Infant Respiratory Distress Syndrome

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Infant respiratory distress syndrome

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I RDS Of all the reasons a baby can get admitted to the NICU I RDS is the single most common and you will find it referred to frequently throughout this booklet. Description this is the syndrome of prematurity and is caused by developmental insufficiency of surfactant production. It is also a structural immaturity of the lungs. I RDS vegan shortly after birth and manifest by to kidney a tachycardia chest wall retractions expiratory grunting nasal flaring and cyanosis. As the disease progresses the baby May develop ventilatory failure and apnea. Despite huge advances and care and treatment of these babies, RDS Remains the leading cause of death within the first month of life in the developmental world. The pulmonary involvement, a baby with an insufficient amount of surfactant will have difficulty and opening their I'll be aligned initially and in keeping those of Eli open. They all bli will collapse making it impossible for the pulmonary capillary bed to transport oxygen or dispose of carbon dioxide. This is when the signs and symptoms of RDS will begin appearing they are to kidney I tachycardia nasal flaring cyanosis chest wall retractions expiratory grunting ventilatory failure and apnea. Prompt attention to the signs and symptoms is critical oxygen and or positive pressure support will be necessary to improve this patient status. Treatment is to provide support per NRP guidelines and continually adapt ventilatory support to accommodate the changes in patient status. Delivery room options include Blow by oxygen CPAP positive pressure ventilation via mask or into tracheal tube and surfactant therapy. A low lung volume strategy is always a goal during the care of an infant in our facility. Weather in the delivery room or in the NICU, we strive to use the absolute lowest level effective positive pressure. In the NICU this goal is achieved by targeting lung volumes to be 4 - 6 ml per kilogram. In the delivery room you will not be able to Target volumes, but with Keen assessment skills and a sharp attention to detail you will be able to alter your respiratory rate Peep and I time to effectively achieve the same effective mean airway pressure while using a lower Peak pressure. This low lung volume strategy is the very best thing we can do for these fragile infants in order to attain and to support the growth of healthy lung tissue this technique will help in preventing the development of long-term bronchopulmonary dysplasia or BPD. Here at Mary Birch while we understand it will not always be possible we do expect this strategy to be the gold on every baby every time.

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Delivery room preductal spo2 goals

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1 minute 60 to 65%

2 minutes 65 to 70%

3 minutes 70 to 75%

4 minutes 75 to 80%

5 minutes 80 to 85%

10 minutes 85 to 95%

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Gestational spo2 goals

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Greater than 35 weeks 92 to 97%

Less than 35 weeks 90 to 95%

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Signs and symptoms of RDS

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Tachypnea tachycardia chest wall retractions expiratory grunting nasal flaring cyanosis ventilatory failure apnea

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Medications pertinent to

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Betamethasone, a steroid given to some Mother's prior to delivery to stimulate fetal lung maturation and to the crease the incidence of intracranial hemorrhage in premature infants.

Magnesium sulfate, is often used to treat severe high blood pressure also known as preeclampsia. It is also used to delay of premature labor by inhibiting uterine muscle contraction. The effects are those of a muscle relaxant..

Prostaglandin, this medication is given to newborn patients with cyanotic heart defects to prevent the closure of a patent ductus arteriosus. These patients are dependent on the PDA for circulations

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Useful terminology

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ALS means Advanced life support

Breech means a baby that enters the birth canal with the buttocks or feet on the downward position as opposed to the normal head first presentation

Vertex means the normal head down position of a baby entering the birth canal

Code pink means baby in cardiac arrest

Code 99 means immediate ALS RCP team help needed

Congenital means at Birth

Failure to progress means a term used when apparently effective labor contractions do not lead to delivery of the baby

Hypoplastic means underdeveloped

Iugr means intrauterine growth retardation

LGA means large for gestational age

SGA means small for gestational age

Micro preemie means a baby weighing less than 800 G or born before 26 weeks

Multiple gestation means more than one fetus in a single pregnancy

No prenatal care means no doctor appointments and no medical advice during a pregnancy prior to come into a delivery a baby

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C-section

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A cesarean section is an incision made through the abdomen and the uterus in order to remove a baby. A mother may be taken to the or for a cesarean section for many different reasons such as a breech baby buttocks down failure to progress, multiple gestations or if the baby has an anomaly. Typically a C-section is performed when a vaginal delivery would put the baby or the mother's health or life at risk. This can be a scheduled procedure or an emergency event. The pulmonary involvement is. a common result following a C-section delivery is that the baby will retain amniotic lung fluid. This fluid will eventually be coughed out, or Beery observed this fluid will eventually be coughed out, or be reabsorbed by the baby. Until one of these things happen the baby may need respiratory assistance. Treatment. Dry stimulate and provide support for NRP guidelines while adapting to changes in patient status. Blow by oxygen, CPT, CPAP, ppv and intubation are all common treatments following a C-section. All patients will be observed for at least 5 minutes for signs and symptoms of RDS.

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D cells or decelerations

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D cells Also known as non reassuring heart racing. This is a drop of a baby's heart rate during delivery. D cells are returned Lee described as early late variable or prolonged variable normal fetal heart rate is 120 to 160 beats per minute. A D cell is considered any heart rate drop below babies low Baseline. Early equals a gradually decline and the onset of the deceleration mirrors the onset of the contraction. This is normal during the labor and is a result of the baby's head being compressed.

Late, similar characteristics as early but the onset is after the onset of the contraction. These dealt D cells are associated with utero placental insufficiency. Contractions start, blood flow is compromised, the baby is left to rely on his own reserves, when that runs out, the D cell occurs. When the contraction ends, blood flow is restored and patient recovers.

