Transient Tachypnea of the Newborn (TTN)

DEFINITION

Transient tachypnea of ​​the Newborn (TTN) is a condition where there is difficulty in breathing in infants, with low levels of oxygen in the blood, which is temporary.

CAUSE

Transient tachypnea occur due to excess fluid in the lungs after the baby is born. This disorder usually occurs in newborns who were born a few weeks ahead of time should or could be in infants who had quite the month. However, transient tachypnea is more common in babies born via cesarean section, especially if the mother has not been entered in the stage of labor (for example on a scheduled Caesarean section).

Before birth, the lungs fill with fluid. Soon after birth, the fluid to be lost from the lungs so it can be filled with air and the baby can breathe normally. Most of fluid in the lungs can be issued when babies are born via vaginal delivery, where the baby's chest will be under pressure as it passes through the birth canal. Too much liquid is absorbed quickly by the cells in the lungs. Absorption is triggered by the release of hormones at birth. However, if the fluid absorption does not take place quickly, then the lungs are still partially filled with liquid and newborn into difficulty in breathing.

Transient tachypnea is more likely to occur in infants:

·         born by Caesarean section

·         born before 38 weeks gestation

·         having a mother with diabetes

·         had mothers with asthma

SYMPTOMS

Newborns with transient tachypnea have difficulty breathing immediately after birth, usually within 1-2 hours. The symptoms can be found in the form:

·         rapid breathing

·         the retraction of the chest wall when breathing

·         flared nostrils while breathing

·         the snoring sound like a baby when exhaling

·         bluish skin color, especially around the mouth and nose, if the oxygen levels in the blood is low

DIAGNOSIS

Diagnosis is based on symptoms exist, and is supported by the results of the examination. Chest x-rays showed an increase of fluid in the lungs. Additionally, blood tests can be done to get rid of the infection.

TREATMENT

Most newborns with transient tachypnea can perfectly recover within 2-3 days, ie after fluid in the lungs has been absorbed completely. The only treatment that is usually required is oxygen. Oxygen is needed to maintain oxygen levels in the blood remains stable.

In rare cases, some newborns may require aids to breathe, such as CPAP (Continuous Positive Airway Pressure), which makes the newborn to breathe by itself to provide air or oxygen low pressure to the baby's nose, or with the aid of a ventilator.

Rapid respiratory rate can make it difficult to get a baby's food intake. Therefore, fluids and nutrients may be given intravenously to infants has improved.

REFERENCE

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

- L, Kimberly G. Transient tachypnea - Newborn. Medline Plus. 2011.

- T, Jennifer A. Transient tachypnea of ​​the Newborn. Kids Health. 2012.

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Small for Gestational Age (SGA)

DEFINITION

If a newborn is smaller than the age of the pregnancy, then the baby is said to Small for gestational age (SGA).

CAUSE

There are several conditions that can cause babies born small for gestational age, namely:

-Heredity or genetics, for example, parents are small or there is a hereditary disease that is associated with a small body stature

-The function of the placenta (cord) are interrupted, for example in:

·         women with high blood pressure (hypertension)

·         women who experience preeclampsia

·         women with kidney disease

·         mothers with chronic diabetes

-Viral infections, such as cytomegalovirus, German measles, or Toxoplasma, which is obtained before the baby is born

-Impaired fetal growth due to mothers who smoke or use alcohol / drugs while pregnant

SYMPTOMS

In contrast to premature infants, SGA infants who are old enough to have had a perfect organ. Most of SGA infants have no symptoms, unless they were infected with the virus or have certain genetic syndromes. In addition to his size, infants were small for gestational age have physical and behavioral characteristics (eg spontaneous activity and appetite) similar to babies who are born with normal size appropriate gestational age.

If prior to delivery in placental function has been impaired, the reduced blood flow during childbirth can jeopardize the delivery of oxygen and causing injury to the fetus.

Babies who are small for gestational age at risk for experiencing:

·         Meconium aspiration. Babies during labor deprived of oxygen will issue its first stool (meconium) into the amniotic fluid. If the baby inhale amniotic fluid containing meconium, the meconium can clog the airway and hampering breathing. The inhaled meconium can also cause inflammation of the lungs.

