Review of Developmental Stages

Developmental stages
Neonate (birth -1month)
Infant (1-12 month)
Toddler (12 mos.-3 yrs.)
Preschooler (3-5 yrs.)
School age (6-12 yrs.)
Adolescent (12-18 yrs.)

Sigmund Freud
1856-1939-an austrian neurologist and the

founder of psychoanalysis
Offered the first real theory of personality
development
He described child development as being a
series of psychosexual stages in which a
child's sexual gratification becomes focused
on a particular body part.

SIGMUND FREUD :
MAY 6, 1856 SIGMUND FREUD WAS BORN IN
FREYBERG TOWN, CRECH REPUBLIC
1881 HE GRADUATED FROM MEDICAL
FACULTY, UNIVERSITY OF VIENNA
1900 HE RELEASED INTERPRETATION OF
DREAMS
SEPTEMBER 23, 1939 FREUD PASSED AWAY
IN HAMPSTEAD HOUSE

PSYCHOANALYTIC THEORY

OVERVIEW OF
PSYCHOANALYSIS

A set of philosophical of human

nature
Psychoanalysis is both an
approach to therapy and a
theory of personality
Emphasizes unconscious

VIEW OF HUMAN NATURE

1.DETERMINISTIC
. Life is about gaining pleasure
and avoiding pain
2. HUMAN AS ENERGY SYSTEM
. Freud believe that human are
motivated by the unconscious,
where the Id is found along
with the aggression and sex
instincts

LEVEL OF MENTAL LIFE

1.UNCONSCIOUS

. Contains all the feeling, urges or instinct that are

beyond our awareness but it affect our
expression, feeling, action
(E.g. Slip of tongue, dreams, wishes)

2.PRECONSCIOUS
. Facts stored in a part of the brain, which are not
conscious but are available for possible use in
the future
(E.g. A person will never think of her home address
at that moment but when her friend ask for it,
she can easily recall it)

3. CONSCIOUS
.

STRUCTURE OF PERSONALITY
Consist of three
parts :
1.Id
2.Ego
3.Superego

1. Id
Infants are born with Id
intact
Operates on PLEASURE
PRINCIPLE to gain
pleasure, avoid pain
Driven by sexual and

2. Ego
The rational level of
personality
Operates on REALITY
PRINCIPLES does
realistic and logical
thinking

3. Superego
Partially unconscious
Operates on MORAL
PRINCIPLES
Able to differentiate between
good and bad, right and wrong
If people follow their
superego, they will feel proud
but if they dont follow, they

I want to eat chocolate!

Example:

 Children progress through SIX

PSYCHOSEXUAL STAGES

psychosexual stages during

psychosexual development

A person become FIXATED or

stuck in a stage when a basic
need is not met, therefore that
person will face difficulty in
transiting to another stage

1. Oral Stage

Birth to 18 months
Pleasure centers on the mouth
sucking, biting, Infant suck for enjoyment
or relief of tension as well as for
nourishment
Fixation :
1.If the child is over stimulated in this
stage, as an adult she/he may become
dependent on cigarette or alcohol,
become chatterbox, or derive pleasure
from acquiring possessions(collect

 18 months until 3 years

2. Anal
Stage
Pleasure
focuses
on bowel movement
(withholding/eliminating feces) During this
time chidrens interests focus on the anal region
as they begin toilet training. This anal interest is
part of toddlers self recovery, a way of
Of exerting independence
Fixation :
I. If parents were over-emphasizing potty
training, the child will develop a retentive
character. He will become obstinate and
stingy
II.If parents were negligent about potty

3. Phallic Stage

3 years to 6 years

Pleasure zone is the sex organ/genitals

mastubation is common during this phase

Fixations :
Oedipus complex in males / Electra
complex in female:

The boy will have the desire to posses

his mother and displace his father and

Cont.