Variable, can occur at any time, before, during or after a contraction. They are characterized by an Abrupt drop in heart rate in abrupt return to Baseline. These D cells vary in size timing depth and duration they are associated with umbilical cord compressions nuchow cord, prolapsed cord and a knot in the cord. One variable can last up to two minutes. A neutral cord means wrapped around the neck a prolapsed cord means the cord enters the birth canal with the baby. A cord knot is a true knot in the cord prolonged variability means the longer the cord compression last, the deeper and longer the D cell will become and more serious. A prolonged variable increases duration and severity of hypoxia of the baby and can last from 2 to 10 minutes the pulmonary involvement. The ALS RCP team is that the delivery in case the infant has been compromised due to hypoxia in utero. The longer the hypoxia the worst the baby will be. The longer and deeper the decel the more likely the baby will come out floppy and with a low heart rate and no respiratory effort. Treatment, dry and stimulate the infant if the infant has been severely compromised by a nuchal cord or prolapsed cord stimulation alone will likely not be enough to make him cry. This infant may require ppv to restore submission heart rate and to encourage respiratory effort. Provide support for NRP guidelines while adapting to changes in patient status once table continue to watch the patient for status changes and for signs and symptoms of RDS.

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Decreased variability

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Decreased variability The pattern of a fetal heart rate tracing over a 1-minute time span is expected to look like a smooth undulating pattern much like a breathing pattern. With each individual baby they have a standard fluctuation near their Baseline heart rate. The pattern of a fetal heart rate tracing over a 1 minute time span is expected to look like a smooth Anjali eating pattern much like a breathing pattern. With each individual baby they have a standard flux station near there baseline heart rate. This way we flexion is watched and measured on the fetal heart rate tracing continuously during labor. The patience range or very ability is measured by the peaks and trough on the tracing itself. The patience baseline heart rate is in the middle of these pics and Trust. They're very bility is the difference between the peak and the trough. Mark very ability equals greater than 25 feet per minute between peak and trough mater very ability equals sick to 25 beat permanent between pecan trough minimal very ability equals less than 5 beef permanent between peak and trough option very ability equals amplitude range is on detective all. So while the president's of good very villages not always predicted good outcome persistent minimal or option very ability appears to be the most significant sign of fetal compromise. The pulmonary involvement, this baby make come out floppy with the low heart rate and no rest try drive. Peters of the essence hear a quick and efficient Rizzo station is imperative for this baby. The treatment is to drive stimulating provide support for in RP guidelines all adopted to changes in patience status. Everything from a simple drawing stimulate to positive pressure ventilation and Interbay Shannara expected at this delivery.

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Premature or preterm infant

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Premature or preterm infant This is an infant between 24 weeks and 37 weeks gestation period a fetus prior to 24 weeks is not considered viable although we may occasionally get a baby in the late 23-week range. 37 to 40 weeks is considered full-term gestation. 24 to 26 weeks is severe prematurity. 27 and 29 weeks is moderate severity. 32 34 weeks is mild to moderate. 35 to 36 weeks is near term. The pulmonary involvement. Lung development and gestational age are directly related. They may both be referred to as premature, however a 24-week or will not be producing surfactant well, we'll have underdeveloped and delicate lung tissue, and weak musculature, will a 35 week or may have fully functional and efficient lungs. On your way to the living room, keep in mind the gestational age of the baby and be prepared for that. The treatment is too dry stimulate and provide support for NRP guidelines while adapting to changes in patient status. At all ages watch closely for signs and symptoms of RDS and be mindful of keeping the paper as low as possible be ready for a 24 to 25 week or 2 require increased oxygen, intubation, full respiratory support, surfactant and transport to the NICU. You can expect slightly less support as the gestational age increases. In some cases that are CP and ALS nurse may even need to perform CPR.

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Meconium aspiration

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Meconium aspiration This happens when the infant's Tools in utero, before birth. The meconium is green tea yellowish in color. If the infant inhales the contaminated amniotic fluid respiratory problems will likely occur. The infant's skin, umbilical cord and nail beds may be staying green if meconium has been present for a prolonged amount of time before birth. The pulmonary involvement, the ability of the lungs to conduct basic gas exchange can be drastically affected by the presence of meconium. This baby will likely develop RDS. They will often need intubation and full respiratory support. Pphn and pneumothorax are also common outcomes. The treatment is if the infant does not cry and is apnic after birth, do not simulate. This patient will need to be intubated by ALS and suction with a meconium aspirator below the vocal cords, following this procedure the baby will often require ppv, dry stimulate and provide rest for support as needed for NRP guidelines. If the infant does cry once delivered dry stimulate an orally suction infant as usual and provide support for NRP guidelines. ALS may also want to suction out the stomach. RCP will provide Blow by oxygen during suctioning. In severe cases meconium babies may need intubation and full respiratory support. If the baby's condition requires intubation or show signs and symptoms of RDS he will come to the NICU to be further evaluated and treated.

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Vacuum forceps delivery

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Vacuum forceps delivery The vacuum or forceps are tools used by delivering physician during a vaginal delivery and occasionally in the or when the infant's head is close to delivering, but no longer progressing. The MD needs the assistance of the vacuum or the forceps to jelly pool and guide the infant out as a mother pushes. The vacuum has a soft cup on it send that is put on the infant's head once the baby's head has begun emerging from the vaginal canal and is held in place by suction pressure. Forceps or large metal tongs that are placed on both sides of the infant's head with in the vaginal Canal. Both of these techniques are used to weigh to help avoid having a c-section after failure to progress and or fetal distress has been established. The pulmonary evolvement, it's either of these techniques are used it is likely that the infant has been in the vaginal Canal for a long. Of time and I shown signs of distress. Expect this baby to be depressed at Birth. The ALS RCP team will be at the delivery to provide the necessary support. The delivering MD will always wait for the ALS team to be present before starting this procedure. The treatment is to dry stimulate and provide support for NRP guidelines wall adapting to changes in patient status and watching for signs and symptoms of RVs. Added to this initial ALS team assessment, we will look for signs of damage or bruising to the skin of the infant's head neck and cheeks were the suction of forceps were touching