·         The number of red blood cells were excessive, it could happen if the SGA infants experiencing mild chronic oxygen deficiency due to inadequate supply of the placenta.

·         Low blood sugar levels, often occurs in a few hours and the first few days due to a lack of glycogen reserves in the baby's body.

·         Difficulty to regulate body temperature

·         Disorders of the immune system

During the womb, infants stunted growth due to poor nutritional intake, but soon after birth, if the baby is getting adequate nutrients, then the growth will be rapid. However, some babies are small for gestational age (SGA) will remain small when childhood and adulthood, depending on the cause and severity of growth retardation occurring.

DIAGNOSIS

Diagnosis is based on symptoms exist and physical examination, in which the baby's weight is less than the average weight loss of 90% of babies born with the same gestational age.

TREATMENT

There is no specific treatment for infants small for gestational age, treatment is done to address the underlying conditions and complications exist.

PREVENTION

It is important to perform regular checks during pregnancy. In addition, pregnant women should avoid the use of alcohol or drugs, and cigarettes.

REFERENCE

- K, Arthur E. Small for Gestational Age. Merck Manual Home Health Handbook. 2009.

- K, James W. Small for Gestational Age. The Merck Manual. 2012.

- V, Linda J. Small for Gestational Age. Medline Plus. 2011.

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Seizures Fever ( Febrile Convulsion )

DEFINITION

Seizures Fever (Febrile convulsion) is a seizure that occurs in infants or children due to fever, the absence of infection in the central nervous system as well as other neurological disorders.

A child who has a febrile seizure does not mean he suffers from epilepsy, because seizures in epilepsy is characterized by recurrent seizures that are not triggered by the presence of fever.

Febrile seizures occur in about 2-5% of children aged less than 6 years old, but most often occurs in children aged 6 months - 3 years. Febrile seizures tend to be passed down in families.

Febrile seizures can make a family anxious, but in fact harmless. However, during a seizure takes place, there is the possibility that the child will suffer injury due to falling or choking on food or saliva alone. Has not been proven that febrile seizures can cause brain damage. Research shows that children who have experienced febrile seizures have normal intelligence and achievement in school.

95-98% of children who have experienced febrile seizures do not progress to epilepsy. But some children have a high risk of suffering from epilepsy, if:

- Prolonged febrile seizures

- Seizure only on certain body parts

- Recurrent febrile seizures within 24 hours

- Children suffering from cerebral palsy, growth disorder or other neurological disorders.

CAUSE

Most febrile seizures occur because of the drastic changes in body temperature suddenly, and most often occurs on the first day of fever.

Viral or Bacterial Infection

Usually, fever triggering febrile seizures are caused by a viral or bacterial infection in children, such as respiratory tract infections or ear infections. On a mild infection, infection and febrile seizure itself is not dangerous. However, it can sometimes life-threatening infections, such as infections of the brain (encephalitis) or the lining of the brain (meningitis) can cause convulsions and fever in children. This disease can also cause seizures without fever in children.

Seizures Post-Immunization

May increase the risk of febrile seizures after children receive certain immunizations, such as DPT or MMR immunization. Not too high fever can sometimes occur after a child gets immunized. In the event of a febrile seizure, then this is caused by a fever that arise after immunization, not as a result of immunization itself.

Febrile seizures tend to be found in one family, so it is thought to involve heredity (genetics).

SYMPTOMS

The symptoms in children who experience febrile seizures among others:

·         there is a fever, the body temperature of more than 38oC

·         loss of awareness, the child does not respond to the call of his parents

·         eyes glared up

·         seizures arise, the child's body shaking, hands and feet jerky

·         Sometimes children do not breathe, and can be blue

·         child may vomit or bite his tongue

·         the child may cry or moan

·         incontinence. Children can bedwetting or defecate outside consciousness.

