Care of High Risk Newborn/Infants Risk Newborns 1. Prem Premat atur uree Bab Babie iess – those born before the 38th week of gestation. a. Term Termiinol nologie ogiess i. Small-for Small-for-gest -gestation ational al age (SGA) (SGA) – birth birth weight is is less than than expected expected for the the th specific gestational age. E.g. baby born on the 38 week of gestation who weighs 5lbs. Risk Factors: 1. Adolescent pregnancy 2. Placental anomaly 3. Diabetes Mellitus 4. Pregnancy-induced-hypertension 5. Smokers 6. Alcoholic
ii. Appropriat Appropriate-fore-for-gesta gestational tional age (AGA) (AGA) – birth birth weight expected expected for the specifi specificc th gestational age. E.g. Baby born on the 34 week of gestation who weighs 5lbs. iii. Large-forLarge-for-gesta gestationa tionall age (LGA) – birth birth weight more more than expected expected for the specific specific th gestational age. E.g. Baby born on the 36 week of gestation who weighs 8lbs. Risk Factors: 1. Diabetes mellitus 2. Multiparous 3. TOGA 4. Omphalocele b. b. Char Charac acte teri rist stic ics: s: i. Have underdevel underdeveloped oped subcutaneou subcutaneouss tissues tissues and less less fat to act act as insulator insulator;; thin skinned. Need: Place inside an incubator with temperature regulated to 33.3-34.4 C, humidity of 55-65%; and frequent positioning on the right side to promote closure of the foramen ovale. ii. Poikilothe Poikilothermic rmic (easily (easily takes takes on temperature temperature of environme environment). nt). Temperatur Temperaturee stabilizes at a lower rate (35-36C). Need: Take temperature by axilla to avoid crying. iii. iii. Physio Physiolog logic ic weight weight loss loss is exagge exaggerat rated. ed. iv. General General activity activity is feeble feeble and weak. weak. (square (square sign sign = elbow passes passes the the midline midline of the body; square window wrist = wrist at a 90 ang le; Recoil of extremities = less or minimal) v. Underd Underdeve evelop loped ed CNS centers centers for for respira respiratio tion. n. Need: Oxygen inhalation. Danger: O2 concentration should not exceed 40%; may lead to retrolental fibrolasias = an overgrowth of retinal blood vessels causing blindness. vi. High nutriti nutritional onal requirem requirement ent – to maintain maintain rapid rapid growth growth appropriate appropriate for for age. (Required caloric intake as much as 200-220 2 00-220 cal/kg) Need: Feeding done by OGT since premies have ineffective sucking not coordinated with swallowing; plus minimal handling is necessary to conserve energy. c. Spec Specia iall Prob Proble lems ms i. Hyperbili Hyperbilirubin rubinemia emia – because because of the immatur immaturity ity of the liver. liver. Management: Phototherapy – photooxidation by the use of artificial light in order to convert bilirubin into excretable form. ii. Infection Infection – Premises Premises are more more susceptibl susceptiblee due to general immaturi immaturity ty of the immune immune system. Premies could not receive (they are born too early) the na tural protection given by mothers to their babies. iii. Anemia Anemia – exaggerated exaggerated of the physio physiologic logic anemia anemia of full-t full-term erm newborn newborn – due to less less iron stores and smaller RBC mass. 1
iv. Respirator Respiratory y Distress Distress Syndrome/ Syndrome/Hyal Hyaline ine Membrane Membrane Diseas Diseasee - due due to to lac lack k of surf urfacta actant nt.. Pathophysiology: Low pulmonary surfactant increased surface tension alveolar ventilation inadequate exchange of O2 & CO2 HYPOXIA increased capillary permeability, causing effusion from the pulmonary capillaries into the alveoli and terminal bronchioles HYALINE MEMBRANE found in the alveoli & bronchioles ATELECTASIS Signs & Symptoms: a. Expira Expiratio tion n grunti grunting ng (pat (pathogn hognomo omonic nic sign sign)) b. b. Incr Increa ease sed d RR c. Flar laring ing ala alaee nas nasii d. Cyano Cyanosi sis, s, retr retrac acti tion ons, s, rales rales e. Resp Respia iart rtor