13.Fetus&Neonatus

8/9/2019 13.Fetus&Neonatus

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• Growth & development of fetus and

neonate depends on 2 factors:

1.Genetic

2.EnvironmentCHIL


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1. !efore married

2. "ranatal

#. Intranatal

$. "ostnatal %neonatal


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1. Genetic factor :

'

(halassemia

2. Chromosom a)normalit*

own s*ndrome + mon,olisme

-linefeiter s*ndrome + turner

#. 'others disease


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1. Em)r*onic period %/0 wees

r,ano,enesis

3actors that in4uence intrauterine

chromosom5 ,en 6ulnera)le period : increased mor)idi

and mortalit*

'

(halassemia

2. 3etal period from the 7th wees )orn


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3i,ure 1.

2 month 5 month neonatus

(fetus)


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(a)le1. 'ilestones of "renatalevelopmentWeek Developmental Events

1 3ertili8ation and implantation9 )e,innin, of em)r*onic period

2 Endoderm and ectoderm appear %)ilaminar em)r*o# 3irst missed menstrual period9 mesoderm appears %trilaminar

em)r*o9 somites )e,in to form

$ eural folds fuse9 foldin, of em)r*o into human/lie shape9 armand le, )uds appear9 crown/rump len,th $/; mm

; Lens placodes9 primitive mouth5 di,ital ra*s on hands

< "rimitive nose5 philtrum5 primar* palate9 crown/rump len,th 21/2# mm

= E*elids )e,in

0 varies and testes distin,uisha)le

7 Fetal period )e,ins9 crown/rump len,th ; cm9 wei,ht 7 ,

1 E>ternal ,enitals distiuisha)le

2 ?sual lower limit of via)ilit*9 wei,ht $


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3i,ure 2.


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@ssociated with certain condition:@.'aternal characteristic

1. @,e at deliver*:

a. A $ *r : / chromosomal a)normalit*

/ Intrauterine ,rowth restriction %I?GB

/ !lood loss %previa5 a)rupttion

). 2 *r : I?GB

"rematurit*


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2. "ersonal 3actora. Dosioeconomic : prematurit*5 infection5 I?GB

). Dmoin,: I?GB5 increased perinatal mortalit*

c. "oor diet: mild I?GB

d. (rauma %acute or chronic: a)ruptio placentae5

fetal demise5 prematurit*


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#. 'edical condition:

a. ia)etes 'ellitus : con,enital anomal*5

still)irth5 BD5 h*po,l*cemia5 macrosomia5

)irth inur*

). (h*roid disease

c. Benal disease

d. H*pertension5 etc


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$. )stetric histor*:

a. "ast histor* of infant with : prematurit*5 aundice5 BD5 anomal*

). 'edications

c. !leedin, in earl* or late pre,nanc*

d. "rematur rupture of mem)arane%"B': infection5 sepsis.

e. (BDCH


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1. 'ultiple ,estation: prematurit*5 twin/twintransfusion s*ndrome5 I?GB5 asph*i>ia5 )irth inur*

2. I?GB5 fetal demise5 con,eniotal anomal*5asph*>ia5 h*po,licemia5 pol*c*themia

#. 'acrosomia: )irth inur*5 con,enital anomal*5h*po,licemia

$. @)normal fetal position+presentation: con,enitalanomal*5 )irth inur*5 hemorrha,e.

;. "ol*hidramnios: anencephal*5 pro)lem withswallowin, %e., a,natia5 esopha,eal atresia

!. 3etal conditions


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1. "remature la)or

2. Bapid la)or

#. "rolaps cord

$. Cesarian section: transient tach*pnea of the

new)orn %((

;. )stetric anal,esia and anesthesia


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1. "rematurit*

2. @sph*>iated )a)*

#. 3oul smell of amniotic 4uid

infection$. Dmall for ,estational a,e%DG@

;. "ostmaturit*


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•Docec factor•iet of themother•Environment

!reastfeedin,)ehavior

utritionalstatus of the

)a)*

utritionalstatus of the

mother

(he ualit* anduantit* of )reast

mil

Humoral secretion@menore post

deliver*


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Classifcation o the Newborn

!* ,estational a,e :

• "reterm #= completed wees

• (erm #= $2 wees

• "ost/term A $2 wees

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!* )irthwei,ht :

• ormal )irth wei,ht %! 2; $ ,

• Low !irth wei,ht %L! 1; , / 2$77 ,

hile most L! infants are preterm5 some are

term )ut small for ,estational a,e %DG@.

L! infants can )e further su)classiJed as

follows :

6er* Low !irth ei,ht %6L! 1/ 1$77 ,

E>tremel* Low !irth ei,ht %EL! 1 ,

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Physical characteristics

• (he ph*sical si,ns that are most valua)le in

the assessment of ,estational a,e are ear

Jrmness5 )reast and ,enital development.