Febrile seizures can be divided into:

·         Simple febrile seizures, febrile seizures are the type most often occur. Seizures lasting for a few seconds to 15 minutes. Febrile seizures are not recurring within 24 hours thereafter. Seizures that occur are comprehensive and not only about the one particular body part.

·         Complex febrile seizures. Febrile seizures lasting more than 15 minutes, occur more than once in 24 hours, or the seizure is limited to one side of the child's body.

After the seizure is usually a child will come back unconscious. But the child does not remember what happened. Some children may feel sleepy and there is also a dazed (temporary and mild in nature).

DIAGNOSIS

Diagnosis is based on the existence of a seizure in a child who has a fever and no prior history of epilepsy. The body temperature is measured to ensure presence of fever. Then examined to find the cause (physical examination, blood, and urine).

Febrile seizures usually do not require further examination to seizures, such as EEG, CT scan of the head, and lumbar puncture. Inspection can be done if:

·         seizures in children aged less than 9 months and over 5 years

·         the child has a disorder of the brain, nerves, or in development '

·         seizure is limited to one part of the body

·         seizure lasts more than 15 minutes

·         the child has more than one febrile seizure in 24 hours

·         children have abnormal findings when examined, for example, the possibility of infection in the central nervous system

TREATMENT

Things that need to be done during a seizure:

·         Place the child in a safe place. Children can be placed on the floor covered by a thick blanket.

·         Remove objects that can make a child injury

·         Loosen tight clothing, especially around the neck. If possible, open or remove clothes from the waist up

·         If the child vomits, or a lot of saliva or mucus in the mouth, put the child tilted to the side, so that the liquid can flow out and the child does not choke. In addition, this position also prevents the tongue blocking the airway.

·         Do not attempt to insert anything into the child's mouth to prevent children from biting his tongue, as this increases the risk of injury and airway obstruction.

·         Do not attempt to restrain or stop the seizure movements by holding child

·         Do not try to give fever-reducing medicines when children seizures, because the risk for choking.

·         Most febrile seizures stop on their own within a few minutes (less than 15 minutes).

·         The child should be immediately taken to the nearest hospital if seizures still lasts more than 10 minutes, recurrent seizures, the child has difficulty breathing or body blue, and the child looks letargis.

After that, the cause of the fever also needs to be known and addressed by bringing the child to the doctor.

Fever in children can be overcome by:

·         Give febrifuge, such as Ibuprofen. Aspirin should not be used to treat fever in children because of the risk for the occurrence of Reye syndrome.

·         Compressing the child. Do not compress the child with cold water or alcohol as it may make the fever worse.

PREVENTION

In most cases, febrile seizures occur in the first few hours when the child has a fever, where an increase in body temperature. Seizures can occur when the body temperature rises or falls rapidly. In most cases, seizures can occur unexpectedly or can not be prevented.

Ways to help reduce the risk of febrile seizures in children:

·         Give febrifuge when the child has a fever Image of giving medicine

·         Make sure children drink enough fluids

·         Make sure the child is not dressed too thick, to help control fever

·         The use of drugs as an anti-seizure prevention is not recommended in general, because there is a risk of side effects from the use of these drugs, such as difficulties in learning, sleep disturbances, irritability, hyperactivity and impaired breath.

REFERENCE

- D, David C. Febrile Seizures. Medline Plus. 2010.

- D, Yamini. Febrile Seizures. Kids Health. 2012.

- M, Margaret C. Seizures in Children. Merck Manual Home Health Handbook. 2009.

- Mayo Clinic. Febrile Seizures. 2012.

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Retinopathy In Premature Babies

DEFINITION

Retinopathy In Premature Babies is a situation where there is interference with the formation of blood vessels of the retina in premature infants. Severe retinopathy is characterized by retinal vessel proliferation, scarring and retinal detachment.

CAUSE

Retinal blood vessels begin to form when 3 months after conception and fully formed by the time the baby is born. If a baby is born prematurely, the impaired development. Retinal blood vessels will begin to form again when the baby's general condition improved and most will grow perfectly.