ory y acid acidos osis is f. ABG: ABG: low low pH pH level level,, low low pO2 pO2 level level,, high high pCO2 pCO2 Management: 1. Monitor vital signs, ABG, skin color, muscle tone. 2. Proper positioning, NPO, IVF, OGT care. 3. Suction PRN. 4. O2 inhalation, high humidity, warmth 5. Sodium bicarbonate – for acidosis, CPAP 2. Postt Postterm erm/P /Post ostma matu ture re Babies Babies – born after the 42nd week of gestation. a. Classic Classic signs signs – “old man man face” – evidence evidence of intraute intrauterine rine weight weight loss, loss, dehydrati dehydration, on, and chronic hypoxia. * Long and thin * Long nails, firm skull * Cracked skin – loose, wrinkled, stained w/ greenish-yellow, no vernix nor lanugo. * Wide-eyed alertness of a one-month old baby *Hypoglycemia b. Managem Management ent:: *Mon *Monito itorr V/S * IV IV as ordere ordered d 3. Neurom Neuromuscu usculos loskel keletal etal Birth Birth Injur Injuries ies a. Facial paralysis – asymmetry face due to damage to facial nerves from a difficult forceps delivery; usually temporary, may disappear in a few days; no nec essary treatment. b. Erb-Duchenne paralysis (brachial paralysis) – caused by a difficult forceps or breech extraction birth; treatment depends on severity of paralysis: Massage & exercise of arm to prevent contractures, application of splints/braces as used in severe paralysis. c. Dislocations and Fractures – diagnosed by crepitation, immobility, variations in ROM. Treatment: Depends on site of fracture, may include application of swadling, splints, slings, or casts and positioning. 4. He Hemo moly lyti ticc Dis Disea ease se a. Rh incompati incompatibili bility ty - occurs when an Rh (-) (-) woman woman is sensitized sensitized to an Rh Rh (+) fetus, fetus, develops antibodies against Rh (+) blood. Consequences: * Erythroblastosis fetalis – occurs in subsequent pregnancies when the antibodies are transferred through the placental barrier to the fetus = agglutination and destruction of RBC. Prevention: Prevention: * RhoGAM (D antigen) immunization [Anti-Rh immunoglobulin] given to Rh (-) mother on the 28th week of pregnancy & 72 hours after birth/abortion. b. ABO incompati incompatibilit bility y – occurs when when the fetal fetal blood type type is A, B, or AB AB and the mother mother is type O; mother’s anti-A or anti-B antibodies are transferred through the placental barrier to the fetus, causing hemolysis = anemia, jaundice, & kernicterus; 1st pregnancy can be affected.
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Manifestations: 1. Jaundice Jaundice and increasing increasing bilirubin bilirubin levels levels during during the the 1st 24 hours 2. Leth Lethar argy gy or irr irrit itabi abili lity ty 3. Poor Poor feed feedin ing g patt patter ern n 4. Hepa Hepato tosp sple leno nome mega galy ly 5. Signs igns of anem anemia ia 6. Sign Signss of of ker kerni nict cter erus us:: a. (-) moro moro reflex, reflex, severe severe letharg lethargy, y, apnea, apnea, high-pitch high-pitched ed cry, assump assumption tion of opisthotonus position, tremors, & seizures Therapeutic interventions: 1. During During pregnancy, pregnancy, amniotic amniotic fluid determi determinatio nations ns are done; elevation elevation readings readings warrant warrant either intrauterine transfusion or induction of labor, depending on AOG. 2. Photothera Phototherapy py – in an attem attempt pt to reduce reduce mild mild to moderate moderate kernict kernicterus. erus. 3. Exchange Exchange transfusio transfusions ns – on severely severely affected affected infants infants to to decrease decrease antibody antibody level level & increase infant’s RBCs & Hgb levels. 5. Cardi Cardiac ac Malf Malform ormati ations ons Classification: a. Acyanotic Acyanotic – Shunt from left to right right side of the the heart. heart. - No abnormal communication between pulmonary & systemic circulation. - If connection within the heart chambers ch ambers exist, pressure forces blood from the arterial (left) to the venous (right) side of the heart, where it is reoxygenated.