Child who had been fixated in

this stage will develop a
phallic character, such as
reckless, proud and vain
This conflict can also cause the
child to be afraid of close
relationship and weak sexual
identity
Freud stated that fixation may
be a root of homosexuality

4. Latency Stage
6 years to 11 years, until
puberty
No fixations occur as the childs
energy are focused on peer
activities and personal mastery
of learning and physical skills

5. Genital Stage
12 years onwards
Sexual interest in opposite sex
increase
The child improve their personal
identities, develop caring feeling
towards others, establish loving
and sexual relationship and
progress in successful careers.
Fixation :
I. Frigidity, impotence and unsatisfactory

Eriksons Psychosocial
Stages of Development

Psychosocial
Development
There were two psychologists who had

developed famous psychosocial theories:

Freud, and Erikson.
Erikson believes that personality develops in a
series of stages.
Freuds theory is well known but also very
controversial.

Eriksons Theory of Development

Shows impact of social experiences across

ones whole lifespan.

There are eight stages over a lifespan
showing the development.
The main elements behind his theory is the
identity of ones ego.
According to his theory when conflicts arise
people have the opportunity to grow or fail
equally.

Trust vs. Mistrust

( learning confidence or learning to love)
Occurs in infancy.

(birth-18 months).
Babies must learn to
trust there parents
care and affection.
If not done the babies
could develop a
distrust and view the
world as inconsistent
and unpredictable.
Questions ones hope.

Autonomy vs. Shame and Doubt

Occurs in the toddler

age. (18 months-3

years).
Child learns to feed
themselves and do
things on there own.
Or they could start
feeling ashamed and
doubt their abilities.
Questions the child's
willpower.

Initiative vs. Guilt

Preschool age (3-5

years old).
Using initiative in
planning or carrying
out plans.
Or develop a sense of
guilt over misbehavior
regarding parents
limits.
Questions ones
purpose and role in life.

Industry vs. Inferiority

School age (5-11

years of age).
Learn to follow the
rules imposed by
schools or home.
Or the child can start
believing they are
inferior to others.
Questions
competency.

Identity vs. Role

Confusion
Adolescence (11-18

years of age).
Acquire a sense of
identity.
Or can become
confused about ones
role in life.
Questions who you
are and if your happy.

Intimacy vs. Isolation

Young adulthood (18-40

years of age).
Develop a relationship
and joint identity with a
partner.
Or can become isolated
and stay away from
meaningful relationships.
Questions if the person is
ready for new
relationships, or if there
is a fear of rejection.

Generativity vs.
Stagnation
Middle adulthood (40-65

years of age).
Making use of time and
having a concern with
helping others and
guiding the next
generation.
Or can become selfcentered, and stagnant.
Questions what the
person will do with their
extra time.

Integrity vs. Despair

Late adulthood (60-and

up).
Understand and accept
the meaning of
temporary life.
Or complains about
regrets, not having
enough time, and not
finding a meaning
throughout life.
Questions ones overview
of their entire life.

History of Psychosocial
Theory
Erikson was one of the first psychologists to

become aware of the influence of culture on

behavior.
He placed more emphasis on the external
world, meaning depression and wars.
The three key factors to Eriksons theory are
the interaction of the body, mind, and cultural
influences.

Eriksons Philosophy
His basic philosophy rests on two themes:
The world gets bigger as we go along
And failure is cumulative.
If an individual has dealt with a terrible past

as a child, they might not be able to cope with

scenarios that life presents later on.
However, human spirit can always be ignited
and overcome these problems.

Overview
Erikson has eight developmental stages that

gives people an idea of what to expect

throughout life.
Behavior is based on culture experiences.
Each person has the ability to choose their
path when it comes to his eight stages.

Eriksons Psychosocial
Stages of Development

Trust vs. Mistrust

( learning confidence or learning to love)
Occurs in infancy.

(birth-18 months).
Babies must learn to
trust there parents
care and affection.
If not done the babies
could develop a
distrust and view the
world as inconsistent
and unpredictable.
Questions ones hope.

Autonomy vs. Shame and Doubt

Occurs in the toddler

age. (18 months-3

years).
Child learns to feed
themselves and do
things on there own.
Or they could start
feeling ashamed and
doubt their abilities.
Questions the child's
willpower.