At retinopathy of prematurity, retinal blood vessels grow abnormally, ie into the clear fluid that fills the back of the eye. Here, the blood vessels do not have a network of advocates to be very fragile and often experience bleeding inside the eye. This will be followed by the formation of scar tissue that pull the retina of the inner layer of the eyeball toward the center so that the retina can come loose. As a result, there can be vision problems, or if the condition was severe, can lead to total blindness.

Many premature babies with impaired growth in the retina that are temporary, but it is usually followed by a normal growth without treatment. Only about 1 in 10 infants with more severe retinopathy.

In the past, the use of excessive oxygen can stimulate the growth of abnormal blood vessels. Currently, oxygen consumption can be monitored accurately and easily, so that blood vessel growth disorders are rare.

The risk of retinopathy because premturitas proportional to the severity of prematurity; the smaller the baby is born, the higher the risk of retinopathy.

SYMPTOMS

Newborns who have retinopathy in prematurity usually has no symptoms. However, severe retinopathy can cause the following symptoms:

·         Leukokoria (white pupils)

·         Nystagmus (abnormal movement of the eyeball)

·         Strabismus (squint)

·         Severe myopia (nearsightedness)

DIAGNOSIS

Retinopathy of prematurity can be diagnosed with the help of ophthalmoscopy examinations. Eye examinations in preterm infants made within 4-9 weeks after delivery and then carried out a re-examination every few weeks until the blood vessels of the retina formed. In infants who have scarring caused by retinopathy, an eye examination should be repeated every 1 year lifetime.

TREATMENT

Mild retinopathy often experience a spontaneous healing process. But although there has been a healing, infants have a risk of suffering from nearsightedness, strabismus and visual impairment.

In the severe retinopathy, can be done with laser surgery or cryotherapy (freezing surgical therapy) to stop the growth of abnormal blood vessels and reduce the risk of retinal detachment and visual impairment. If retinal detachment has occurred, it is necessary to surgically restore the retina into place.

PREVENTION

The most effective prevention is to prevent premature birth. If a baby is born prematurely and suffered from respiratory problems, there should be strict monitoring of oxygen consumption.

REFERENCE

- G, Paul B. Retinopathy of Prematurity. Medline Plus. 2013.

- J, Elana P. B. Retinopathy of Prematurity. Kids Health. 2013.

- K, Arthur E. Retinopathy of Prematurity. Merck Manual Home Health Handbook. 2009.

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Respiratory Distress Syndrome ( Hyaline Membrane Disease )

DEFINITION

Respiratory distress syndrome (formerly also known as hyaline membrane disease) is a condition in which the air sacs (alveoli) in the lungs of the baby can not stay open due to the high surface tension due to the lack or absence of surfactant.

CAUSE

Surfactant is a substance that coats the alveoli in the lungs, which is produced by cells in the alveoli. The surfactant serves to keep the alveoli can remain open throughout the respiratory cycle so the baby can breathe freely. Surfactants are usually generated when started around 32 weeks gestation.

The more premature the baby is born, the less surfactant is present, so the greater the risk of respiratory distress syndrome in infants after birth.

Respiratory distress syndrome is almost always occurs in premature newborns, and is more common in babies born to mothers with diabetes. In rare cases, the syndrome is passed down in families.

In the majority of extremely premature infants, the lungs can be very stiff, so that the baby is not able to begin breathing at birth. However, more often, newborns tried to breathe, but because the lung is very stiff it happens great difficulty breathing.

SYMPTOMS

The symptoms of respiratory distress syndrome in newborns such as:

- Rapid breathing

- Attraction of the chest wall muscles while inhaling

- Nostril expands when breathing

- Shortness of breath and can occur stopping breathing (apnea)

- The color of the skin and mucous membranes turn blue due to low oxygen levels in the blood

For a few hours later, trouble breathing in infants tend to be more severe because of the fatigue of the muscles used for breathing effort, a bit of surfactant in the lungs has been used, and a growing number of alveolar collapse. In the end, if left untreated, newborns may experience damage to the brain and other organs of the body due to lack of oxygen or even death.