i. Ventri Ventricul cular ar Sept Septal al Defe Defect ct (VSD) (VSD) - Abnor Abnorma mall openi opening ng betw betwee een n the two two vent ventri ricl cles es.. - High High pressur pressuree in right right ventr ventricl iclee causes causes hypert hypertrop rophy; hy; low low harsh harsh murmu murmur r heard throughout systole;\ - Mortality Ra Rate: >5 >5% Specific therapeutic intervention: 1. Closure of the opening at the septum. ii. Atrial Atrial Septal Septal Defect Defect (ASD) (ASD) - Abnor Abnorma mall openi opening ng bet betwe ween en the the two two art arter erie iess - Murmur Murmur hear heard d high high on the ches chestt with with fixed fixed split splittin ting g of the the heart heart sound. sound. - Mortality ra rate: >1 >1% Specific therapeutic intervention: 1. Closur Closuree of the opening opening at the the septu septum. m. iii. iii. Patent Patent Duct Ductus us Arter Arterios iosus us (PDA (PDA)) - Failur Failuree of the the fetal fetal connec connecti tion on betwee between n the aorta aorta & pulm pulmona onary ry arter artery y to close. - Shunting of of blood pulmonary hypertension cardiomegaly. - Machin Machinee type type murmu murmurr heard heard throu throughou ghoutt the the heartb heartbeat eat in in the left left 2nd to 3rd interspace. Specific therapeutic intervention: intervention: 1. Closure of the opening between aorta & pulmonary artery. iv. iv. Coar Coarct ctat atio ion n of the the Aor Aorta ta - In utero utero,, failure failure of the the aorta aorta to develo develop p complete completely; ly; with with stric strictur turee below below level of the aortic arch. - Increa Increased sed syste systemic mic circu circulat lation ion above above strict stricture ure:: bounding bounding radia radiall & carotid carotid pulses, headache, dizziness, epistaxis. - Decreased Decreased systemic systemic circulati circulation on below stricture: stricture: absent femoral femoral pulses, pulses, cool lower extremities. - Increased Increased pressure pressure in aorta aorta above the defect defect:: left left ventricular ventricular hypertroph hypertrophy. y. Specific therapeutic intervention: 1. Resection Resection of the defect defect and and anastomos anastomosis is of ends of aorta.
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v. Aort Aortic ic Sten Stenos osis is - Narr Narrow owin ing g of of the the aort aortic ic valv valve. e. - Causes Causes incr increas eased ed worklo workload ad on the left left ventr ventricl icle, e, and the the lowere lowered d pressur pressuree in aorta reduces coronary artery flow. Specific therapeutic intervention: 1. Divisi Division on of the sten stenoti oticc valves valves of the the aorta. aorta. vi. vi. Pulm Pulmon onar ary y sten stenos osis is - Narr Narrow owin ing g of the the pulm pulmon onic ic val valve ve.. - Causes Causes decre decrease ased d blood blood flow to to the lungs lungs and incr increas eased ed pressu pressure re to the the right right ventricle. Specific therapeutic intervention: 1. Valvot Valvotomy omy or ball balloon oon angiopl angioplast asty y b. Cyanotic Cyanotic – shunt shunt from from the the right right to left side of of the heart. heart. - Abnormal connection between the pulmonary & systemic circulations. - Venous (unoxygenated) blood enters systemic circulation. - Polycythemia occurs as body compensate for inadequate supply of oxygen. - Squatting or knee chest position is preferred because it decreases venous return by constricting femoral veins, among other physiologic actions. i. Tetr Tetral alog ogy y of Fal Fallo lott (TOF (TOF))
* Four Associated Defects: 1. Pulmonary valve stenosis 2. Ventricular septal defect 3. Overriding of aorta, receiving blood from both ventricles, or an aorta arising from the right ventricle. Specific therapeutic intervention: 1. Blalock-Taus Blalock-Taussig sig procedure: procedure: subclavi subclavian an artery to pulmonar pulmonary y artery anastom anastomosis. osis. 2. Complete Complete Repair: Repair: Closure Closure of ventric ventricular ular septal septal defect defect and resection resection of the the infundibular stenosis.