Initiative vs. Guilt

Preschool age (3-5

years old).
Using initiative in
planning or carrying
out plans.
Or develop a sense of
guilt over misbehavior
regarding parents
limits.
Questions ones
purpose and role in life.

Industry vs. Inferiority

School age (5-11

years of age).
Learn to follow the
rules imposed by
schools or home.
Or the child can start
believing they are
inferior to others.
Questions
competency.

Identity vs. Role

Confusion
Adolescence (11-18

years of age).
Acquire a sense of
identity.
Or can become
confused about ones
role in life.
Questions who you
are and if your happy.

Intimacy vs. Isolation

Young adulthood (18-40

years of age).
Develop a relationship
and joint identity with a
partner.
Or can become isolated
and stay away from
meaningful relationships.
Questions if the person is
ready for new
relationships, or if there
is a fear of rejection.

Generativity vs.
Stagnation
Middle adulthood (40-65

years of age).
Making use of time and
having a concern with
helping others and
guiding the next
generation.
Or can become selfcentered, and stagnant.
Questions what the
person will do with their
extra time.

Integrity vs. Despair

Late adulthood (60-and

up).
Understand and accept
the meaning of
temporary life.
Or complains about
regrets, not having
enough time, and not
finding a meaning
throughout life.
Questions ones overview
of their entire life.

History of Psychosocial
Theory
Erikson was one of the first psychologists to

become aware of the influence of culture on

behavior.
He placed more emphasis on the external
world, meaning depression and wars.
The three key factors to Eriksons theory are
the interaction of the body, mind, and cultural
influences.

Eriksons Philosophy
His basic philosophy rests on two themes:
The world gets bigger as we go along
And failure is cumulative.
If an individual has dealt with a terrible past

as a child, they might not be able to cope with

scenarios that life presents later on.
However, human spirit can always be ignited
and overcome these problems.

Overview
Erikson has eight developmental stages that

gives people an idea of what to expect

throughout life.
Behavior is based on culture experiences.
Each person has the ability to choose their
path when it comes to his eight stages.

HIGH RISK NEW BORN

High risk newborn can be defined as a newborn,
regardless of birth weight, size or gestational age who has a
greater than average chance of morbidity especially within
the first 28 days of life

The

high-risk neonate is defined as a

newborn, regardless of gestational age or
birth weight, who has a greater-than-average
chance of morbidity or mortality, usually
because of conditions or circumstances on
the normal course of events associated with
birth and the adjustment to extrauterine
existence. The high-risk period begins at the
time of viability
(the gestational age at which survival
outside the uterus is believed to be possible,
or as early as 23 weeks of gestation) up to 28
days after birth and includes threats to life
and health that occur during the prenatal,
perinatal, and postnatal periods.

Problems related to Maturity

Gestational age

280 days (38-42 weeks AOG) Full term

37 weeks and below Preterm

Above 42 weeks Post term

Definition
Prematurity

Delivery of a neonate before the end of 37th week of

gestation.

Very prmature babies born before week 26, are at most

risk and are sometimes known as micro preemies.
1.

2. Post maturity
Infants born of a gestation that extend 42 weeks as
calculated from the mothers last menstrual period.

Causes: of PREMATURITY
. Infections
Gestational hypertension

Cervical insufficiency
High unexplained alpha fetoprotein level
in
second trimester
Lack of prenatal care
Multiple pregnancy
Placenta previa
Substance uterine abnormalities
Underlying condition that results in the
delivery of the neonate before term.