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Prolapsed cord or umbilical cord prolapse

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Prolapsed cord or umbilical cord prolapseThis is when the umbilical cord precedes the fetus exit from the uterus. It is an obstetric emergency during pregnancy or labor that immediately and dangers the life of the fetus. Prolapsed cords are rare occurring in about one of every three hundred births. Cord prolapse is often concurrent with the rupture of the amniotic sac. After the sac ruptures, the fetus move downward into the pelvis and puts pressure on the cord. As a result, oxygen and blood supply to the fetus are diminished or cut off and the infant must be delivered quickly. The doctor will try to reduce the pressure on the cord and the den deliver the baby vaginally, if this fails an emergency C-section is needed. The mother is placed in Trendelenburg position and an attendant reaches up the bat ghina and pushes the baby up into the pelvis to remove the pressure from the cord until the C-section is performed. The pulmonary involvement, the infant will most likely be delivered by C-section. This infant could be severely depressed at Birth due to its oxygen and blood supply being diminished. The RCP should be prepared to provide extensive support depending upon the infant's condition. The baby's heart rate will be monitored for as long as possible in the OR prior to the C-section starting. Be aware of the heart rate. It will help you gauge the baby's condition. The treatment is to dry stimulate and provide support for NRP guidelines wall adapting to changes in patient status. Everything from a simple dry and stem the ppv and intubation are expected at this delivery.

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Twins and multiples

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Twins and multiples The similarities and differences between Twins triplets and so on are determined that several stages during a pregnancy. Genetic similarities are determined at conception. The intrauterine environment is developed shortly thereafter and that can affect their ability to grow. Also individual babies can have an effect on each other both in utero and during the birthing process. Below I have tried to simplify the terminology of twins explain the reasons why we are expected to attend twin deliveries and the complications we may see. Discordant twins equal any twins that are greater than or equal to 10% difference in their size at Birth. Concepcion fraternal twins two or more eggs we eat fertilized individually. This type of conception creates two or more embryos that are no more genetically alike than ordinary full siblings. Identical twins equal a single fertilized egg splitting into two or more embryos each carrying the same genetic material. Conjoined twins equal identical twins that either fail to separate completely in utero or perhaps separate completely and then partially rejoin. Intrauterine environment equals the four terms used to describe the intrauterine environment are listed below with their meanings mono equals one equals two chorion equals placenta amnion equals amniotic sac.

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Amniotic fluid embolism

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Amniotic fluid embolism A very rare in catastrophic obstetric emergency in which amniotic, fetal cells, and other amniotic debris into the mother's bloodstream via the placental bed within the uterus. This event triggers an allergic reaction and the result is cardiorespiratory collapse and the coagulopathy. It's emergency for mother and baby, can happen at any time during the pregnancy of or the labor. There are two phases. First phase equals acute shortness of breath and hypotension. This rapidly progresses to cardiac arrest. And then patient lapses into a coma. Second phase equals although many women do not survive the first phase, 40% of initial survivors will pass into the second phase known as hemorrhagic phase and may be accompanied by severe shivering, coughing, vomiting and a bad taste in the mouth. There's also excessive bleeding as the blood loses its ability to clot. Next section collapse of the cardiovascular system leads to fetal distress and death unless the infant is delivered swiftly. An immediate C-section to get the baby out is imperative for both mother and baby. When baby and placenta are removed the amniotic fluid can no longer enter mother's bloodstream. Most most mothers do not survive this event. The pulmonary involvement, this infant will likely be in severe distress due to the mother's condition and two acute hypoxia in utero. Prematurity and C-section may also be a concern for this infant along with gestational expectations, the duration and severity of intrauterine hypoxia will determine this Baby's condition. The treatment is this infant will likely require a full extensive resuscitation and even then, the prognosis is poor. Provide support for NRP guidelines while watching closely for changes in patient status and communicating effectively with the team.

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Gestational diabetes mellitus gdm

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Gestational diabetes mellitus Gdm is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy especially during third trimester. It usually starts around the 24th week, and is caused by insulin receptors that do not function properly. While in utero the baby is affected by the mothers glucose instability. Gdm babies tend to be LG a large for gestational age and as a result are often delivered by C-section for their size and inability to safely exit the mother vaginally. The pulmonary of involvement, these babies often demonstrate signs and symptoms of RDS and require support at Birth. A GED and baby will often be delivered in the 35 to 36 week range, making them premature. Keep in mind that these babies are larger than most and that size is not the same thing as maturity. They may show signs of RDS do to retain lung fluid or prematurity. Treatment is dry stimulating Provide support for NRP guidelines wall adapting to changes in patient status. Monitor babies closely for signs and symptoms of respiratory distress.

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HELLP stands for hemolysis elevated liver enzymes and low platelet count.

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HELLP is an acronym that stands for hemolysis elevated liver enzymes and low platelet count. This is a life-threatening complication to the mother, usually considered to be a variant or complication of preeclampsia. For the baby's sake, the mother Simpsons will be managed for as long as possible by being given corticosteroids, antihypertensives, and maybe magnesium sulfate. Sometimes this treatment can be successful and holding off the birth for sometime. If the mother symptoms become unmanageable the infant will need to be delivered immediately and possibly prematurely. The mother will likely have difficulty recovering from this condition. And severe cases long-term maternal liver damage and even death are possibilities. This condition occurs in late stages of pregnancy. The pulmonary involvement, these babies are often SGA or small for gestational age, however their lungs are usually appropriately mature or even even more mature due to the stress of their environment. No the gestational age of the baby prior to delivery and prepare for that. Keep in mind also that magnesium sulfate may have been used to treat the mother, so this baby may come out floppy with Porton. The treatment is to dry stimulating Provide support for NRP guidelines while adapting to changes in patient status. Everything from simple dry and stim to ppb can be expected at this delivery watch closely for signs and symptoms of RDS.