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ii. Transp Transposi ositio tion n of the Great Great Vesse Vessels ls (TOGA (TOGA)) - Aorta arises arises from from the the right right ventri ventricle, cle, and and pulmonary pulmonary artery artery arises arises from the left ventricle (incompatible with life). Specific therapeutic interventions: 1. Palliativ Palliativee treatment treatment procedures procedures perfor performed med to prevent prevent pulmonary pulmonary vascular vascular resistance and CHF until child is able to tolerate complete repair. a. Rashkind Rashkind procedure procedure – enlarge enlargement ment of an an existing existing atrial atrial sepetal sepetal defect defect by pulling a balloon through the defect during a cardiac catheterization. b. Pulmonary Pulmonary artery artery banding banding – to decreased decreased blood blood flow flow to lungs lungs & increas increasee shunting of oxygenated blood intraventricularly of the aorta. c. Pharma Pharmacol cologi ogicc dilatio dilation n of Prosta Prostagla glandi ndin n d. Blalock-Hanl Blalock-Hanlon on operatio operation: n: surgica surgicall creation creation of an ASD. 2. Comp Comple lete te repa repair ir a. Rastel Rastell’s l’s proced procedure ure:: closu closure re of of VSD> VSD> b. Mustard Mustard or Senning Senning Procedur Procedure: e: removing removing an entire entire atria atriall septum septum & creating a new atrial septum from existing pericardium. c. Jatene operat operation: ion: transpo transposing sing the the great vessels vessels to the the correct correct anatomic anatomic placement with reimplantation of the coronary arteries. iii. iii. Tric Tricus uspi pid d Atre Atresi siaa - Absence Absence of the tricus tricuspid pid valve; valve; (incompatibl (incompatiblee with with life life unless unless there there is ASD, ASD, VSD, or PDA. Specific therapeutic intervention: 1. Palli Palliati ative ve treatm treatment ent procedu procedure: re: same same as for TOF TOF 2. Complete Complete repair: repair: Modified Modified Fontan Fontan procedure, procedure, conversi conversion on of the right right atrium atrium into an outlet for the pulmonary artery. iv. iv. Trun Truncu cuss Arte Arteri rios osus us - Singl Singlee great great vessel vessel aris arising ing from from the the base base of the the heart, heart, serv serving ing as as a pulmonary and aorta. - Systo Systoli licc murmur murmur is is heard heard with with a loud loud secon second d that that is not not split split.. Specific therapeutic intervention: 1. Palliativ Palliative: e: banding banding of pulmonary pulmonary arteri arteries es to decrease decrease blood flow flow to lungs. lungs. 2. Completer Completer repair: repair: Rastell Rastelli’s i’s procedure procedure – excisin excising g pulmonary pulmonary arteries arteries from from aorta & attaching them to the right ventricle by means of a prosthetic valve. General Clinical Findings: 1. Dyspne Dyspnea, a, espe especia cially lly on exer exertio tion. n. 2. Feedin Feeding g diffcul diffculty ty & failur failuree to thrive thrive (ofte (often n 1st sign) 3. Stri Stridor dor or cho choki king ng spe spell llss 4. HR more more than than 200, 200, RR RR = 60 5. Recurr Recurrent ent respir respirato atory ry tract tract infect infection ions. s. 6. In older older children: children: poor physical physical develop development, ment, delayed delayed milesto milestones, nes, & decreased decreased exercise tolerance. 7. Cyanosis, Cyanosis, squatting, squatting, clubbing clubbing of fingers fingers & toes. 8. Hear Heartt mur murm murs urs 9. Exce Excess ssiv ivee persp perspir irat atio ion. n.
