NEONATOLOGY INTRODUCTION

Assistant Prof. Paediatics Dr. Muhammad Sajjad

SabirMBBS, DCH, MCPS, FCPS

Neonatology Neonatology is a subspecialty of Paediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn (up to 28 days after birth)

neo, "new", natal, "pertaining to birth or origin“

It is a hospital-based specialty, and is usually practiced in Neonatal Intensive Care Unit (NICUs)

Neonatal period

The neonatal period commences at birth and ends 28 completed days after birth

Early Neonatal Period: first seven days

Late Neonatal Period: 7-28days of life

Perinatal period

The perinatal period commences at 22

completed weeks (154 days) of gestation

(the time when birth weight is normally 500 g), and

ends seven completed days after birth

Preterm < 37 wks

Term 37-42 wks

Post term > 42 wks

Classification (Gestational age)

Classification (birth weight)

Normal birth weight   2.5-3.5 Kg Low birth weight  <2.5Kg

Large for gestational age (LGA) > 4.2Kg

There is No Precious babyThere is No Precious baby All Babies are precious All Babies are precious

Neonatal care

Components Of NICU

Warmer

Components Of NICU

Incubator Baby Crib

Ventilator CPAP

Components Of NICU

Suction

Oxygen

Phototherapy Light

Biliblanket Phototherapy Light

I. Respiratory Distress SyndromeII.Neonatal JaundiceIII.Neonatal Sepsis IV.Pre-termV.Hemorrhagic diseasesVI.CNS problemsVII.Meconium Aspiration

VIII.Pre and post -operative cases

Common Cases of NICU Admission

ProceduresProcedures

1.Endotracheal tube (ET)

2.Chest Intubation

3.I.V cannula

4.Umbilical catheter

5.Blood transfusion

6.Phototherapy

7.Exchange transfusion

1.Name: Mother name/ Fathers name2. Gender : Male, Female or ambiguous

genitalia!3. Sibling: History of other siblings - IUD ,

Abortions , RH,ABO incompatibility , Metabolic, genetic diseases

4. Consanguinity : For congenital abnormalities5. Mode of delivery? SVD or LSCS6. Gestational age: Full term or preterm

Ballard Maturational Assessment7. Age of the Baby8. Maternal risk factors G.. P.. + ….

History taking

5. Mode of delivery? SVD or LSCS

LSCS SVD• Cause ?

• Anesthesia

• More Liable for RDS

• Obstructed labor

• Traumatic Labor

• Less liable for RD

1- Maternal age: <18 years or >35 years2- Socio-demographic factors:•Low educational status•Cigarette smoking•Drug addiction•Poor nutrition•Poverty3- Obstetric factors:• Previous cesarean section• Multiple pregnancies• Prior infertility•Blood transfusion

Maternal risk factors

4- Medical conditions:•Diabetes mellitus•Hypertension•Pregnancy induced hypertension (PIH)•Pre-eclamsia•Congenital heart disease•Auto-immune diseases•Infections

Mortality RatesDefinitions and Measurement

Live BirthComplete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered liveborn

Fetal Death, StillbirthDeath prior to the complete expulsion

or extraction from its mother of a product of conception, irrespective of

the duration of pregnancy; the death is indicated by the fact that after such

separation the fetus does not breathe or show any other evidence of life,

such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles

Perinatal Mortality

An important indicator of:Maternal careMaternal health and nutritionQuality of obstetric and paediatric care

Perinatal MortalityPerinatal Mortality Rate:The number of deaths of fetuses (according

to the reporting criteria) plus the number of early neonatal deaths, per 1000 total births

x 1000

Pakistan 40.7 per 1000 live births(2012)

Fetal and Early Neonatal Deaths___________________________Total Births

Neonatal Mortality

Neonatal Mortality Rate:The number of deaths of infants during the

neonatal period, per 1000 live births

x 1000

Pakistan 42 per 1000 live births.(

Neonatal Deaths_______________Live Births

Neonatal Mortality

Early Neonatal Mortality Rate:The number of early neonatal deaths during

a given year per 1,000 live births in the same year.

x 1000

Pakistan__?_ no rate calculated

Early Neonatal Deaths____________________Live Births

Post-Neonatal Mortality

Post-Neonatal Mortality Rate:The number of deaths of infants aged 28 to

364 days, per 1000 live births

x 1000Post-Neonatal Deaths___________________

Live Births

Infant Mortality

Infant Mortality Rate:The number of deaths of infants aged less

than one year, per 1000 live births

x 1000

Pakistan 53.9 per 1000 live births (2016)

Deaths under 1 yr of age_____________________Live Births

Child Mortality

The most importantis

Under-5 Mortality Rate

Under-5 Mortality Rate

A leading indicator of the level of child health and overall development in countries.

The fourth indicator of 8 MDGs (Millennium Development Goals)

Under-5 Mortality Rate

Under-5 Mortality Rate:The number of deaths of children aged less

than 05 year, per 1000 live births

x 1000

Pakistan 86 per 1000 live births (2016)

Deaths under 5 yr of age_____________________Live Births

Hope Happiness finds you every where !