Sakharova Inna. Ye., MD, PhD An introduction to the neonatology. Medical care for the newborns in a maternity hospital. Sakharova Inna. Ye., MD, PhD

“The most dangerous time in an infant’s life is the neonatal period, the 28 days after birth. For those babies who survive, over seven decades of life may be anticipated.” H.E. Evans

Neonatology is a branch of pediatrics that studies the care, development, and diseases of newborn infants.

Gestational age is measured from the first day of the mother's last normal menstruation. The average gestational age is 40 weeks (280 days). The majority of infants is born between 37 weeks (259 days) and 42 weeks (294 days) and is referred to as term infants.  Preterm infants are those born before 37 weeks while post-term infants are born on or after 42 weeks. 

Intranatal period begins from the first signs of the delivery, extends until the birth of the baby.

Perinatal period begins from 28 weeks of gestation, extends until the 7 days after delivery, and includes: a) late antenatal period (from 28 weeks of gestation to 40 weeks of gestation); b) intranatal period (from the first signs of the delivery until the baby will born); c) early neonatal period (from the birth of the baby until 7 days after birth)

Neonatal period begins from the birth of the baby, extends until 28 days after birth. Neonatal period divides on: 1.Early neonatal period – from the birth until 7 days after birth. 2.Late neonatal period - from 7 days until 28 days after birth.

The functional status and grade of maturity of the newborn are evaluated with: Apgar score. Ability to maintain the stable temperature. Presence of the newborns reflexes. Sufficient levels of movement activity and emotional reactions. Newborns maturity signs according clinical features and special tables.

Care for newborn immediately after birth. Clearing the airway. Assessment by Apgar score.

Apgar score SIGN SCORE 1 2 Heart rate Absent Less than 100/min 1 2 Heart rate Absent Less than 100/min Over 100/min Respiratory effort Weak/irre-gular Strong/re-gular Muscle tone Atony Some flexion Active movement Reflex irritability No response Grimace Cough or sneeze Color Universal cyanosis or pallor Pink body, acrocyano-sis Completely pink

Care for newborn immediately after birth. Warming. Umbilical cord care.

After birth, the cord is clamped and cut After birth, the cord is clamped and cut. The recommended length of the stump after cutting is 2 or 3 cm. Solution of 0.5% chlorhexidine and 70% alcohol (brilliant green, iodine tincture) is used to clean the cord twice daily on admission and daily for the first three days. Eventually between 5-7 days the cord will become dry and will naturally fall off. During the time the cord is healing it should be kept as clean and as dry as possible. Daily care for umbilical wound include application of 3 % hydrogen peroxide or 5% KMnO4.

Care for newborn immediately after birth. Gonoblennorrhea prophylaxis (30 % solution of natrii sulfacyl, chloromycetin ointment) First feeding

The causes of neonatal transient (temporary, physiological) states: the environment becomes totally different change of barometric pressure unstable temperature of surroundings other tactile irritants microbic environment

Transient erythema Transient weight loss of up to 10 % of birth weight may occur during the first 3 to 5 days of life. Birth weight is usually regained by the seventh day. Transient erythema usually appears in all newborns during first 3-7 days of life because of capillary reaction for skin receptors stimulation with different external irritants. After erythema there is slight desquamation on the skin.

Erythema toxicum neonatorum can appear on the 2-5 day of life like allergic reaction.  It looks like red blotchy rash, associated with whitish papules (which may look like pustules but without puss, contain eosinophiles) on the trunk, extremities, and the face. It disappears during 2-3 days usually. No treatment is indicated.

Transient changes of heat balance: transient hypothermia transient hyperthermia

Neonatal transient nonhemolytic hyperbilirubinemia (physiological jaundice). It occurs in approximately 50% of newborns on the 2-3-rd day of life and disappears up to the end of the second week. Total serum bilirubin concentration doesn’t exceed 205 mkmol/L (12 mg/dL).

Sexual (hormonal) crisis In newborn on the 3-4-th day of life can appear symmetrical breast engorgement, nipple discharge (white transparent fluid). Desquamative vulvovaginitis (mucous vaginal discharge during first 3 days of life) also can have place. In 5-10% of girls on the 5-8-th day of life can be present pseudomenstruation, lasts for 1 day

Transient peculiarities of the renal function In all newborns during first 3 days there is early neonatal oliguria, transient albuminuria. During the first week of life can be uric acid infarct which clinical features are rick-red or dark orange spots on the swaddling bands or newborns clothes, diapers after urination.

Transient dysbacteriosis The transient stool of the newborn is meconium- a sticky greenish substance that is excreted during the first few days after birth Transient dysbacteriosis frequent watery greenish stool. The causes of this disorder are bacterial contamination of sterile intestine and new milk food.

Contraindications to “early” discharge (< 30 hours): 1. Birth asphyxia 2. Diagnostic work-up in progress 3. Presence of significant congenital anomalies (i.e.cleft lip/palate, heart disease, chromosomal abnormalities, hydrocephalus, meningomyelocele...) 4.  Medical/surgical problems requiring further care (i.e. congenital infections, apnea episodes, drug withdrawal, poor feeding, anemia, paralysis, blindness, abnormal neurological function)

5. Multiple birth 6. Parental history of significant medical/psycho-social problem (i.e. substance abuse, uncontrolled epilepsy, mental retardation, psychiatric problem) 7. Maternal age 16 or younger 8. Maternal death 9. High risk for child abuse (i.e. previous child abuse family, poor social conditions, unwanted pregnancy, poor parental problems) 10. Severe family economic problems (i.e. inadequate housing)

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