ADOLESCENT PREGNANCY

INFECTIONS
Caused by BACTERIA
weaken the membranes around the

amniotic sac and cause premature

rupture of membranes, or PROM,
commonly known as "water
breaking."
bacterial vaginosis, or BV, as the
most common vaginal infection
occurring in pregnant women.
Symptoms of BV include a thin white
or grayish discharge with a strong
fishy odor, burning with urination and
irritation of the skin in the genital
area. Other infections which can
cause prematurity are
trichomoniosis, gonorrhea and
chlamydia

Theamniotic sac(alsobag of waters) is the sac in which

thefetusdevelops , It is a thin but tough transparent pair of

membranes, which hold a developing embryo (and later
fetus) until birth. The inner membrane, the amnion,
contains the amniotic fluid and the fetus. The outer
membrane, thechorion, contains the amnion and is part of
theplacenta. Its wall is theamnion, the inner of the
twofetal membranes. It encloses the amniotic cavityand
theembryo. The amniotic cavity contains theamniotic
fluid. On the outer side, the amniotic sac is connected to
theyolk sac, to the allantoisand, through theumbilical
cord to the
placenta.

High unexplained alpha fetoprotein level in

second trimester
elevated level of maternal serum alpha-fetoprotein

during the second trimester of pregnancy may indicate

that the fetus has died or is about to die. It is uncertain,
however, whether the finding is associated with an
increased risk of fetal death later in gestation
independent of known causes of elevation, such as the
presence of neural-tube defects or multiple gestation.
MSAFPabovenormal
is
seen
inmultiple
gestatio, when there isplacental abruption, as
well as in a number of fetal abnormalities, such
asnueral
tube
defects
includingspina
bifidaandanencephaly, andabdominal wall
defects.

Cervical insufficiency(cervical
it means that the

cervix has started to

efface and dilate too
soon. This can cause
to give birth too
early, typically
between 16 and 24
weeks. Cervical
insufficiency can
result in miscarriage
orpreterm delivery.

incompetence)

Who's most at risk for cervical

insufficiency?
Those who had a procedure such as a cone
biopsy or LEEP done on thier cervix.(loop
electrosurgical excision procedure)
cervix was injured during a previous birth or
dilation and curettage (D&C).
had one or more second-trimester
miscarriages with no known cause.
had cervical insufficiency in a prior pregnancy
had one or more
spontaneous preterm deliveries.
have a uterine abnormality
(such as abicornate uterus).

Gestational
hypertension
is the development of newhypertensionin
apregnantwoman after 20 weeks gestation
without the presence of protein in the urine or
other signs of preeclampsia

Previous Preemie
previous premature births, risk is higher

with each successive pregnancy.

tocolytics-- inhibit uterine contractions
and suppress pre-term labor.
Tocolyticscan delay labor and give more
time for fetal growth and for the fetal
lungs to mature. They are most effective
when given early in premature labor.
Sample of tocolytic drugs are:
Magnesium sulfate
Terbutalin
Ritodine
nifidipine

Pre-eclampsia
Pre-eclampsia is a serious condition that only

occurs during pregnancy, typically after 20

weeks. It is a combination of hypertension
(high blood pressure) and proteinuria (protein
in your urine).
Pre-eclampsia is thought to affect between
two to eight in 100 women. In most of these
cases, it will be a mild case and may have no
effect on pregnancy.

Signs and symptoms of pre-eclampsia

The main signs are raised blood pressure

combined with the presence of protein in the

urine.
If pre-eclampsia gets more severe, more serious
symptoms can develop, including:
severe headache that doesnt go away with
simple painkillers
problems with vision, such as blurring or flashing
before the eyes
severe pain just below the ribs
heartburn that doesnt go away with antacids
swelling of the face, hands or feet
vomiting
feeling very unwell.

HELLP SYNDROME
HELLP syndrome is a severe form of pre-eclampsia, and is

potentially as dangerous as eclampsia It is most likely to occur

immediately after the baby is delivered, but can appear any
time after 20 weeks of pregnancy, and in rare cases before 20
weeks.
Signs include HEMOLYSIS (where the red blood cells
disintegrate), ELEVATED levels of Liver enzymes and a Low
count of platelets (white blood cells).
The main symptoms are:
nausea and vomiting
pain in your upper abdomen (below the ribs)
general feeling of illness and discomfort
swelling of the body.
The only way to treat the condition is to deliver the baby as
soon as possible.

PLACENTA PREVIA

A complication in which theplacentais inserted

partially or wholly in the lower uterine segment.