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6. Neuro Neurolo logi gicc Malfo Malform rmati ations ons a. Spina Bi Bifida
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Malfor Malformat mation ion of the the spine spine in which which the poste posterio riorr portion portion of the the lamina laminaee of the vertebrae fails to close; usually in the lumbosacral area.
Classification: 1. Spina bifida bifida occulta occulta – defect defect only of of the vertebrae; vertebrae; spinal spinal cord cord & meninges meninges are intact. intact. 2. Meningocele Meningocele – meninges meninges protrude protrude through through the vertebral vertebral defect. defect. 3. Meningomyel Meningomyelocele ocele – meninges meninges & spinal spinal cord protru protrude de through through the defect defect.. Clinical Findings: 1. Degree of of neurologic neurologic dysfu dysfunction nction directly directly related related to to level of of defect. defect. 2. Defective Defective nerve nerve supply supply to bladder bladder affects affects sphincter sphincter & muscle muscle bone. bone. 3. Freque Frequentl ntly y poor anal sphi sphinct ncter er contro controll Treatment 1. Surgical repair of sac. 7. Gastroi Gastrointes ntestin tinal al Malfor Malformat mation ionss a. Cleft lip lip – failure failure of median median maxillary maxillary nasal nasal process process to fuse fuse by 5-8 weeks weeks of pregnancy pregnancy.. - Cause: UN UNKNOWN - Predi redisp spos osiing Facto actorrs: 1. Her Heredi editary ary. 2. Mate Matern rnal al smok smokin ing g
Chances of Having the Defect: 1. If history history of either either anomaly anomaly present present in in one parent parent = 4% chance chance that that 1st infant will have the defect. 2. If one infant infant is born born with a cleft cleft lip/pala lip/palate te but no hx of anomaly anomaly in in family, family, then chance chance of occurrence in next infant is 4%. 3. More More comm common on in male males. s. Clinical Findings: 1. Difficult Difficulty y feeding because because infant infant cannot cannot form a vacuum with with the mouth mouth to suck. suck. 2. Mouth breathi breathing, ng, resultin resulting g in increased increased swallowed swallowed air air causing causing a distended distended abdomen. abdomen. 3. Pressu Pressure re agains againstt the the diaphr diaphragm agm 4. Drying Drying up of of mucous mucous membra membranes nes in oroph orophary arynx. nx. Treatment : 1. Surgic Surgical al repai repairr – Cheilop Cheiloplas lasty ty (1-3 (1-3 month) month) Pre-op feeding technique: 1. Feed Feed in an an uprig upright ht pos posit itio ion. n. 2. Feed with with a soft soft large-h large-holed oled nipple nipple or or rubber rubber tipped tipped syringe syringe.. 3. Burp Burp freq freque uent ntly ly.. 4. Give Give water water after after each each feeding feeding for for cleans cleansing ing.. 5. To prevent prevent infection infection from from irritati irritation: on: restraint restraint’s ’s arm; provid providee pacifier. pacifier. 6
Post-op Care: 1. Main Mainta tain in a pat paten entt airw airway ay.. 2. Cleanse Cleanse suture suture line to to prevent crust format formation ion & eventual eventual scarri scarring. ng. 3. Prev Preven entt cryi crying ng.. 4. Place infant infant in in supine supine position position with with arm or elbow restra restraints ints.. 5. Feed 6. Logan Logan bar – ½ stre strengt ngth h H2O2 & sali saline ne soluti solution on b. Cleft Palate Palate – failure failure of the the palate palate to fuse fuse by 9-12 9-12 weeks of pregnancy. pregnancy. - may involv involvee the soft soft or hard hard palat palatee & may may extend extend into into nose nose,, formin forming g an oronasal passageway - Mor More com common mon in femal emales es Clinical Findings: 1. Infect