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Dr Prakash.I
Biological Genetic Metabolic Environmental No apparent riskDouble vulnerability
IVH- PVH- WMD- PVL Factors contributing- Less cerebral autoregulation Alteration in cerebral blood flow and
pressure
1- Isolated GMB 2- IVH without ventricular dilatation 3- IVH with ventricular dilatation 4- IVH with parenchymal hemorrhage
CP Visual impairment Hearing impairment IQ Learning difficulties ADHD Social development/ Psychological
problems Health outcomes
Perinatal asphyxia Neonatal seizures 45% survivors have NDD 6-23% of CP due to asphyxia Athetoid/ Dyskinetic CP- acute perinatal
HI Spastic tetraplegic CP- damage to gray
and white matter and cerebral atrophy Hemiplegic CP- focal cerebral infarction
Stage 1- Mild
Stage 2- Moderate
Stage 3- Severe
AGPAR score <_ 3 at > 5 mins Fetal HR <60 beats/ min Prolonged antenatal acidosis Seizures within 24- 48 hrs Need for PPV > 1 min or 1st cry delayed
>5 mins
Selective head cooling Systemic hypothermia Magnesium Sulphate Antioxidants Calcium Channel blockers Hyperbaric Oxygen treatment
30% risk of NDD Interrupts development of the maturing
nervous system High risk groups- HIE, Meningitis, Hypoglycaemia Low risk groups- Late hypocalcaemia Subarachnoid haemorrhage
Parieto occipital white matter abnormalities
Maternal conditions Diabetes Drugs Intrapartum glucose administration
Neonatal problems Preterm IUGR Perinatal HI Hypothermia Infections Polycythemia Following exchange transfusion
Bilirubin encephalopathy 80% die in neonatal period Athetoid CP, tone abnormalities, lower IQs, sensory
neural hearing deficits Classic perlstein’s tetrad of kernicterus- extrapyramidal
abnormalities, sensori neural hearing loss, gaze abnormality, dental dysplasia
1st year- poor feeding, high pitched cry, persistent ATNR, hypotonia, and increased DTRs
Athetosis- as early as 18 mths dysarthria, facial grimacing, drooling,
difficulty in chewing and swallowing
Responsible for 5% of MR and GDD Accumulation of a n/ abn metabolite or
deficiency resulting from enzyme defect Present as acute/ chronic
encephalopathy with or without non- neuronal involvement, seizures, movement disorders, muscle weakness etc
Apnea Meconium aspiration syndrome Persistent pulmonary hypertension of
newborn Neonatal shock Neonatal sepsis
Pain and analgesia Neonatal infant pain scale ( NIPS)1.Pharmacological- Opiods ( Morphine, fentanyl, codeine) Non opiods (paracetamol, sucrose,
midazolam) Anaesthetic agents ( EMLA, lidocaine,
ketamine, thiopental)
2. EnvironmentalMinimising/clustering painful IxDecreased handlingReducing ambient noise/ light3. BehaviouralGentle sensory stimulationOral sucroseKMC
Neonatal transport Perinatal steroids Mechanical ventilation
Neonatal behavioral assessment scale (NBAS)
Assessment of Preterm Infant’s behavior (APIB)
Neurological Assessment of the Fullterm and preterm newborn infant
Morgan Neonatal Neurobehavioral examination
Movement Assessment of infants Milani- Comparetti Motor Development
Screening Test
