It is the neonatal period where the patient becomes important for growth and development. During this period up to 28 days of a newborn’s age, he/she is really vulnerable to all kinds of pathological conditions, which start from mild pathology to fatal morbidity. Neonatal disorders and their management are something that every medical student needs to know. They prepare you for an extremely critical time of patient care, which could change the health and development of the child for good. This blog overviews some of the most common and important neonatal disorders.
Neonatal Respiratory Distress Syndrome (NRDS)
Neonatal Respiratory Distress Syndrome is a condition that mainly affects preterm infants due to the fact that their lungs are not fully developed. This condition is caused by failure in producing a chemical known as a surfactant. Surfactant is a natural chemical produced that aids in keeping the lungs open by lessening the surface tension within the lungs to the point where they do not collapse on expiration.
Etiology: Prematurity is the most common cause of NRDS. The more closely gestational age approaches the preterm threshold, the greater are the chances for surfactant maturity of the infant. It can also be present in infants born to diabetic mothers.
Presentation: Symptoms classically present within hours of delivery and include tachypnea, granting, flaring of nostrils, and chest retractions. The severe varieties are susceptible to cyanosis and mechanical ventilation.
Management: Supportive management with ventilatory support and oxygen supplementation, CPAP, and surfactant replacement therapy forms the mainstay of treatment. The patient should be intubated when the conditions get complicated. Mothers at risk will receive antenatal corticosteroids to prepare them for advancing the level of surfactant in their preterm baby.
Read more: Pediatrics Blogs for Fmge and Neet PG Preparation
HIE
Overview: Hypoxic-ischemic encephalopathy is birth asphyxia in the neonate, creating an insult to the brain and therefore causing damage; it is usually associated with perinatal asphyxia.
Etiology: HIE causes complications at the time of labor and delivery, such as umbilical cord accidents, placental insufficiency, or uterine rupture; also health issues to the mother that include preeclampsia or infection.
It can present with very varied signs and symptoms over a range of intensities. At times, children have presented with lethargy, feeding abnormal tone, and even seizures. In some cases, they start to develop abnormal respiratory patterns. It causes long-severe impairments of the neurological system.
Management: The baby should be resuscitated immediately and oxygen support initiated. One of the treatments is known as therapeutic hypothermia, in which the baby is cooled to 33-34 °C for 72 hours. Such treatments have already been shown to prevent the catastrophic forms of neurological damage. Early diagnosis ensures minimal damage to the brain.
Neonatal Jaundice
Overview: The most common condition encountered in neonates is jaundice. Definition Jaundice is the condition wherein the levels of bilirubin are elevated way beyond their normal range within the blood, and it usually appears as a yellowish-yellow discoloration both in the skin and in the sclerae of the eye.
There are two primary subtypes: physiologic and pathological. Physiologic jaundice represents the most common disorder of neonates, as their livers are functionally immature, thereby having limited ability to conjugate bilirubin. Secondary or pathological causes may include other hemolytic disorders (e.g., incompatibility such as Rh hemolytic disease), infection, or a primary disorder of the liver.
Signs and symptoms. Yellowish discoloration of the skin and whites of the eyes. In most patients, serum levels of bilirubin are measured to provide an estimate of the degree of disease activity.
Management: Treatment of physiologic jaundice is hardly recommended since it clears up on its own within just a few weeks. It is however applied in severe conditions; phototherapy can be given to the baby, and light will degrade the bilirubin produced in the skin. Pathologic jaundice will require treatment of the causal condition; exchange transfusions may need to be done depending on the condition state
Neonatal Sepsis
Neonatal Sepsis is a severe bacterium infection that causes systemic inflammation and organ dysfunction. It has become one of the most common causes of morbidity and mortality in neonates, particularly among preterm birth or immunocompromised individuals.
Etiology: Neonatal sepsis is divided into early-onset sepsis within 72 hours of life and late-onset sepsis after 72 hours. Group B Streptococcus, Escherichia coli, and Listeria monocytogenes are the common pathogens that cause neonatal sepsis.
Signs and Symptoms: Fever, poor feeding, lethargy, respiratory distress, and abnormal vital signs are included in the symptoms. It can advance very rapidly. Early diagnosis prevents organ failure.
Management: A presumed neonatal sepsis needs to be initiated with broad-spectrum antibiotics; culture needs to be done so the pathogen may be targeted within the antibiotic regimen. Supportive care would entail fluids and ventilation support.
Intraventricular Hemorrhage (IVH)
Overview. Intraventricular Hemorrhage refers to bleeding within the ventricular system of the brain; this condition occurs more frequently in preterm infants who are delivered before 32 weeks of gestation. Such intraventricular hemorrhage, given such a dangerous health condition, would lead to a lifetime disability if it occurred.
Etiology. The most common risk lies with premature babies. Since blood vessels within the premature baby’s head are sensitive and prone to bleeding, it is most likely to hemorrhage, particularly during the early days after delivery.
Manifestation and signs: slight may either be asymptomatic or can also come in manifestation through fits, failure to feed, unconsciousness, and alteration in the muscle tone for severe.
Management: It is preventive one. Antenatal corticosteroids even make the lung mature with lesser cases of IVH. Supportive care will be highly needed for such a patient to get it closer in further observation. The surgical approach will interfere with the patient even when of very grave form IVH and lead to a situation in which the event known as hydrocephalus occurs
MAS
Overview: Meconium Aspiration Syndrome is one of the conditions in which the baby ingests meconium, or stool of the fetus, during or shortly after birth. Such intuitions are said to relate with more disturbances of the infant’s respiratory system as well as numerous complications.
Etiology: MAS is usually seen in post-term babies and babies who have had fetal distress at the time of delivery. The fetal distress leads to a passage of meconium from the baby into the amniotic fluid before delivery that is aspirated at birth by the baby.
Symptoms/Manifestations. Common presentations include the association of dyspnea or respiratory distress with cyanosis. Some of the presentations are chest X-ray abnormalities that may have a patchy infiltrates or hyperinflation appearance. There may be pulmonary hypertension and acute respiratory failure at times.
Management: High-pressure suction on the airway must be followed with immediate resuscitation. Also, oxygen therapy and ventilatory management must follow when it is manifested seriously. Patients may have to be treated with Nitric oxide and even surfactant
Heart Defects that are Congenital
About: Congenital heart defects are structural heart anomalies at birth. It varies from mild to severe and even life-threatening and can cause heart failure and cyanosis.
Etiology: This condition is multicausal in its etiology. Thus, sometimes together, the involvement of environmental, genetic, and maternal factors leads to the causation. To give a flavor, maternal diabetes, infections, and some medicines are well-known conditions that can predispose a patient to this disease.
It often presents with cyanosis, poor feeding that is usually accompanied by signs of heart failure. The clinical signs of which include tachypnea and edema. Others are symptom-free at birth. Some become symptomatic subsequently, especially patent ductus arteriosus.
Management of CHDs is generally related to the nature of the defect. While for some it will resolve spontaneously; for instance, a patient with patent ductus arteriosus may only be treated by a simple medication; for others, catheter intervention could be offered when surgery would be necessary.