DIAGNOSIS

Diagnosis:

- The symptoms are there

- The results of a physical examination

- The results of blood gas analysis

- Abnormal chest radiograph

TREATMENT

After birth, the newborn with mild respiratory distress syndrome might only require supplemental oxygen administration. However, newborns syndrome, respiratory distress severe may require breathing aids, such as CPAP (Continuous Positive Airway Pressure), in which the baby can breathe by themselves when given oxygen or air is a little pressure on the nose, or it could be assisted with a ventilator ,

Surfactant administration may be actions that save lives and reduce complications such as pneumothorax. Artificial surfactant is given to work in the same way as the original surfactant.

PREVENTION

The risk of respiratory distress syndrome in newborns can be extremely lowered if the delivery was delayed until fetal lung surfactant has produced in sufficient quantities. If preterm labor can not be avoided, then the baby while still in the womb, can test lung maturity.

REFERENCE

- K, Arthur E. Respiratory Distress Syndrome. Merck Manual Handbook. 2009.

- K, Anand D. M, John T. Respiratory Distress Syndrome. The Merck Manual. 2012.

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Pulmonary Hypertension

DEFINITION

Pulmonary hypertension is a condition where blood vessels in the lungs constrict newborn and cause a reduction in the amount of blood flowing to the lungs so that blood oxygen levels become very low and can be fatal.

CAUSE

The fetus does not breathe, so that blood does not have to flow through the lungs so much oxygen. Many fetal blood that flows directly from the right side of the heart to the left side of the heart through a hole between the two atria of the heart (foramen ovale).

Blood on the right side of the heart, of the pulmonary arteries mostly flow into the aorta through a blood vessel that connects two major vessels, namely the ductus arteriosus. Only a small portion of blood to the lungs.

At birth, the foramen ovale and ductus arteriosis close and blood flows from the right side of the heart to the lungs. But in some babies, the blood vessels in the lungs constrict so foramen ovale remains open; ductus arteriosus may also remain open. If this is the case, then the blood to the lungs only slightly so that the baby's blood oxygen levels are very low.

Pulmonary hypertension is more common in post-mature infants or infants whose mothers had taken aspirin or indomethacin. This situation is more common in infants suffering from lung diseases, such as meconium aspiration syndrome or pneumonia, but it can also occur in infants whose lungs normal.

SYMPTOMS

Sometimes persistent pulmonary hypertension occurs at birth, but can also appear after the first day or two after birth. The symptoms can be found:

·         Baby's breathing is usually rapid. Difficulty breathing may occur terrific if the newborn had lung problems underlying.

·         Blue or pale skin due to low oxygen levels in the blood

·         Weak pulse and rapid heartbeat

DIAGNOSIS

Allegations of persistent pulmonary hypertension based on existing symptoms and results of a physical examination, which is supported by the history of the use of aspirin or indomethacin by a mother for a long time during pregnancy or difficulties in childbirth.

Examination Chest x-rays may be normal if there is no underlying lung disorder. A definitive diagnosis requires echocardiography to assess the pressure in the pulmonary artery.

TREATMENT

Infants are usually placed in the room which has a 100% oxygen levels, or in severe cases, given the ventilator with 100% oxygen. High oxygen levels in the blood to help open the pulmonary artery.

In the case of very heavy, gas nitric oxide in very small concentrations can be added to the baby's oxygen inhaled. Nitric oxide opens the arteries in the lungs of infants and reduces pulmonary hypertension. This therapy may be needed for a few days.

In rare cases, if all therapy is not successful or if the baby's condition is very critical, then rotated the baby's blood through a heart-lung machine (membrane oxygenator) which functions to add oxygen to the blood and remove carbon dioxide from the blood; then the blood is returned to the baby's body.

REFERENCE

- K, Arthur E. Persistent Pulmonary Hypertension. Merck Manual Handbook. 2009.

- NYU Langone Medical Centre. Persistent Pulmonary Hypertension of the Newborn. 2013.

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Prenatal Drug Exposure

DEFINITION

More than 50% of pregnant women using drugs, both drugs are prescribed by doctors, the drugs are sold freely, or even drugs and illicit substances (such as cocaine, alcohol, or tobacco).