Infection ion,, especiall especially y aspirati aspiration on pneumoni pneumonia. a. 2. Defect Defective ive speech speech – nasa nasall spee speech ch 3. Exce Excess ssiv ivee dent dental al cari caries es 4. Malocclusi Malocclusion on from from displace displacement ment of maxillary maxillary arch 5. Eati Eating ng diff diffic icul ulty ty Treatment: 1. Surgic Surgical al repair repair – Uran Uranopl oplast asty y done between 4-6 months c. Trach Tracheo eoes esop ophag hageal eal Anoma Anomali lies es Classification: 1. Abse Absenc ncee of eso esoph phag agus us 2. Tracheoesoph Tracheoesophageal ageal fistula fistula – abnormal abnormal connect connection ion between between the trachea trachea & esophagus. esophagus. 3. Atresia Atresia – failure failure of the esophagu esophaguss to form a continu continuous ous passage passage from the pharynx pharynx to the stomach during embryonic development. a. Atresi Atresiaa of esophagus esophagus witho without ut trach tracheal eal fistu fistula. la. b. Proximal Proximal esophageal esophageal atresia atresia combined combined with distal distal tracheoes tracheoesophagea ophageall fistula. fistula. Cause: UNKNOWN Clinical Findings: 1. 3C’s: 3C’s: coug coughin hing, g, choki choking, ng, & cyanos cyanosis is 2. Exce Excess ssiv ivee droo drooli ling ng 3. Excessive Excessive mucus in in nasopharynx nasopharynx causing causing cyanosis cyanosis,, reversible reversible by suctio suctioning. ning. 4. Choking, Choking, sneezing, sneezing, & coughing coughing during during feeding, feeding, with regurgi regurgitati tation on of formula formula through through mouth & nose. 5. Inabil Inability ity to to pass a cathet catheter er in the the stoma stomach ch Treatment: 1. Surgical Surgical repair repair – Fistula Fistula division division & gastrostomy gastrostomy,, esophageal esophageal anastomosis anastomosis or colonic colonic transplant. d. Inte Intest stin inal al Obst Obstru ruct ctio ion n Classification: 1. Mechan Mechanica ical: l: constr constrict icted ed or occlud occluded ed lumen. lumen. 2. Muscular: Muscular: Interf Interference erence with normal normal muscular muscular contraction contraction.. Clinical Findings: 1. Abdom Abdomin inal al dist distent entio ion n 2. Absence Absence of stools stools esp. meconium meconium in the the newborn newborn (meconium (meconium ileus) ileus) 3. Vomiting Vomiting of bile-stai bile-stained ned materi material; al; may may be projectile projectile 4. Cyanos Cyanosis is & weak weak grunti grunting ng respi respirat ration ions. s. 5. Paro Paroxy xysm smal al pain pain.. 6. We Weak, ak, thre thread ady y puls pulse. e. Treatment: Surgical Repair 7
e. Anorect Anorectal al Anoma Anomalie liess (Imper (Imperfor forate ate Anus Anus)) Classification: 1. Low Low anom anomal alie iess 2. Inte Interm rmed edia iate te anom anomal alie iess 3. High High ano anoma mallies ies Clinical Findings: 1. Failur Failuree to to pass pass meconi meconium um stoo stool. l. 2. Inability Inability to to insert insert a thermometer thermometer,, catheter catheter or small small finger into rectum. rectum. 3. Abdom Abdomin inal al dist distent entio ion n Treatment : 1. Surgical Surgical correction correction;; possible possible colostomy colostomy with multis multistaged taged surgical surgical repair. repair. f. Pyl Pylori oric Ste Steno nosi siss - Congenital Congenital hypertrophy hypertrophy of muscul muscular ar tissue tissue of the the pylori pyloricc sphincte sphincter, r, usuall usually y asymptomatic until 2-4 weeks after birth. - 5 tim times es mor moree comm common on in in male maless than than fem femal ales es.. Characteristics: Characteristics: 1. Grossly Grossly enlarged enlarged circular circular muscle muscle of pylorous. pylorous. 