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Chorioamnionitis

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Chorioamnionitis is an infection of the sac in the amniotic fluid that surrounds the baby. The sack also known as the fetal membranes. The best this bacterial infection is often the result of the premature rupture of the membranes and prolonged labor. The mother will develop a fever due to the infection and will cause a baby to be hot as well. Subsequently the baby will be tachycardic fetal tachycardia. There is also a possibility that the internal infection reaches the baby, in which case the baby will also be showing signs of infection I can Kris Temp and tachycardia. It is difficult to differentiate between mother and baby in the situation so, we will usually assume that both of them are infected. When getting called to this delivery it will often be termed maternal temp / fetal tack. Pulmonary involvement, this baby may or may not show signs of infection or distress once delivered. The ALS RCP team will be present in order to assess the patient's condition and provide support as necessary. The treatment is to dry stimulating Provide support for NRP guidelines while adapting to changes in patient status. If the mother is considered a Correo patient by the delivering MD the infant will need to come out to the NICU for further care and treatment, even if the baby is asymptomatic. If the mother is considered Correo open the baby is too.

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Oligohydramnios

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Oligohydramnios The presence of an insufficient amount of amniotic fluid around the infant. This condition is diagnose during a prenatal ultrasound. Pulmonary involvement, this condition can often cause for long development to do the dehydration a pulmonary tissue. This pulmonary hypo play Asia will cause the lungs to be immature and stiff. Premature redeem maybe a concern for this infant, as well as an increased risk for umbilical cord compression. Depending on the duration of the old ago this infant may have IU gr as well. The longer the state of dehydration the more likely the baby will have growth retardation. Expect this infant to require some level of positive pressure been elation. The treatment is to drive stimulating provide support for enter P guidelines will attacking to changes and patience status. Be mindful to keep positive pressures to the absolute minimum affect level watch closely for signs and symptoms of RDS and treat accordingly

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Polyhydramnios

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Polyhydramnios is the presence of too much amniotic fluid around the infant. This can be caused by diabetes mellitus, RH isoimmunization, or fetal anomalies that can impair the ability of the fetus to swallow and process amniotic fluid. This condition is diagnosed during a prenatal ultrasound. The pulmonary involvement, some complications of this are umbilical cord prolapse, placental abruption, premature birth and occasionally perinatal death due to congenital abnormalities. The likelihood of congenital abnormalities such as dwarfism or hydrops is increased when this condition is present. Due to these Associated problems infant may present with congenital issues that require respiratory support. The treatment is to dry stimulating Provide support for NRP guidelines all adapting to changes in patient status. Monitor closely for signs and symptoms of RDS accommodating your technique for physical abnormalities may also be a part of this patient's treatment.

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Placenta accreta

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Placenta accreta it is normal for the placenta to be attached to the endometrium which is the innermost layer of the uterine wall. Placenta accreta is an abnormally deep attachment to the placenta, do the endometrium and into the myometrium middle layer of the uterine wall. This condition is difficult to diagnose and is not always seen on antenatal ultrasound. This condition puts mother at Great risk for Hemorrhage during the removal of the placenta. If it is diagnosed prior to delivery the baby will most likely be delivered by C-section and mother may need to have a hysterectomy following the birth if mother has a vaginal delivery, blood products will be needed for a possible transfusion. They are three forms of acredito, measurable by depth of penetration acredita, Invasion by the myometrium which does not penetrate the entire thickness of the muscle. Incredible occurs when placenta extends further into the myometrium penetrating the muscle. Per credit which is the worst form placenta penetrates entire myometrium to the uterine serosa through the entire uterine wall. The pulmonary involvement is the premature delivery, C-section and subsequent complications of the primary concerns for this infant. Be prepared for an infant with retained lung fluid and most likely gestational appropriate status. The treatment is dry stimulate Provide support for NRP guidelines while dabbing change in patient status watch closely for signs and symptoms of RDS.

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Placenta previa

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Placenta previa is the placenta is the vital organ that is attached to the uterine wall that allows nutrients wasting gas to exchange between mother and the baby. The placenta is part of the of the amniotic sac the bag that surrounds the baby. The placenta can develop anywhere within the uterus and attached itself anywhere to the uterine wall. Placenta previa is when the placenta is attached to uterine wall close to the covering the cervix. This usually occurs during the second or third trimester. This complication is the leading cause of antepartum bleeding, and put some other at increased risk for postpartum hemorrhage. For the safety of the baby in the mother these infants are usually delivered by C-section. There are four types low-lying, the potential and coaches the lower segment of uterus but does not infringe on the cervical orifice. The second is marginal placental touches, but does not cover the top of the cervix. The third is partial placental partially covers top of the cervix. Or for complete the potential completely covers the top of the cervix. The pulmonary involvement, this infant will usually be delivered by C-section and Minnie and may be premature. If there has been anti part of bleeding this infant could have acute blood loss, could be iugr due to poor placental perfusion and it is at increased risk for congenital anomalies. The treatments of dry stimulating Provide support for NRP guidelines or adapting to changes in patient status everything from dry and stim the ppv and Tim intubation can be expected at this delivery watch closely for signs and symptoms of RDS.

