Medicine for life

  Hypoxic Ischemic Encephalopathy : state of hypoxia (arterial O2 lack), Ischemia (lack of perfusion) affecting CNS (Hypoxic Ischemic Encephalopathy) wich occurs in infants exposed to perinatal asphyxia presented by decreased Apgar score, cyanosis, pallor, convolutions, hypotonia, apnea within 12 hours after birth (variable severity). Perinatal asphyxia:   hypoxemia-hypercapnia and metabolic acidosis due to disturbed gas exchange in the placenta or lungs. lung expansion doesn't occur within minutes after birth and is unable to establish ventilation and pulmonary perfusion. manifested by increase respiratory effort(1ry hyperpnea) followed by 1ry apnea 1minute then rythmic gasping 8-10 gasps/min. for several minutes then 2ry apnea occurs. Criteria of diagnosis ( profound metabolic or mixed acidosis and low Apgar score < 3 in 1st 5 minutes). Pathology of HIE: Hypoxia increases glycolysis in brain cells and decreases cerebral ATP leading to an increased amount of lactate, ...

 HISTORY taking and Neonatal examination: Perinatal history: Prenatal: ( maternal history during pregnancy): -Age. -Blood group. -Illness. -Drugs, X-rays. -Trauma. Natal: _Anathesthesia. -Site of labor. -Type of labor. -Duration. -Premature rupture of the membrane. Postnatal: _Condition of the baby. -resuscitation. Past history: -History of abortions. -IUFD or premature. Family history: -Number of kids. -Similar condition. -Consanguinity. -Inherited diseases. ** Newborns are examined immediately after birth to check for major abnormalities and then should be examined with a complete physical examination within 24 hours of delivery. EXAMINATION: Quick examination. Detailed examination. Special examination. Quick examination : (in the delivery room). Agar score : -At 1 and 5 minutes. -At 10 and 20 minutes if the score at 5 minutes <7. -Check the baby's activity, pulse, grimace, appearance, and respiratory rate. -Placed on the servo with neck baby. Color: -An indicator of cardiopul...

 Pathophysiology: poor control of diabetes leads to fetal hyperglycemia then hypertrophy of beta cells of the pancreas and hyperinsulinemia and increased hepatic glucose uptake, glycogen synthesis, lipogenesis, and protein synthesis leads to an increase in the weight of the placenta and fetal organs except for the brain. *Macrosomia LGA. *Myocardial hypertrophy. *extramedullary hematopoiesis. Separation of the placenta leads to interrupted glucose infusion, hyperinsulinemia, and hypoglycemia in 40% of cases this occurs 1-2 hours after delivery of blood glucose less than 35mg/dl. the baby suffered from lethargy, apnea, jitteriness, hypotonia, and poor feeding. 1-3% of gestational diabetic mothers. 0.5% of Insulin-dependent Diabetes Mellitus. Clinical manifestations in the infant of the diabetic mother:  *Hypocalcemia: due to delay of parathyroid hormone rise or hypomagnesemia. *Respiratory distress: due to  # transient tachypnea of neonate (TTN). #hpertrophic cardiomyopat...

 Neonate:                 Is the period of life from the 28th week of gestational age to the 28th day after birth. Fetal assessment:                 This means a determination of well well-being of the fetus. The fetus:                  The end of the eighth week of conception is when the major structures have formed until birth. this assessment needs some common procedures: * Medical history and examination of the mother.  * Chemical assessment of placental function. *Amniocentesis for assay of amniotic fluid assay of bilirubin in Rh incompatibility &assay of respiratory distress syndrome by lecithin and sphingomyelin ratio and assay of surfactant production. *Chorionic villus sampling for genetic abnormalities. * Electronic and ultrasonic fetal H.R.monitoring, * Precautions umbilical blood sampling (cordocentesis). * Ultrasonography: a non-invasive...

 Definition of Congenital anomalies:  Abnormalities of body structure that originate before birth. Etiology: Genetic: chromosome abnormality : 6% in incidence & autosomal abnormalities and more severe than sex-chromosome. prenatal or postnatal retardation of linear growth, brain growth, mental retardation, and multiple anomalies of early embryogenesis. Single gene defect:  7.5%  Isolated: in one organ or system e.g hydrocephalus, microphthalmia, polydactyly. Multiple: multiple organs or systems don't have an embryological relationship.                e.g. Meckel syndrome: Autosomal recessive (encephalophy& polydactyly and polycystic                        kidney.        3. multifactorial:              majority of cases.             polygenic inheritance of 2 or more genes inclu...

 We Will review some of the most common congenital anomalies examples in brevity: *Cleft lip /palate: most common head and neck anomalies. leads to recurrent chest and ear infections. must engorgement breastfeeding (may need breastfeeding consultant to prevent aspiration) surgical closure before phonation to prevent hypernasality. * Choanal atresia: Congenital blockage of the posterior nares due to the persistence of the bony septum in 90% of cases or soft tissue septum in 10% of cases. Inability to pass catheter in the resuscitation room. Respiratory distress due to upper airway obstruction. Must use oral airway if bilateral closure detected until a surgical correction occurs. *Tracheal-esophageal fistula (TOF): It May happen isolated or with VATER syndrome. Esophageal atresia with distal TOF occurs in 85% Suspected in polyhydramnios. A lot of secretions with cough and choking with feeding. Failure to pass the nasogastric tube beyond the proximal esophagus. Do an X-ray to diagnose...