A. FASE INTRAUTERINA 1. PERIODO DELLO ZIGOTE 2. …  II anno/Agostiniani/1... · A. FASE...

FASI DELL’ETA’ EVOLUTIVA

A. FASE INTRAUTERINA1. PERIODO DELLO ZIGOTE2. PERIODO EMBRIONALE3. PERIODO FETALE

B. FASE EXTRAUTERINA 1. PRIMA INFANZIA2. SECONDA INFANZIA3. TERZA INFANZIA4. PUBERTA’5. ADOLESCENZA

PRIMA INFANZIA: dalla nascita al compimento del 2° anno di vitaPERIODO NEONATALE:

Precoce (nascita – primi 7 gg di vita)Tardivo (dall’8° giorno di vita al 28°)

PERIODO POST-NEONATALE (dal 29° giorno al 2°anno)P. del lattante (fino al primo anno)Prima infanzia propriamente detta

SECONDA INFANZIA: dal compimento del 2° al compimento del 6°annoTERZA INFANZIA: dai 6 anni all’inizio dello sviluppo puberale PUBERTA’: inizia con la comparsa dei CSS (8½ – 13aa ♀ ; 10½ – 15aa ♂) e si completa in circa 4 anni , con l’acquisizione funzionale delle gonadi .ADOLESCENZA: dalla fine della pubertà sino all’età in cui termina l’accrescimento staturale (18-20 aa nelle ♀ ; 20-21 aa nei ♂)

FASI DELL’ETA’ EVOLUTIVA

CLASSIFICAZIONE DEI NEONATI

A. CRITERIO PONDERALE: peso alla nascita2500-4250 g NEONATI NORMOPESO> 4250 g NEONATI MACROSOMI< 2500 g NEONATI IMMATURI

B. CRITERIO TEMPORALE: durata della gestazione basata sulla data del primo giorno dell’ultima mestruazione (settimane di EG).

PESO: NORMALI (2501-4249 g)MACROSOMI (> 4250 g)IMMATURI (< 2500 g)

EG: A TERMINE (37-41 sett)POST-TERMINE (≥ 42 sett,)PRE-TERMINE (≤ 36 sett.)

PESO/EG: APPROPRIATO PER L’ETA’ (AGA)PICCOLO PER L’ETA’ (SGA)GRANDE PER L’ETA’ (LGA)

CLASSIFICAZIONE DEI NEONATI

Griglia di Denver: classificazione dei neonati in base a peso ed età gestazionale

PARAMETRI ANTROPOMETRICI NEONATALI

MASCHI FEMMINE

PESO (g) 3.350 ± 200 3.200 ± 200

LUNGHEZZA (cm) 50 ± 1 49 ± 1

CRF.CRANICA (cm) 35 ± 1 34 ± 1

CRF. TORACICA (cm) 33 ± 1 32 ± 1

ALTEZZA TESTA (cm) 12.5 12.5

Diverse proporzioni corporee nel neonato e nell’adulto

Indice di APGARSEGNI CLINICI 0 1 2

ATT. CARDIACA assente <100 >100

RESPIRAZIONE assente irregolare vigorosa (gasping)

TONO MUSCOLARE assente debole normale

RISPOSTA STIMOLI assente scarsa vivace

COLORITO cianosi o tronco completamentepallore roseo roseo

con estremità cianot.

Valutazione del neonato in sala parto

I. A.BUON ADATTAMENTO 8-10 90-95%NEONATALE

ADATTAMENTO 4-7 5-6%NEONATALE PRECARIO

RIANIMAZIONE <=3 0,2-0,5%PRIMARIA SALA PARTO

Normal Newborn Care

Advances in Maternal and Neonatal Health

1. Define essential elements of early newborn care

2. Discuss best practices and technologies for promoting newborn health

3. Use relevant data and information to develop appropriate essential newborn recommendations

World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide.

Newborn Deaths

• 8.1 million infant deaths (1993)

• 3.9 million (48%) newborn deaths

• 2.8 million (67%) early newborn deaths

• Major causes of newborn deaths– Birth asphyxia: 21%– Infections: 42%

(tetanus, sepsis, meningitis, pneumonia, diarrhea)

• Birth process was the antecedent cause of 2/3 of deaths due to infections:

– Lack of hygiene at childbirth and during newborn period

– Home deliveries without skilled birth attendants

• Birth asphyxia in developing countries:

– 3% of newborns suffer mild to moderate birth asphyxia

– Prompt resuscitation is often not initiated or procedure is inadequate or incorrect

Newborn Deaths

• Hypothermia and newborn deaths

– Significant contribution to deaths in low birth weight infants and preterm newborns

– Social, cultural and health practices delaying care to the newborn

• Countries with high STD prevalence and inconsistent prophylactic practices

– Ophthalmia neonatorum is a common cause of blindness

Newborn Deaths

Essential Newborn Care Interventions

• Clean childbirth and cord care

– Prevent newborn infection

• Thermal protection

– Prevent and manage newborn hypo/hyperthermia

• Early and exclusive breastfeeding

– Started within 1 hour after childbirth

• Initiation of breathing and resuscitation

– Early asphyxia identification and management

• Eye care

– Prevent and manage ophthalmia neonatorum

• Immunization

– At birth: bacille Calmette-Guerin (BCG) vaccine, oral poliovirus vaccine (OPV) and hepatitis B virus (HBV) vaccine (WHO)

• Identification and management of sick newborn

• Care of preterm and/or low birth weight newborn

Essential Newborn Care Interventions

Thermal Protection

• Newborn physiology

– Normal temperature: 36.5–37.5°C

– Hypothermia: < 36.5°C

– Stabilization period: 1st 6–12 hours after birth

• Increase hypothermia

– Newborn left wet while waiting for delivery of placenta

– Early bathing of newborn (within 24 hours)

Hypothermia Prevention

• Deliver in a warm room

• Dry newborn thoroughly and wrap in dry, warm cloth

• Keep out of draft and place on a warm surface

• Give to mother as soon as possible

– Skin-to-skin contact first few hours after childbirth

– Promotes bonding

– Enables early breastfeeding

• Check warmth by feeling newborn’s feet every 15 minutes

• Bathe when temperature is stable (after 24 hours)

Eye Care To Prevent or Manage Ophthalmia Neonatorum

• Ophthalmia neonatorum– Conjunctivitis with discharge during first 2 weeks of life– Appears usually 2–5 days after birth– Corneal damage if untreated – Systemic progression if not managed

• Etiology– N. gonorrhea

» More severe and rapid development of complications» 30–50% mother-newborn transmission rate

– C. trachomatis

• Prophylaxis– Clean eyes immediately– 1% Silver nitrate solution

» Not effective for chlamydia– 2.5% Povidone-iodine solution– 1% Tetracycline ointment

» Not effective vs. some N. gonorrhea strains• Common causes of prophylaxis failure

– Giving prophylaxis after first hour– Flushing of eyes after silver nitrate application– Using old prophylactic solutions

Eye Care To Prevent or Manage Ophthalmia Neonatorum

Immunization

• BCG vaccinations in all population at high risk of

tuberculosis infection

• Single dose of OPV at birth or in the two weeks

after birth

• HBV vaccination as soon as possible where perinatal

infections are common

Summary

The essential components of normal newborn care include:

• Clean delivery and cord care

• Thermal protection

• Early and exclusive breastfeeding

• Monitoring

• Eye care

• Immunization