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Pre-eclampsia toxemia or pregnancy-induced hypertension

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Pre-eclampsia toxemia or pregnancy-induced hypertension is when a pregnant woman develops high blood pressure and high protein levels in the uterine after the 20th week of pregnancy is known as preeclampsia or pregnancy induced hypertension pah. Severe hypertension can be very dangerous for mother and baby. Full-blown eclampsia is when the mother has seizures due to the PIH. The best treatment for this condition is to deliver the infant before it gets to that eclamptic stage. Once the baby is out the mother's health is usually restored. If the toxemia is not too severe the delivering doctor or treat the mother with magnesium sulfate in order to temporarily stabilize the mother and to postpone delivery of the baby for as long as possible. Pre-eclampsia can happen at any time after the 20th week gestation period the pulmonary involvement, there are three things that affect the condition of the pH baby. Gestational age maternal hypertension and often magnesium sulfate. Gestational age and lung maturity often do not correlate with these babies. The stress of pH can actually help lung maturity, making him a bit more stable than other babies have the same gestational age. Be prepared for their crew gestational age but you may be surprised. Magnesium sulfate on the other hand is a muscle relaxant and would likely cause the baby to be floppy and depressed until it wears off. The treatments to dry stimulating Provide support for dinner pink eye Linesville adapting to changes in patient status everything from dry and stem 2 ppv and intubation are expected this delivery

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Prom

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Prom is premature rupture of the membrane it is a condition in which the amniotic sac develops a tear tear that either League Starburst 1 hour or more before Labor begins. Typically when this occurs labor will naturally begin within 48 Hours. Premature rupture of the membrane equals ruptured 1 hour or more prior to onset of Labor. Prolonged rupture of the membranes equals ruptured 18 hours of War prior to onset of Labor. The mother won't be watched for 24 hours to see if Labour will begin naturally if no labor begins after 24 hours usually medication will be used to start labor. Depending on the age of the fetus and signs of infection, labor make sometimes we were offended or deferred so the infant can be allowed to mature. Steroids can be given during this period to mature the infant's long as an antibiotic is given to signs for signs of infection. The pulmonary involvement, lung involvement will all depend upon it how premature the infant is, how long the amniotic sac has been ruptured. I'll prolong timeline between rupture and birth greatly increases infants risk for infection. Oligohydramnios and choreo amnionitis are conditions typically associated with prolonged rupture of the membrane, both of which support for lung development and hypoplasia in premature infants. If the rupture was a prolonged amount of time weeks before birth do not expect long development to be appropriate for gestational age. The treatment is to dry stimulating Provide support for NRP guidelines for adapting to change in patient status. Be mindful of patients age watch closely for signs of RDS.

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Velamentous cord insertion

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Velamentous cord insertion normally the umbilical cord and starts into the middle of the placenta. In this condition the umbilical cord inserts into the amniotic sac in the vessels travels within the thin membranes of the sack over the to the center. These vessels are not protected by the gelatinous structure of the placenta and are vulnerable to the rupture. This is diagnosed on the prenatal ultrasound and is monitored closely. With these vessels are located near or over the cervix this mother should not go into labor. Even early labor could rupture these vessels this baby will need to be delivered by C-section and prematurely. Usually approximately 35 weeks gestation period the pulmonary involvement, primary concern is of course rupture of the veins of subsequently acute hypoxia of the baby however in a controlled environment the likelihood of this happening greatly diminishes. Delivery by C-section and near-term prematurity are the primary concerns for this patient following the delivery. Retain lung fluid in mild to moderate respiratory stress can be expected for this baby. The treatment is to dry stimulating Provide support per Blow by oxygen is expected at this delivery. Monitor closely for signs and symptoms of RDS. If more support is required, communicate well with other team members to decide whether or not CPAP is appropriate for this 34 to 46 weeker. Giving CPAP traditional education increases the likelihood of pneumothorax.

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Diaphragmatic hernia

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Diaphragmatic hernia is a genetic defect resulting in a hole in the diaphragm. The whole allows the abdominal contents to move into the chest cavity. This defect is usually found on the left side of the diaphragm and the amount and size the displaced abdominal contents varies from case to case. The pulmonary involvement, during the baby's development this malformation will not allow healthy lung tissue to form an area of the chest that the misplaced abdominal contents have been found. The unaffected are you should have healthy lung tissue. Patients need the rest / support will vary depending on the size of the underbelly whipped area within the Longfield hypoplastic long. You can expect this patient require Blow by oxygen possible positive pressure ventilation. The treatment is to dry simulating Provide support for NRP guidelines being careful to use the lowest possible effective positive pressure if it is needed. If CPAP or ppv is required and intubation will be necessary. This procedure will decrease air entry to the stomach and bowels subsequently minimizing thoracic pressure. ALS to place orogastric tube immediately in order to decrease thoracic pressure. Patient will need surgery right away once the babies assess and stabilize we will transport him to r c h.

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Gastroschisis

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Gastroschisis is a congenital defect of the abdominal wall through which the abdominal contents protrude freely. There is no over lying sack to cover these contents and the site of the defect is usually to the right of the umbilicus. Usually the baby with this congenital defect is an otherwise healthy child and does not have any other abnormalities. This defect is diagnosed on the prenatal ultrasound in the baby will be delivered by C-section as close to term as possible. The pulmonary involvement this patient's primary concerns are the cleanliness of the exposed abdominal contents and usually retained lung fluid. It's a patient has distressed, intubation will be preferred as it will support the Kris pressure within the abdominal content. The treatment is this patients expose abdominal contents will need to be wrapped immediately by ALS in the stereo manner. In the event that the patient needs rest person port keep yourself and all equipment well away from the abdominal area. Provide support for entropy guidelines be prepared for Vice support all the rap is being placed. Be careful to use the lowest possible effective pressure it posture pressure is needed. If CPAP repeat previous needed in to Beijing will be necessary limited air intruder the stomach and bowels will be very important. And OG will be placed to evacuate air from the stomach. This patient will need to have surgery right away humble be transported Brady's Children's Hospital following evaluation and stabilization

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Neural tube defects

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Neural tube defects is a neural tube defect is an opening anywhere within the structure of the spinal tumor brain. During the third week of pregnancy the fetus begins to fuse its dorsal or back side and within it it's journal to. When this too but does not completely closed, a neural tube defect develops this is diagnosed on a prenatal ultrasound. There are several types of ntds, but those most commonly seen at this facility are encephalocele which is a sac-like protrusion of the brain in the membrane that cover it, somewhere along the Centerline of the skull. In the Western World this defect is usually found at the base of the skull.