Generally, the drugs should not be used during pregnancy, unless it is very necessary. This relates to the risks that can harm the fetus, for example, the occurrence of congenital defects. Nevertheless, there are certain medications that are important to the health of pregnant women and the fetus, such as certain vitamins and minerals. Therefore, before using medication or supplements, pregnant women should consult a physician first.

CAUSE

The drugs consumed by pregnant women can get to the fetus, particularly through the placenta, along with the entry of nutrients and oxygen required for growth and development of the fetus.

The drugs are consumed by a pregnant woman can affect the fetus in several ways:

Working directly on the fetus, is to cause damage, developmental abnormalities (causing birth defects), or even death.

Interfere with placental function, thus making the supply of oxygen and nutrients to the fetus is reduced. Sometimes these conditions make babies have low birth weight and less developed.

Creating strong muscles of the uterus to contract, which can reduce the blood supply to the fetus or trigger birth prematurely.

Affect the fetus indirectly, for example by reducing the mother's blood pressure, so it can make a reduction in blood flow to the placenta resulting in the supply of oxygen and nutrients to the fetus is reduced.

SYMPTOMS

How drugs affect the fetus depends on the level of development of the fetus, as well as the strength and dose of drugs used.

Level of Fetal Development

Effects of the drug within 20 days after conception lethal or no effect at all. At this time the fetus is highly resistant to the occurrence of birth defects.

At the age of 3-8 weeks after fertilization, the use of drugs can cause miscarriage, congenital defects, or may not effect anything. At this time, the organs of the fetus is growing, so that the fetus is susceptible to the occurrence of birth defects.

When the second and third trimesters, fetal organ development is complete. The use of drugs is unlikely to pose a clear Bawan defects at birth, but it is not known about the long-term effects. However, there could be a change in the normal growth and function of organs and tissues.

Strength and Drug Dosage

FDA (The Food and Drug Administration) classifies medicines based on risk to the fetus if used during pregnancy. Some drugs are highly toxic to the fetus, so it should not be used for pregnant women. For example, thalidomide. Several decades ago, thalidomide causes severe developmental disorders in the hands and feet, as well as abnormalities in the intestine, heart, and blood vessels from babies conceived by women who become pregnant while taking this drug.

Some drugs can cause effects although it has been discontinued, such as isotretinoin, a drug used to treat skin irritation. Isotretinoin is stored in the fat under the skin and is released slowly. Therefore, although the use of these drugs has been discontinued, but the effect will still exist for a certain time. Isotretinoin can cause birth defects if pregnancy occurs within 2 weeks after the drug is discontinued. Women who use isotretinoin are advised to wait for at least 3-4 weeks after the drug is stopped, before she was pregnant.

Effects Use of Recreational Drugs or Prohibited Substance Pregnancy

Smoking (tobacco). Smoke effects that are harmful to pregnant women and the fetus. Effects of smoking on the fetus most commonly found is the lack of birth weight. The more a woman smokes during pregnancy, the less weight gain babies.

In addition, pregnant women who smoke also can cause:

·         Congenital defects of the heart, brain, and the baby's face. This condition is more common in babies born to women smokers, rather than women who do not smoke.

·         Increased risk of sudden death syndrome

·         Improper position of the placenta (placenta previa)

·         Placenta separated early

·         Premature birth

·         Infection of the uterus

·         Miscarriage

·         Stillbirth

Children born to women who smoke also have a slight disturbance in physical growth and intellectual development and behavior. This is caused by carbon monoxide and nicotine in cigarettes. Carbon monoxide can reduce the oxygen supply to the tissues of the body. Nicotine stimulates the release of hormones that constrict blood vessels, which supply blood to the uterus and placenta, as a result of oxygen and nutrients to the fetus less.

Pregnant women who do not smoke should avoid cigarette smoke (no secondhand smoke), because it would also harm the fetus.

Alcohol. Alcohol consumption during pregnancy is known to cause the most likely to cause birth defects. The risk of miscarriage is also increased by nearly 2X in women who drink alcohol during pregnancy, especially if he is a heavy drinker.

