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The Neonate
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Laura De Angelis, Luca Ramenghi
Meconium is the first intestinal discharge of newborn infants, normally expelled within the first 24 hours from birth. It is a thick, dark-greenish mass composed of substances ingested during the intrauterine life, including intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile, and water. Intrauterine or intrapartum stress may cause the meconium to be expelled before birth. Meconium-stained fluid is present in 8%–20% of deliveries, and it is almost exclusively found in term or postterm infants. Meconium aspiration syndrome occurs intrapartum when a newborn infant breathes a mixture of meconium or meconium-stained amniotic fluid. The presence of meconium in the lungs may cause bronchial obstruction and lung inflammation, leading to a moderate to severe respiratory insufficiency. The treatment is based on the infant’s conditions at birth. If the baby is vigorous and cries immediately, routine neonatal care should be administered. If the infant is floppy or lethargic, prompt intubation and direct suction of the trachea are warranted. Intrapartum endotracheal intubation and tracheal suction before the shoulder’s delivery is no longer recommended in case of meconium-stained amniotic fluid (see Chap. 25) [6].
Amnioinfusion
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
James Kerns, Erol Amon, Hung N. Winn
Prior to the use of amnioinfusion, combined obstetric and pediatric suctioning of the neonate’s airway during and after delivery was the mainstay of preventing meconium aspiration syndrome. This technique, as described by Carson and colleagues (26), was reported to decrease the frequency of meconium aspiration syndrome, assuming the aspiration occurred during the delivery process.
Mechanical ventilation and support
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Which of the above pressure settings would be the most appropriate for the following situations? Each option may be used once, more than once, or not at all. A 27-week-gestation infant on day 1 of life, treated with surfactant. Most recent blood gas demonstrates pH 7.42, PCO2 3.5 kPa. Current ventilator settings 20/4 in 21% oxygen.A term baby with meconium aspiration syndrome. Currently ventilated with 22/4. PCO2 is 4.5, pH 7.38, 70% oxygen.A 24/40 infant on day 3 of life. Currently ventilated on 18/4 in 30% oxygen. Recent blood gas PCO2 7 kPa, pH 7.18.A 28-week-gestation infant ventilated from birth. Current settings 22/5 in 21% oxygen. Blood gas demonstrates pH 7.16, PCO2 9 kPa.
Congenital bilateral nasolacrimal duct cysts with respiratory distress in a newborn
Published in Acta Oto-Laryngologica Case Reports, 2022
Haruo Yoshida, Chiharu Kihara, Kyoko Kitaoka, Chisei Satoh, Yoshihiko Kumai
A 0-day-old female infant was born at 40 weeks and 2 days of gestation with oligohydramnios and a low birth weight of 2440 g. The Apgar score was 8 points in both 1 and 5 min, but she exhibited respiratory distress requiring oxygenation immediately after birth. She was then transported to the neonatal intensive care unit in our hospital as an emergency case. Blood examination, blood gas analysis, and chest X-ray were performed. Meconium aspiration syndrome was suspected initially because of elevated blood carbon dioxide levels and pulmonary air leak and partial atelectasis of the left lung. Thus, nasal continuous positive airway pressure (nCPAP) delivery was implemented, and ampicillin was administered intravenously for 4 days. However, resistance was felt during suctioning of both nasal cavities, and large amounts of nasopharyngeal secretions could not be removed; therefore, she was referred to the Department of Otolaryngology at 3 days of age.
Use of the modified myocardial performance index for evaluating fetal cardiac functions in pregestational diabetic pregnancy babies
Published in Journal of Obstetrics and Gynaecology, 2021
Merve Oncel Alanyali, Fatos Alkan, Burcu Artunc Ulkumen, Senol Coskun
Mode of delivery in pregnant women participated in the study was vaginal in 28.3% (n = 17) and caesarean in 71.7% (n = 43). In PDM group vaginal delivery was 23.3% (n = 7) and caesarean in 76.7% (n = 23). Pregnancies of the control group resulted vaginal in 33.3% (n = 10) and 66.7% (n = 20) resulted in caesarean delivery. There was no statistically significant difference between birth status and disease status (p = .567). Eight (26.6%) of the PDM mother babies had birth weight >4000 g (macrosomic) and just one of the control group were macrosomic. At the end of the delivery, complications were detected in 26% (n = 8) of the pregnancies in the PDM group and they were followed up in the neonatal intensive care unit. Two of them had an infection, moaning, and tachycardia, birth weight of less than 2500 g in one, respiratory distress in one, meconium aspiration syndrome in one and one hypoglycaemia was found as a complication. Only one of the pregnancies in the control group had a postpartum infection-related complication. Postpartum complications were more frequent in the infants of PDM than in the control group and this was statistically significant (p = .026).
Correlations of Enzyme Levels at Birth in Stressed Neonates with Short-Term Outcomes
Published in Fetal and Pediatric Pathology, 2018
Junya Nakajima, Norito Tsutsumi, Shonosuke Nara, Hiroki Ishii, Yusuke Suganami, Daisuke Sunohara, Hisashi Kawashima
Transient tachypnea of the newborn (TTN) and meconium aspiration syndrome (MAS) were diagnosed based on risk factors (i.e. meconium staining of amniotic fluid, premature rupture of membranes, and maternal infection) and characteristic chest X-ray findings. Perinatal asphyxia was diagnosed according to perinatal data (e.g., birth following placental abruption or fetal distress) and exclusion of other disorders such as TTN and MAS. At our institution, venous blood samples of either patients born at our institution or at other hospitals are routinely collected at the time of admission to the NICU, not in delivery rooms. Venous blood gas analysis, complete blood count, and blood chemistries, including the intracellular enzymes listed below, are drawn routinely. We collected patient background data, gestational age, birth weight, method of delivery, Apgar scores at 1 and 5 mins, and the duration between birth and the time of blood sampling. We recorded pH, base deficit, and levels of lactate, AST, ALT, LDH, and CK at the time of admission. We evaluated pH, base deficit, and lactate using the ABL800 FLEX (Radiometer, Copenhagen, Denmark), and AST, ALT, LDH, and CK using the VITROS5600 (Johnson and Johnson, New Jersey, USA) and LABOSPECT008 (Hitachi High-Technologies Corporation, Tokyo, Japan), according to manufacturer's instructions. The reference ranges for each parameter shown in the Tables were according to Japanese standards for healthy newborn infants (11).