Spina bifida occulta which is the mildest of these defects. It is a non closure of the neural tube along the spine at the lumbar sacral region. This lesion is small and does not protrude out of the spinal column. Usually this defect is covered by skin and undetectable. Sometimes whoever it is detectable by a severe dimple, hair at the legion site or a birthmark.

Myelomeningocele ocelli, this is the most severe form within the above spina bifida group of defects. This leaving is much larger and allows for the spinal cord to protrude through an opening in the spinal column. Usually the spinal elements will be within the membranous sac, but not always.

Pulmonary involvement, if the Allegiant is found on the prenatal ultrasound this patient will be C-section and will often be mildly premature. Keeping the lesion clean, prematurity and a C-section delivery of the patient's primary concerns. Lung development can be expected to be appropriate to gestational age. Retain lung fluid is likely as vigorous Tim is initially awkward. Treatment any protrusions will immediately get a sterile rap patient will likely be laying on their side be adaptable Provide support to patient will wrap as being placed and keep all equipment a tubing away from clean Fields standard NRP guidelines are appropriate

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Omphalocele

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Omphalocele is a defect of the abdominal wall in which the intestines liver and occasionally other organs can remain outside the abdomen. These organs are contained within the membranous sac and protrude through the umbilicus. An omphalocele is caused by a defect in the development of the muscles of the abdomen wall. This defect is diagnosed during pre-natal ultrasound. Often cardiac anomalies neural tube defects in occasionally chromosomal abnormalities are associated with this babies as well. These babies will be delivered by C-section possibly prematurely. Pulmonary involvement, along with the obvious abdominal abnormality cardiac issues, prematurity and retain long food will often be concern for this patient. Expect his patients require some level of respiratory support. That support level be extremely varied from case to case. A baby with a small lesion and no abnormalities may not require much assistance at all. A baby with a large protruding sack and other so she'd animalities will likely require intubation a full support. The treatment any protrusions will meet League at Estero rap be adaptable Provide support for NRP guidelines for being mindful to keep all equipment away from clean Fields be careful to use the lowest possible effect of pressure ppv is needed. If PPD is required in its base won't be preferred. An orogastric tube will be placed an order to decrease pressure within the abdomen. Once this patient is stable he require surgery and will be transported r c h though not always immediately.

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Peyton ductus arteriosus and cardiac defects

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Peyton ductus arteriosus in cardiac defects the ductus arteriosus is a blood vessel present in all babies while in the womb. In utero the Muslim mother supplies the oxygen to the baby, so the babies are not required to use their lungs yet. The ductus arteriosus allows blood to bypass the pathway to the lungs and allows blood to flow freely between the pulmonary artery and the aorta. When the umbilical cord is cut, the lungs are suddenly needed to supply oxygen. The lungs inflate and the pulmonary vascular bed relaxes to accept the increase blood flow. Gradually over the first few hours of life the ductus is expected to close due to decreased pulmonary vascular resistance. All the ductus is open it is referred to as a patent or open ductus arteriosus or PDA. In most cases it is preferred that the PDA close, however in the case of some cardiac defects it is essential that the PDA remain open in order for the baby to survive. The location and severe Ed of the cardiac defect determine if the baby has a duct dependent anomaly, and if so, how dependent the baby will be on the PDA. There are two different ways the connection between the aorta and the pulmonary artery can be essential for these babies. They are number one for some duck dependent anomalies the PDA can be the only adequate source of blood flow to get the lungs and without it the baby blood will not get oxygenated. Number to four other duck dependent anomalies the PDA can be crucial to making a pathway for oxygenated blood to get away from the heart and out of the rest of the body. The pulmonary involvement, please remember that not all cardiac defects are duck dependent and that a thorough discussion between all RCP, alst members and the attending MD is vital to understanding what to expect. The degree of duck dependence is often difficult to determine prior to birth and it is common for the RCP, ALS team nmd to expect and prepare for a poorly oxygenated patient presentation. It is critical to remember in these cases that oxygen is a peripheral vasoconstrict ER and that the administration of oxygen to a duck dependent cardiac defect May hasten closure of the PDA. It is not is it advised not to use the increased oxygen during the resuscitation of these patients unless absolutely necessary and agreed on by the md&a ls team. The attending MD will determine the Aloha acceptable spo2 goals which are often Peyton dr. Sartorius's and cardiac defects the doctor sartorius's is a blood vessel present and all babies wall in the room. And you were all the mother mother supplies the oxygen to the baby, so the babies are not required to use their lunch yet. The doctor sartorius's allows blood to bypass the pathway to the lungs and allows blood to flow freely between the pulmonary artery and the iota order. When the bill local cord is cut, the lungs are suddenly needed to supply oxygen. The lungs inflate in the pulmonary vascular bed relaxes to accept the increase blood flow. Gradually over the first flu few hours of life the duck this is expected to closed due to decreased pulmonary vascular resistance. All the duck this is open it is referred to as a patent or open duct sartorius's or PDA. In most cases it is preferred at the PTA clothes, however in the case of some cardiac defects it is essential that the PTA remain open in order for the baby to survive. The location answer buried of the cardiac defective term and if the baby has a duct dependent anomaly, and if so, how dependent the baby will be on the PTA. There are two different ways the connection between the aorta and the pulmonary artery can be essential for these babies. They are number one for some duct dependent anomaly the PTA can be the only adequate source blood flow to get the lungs and without it the baby blood will not get oxygenated. Number two for other duct dependent anomalies the PDA can be crucial in making a pathway for oxygenated blood to get away from the heart and out to the rest of the body. Pulmonary involvement please remember that not all cardiac defects are duct dependent and that a thorough discussion between all RCP, alst members and the attending MD is vital to understanding what to expect. The degree of duck dependence is often difficult to determine prior to birth and it is common for the RC PLS team nmd to expect and prepare for a poorly oxygenated patient presentation. It is critical to remember in these cases that oxygen is a peripheral vasoconstrict ER and that the administration of oxygen to the duck dependent cardiac defect May hasten closure of the PDA. It is not advised do use increased oxygen during the resuscitation of these patients unless absolutely necessary and agreed on by the md&a ls team. The attending MD will determine the low acceptable spo2 goals which are often as low as the mid-60s. Treatment number one a resuscitation for NRP guidelines with modified saturation goals is expected. Number to use increase fio2 only if it buys by the MD. Number three throw be an RN team to immediately start an IV so that prostaglandin also referred to as PG can be started within minutes of birth. This medication will keep the PDA open. Keep in mind that this medication also has a possible side effect of central apnea so once your patient starts getting it be prepared to intubate quickly if Central apnea occurs in the delivery room or during transport. These patients will immediately be transported to Rady's for further cardiac assessment.