Another effect of the use of alcohol on the fetus, among others:

·         Often the baby's birth weight is lower than normal

·         Newborns of women who drink alcohol during pregnancy may have failed to grow and tend to die shortly after birth

·         Alcohol syndrome in infants, which consists of:

·         inadequate growth before or after birth

·         facial deformities

·         small head size (possibly due to inadequate brain growth)

·         intellectual impairment

·         the development of abnormal behavior.

·         abnormalities positions and joint function

·         heart defects

·         Severe behavioral disorders in infants or children, for example, anti-social behavior and attention deficit disorder.

·         Caffeine is found in coffee, tea, some sodas, chocolate, and certain medications. Caffeine can get into the fetus through the placenta and cause:

·         increased heart rate

·         decrease blood flow to the placenta

·         decrease the absorption of iron, so that it can increase the risk of anemia

Some evidence suggests that drinking more than seven cups of coffee a day can increase the risk of stillbirth, premature birth, miscarriage, or the birth of a baby with low birth weight.

Amphetamines. Amphetamine use during pregnancy can cause birth defects, especially of the heart, and the possibility of inadequate growth before birth.

Marijuana. The main component of marijuana, tetrahydrocannabinol ie, can cross the placenta and can harm the fetus. However, marijuana does not seem to increase the risk of birth defects or obstacles in the growth of the fetus.

Cocaine can cross the placenta and cause constriction of blood vessels and increases the blood pressure of the fetus. Cocaine use by pregnant women can cause miscarriage, birth defects in the kidney, eye, brain, gastrointestinal tract, or the limbs of the body. Babies whose mothers are cocaine addicts tend to have low body weight and body length and head circumference below normal. All of this is caused by local ischemia due to narrowing of the arteries caused by cocaine. Children born to mothers who use cocaine also seems to have a lower IQ, lack of attention and vigilance, as well as disturbances in motor skills.

Some newborns may show withdrawal symptoms if the mother used cocaine shortly before giving birth, but these symptoms are less frequent and lighter than the symptoms of opioid withdrawal.

Opioids (eg, heroin, methadone and morphine) can pass through the placenta. Opioids rarely causes birth defects, but the baby could be born in a state of addiction. Withdrawal symptoms usually occur 6 hours to 8 days after birth, namely in the form of diarrhea, vomiting, stiffness in muscles, irritability, rapid respiratory rate, and seizures.

The use of opioids during pregnancy also increases the risk of complications during pregnancy, such as miscarriage, abnormal position of the baby, and preterm delivery.

REFERENCE

- G, Ravindu. P, Avinash S. Drug Use During Pregnancy. Merck Manual Handbook. 2013.

- J, Nicholas. Prenatal Drug Exposure. The Merck Manual. 2012.

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Prematurity

DEFINITION

Prematurity is a condition in which a baby is born before 37 weeks of pregnancy (more than 3 weeks before the expected date of delivery).

About 12% of babies are born in a state prematurely. Many babies born a few weeks ahead of time should not experience any problems related to prematuritasnya. However, the more premature the baby is born, the baby is more vulnerable to a variety of serious complications and even life threatening.

Premature infants who have organs are not fully developed, which may not be ready to function outside the womb. As a result, infants at high risk for the disorder after birth. Prematurity (especially extreme prematurity) is a major cause of problems and death in newborns.

CAUSE

The causes of preterm birth is usually unknown. However, the risk of preterm birth is higher in pregnant women who:

- Pregnancy in women younger (less than 18 years)

- Pregnancy in older mothers

- Lower socio-economic group

- Irregular prenatal care

- Pregnancy doubles / twins

- The state of poor nutritional

- Having a weight under or over before pregnancy

- It has not resolved the infection, such as urinary tract infections or sexually transmitted diseases

- Abusing drugs (eg, amphetamines or cocaine), drinking alcohol, or smoking

- History of preterm labor in a previous pregnancy

- Having a serious or chronic illness, such as heart disease, kidney disease, diabetes mellitus, preeclampsia or eclampsia

