrospinal fluid culture.

To determine whether there is infection in the lungs, it is necessary to chest X-rays. Liver biopsy, lymph nodes, lungs, or the lining of the lungs could be done to confirm the diagnosis.

TREATMENT

Therapy depends on whether there is an active tuberculosis disease or only a positive tuberculin skin test results (in the mother, the baby, or both) that indicate the presence of infection without disease manifestation.

TB treatment should be administered in accordance with the doctor's instructions (either a combination of drugs, drug dosage and duration of use). Treatment compliance is crucial, it relates to the success of the treatment and prevention of bacterial resistance to the drugs given. In addition, improper use of drugs can be dangerous because of the risk of side effects that occur.

REFERENCE

- C, Mary T. Perinatal Tuberculosis. The Merck Manual. 2013.

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Neonatal Hepatitis B

DEFINITION

Hepatitis is a viral infection of the liver.

CAUSE

Hepatitis B infection is a major cause of hepatitis infections in newborns. Infection is transmitted from an infected mother to her baby during delivery, which comes in contact with infectious secretions in the birth canal.

Hepatitis is usually not transmitted over the baby in the womb because the virus does not easily cross the placenta (afterbirth).

Transmission after birth usually rare, namely through exposure to blood, saliva, urine, feces, or breast milk of an infected mother.

SYMPTOMS

Most newborns who are infected have no symptoms, but will experience chronic hepatitis (chronic hepatitis) that usually only causes symptoms in childhood.

Many babies born to mothers with acute hepatitis B during pregnancy have lower birth weight, regardless of whether the baby is infected or not.

In rare cases, newborns who are infected may develop acute hepatitis B, which is usually mild and get better by itself. The symptoms that arise can be:

- Yellow (jaundice)

- Letargis

- Failed to thrive

- Abdominal distension

- Pale stools

- Increased levels of bilirubin

- Enlarged liver (hepatomegaly)

- Ascites (accumulation of fluid in the abdomen)

Hepatitis in newborns is a serious illness, 25% of the patients died.

DIAGNOSIS

The diagnosis is based on symptoms, physical examination and blood test results.

TREATMENT

Treatment is supportive, ie by giving the handling of the existing symptoms and also the provision of adequate nutrition. There is no therapy that can prevent a chronic infection after infection with hepatitis B.

Administration of drugs to help inhibit viral replication process may only be used after consultation with medical experts.

PREVENTION

Pregnant women need to be checked against the possibility of hepatitis B virus infection Babies are usually newly infected during birth, therefore, newborns whose mothers have hepatitis B should be given an injection of hepatitis B immunoglobulin within 12 hours after birth, before infection occurs. This injection will protect the baby for a while. At the same time also be given hepatitis B vaccination for long-term protection.

REFERENCE

- C, Mary T. Neonatal Hepatitis B Virus Infection. The Merck Manual. 2013.

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Neonatal Asphyxia

DEFINITION

Neonatal asphyxia is a state where a baby can not breathe spontaneously soon after birth and regularly. When there is interference or transport of O2 gas exchange during pregnancy / childbirth, will occur asphyxia. This situation will affect the function of body cells and if not resolved will lead to death.

Infants with a history of fetal distress before birth, will generally be asphyxiated at birth. This problem is closely related to the health problems of pregnant women, umbilical cord abnormalities, or problems that affect the welfare of the baby during or after childbirth.

CAUSE

Certain factors are known to be the cause of asphyxia in newborns, including the factor of maternal, infant clan umbilical cord following:

1. Maternal factors

Preeclampsia and eclampsia

Abnormal bleeding (placenta previa or placental abruption)

Prolonged labor or obstructed

Fever during labor Severe infections (malaria, syphilis, tuberculosis, HIV)

Limitations of pregnancy (after 42 weeks gestation)

2. Factors Umbilical Cord

Nuchal cord

Short umbilical cord

Knot cord

Umbilical cord prolapse

3. Factors Babies

Baby prematurely (before 37 weeks gestation)

Deliveries to the action (breech, twins, shoulder dystocia, vacuum extraction, extraction forceps)

Congenital abnormalities (congenital)

Amniotic fluid mixed with meconium (greenish color)

CLASSIFICATION neonatal asphyxia:

Mild neonatal asphyxia: 7-10 Apgar scores. Considered healthy baby, and does not require special action.

