acquired problems of NB

• Acquired problems

  Conditions resulting from environmental rather than genetic factors, like birth trauma, infant of a mother with diabetes, neonatal infections, effects of maternal substance abuse on the fetus and neonate, effects of maternal use of benzodiazepines barbiturates and antidepressant medications during pregnancy
• Birth trauma

  • Physical injury sustained by a neonate during labor or birth, some birth injuries are avoidable but some are unavoidable despite skilled and competent obstetric care, care of infant with birth injury is individualized based on type of injury
• Risk factors for birth trauma

  • Maternal age of <16 or >35
  • Primigravida (first time mom)
  • Uterine dysfunction
  • Preterm or post term labor
  • Oligohydramnios
  • Macrosomia
  • Multifetal gestation
  • Abnormal or difficult presentation
  • Obstetric birth techniques
• Soft tissue injuries from birth trauma

  • Erythema and ecchymosis
  • Petechiae
  • Abrasions and lacerations
  • Forceps injury
  • Accidental lacerations
  • Subconjunctival and retinal hemorrhages
  • Cephalhematoma and subgaleal hemorrhage
• Skeletal injuries from birth trauma

  • Skull fracture (linear fractures or indentations)
  • Clavicle fracture
  • Humerus or femur fracture
• Peripheral nervous system injuries from birth trauma

  • Brachial plexus injury from shoulder dystocia
  • Erb-duchenne palsy (upper plexus injury)
  • Klumpke's palsy (lower plexus injury)
  • Phrenic nerve injury
  • Facial paralysis (palsy)
• Central nervous system injuries from birth trauma

  • Intracranial hemorrhage
  • Subdural hemorrhage
  • Subarachnoid hemorrhage
• Acute bilirubin encephalopathy

  Bilirubin crosses the blood brain barrier and deposits itself into the brain and occasionally rise to toxic levels, causing acute inflammatory response
• Early signs of acute bilirubin encephalopathy

  • High pitched cry
  • Poor feeding
  • Hypotonia
  • Temperature instability
• Late signs of acute bilirubin encephalopathy

  • Seizures
  • Unresponsiveness
  • Fever
  • Death
• Kernicterus

  Yellow staining of the brain tissue visible on autopsies, can result in chronic long term outcomes like mortality, ataxia, dental hypoplasia, deafness, seizures, developmental and motor abnormalities, cerebral palsy
• Congenital anomalies in infants of diabetic mothers

  • Cardiac
  • Renal
  • Musculoskeletal
  • Central nervous system
• Macrosomia

  Excessive shoulder size often leads to dystocia
• Other issues in infants of diabetic mothers

  • Birth trauma
  • Perinatal hypoxia
  • Respiratory distress syndrome
  • Hypoglycemia
  • Hypocalcemia
  • Hypomagnesemia
  • Cardiomyopathy
  • Hyperbilirubinemia
  • Polycythemia
• Neonatal infections

  Newborn infant is susceptible to infection because of immature immune system, sepsis is one of the most significant causes of neonatal morbidity and mortality
• Types of neonatal infections

  • Early onset sepsis (first 7 days, usually GBS or staph)
  • Late onset sepsis (7-30 days, maternally derived or healthcare acquired)
• Symptoms of neonatal sepsis

  Vague and nonspecific (lethargy, poor feedings, temperature instability)
• Interventions for neonatal sepsis

  • Antibiotics
  • Supportive care
  • Breastfeeding
  • Handwashing (preventative measure)
• Viral infections in newborns

  • Cytomegalovirus
  • Varicella
  • Rubella
  • HIV
  • Herpes simplex
  • Hepatitis B
  • Enteroviruses
  • Parvovirus B19
  • Influenza
  • Zika
• Bacterial infections in newborns

  • Group B Streptococcus
  • Chlamydia
  • Gonorrhea
  • Syphilis
  • E. coli
  • Staph
  • Listeriosis
  • Toxoplasmosis
  • Candida
• Effects of maternal substance abuse on newborns

  • Tobacco (low birth weight)
  • Alcohol (FASD)
  • Opioids (NAS)
  • Marijuana
  • Cocaine
  • Amphetamines
  • Benzodiazepines
  • Barbiturates
  • SSRIs
• Substance use care management

  Maternal history identification, thorough newborn assessment, urine/meconium screening, planning for care challenges, education and social support, supportive care, medications, breastfeeding support
• Hemolytic disease of the newborn

  Maternal antibodies are present naturally or form in response to an antigen from the fetal blood crossing the placenta and entering the maternal circulation, occurs most frequently with ABO or Rh (D) incompatibility
• Rh incompatibility

  Rh positive offspring or an Rh negative mother are at risk, mother forms antibodies that then destroys fetal red blood cells, results can be mild fetal jaundice or severe like erythroblastosis fetalis or hydrops fetalis
• ABO incompatibility

  Fetal blood type is A, B, or AB and maternal type is O, naturally occurring anti-A and anti-B antibodies are transferred across the placenta to the fetus, exchange transfusions required occasionally
• Hydrops fetalis

  Fetal erythrocytes are destroyed by maternal antibodies and can cause fetal jaundice, fetus tries to compensate by creating large numbers of erythrocytes (erythroblastosis fetalis), if this continues hydrops fetalis develops with severe anemia, cardiomegaly, hepatosplenomegaly, excessive third spacing
• Intrauterine surgery

  Correction or management of congenital anomalies while the fetus is still in the uterus, including open fetal surgery, fetoscope/fetal image guided surgery, blood transfusions, amniotransfusion or reductions, and amniotic bands release