- Obtain physical trauma

- Having abnormalities in the uterus or cervix

- Never a few times to have a miscarriage or abortion

- Premature rupture of membranes

- Placenta previa (abnormal location of the placenta)

SYMPTOMS

Physical description of premature infants:

·         Small size

·         Low birth weight (usually less than 2.5 kg)

·         Head of the relatively large size compared to the baby's body

·         Little fat under the skin so the skin looks wrinkled

·         Veins under the skin looks

·         The lines on the soles of the feet is still small

·         The presence of fine hair on many parts of the body (lanugo)

·         Ear soft, with little cartilage

·         In the boys, the scrotum (scrotum) is small and has little crease, and the testicles may not descend on extremely premature infants

·         In baby girls, the labia majora not cover the labia minora and clitoris looks great

·         Abnormal breathing patterns, where breathing is rapid and shallow, and can attack a short stopping breathing

·         Sucking and swallowing reflexes are weak and have not coordinated

·         Cries weak

·         Lack of physical activity and weak muscle tone

·         Almost always sleep all day

The symptoms found in premature newborns are often associated with the various organs that have not fully developed. Premature babies can also experience difficulty in maintaining body temperature and blood sugar levels. Newborns generally have a low body temperature, especially immediately after birth. In addition, the baby's immune system is still not perfect.

Complication

The lower the gestational age (the more premature babies), then the risk of complications increases. In addition, the risk of complications is also dependent on the presence of several causes of prematurity, such as infections, diabetes, high blood pressure or pre-eclampsia in the mother. Some of the complications that can occur include:

-Brain development is not perfect, so it could happen:

·         Irregular breathing patterns and could happen stopping breathing

·         Difficulties to align drink and breathe

·         The risk of bleeding in the brain, usually occurring during delivery or when there are problems in breathing.

-The development of the liver and the gastrointestinal tract are not perfect, so it can cause a variety of problems, among others:

·         Frequent spit up (regurgitation)

·         Severe intestinal disorders (necrotizing enterocolitis), in which the intestines can become inflamed, tissue death, and even perforated.

·         Yellow (jaundice), due to the accumulation of bilirubin due to liver function has not been perfect. Bilirubin levels that are too high can even cause damage to the baby's brain (kernicterus).

-The development of the immune system is not perfect, so the risk for infection.

-Kidney development are rudimentary, so that the baby can be difficult to regulate the levels of salt and water in the body.

-Lung development are rudimentary. Premature babies often do not produce adequate amounts of surfactant. Consequently during breathing, the lungs can occur deflate and Respiratory Distress Syndrome.

-Difficulty to keep blood sugar levels

-Difficulties to maintain body temperature. Premature babies tend to lose body heat more quickly, especially when exposed to cold environments. Therefore, the baby's body temperature needs to be maintained with engine warmers or incubators.

DIAGNOSIS

Diagnosis based on physical description and gestational age at birth. Ulstrasonografi examination of the fetus during early pregnancy and newborn physical examination can be performed to determine gestational age.

Several tests that can be performed on premature babies, among others:

- Chest X-ray to see lung maturity

- Eye examination

- Blood gas analyzer

- Blood sugar levels

- Blood calcium levels

- Levels of bilirubin

TREATMENT

Therapy given to premature babies in the form of handling the complications that occur, for example, respiratory distress syndrome and high bilirubin levels.

Nutrition for extremely premature infants can be intravenously until they can start getting food intake. Food initially began to be given through a tube inserted into the baby's stomach, until the baby can suck and swallow well. Breast milk is the best food for premature babies.

Premature babies are very rapid heat loss and have difficulty in maintaining body temperature, so they are usually placed in an incubator. In addition, babies may need the help of a respirator and supplemental oxygen.

PREVENTION

One of the most important steps in preventing prematurity is to start doing prenatal care as early as possible and continue to carry out regular checks during pregnancy.

REFERENCE

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

- L, Kimberly G. Premature Infant. Medline Plus. 2011.

- Mayo Clinic. Premature Birth. 2011.

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