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coarctation

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Coarctation a narrowing within the aorta. This narrowing can be at any point within the aortic vessel and causes the left side of the heart to work harder to pump blood through the narrow road area. Left-sided cardiac pressures will be increased. Quartation is difficult to diagnose before birth and may not be detected during prenatal ultrasound. A postnatal echocardiogram will definitively diagnose this defect. This baby is dependent on the PDA staying Peyton until surgery is done ductal dependent. During treatment of this baby it is imperative to keep oxygen used to an absolute minimum because oxygen one courage closure of the PDA. Pulmonary involvement, the location within the aortic vessel and the size of the narrowing, will determine the effect it has on the patient status. while there is no Direct lung involvement this patient will often need respiratory support. Oxygenated blood will have a hard time getting past the narrowed area and subsequently the right arm and head preductal region may have a higher saturation and better perfusion than the left arm and lower extremities postdoctoral region. The treatment is to drive stimulating Provide support for NRP guidelines using as little oxygen as possible. The attending neonatologist will determine the low acceptable spo2. Prostaglandin PGE will likely be started in order to keep the PDA patent. Monitor closely for signs and symptoms of RDS. This baby will likely be transported to Rady's children's sooner than later.

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Hypoplastic left heart

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Hypoplastic left heart parts of the left heart or undeveloped in other words Mitchell valve left ventricle aortic valve and aorta. With these underdeveloped parts the left heart is unable to do the necessary pumping and leaves all the work to the right side of the heart. The right side of the heart is then required to pump not just to the lungs but to the body as well. The heart can do this for a while, but this condition will eventually caused the right side to fail as well. This baby is dependent on the PDA stand Peyton in order to get any Oxygen to the body. It is imperative to keep oxygen used to an absolute minimum because oxygen will encourage closure of the PDA. The pulmonary involvement, this patient will likely have central cyanosis that does not improve with crying. The oxygenated blood is just not going to get to the body as quickly as needed. The treatment is to dry stimulating Provide support for NRP guidelines keep it in mind to give his least amount of possible of oxygen as necessary. Ello acceptable range of spo2 will be determined by the attending MD. Monitor closely for signs and symptoms of RDS. This patient will likely require intubation and ppv. This patient will be dependent on their Peyton ductus arteriosus. Prostaglandin will likely be started quickly to keep their PDA open. This patient will be transported to Rady's children's this baby or acquired a series of surgeries. A possible side effect of prostaglandin is Central apnea be prepared to intubate and support at all times during the administration.

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Tetralogy of fellow

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Tetralogy of fellow is a congenital heart defect that involves for anatomical abnormalities although only three of them are always present. One is pulmonary infundibular stenosis, two is overriding aorta, three is ventricular septal defects, for is right ventricular hypertrophy. It is the most common cyanotic heart defect and the most common cause of blue baby syndrome. This pain is dependent on the PDA in order to oxygenate their body. The pulmonary involvement, there is an overall decreased oxygenation in the patient's blood supply due to the mixing of oxygenated and deoxygenated blood in the left ventricle right-to-left shunt. The level of decreased oxygenation will vary from case to case. This patient may present pink and stable While others may present blue with spo2 in the 60s. Pink tet equals baby is not synodic Bluetec equals baby is cyanotic. The treatment is too dry stimulate and provide support for NRP guidelines being mindful to keep the FL to as low as possible. Louis ceptable spo2 range will be determined by the attending physician. Prostaglandin PGE will likely be starred in order to keep the PDA open. We will transport this patient to rch. Although not always immediately. Be prepared to intubate support following prostaglandin Administration

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Transposition of the great arteries and vessels

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Transposition of the great arteries and vessels, arteries the position of the two major arteries leaving the heart are reversed, so that each arteries arising from the wrong pumping chamber. Vessels the position of the true crate vessels are switched they order and the pulmonary artery. So, oxidative blood is pumped from the lungs back to the harp into the lungs again, and never pumped to the body. This patient is completely depend on their PDA in order to auction it their body at all. Give oxygen only if absolutely necessary as it will encourage closure of the PDA. The pulmonary involvement this baby will be severely cyanotic. This baby has function of lungs and oxygenated blood it's just not going to get pumped to the body. The treatment is to dry simulating Provide support for NRP guidelines keep it in mind to give the least possible amount of oxygen do not hesitate to until I get this baby if needed low acceptable spo2 Range Rover determined by the a neonatologist and prostaglandin will be started immediately. 1 stabilized is patient be transported to rch for for the assessment and treatment. A possible side effect of prostaglandin central apnea be prepared to intubate and support this patient at all times following its Administration.