2. Narrow Narrowed ed openin opening g between between stoma stomach ch & duodenum duodenum.. 3. Inflammati Inflammation on & edema that cause total obstructio obstruction. n. Clinical Findings: 1. Vomiting, Vomiting, progress progressively ively projectil projectile, e, non-bile non-bile stained stained vomitus vomitus.. 2. Cons Consttipat ipatio ion n 3. Dehy Dehydr drat atio ion n & weig weight ht los losss 4. Olive Olive shape shape mass mass in in the the RUQ RUQ – patho pathog g sign sign 5. Disten Distenti tion on of the epigas epigastru trum m 6. Vesi Vesibl blee peri perist stal alsi siss Treatment: 1. Surgic Surgical al Repair Repair – Fredet Fredet-Ra -Ramst mstedt edt proced procedure ure g. Megacol Megacolon on (Hirsc (Hirschspr hsprung’ ung’ss Diseas Disease) e) - Absenc Absencee of parasy parasympa mpathe thetic tic gangl ganglion ion cells cells in in a portion portion of the the bowel, bowel, which which causes enlargement of the bowel proximal to the defect. - 4 tim times es mor moree comm common on in in male maless than than fem femal ales es.. Characteristics: 1. Length Length of involved involved bowel varies varies from from only interna internall sphincter sphincter to entire entire colon. colon. 2. Rectosigmoi Rectosigmoid d colon involvement involvement – most most commonly commonly affected affected Clinical Findings: 1. Constipati Constipation on of passage passage of ribbon-l ribbon-like ike or pellet-li pellet-like ke stools. stools. 2. Inte Intest stin inal al obstr obstruc ucti tion on.. 3. Abdom Abdomin inal al dist distent entio ion. n. Treatment: 1. Surg Surgic ical al repa repair ir h. Diap Diaphr hrag agma mati ticc Hern Hernia ia - Failur Failuree of pleurop pleuroperi eriton toneal eal cavit cavity y to close close complete completely ly during during embry embryoni onicc life.
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Characteristics: 1. Most of abdomina abdominall organs organs maybe maybe found found in in the thorax. thorax. 2. Respirati Respirations ons are compromi compromised sed by increased increased content contentss of thechest thechest – interfer interferes es with normal diaphragmatic breathing. Clinical Findings: 1. Severe Severe respir respiratory atory difficulty difficulty with cyanosis. cyanosis. 2. Relatively Relatively large chest, especially especially on affecte affected d side. side. 3. Failure Failure of affected affected side side to expand during during respir respiration, ation, absence absence of breath breath sounds. sounds. 4. Rela Relati tivel vely y small small abdo abdome men. n. Treatment: 1. Respir Respirato atory ry support support (upri (upright ght posit position ion). ). 2. Surg Surgic ical al Repa Repair ir a. Diaphr Diaphragm agmati aticc repai repairr withi within n 24 hour hours. s. 8. Sub Substan stance ce Dependenc Dependencee (Neonatal (Neonatal Abstin Abstinence ence Syndrom Syndrome) e) - infant infant born born with with physio physiolog logic ic depend dependence ence on alco alcohol hol or or drugs drugs as a resu result lt of maternal drug use and/or abuse. - Common Common Drugs: Drugs: Alcohol Alcohol,, Meth Methado adone, ne, Heroin Heroin,, Coca Cocaine ine
Withdrawal Symptoms: 1. Hype Hyperract activit ivity y 2. Shrill cry 3. Tremors 4. Sneezing 5. Yawning 6. Dist Distur urbe bed d slee sleep p 7. Seizures 8. Tachypnea 9. Drooling 10. Poor sucking sucking reflex reflex 11. Vomit Vomiting ing 12. Stuffy Stuffy nose nose 13. Excoriated Excoriated buttocks buttocks 14. Facial Facial scratc scratches hes Signs: 1. Resp Respir irat ator ory y dis distr tres esss 2. Jaundice 3. Conge Congeni nita tall anoma anomali lies es 4. Beha Behavi vior oral al alt alter erat atio ions ns Treatment: 1. Supportive Treatment
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