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Birth Weight: most commonly used criterion for defining a neonatal population with special risks, and for

defining national and international census. Low BW: <2500g Very low BW: 1000-1500g Extremely low BW: <1000g Gestational age: no of completed wks that have elapsed w the 1st day of !"# and date of delivery SGA: <10$ile for the pop LGA: %&0$ile Preterm neonate: <'( completed wks ) <25& completed days *irrespective of +,Term neonate: '(-.2 completed wks ) 25&-2&. days Post-term neonate: %.2 completed wks ) %25& days Fetal death: death prior to the complete e/pulsion from the mother of the product of human conception irrespective of duration of pregnancy. Indications: no reath no heart eat no pulsation of um ilical cord no definite movement of vol.m Fetal death is s !di"ided accdg to timing and mode# 1. Early $etal death %a!ortion&# - death prior to e/pulsion - ,: 500g or less - 012: 20wks 3e/cludes termination of pregnancy 2. Late Fetal death %still!irth&# - death efore e/pulsion - ,: %500g or unknown - 012: %20wks - or if ,)012 is unavaila le, a ody length 25cm is e4uivalent to 500g

'. Ind ced termination o$ 'regnancy - purposeful interruption of an intrauterine pregnancy (eonatal death# death of live orn neonate efore neonate ecomes 25 days 1. early neonatal death: first (d 2. late neonatal death: after ( d ut efore 25 d In$ant death: any death at any time from irth up to <1year )aternal death: death of a woman within .2 days of termination of pregnancy *irect o!stetric death: death of a woman resulting from o stetric complications of pregnancy, la or, puerperium Indirect o!stetric death: death of woman resulting from a previously e/isting dse or dse that developed during pregnancy, la or or puerperium GESTATI+(AL AGI(G Assessing GA !y Sim'le ins'ection %TE,)& %in$erior "ena ca"a dee's& n$"cd's 1. sucks well 2. fle/es arms and legs '. veins seen under skin - 61 .. nipple clearly seen 5. palpa le reast ud 7. descended testes (. covered la ia minora post term infants: long fingernails 6euromuscular maturity tests passive fle/or tone #assive fle/or tone - develops earlier than e/tensor tone - develops earlier in lower e/tremities than upper maneuvers must e done with the head as the midline, without grasping the palms and soles e/tremely premature infants must e scored w)in 12 hrs * efore skin undergoes changes-

(e rom sc lar mat rity SS-APP -infant lies supine, awake and not crying Post re 8 more mature infants have etter fle/ion of lim s S. are window 8 gently push the back of the hand towards the forearm. "ore mature infants have greater wrist fle/ion Arm recoil 8 bend the arm at elbow so that the hand reaches the shoulder, and keep it flexed for 5 sec. Then extend the arms by pulling on fingers. Release the arm after it is fully extended and observe recoil. +etter in mature infants Po'liteal angle 8 hold knee against abdomen, then gently push the ankle towards the face. !ess e/tension in mature infant Scar$ sign 8 gently pull the hand across the chest like a scarf. Then gently press the elbow to help the arm around the neck. 6ot easily pulled across the chest in mature infants -eel to ear 8 hold toes and gently pull foot towards the ear. Allow knee to slide down at side of abdomen. "ature infants have less fle/ion of hips, thus cannot ring heel towards the ear. Physical )at rity %mat re in$ants& BLEEP S/in 0 thicker skin lan go 0 decreases with maturity 'lantar creases 0 more creases Breast 0 igger areola and reast ud Ear 0 External genitalia -IG- ,IS1 (EWB+,( - infant who is <25days of age and has 1 or more features that would incrs his odds of mortality and mor idity. - categories o$ high ris/: 1. preterm infant 2. infants who re4uire techno. support '. infants at risk ecause of family issues .. infants with irrev conditions wc may result in an early death