• (one and posture are also valua)le

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Assessment of newborn’s nutritional

status

•Determined gestational age by Ballard Score

• Measure the birth weight

• Plot in the ubchenco cur!e


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Ballard score

2"


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2#


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2$

Score Weeks

%10 20

%# 22

0 2"

# 2$

10 2&1# '0

20 '2

2# '"

'0 '$

'# '&

"0 "0

"# "2

#0 ""


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2(

)ntrauterine *rowth cur!e

Battaglia + ubchenco

,1-$(.

LGA : large for gestational ageAGA : Appropriate for gestational age

SGA : Small for gestational age


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@G@ @ppropriate for ,estational a,e

LG@ Lar,e for ,estational a,e a)ove the 1 th percentile.

LG@ can )e seen in infants of dia)etic mothers5

constitutionall* lar,e infants with lar,e parents or infants with

h*drops fetalis

DG@ + I?GB Dmall for ,estational a,e )elow the 1 th

percentile

Commonl* seen in infants of mother who have h*pertension or

preeclampsia or smoe. (his condition has also )een

associated with (BCH infections5 chromosomal a)normalit*

and other con,enital malformations

Note : SGA baby is not always IUG

2&


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@nthropometr*

Derial measurement for ,rowth evaluation isneeded :

a. !od* wei,ht :

3ull/term )a)* 25;/$5 ,ram"ostnatal ,rowth varies from intrauterine ,rowth in

that it )e,ins with a period of wei,ht loss5primaril* throu,h the loss of e>tracellular 4uid.

(he t*pical loss of ;/1K of ! for a full/term infant.

It ma* increased to as much as 1;K of ! in infants)orn preterm.

ur ,oals are to limit the de,ree and duration ofinitial wei,ht loss and to facilitate re,ain of !


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(he time for ,ain the )irth wei,ht of

preterm )a)* is lon,er than full term )a)*Increased of )od* wei,ht )e,in in the 2nd

wee

(he ran,e of )od* wei,ht ,ain depends onintrauterine ,rowth %normal or not

1/2 ,+da* or

2/# ,+da* 'ean 1/#K )od* wei,ht+da*

!od* wei,ht measured ever*da*


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). !od* len,th

Crown/foot len,th is $0/;# cm

'easured ever* wee

'ean ,ain of )od* len,th :

"reterm : 510/15 cm+wee

3ull term : 5


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c. Head Circumference

Intrauterine ,rowth 5; 50 cm+wee

as indicator of )rain development

(he avera,e full term head

circumference is ##/#0 cm


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Bestin, posture loosel* clenched Jsts & 4e>edarms5 hips5 and nees.

"rimitive Be4e> normal found in the new)orn :

"almar ,rasp+ ,rasp re4e> place a Jn,er in

the palm of the infants hand and the infant will

,rasp the Jn,er

Bootin, Be4e> stroe the lip and the corner of

the chee with a Jn,er and the infant will turn

in that direction and open the mouth

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'oro Be4e> support the infant )ehind the upper

)ac with one hand5 and then drop the infant )ac

1 cm or more to )ut not on the mattress. (his

should cause the a)duction of )oth arms and

e>tension of the Jn,ers. ormall* s*mmetr*.

@s*mmetr* a fracture clavicle hemiparesis and

)rachial ple>us inur*.

Be4e> %/ intacranial )leedin,5 cere)ral edema.

'"


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ec ri,htin, re4e> turn the infants head to

the ri,ht or left and movement of the contralateral

shoulder should )e o)tained in the same direction

Ducin, Be4e> placin, a nipple in the mouth

Dteppin, and placin, holdin, the infant upri,ht

with the feet on the mattress and then main, the

)a)* lean forward. (his forward motion often sets

oM a slow alternate steppin, action.

'#


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1. eonatal @sph*>ia :

(he condition where the )a)* fail to

spontaneous )reathin,5 re,ular and

adeuate

"ermanent impaired of CD must

)e prevented and if its alread*

happens have to )e mana,ed

fast and precisel*


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2. !irth inuries

Bis factor :

"rimi,ravida

"artus precipitatus

li,oh*dramnion

#. H*po,licemia :

!lood ,lucose $; m,K


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$. H*per)iliru)inemia

Indirect )ile -ern Icterus

Hearin, distur)ance

'ental retardation

"eriod follow up ,rowth5 mental

development5 e*e si,ht


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;. Low )irth wei,ht )a)*

!irth wei,ht 2; ,

Bis factor increased mor)idit* &

mortalit*


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13.Fetus&Neonatus