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Congenital cystic adenomatoid malformation C cam

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Congenital cystic adenomatoid malformation C cam, This Is A congenital disorder in which a large section often an entire lobe of the lungs replaced by a non-functional cystic mass of abnormal tissue. The abnormal tissue will never function as a normal tissue and sometimes these masses continue to grow after birth. The pulmonary involvement the size of the math will determine the overall Pomeranian Waldman. The majority of cases have a favorable outcome, however in some cases in math can be so large that it not only decreases the volume but also limit the growth of the surrounding on tissue and can cause pressure against the heart is can be life-threatening this defect is usually diagnosed during a routine prenatal ultrasound. The treatment is to drive simulator support for NRP guidelines. Monitor closely for signs and symptoms of RDS and treated accordingly. This patient even if stable will come to the NICU for further evaluation and treatment. Most cases will eventually have the seachem mass removed via surgery once patient is big enough and stable enough.

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Hypoplastic lung

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Hypoplastic lung is under development a hypoplastic long is a Long Day's not completely developed, usually it is secondary to other fetal abnormalities that have interfere with normal lung development such as oligohydramnios or congenital diaphragmatic hernia. This condition is often detected as part of a routine prenatal ultrasound while being evaluated for the primary abnormality. These babies are at risk for preterm birth and this disorder is a common cause of neonatal death. The pulmonary involvement, support needed will vary case-by-case depending on the severity of the hypoplastic come the gestational age and the national abnormality that causes the poor lung development. These patients will likely need respiratory support as a result of their limited functional long volume. The treatments of dry stimulate Provide support for NRP guidelines will adapt into changes in patient status. Most of these babies will need supplemental oxygen ventilator pork. Be mindful to keep positive pressure to the App Store Loop minimum effective level. A low lung volume high frequency strategies off ineffective. Every piece of functional lung is critical to this baby once this patient is stable we will transport to our NICU for further evaluation and treatment

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Hydrocephalus

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Hydro selfless is a condition that happens when there's an normal accumulation of the three bro spinal fluid in the venture Kohl's or cavities at the brain. This may cause increased entertainer roll precious inside the skull with progressive enlargement of the head. Conversions tunnel vision mental disabilities and even sometimes death can occur as results this condition. This fluid accumulation as usually diagnose during prenatal ultrasound. These babies me need to be delivered by c-section. The pulmonary involvement while there is no direct long were heart involvement with this condition, the severity of this hydro selfless will determine the babies need for us pray support. If the excessive fluid hasn't fringe down there development of the brain, it is impossible that is rest for a drive will be affected. Assessment and close monitoring at birth will be the only way to determine this patience rest Troy driving stamina. The complications following is c-section delivery email Sylvia concerned for this baby. The treatment is to dry stimulating provide support for enter P guidelines. One to for closely for sends of RDS. This patient me or may not require any rest for support, however once he is table we are transport him to nicki for further evaluation. Been disabled Grady's to have a shot place to drain the excess fluid away from the brain.

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Hydrops

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Hydrops is the accumulation of fluid or edema inch or more compartments of the fetus's body. This usually stems from a fetal anemia, the cause of which can be numerous. This condition can be cause spontaneous abortion due to fetal heart failure. This condition is usually diagnosed during a prenatal ultrasound and often develops very quickly. Location of fluid accumulation can include subcutaneous tissue and scalp full body edema usually present, plural plural of fusion, pericardium pericardial effusion, abdomen ascites. The pulmonary involvement, the severity of the condition will determine the respiratory support needed. Accumulation of fluid in three of these areas directly affects the patient's lung volume all four of them increased intrathoracic pressure and increased strain on the heart this patient's lung tissue and it's often extremely moist and fragile this baby may need may also be born via C-section or prematurely but the hydrops will still be the primary concern. The treatment I hate to say it but expect the worst with these patients a severe case can be close to heart failure while a mild case may need CPAP with oxygen. Dry stimulating Provide support for NRP guidelines this patient will always require intubation and positive pressure ventilation intrathoracic pressures will be high and this baby and you will likely need to adapt your bagging a long time or high-frequency bagging is preferred to a fire pit as pneumothoraces are common for these babies be adaptable and try something else if your Technique is not working unstable the station will come to the NICU to be further evaluated and supported.

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Trisomy

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Trisomy is a chromosomal anomaly in which there are three copies instead of the usual two copies of a particular chromosome trisomy 21 + 18 of the most common some examples are trisomy 21 which is Down syndrome Trisomy 18 which is Edwards syndrome Trisomy 13 which is patau syndrome the pulmonary involvement well there is usually no direct lung involvement they're often either cardiac or physical anomalies that play a part in determining his patients need for support cleft palate or lip palate preterm gestational age be part of this pictures while severe difficulty syndromes will vary from case to case. The treatments to dry steam link device support for energy guidelines the rare the syndrome the worst a baby will be in the more venomous Coral be expected monitor closely for RDS

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Embryological development of the fetus

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Fertilization is the union of a sperm cell and a mature ovum the ovum is the female germ cell extruded from the ovary at ovulation occurs in the outer third of the fallopian tube.

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Development and growth stages

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The first stage is the. From conception to the completion of implantation approximately 12 to 14 days. Cellular division or cleavage begins as the ovum travels down the fallopian tube towards the uterus. Blastomere is one of the two cells that develop in the first division of the fertilized ovum. The blastomere is surrounded by a tissue enveloped called the Zona pellucida. Morella is a ball that is formed after substantial growth of the above cells. The ovum consisting of 16 to 50 cells enters the uterus.

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The blast site

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Blast site is formed when food begins collecting in the cavity in the center of the morla the Zona pellucida is now replaced by the outer layer of the cells called the trophoblast. As the Blastoise I continues to expand some of the cells gather toward the informing what is known as the blastoderm. This group of cells become the fetus