Factors the 'redis'ose in$ants to !e high ris/ 23 )aternal $actors 0add !shom' - <17 or %.0 y)o - drug or alcohol e/posure - dm - hpn leeding - 9:;s - multiple pregnancy - oligo)polyhydramnios - #<1" 2. *eli"ery $actors - $$!mn - fetal distress)asphy/ia reech delivery presentation - meconium staining - nuchal cord - forceps)cs delivery '. (eonatal $actors 0 '!! ssminnr !th - pre and post term *<'( or %.0 012- +, <2500g or %.000g - 920 - medication or resuscitation in delivery room irth defects - respiratory distress - inf/n - sei=ures - hypoglycemia - need for 12 or monitoring - need for special t/ - twins, triplets, and other multiple a ies with medical conditions ,is/ $actors may ma/e (B to !e com'romised and exhi!it one or more o$ the $$# 1. poor muscle tone 2. depression of respiratory drive '. radycardia .. low p 5. tachypnea 7. cyanosis Premat re in$ants are -IG- ,IS- (B 0dr wiss'' 1. decd drive to reathe 2. rapid heat loss, poor temp control '. weak m. make spont. reathing difficult

.. immature tissues may e damaged y e/cessive 12 5. suscepti le to rain hemorrhage 7. suscepti le to hypovolemia secondary to lood loss (. possi le inf/n 5. possi le surfactant def >?: ''-'5cm !ength: .5-5'cm 4 'hysiologic com'etencies that are generally recogni5ed as essential !e$ore discharge 1. a ility to maintain normal ody temp fully clothed in an open ed with normal am ient temp 2. a ility to coordinate suckle feeding, swallowing and reathing while ingesting ade4 vol of feeding '. a ility to grow at accepta le rate Ga"age $eeding 8 primary mode of enteral feeding of sick and premature infants >epa + vaccine: 10ug, @", on lateral aspect of another thigh >epa + @g: 0.5ml, @", in a separate site of other thigh +reastfeed every 1-2hr Aital signs taken every . hrs minimum duration of stay in hospital is 2. hrs

6riteria $or discharge 1. normal vital signs and #B 2. a ility to suckle on reast with satisfaction '. ade4u. urine and stool output .. complete neonatal screening tests 5. complete anthropometric measurements 7. demo of maternal a ility to care for her own a y

(7T,ITI+( Goal o$ n tritional thera'y term neonate: ensure successful growth transition from fetal to postnatal period preterm neonate: continue the process of intrauterine growth in e/trauterine environment until .0th wk postconception and to foster catch-up growth and nutrient accretion in postdischarge period ( trition re$erence standard term neonate: reast fed infant preterm neonate: estimated nutrient intrauterine accretion rate achieved at corres stages during last trimester of pregnancy average daily weight gain: 10-20g)kg)d or 20-'0g)kg)d o infants <2kg C %15g)kg)d o infants %2kg C %20g)kg)d nadir of physiologic weight loss: .-7d o term: 5-10$ w-loss, regained on 2nd wk o preterm: 10-15$ w-loss, regained on 'rdwk average length gain: 0.(-1cm)wk o term: 0.7&-0.(5cm)wk o preterm: 0.5-1cm)wk average hc gain: 0.5-1cm)wk %1.25cm)wk in those w) hydroceph and intraventricular hemorrhage

'. e/treme prematurity .. sepsis 5. mala sorption Goals 1. provide sufficient nutrient to prevent negative energy and 6 alance and essential D0 def 2. support normal rated of intrauterine growth of appropriate composition '. prevent significant mor idity Timing o$ 'arenteral and enteral n trition at irth: glucose E12hrs: 00 2.-.5hrs: @A fats 2. hrs: trophic feeding 6om'onents o$ TP( 23 ?ar o 83 #roteins 43 Dats 6om'lications o$ TP( 1. cholestatic Faundice 2. catheter-related complications a. sepsis . throm osis '. meta olic complications a. electrolyte im alance . hypo, hyperglycemia c. hypo, hypercalcemia d. hypophosphatemia e. hyperlipidemia

G idelines $or the se o$ $orti$ied h man mil/ $or 'remat re in$ants 1. infants <'.wks 2. <1500g at irth '. on :#6 greater than 2wks .. %1500g at irth w) su optimal growth 5. %1500g at irth w) limited a ility to tolerate incd volume intake Total 'arenteral n trition Indications - crems 1. congenital malformation of 2@: 2. <;9

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