Neonatal asphyxia were: Apgar score 4-6. On physical examination will look frequencies of more than 100 / min, poor muscle tone or both, cyanosis, no reflex irritability.

Asfisia neonatal weight: Apgar score 0-3. On physical examination found the heart rate of less than 100 / min, muscle tone is bad, severe cyanosis, and sometimes pale, reflex irritability does not exist, the asphyxia with cardiac arrest is heart sounds of the fetus disappeared no more than 10 minutes before it was born full or sounds heart disappeared the same post partum physical examination severe asphyxia 

SYMPTOMS

Signs and symptoms of neonatal asphyxia

·         Not breathing or gasping breathing or slow breathing (less than 30 beats per minute).

·         Irregular breathing, snoring or retraction (pelekukan chest)

·         Weak cries or whimpers

·         Pale or blue skin color (cyanosis)

·         Limb weakness or muscle tone is weak

·         No heartbeat or slow (bradycardia) (less than 100 beats per minute).

DIAGNOSIS

In newborns with asphyxia usually the baby was pale and bluish, irregular breathing, apart from the above physical examination, the diagnosis of asphyxia was also established as follows:

a. FHR <Fetal Heart Rate>

The circumstances in which the frequency of fetal heart rate drops below 100 / min, or irregular heartbeat. Electro cardiogram fetus is used to continuously monitor the fetal heart.

b. Meconium in the amniotic fluid

The presence of meconium in cephalic presentation, showed impaired oxygenation, can be an indication to terminate labor.

c. Examination of the fetal blood pH

By using a blood sample taken amnioskop fetal acidosis caused a decline in pH. When the pH drops below 7.2 a sign of harm to the fetus.

TREATMENT

A very important aspect of neonatal asphyxia resuscitation on infants was to assess, determine the action to be performed and eventually carry out resuscitation. Assessment for resuscitation solely determined by three important signs are: breathing, heart rate, and skin color.

A. Common actions

1) Control of temperature

Newborns relative heat loss followed by a drop in body temperature, so as to enhance the metabolism of tissue cells so that the increased oxygen demand, need to be considered to keep the newborn warm temperatures with:

a) Drying the baby from amniotic fluid and fat.

b) Using light to warm up outside.

c) Wrap the baby with a dry cloth.

2) Adjust the position of the baby

Lay the baby on her back with her head near a helper. Wedge shoulders so that head a little extension.

3) Cleaning the airway

Upper respiratory tract immediately cleared of mucus and amniotic fluid, the baby's head should be lower position so as to facilitate discharge.

4) Tactile stimulation to cause respiratory

Stimulation of pain in infants can be generated with both feet hitting the baby, pressing the achilles tendon or give an injection of vitamin K. It works to improve ventilation.

B. Special measures

1) severe asphyxia (Apgar score 0-3)

Active resuscitation in this case should be done is by:

a) Improving lung ventilation to give O2 directly and repeatedly, or by performing endotracheal intubation and O2 inserted with pressure not more than 30 ml. This prevents the occurrence of excessive lung irritation that can rupture aveoli. Positive pressure is done by blowing air into the catheter from the mouth to the pipe or vent pipe to the bag.

b) Provide natrikus bicarbonate at a dose of 2-4 mEq / kg

c) cardiac Massage done by applying pressure on the sternum regularly 80-100 x / mnt. This action is interspersed with artificial respiration, ie each 5 x massage followed 1x giving breath. It aims to avoid the possibility of complications pneumotoracks if these actions are taken simultaneously.

Emphasis images Finger At Heart Infant Massage

Source: http://donadewani.blogspot.com

d) Provide drugs 1 / 10,000 andrelin with 0,5- 1 cc dose intravenously (sebegai inotropes) and calcium gluconate 50-100 mm / kg intravenously, to increase the frequency of heart.

2) asphyxia medium (Apgar score 4-6)

Do stimulation to induce respiratory reflexes with:

a) stimulation 30-60 seconds after the first minute APGAR assessment.

b) Perform artificial respiration by inserting a tube into the nose, O2 flowed at a speed of 1-2 liters / minute. Baby is placed with the head in dorsiflexion, done by opening and closing the nostrils and mouth accompanied by moving the chin up and down in frequency 20 x / min.

c) Perform mouth-to mouth that should be included in the baby's mouth pharingeal airway function push the tongue forward, before the mouth of the helper filled O2 before blowing, blowing is done regularly with a frequency of 20-30 x / min.

C. Other measures in resuscitation

1) Aspiration of gastric fluid carried on certain infants are premature infants, before infants experiencing fetal distress, in mothers who received anesthesia in childbirth.

2) The use of drugs given to infants Nalorphin caused by respiratory suppression due to morphine or pethidine given during labor

REFERENCE

Sarwono, P. 2002. Health Care Practitioner Materials and Neonatal Jakarta: Yayasan Bina Library.

Dep. Kes. RI. 2007. Neonatal Basic Emergency Obstetric Care. Jakarta.

FKUI. 2005. Pediatrics. Jakarta: Infomedika.

Hidayat, A. 2005. Introduction of Nursing Children 1. Jakarta: Salemba Medika.

Ladewig, P. 2006. Handbook Nursing Mother-Newborn. Jakarta: EGC.

Saifuddin, A. 2002. Reference Books National Maternal and Neonatal Health Services. Jakarta: YBP-SP.

Surasmi, A. et al. 2003. High-Risk Infant Care. Jakarta: EGC.

Wong, D. 2004. Guidelines for Nursing Clinical Pediatrics. Jakarta: EGC.

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Necrotizing Enterocolitis

DEFINITION

Necrotizing enterocolitis is a condition in which the inner lining of the intestinal injury and inflammation. If the disease is severe, partial intestinal tissue may die (become necrotic) and cause intestinal perforation and peritonitis.

Necrotizing enterocolitis is most common in premature infants. Necrotizing enterocolitis is a serious situation, with a mortality rate of nearly 25%.

CAUSE

The cause is unknown, but thought to be caused by reduced blood flow to the intestine so that the intestines can not produce mucus, which normally serves to protect the intestinal lining. Other factors are also thought to play a role is the bacteria in the gut. Bacteria can enter the intestinal wall is damaged and cause gas in it. Bacteria can even enter the bloodstream and cause infection (sepsis).

If the damage to the intestine to grow until the entire thickness of the bowel wall and tear occurs in the intestinal wall, then the contents of the gastrointestinal tract can get out into the abdominal cavity and cause inflammation and infection usually occurs in the abdominal cavity and the lining (peritonitis).

Risk factor enterocolitis nekrotisans:

·         Premature babies

·         Infants who received formula milk too thick

·         Babies who were in the treatment room, where there is an outbreak of this disease

·         Babies who underwent exchange transfusion

SYMPTOMS

Nektrotikans symptoms of enterocolitis in infants can include:

- bloated

- Vomiting green

- There can be blood in the stool

- Severely ill and looked listless

- Body temperature is low and unstable

- Could happen stopping breathing attack

- Do not want to eat

- diarrhea

Complications:

·         Bowel perforation (a hole in the intestines)

·         Sepsis (blood infection)

·         Peritonitis (inflammation of the stomach lining)

·         Narrowing of the intestine that can cause a blockage in the gastrointestinal tract

·         Shock

DIAGNOSIS

Diagnosis is based on symptoms and examination results, among others:

- Abdominal X-ray photograph (indicate the presence of gas in the intestinal wall or the presence of free air in the abdominal cavity, if the intestinal wall is perforated)

- Blood test in the stool

- A blood test to see if there are bacteria and other indicators of sepsis

TREATMENT

In case of necrotizing enterocolitis, then feeding should be discontinued. The air inside the intestine will be removed through a small tube inserted into the stomach. As a substitute for milk or breast milk, given fluids intravenously.

In case of intestinal perforation or peritonitis, it is necessary to surgery. Surgery may also be necessary if the baby's condition worsened, although it has been treated. Damaged intestinal tissue is cut and removed and a colostomy or iliostomi (where the ends of the intestine connected to the stomach wall for a while, so that the dirt will come out of the hole in the abdominal wall). Reconnection of the intestine was a few weeks or a few months later after infection and inflammation subsides.

REFERENCE

- E, Todd. Necrotizing enterocolitis. Medline Plus. 2011.

- K, Arthur E. Necrotizing enterocolitis. Merck Manual Home Health Handbook. 2009.

- R, J. Fernando. Necrotizing enterocolitis. Kids Health. 2011.

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