It is a leading cause ofantepartum
hemorrhage(vaginalbleeding)
Women with placenta previa often present with
painless,
bright red vaginal bleeding.
This occurs around 32 weeks ofgestation, but
can be as early as late mid-trimester.
This bleeding often starts mildly and may
increase as the area of placental separation
increases. Previa should be suspected if there is
bleeding after 24 weeks of gestation.

Type

Description

Minor

Placenta is in lower uterine segment, but the lower edge

does not cover theinternal os

Major

Placenta is in lower uterine segment, and the lower edge

covers the internal os

GESTATIONAL DIABETES
Gestational

diabetes - develops during

pregnancy. It happens because the body
cannot produce enough insulin (a hormone
important in controlling blood glucose) to
meet its extra needs in pregnancy and/or
because the body is more resistant than
usual to insulin. The result is that blood
sugar levels go up.
gestational diabetes can cause serious
problems, especially if it goes unrecognized.
It is associated with stillbirth and premature
laborand needs careful monitoring

What are the risks of gestational

diabetes?
Any form of diabetes - including diabetes that

developed before the pregnancy - must be

managed carefully because it is associated with
complications such as:
premature birth
giving birth to a large baby
having problems during the birth,such as
shoulder dystocia (where the shoulder gets stuck
after delivery of the head)
the death of the baby around the time of the
birth.

Substance
abnormalities
Congenital uterine
means that
something is
present at birthits something youre
born with. About 3 in 100 females (3
percent) are born with a defect in the size,
shape or structure of the uterus.
When the baby is developing in the
womb, two small tubes callMullerian ductcome together at about 10 weeks
gestation (10 weeks of pregnancy) to form
her uterus. For some the Mullerian ducts
dont come together completely. This can
cause problems with the uterus, including:

Septate
uterus.
most common
congenital uterine
abnormality, a band of muscle or tissue
divides the uterus into two sections.
This cause women to have repeat
miscarriages.
sohealth care providersoften recommend
surgery to repair the uterus and reduce your
risk of miscarriage.
Miscarriage is the death of a baby in the
womb before 20 weeks of pregnancy.Repeat
miscarriagemeans a woman has two, three
or more miscarriages in a row.

Bicornate uterus
(also

called heartshaped uterus). In

this condition, the
uterus
has
two
cavities
(spaces)
instead of one large
cavity. Most women
with this condition
dont need surgery
to repair it.

Unicornate

uterus(also called
one-sided uterus).
This condition
happens when only
half the uterus
forms. Surgery cant
make the uterus any
larger.

Didelphic
uterus(also called

double uterus). In
this condition, there
are two small,
separate cavities,
each with its own
cervix (opening).

2.Post maturity
Post maturity is more likely to happenwhen

a mother has hada post-term pregnancy

before. Sometimes a mother's pregnancy
due date isoff because she is not sure of
her last menstrual period.Getting the date
wrongmay mean the baby is born earlier or
later than expected
primigravida mother

anencephalic fetus
history of post maturity
delayed fertilization and

ovulation

Why is postmaturity a concern?

Postmature babies are born after the normal length of pregnancy. The

placenta, which supplies babies with the nutrients and oxygen from
the mother's blood, begins to age toward the end of pregnancy.It
may not function as efficiently as before. Other concerns are:
Less amniotic fluid.Thismay stop the baby fromgaining weight or
may even cause weight loss.
Poor oxygen supply.Babies that don't get enough oxygen may
have problems during labor and delivery.
Large size.A large baby may cause problems for the mother during
labor and delivery.
Meconium aspiration.Babies who stay in the womb longer are
more likely to breathe in fluid containing their first stools (meconium).
Hypoglycemia (low blood sugar).This happens when the baby
has already used up its glucose-producing stores

What are the symptoms of post maturity?

Each baby may show differentsymptoms of

postmaturity. Some of those symptoms are:

Dry, loose, peeling skin
Overgrown nails
Abundant scalp hair
Visible creases on palms and
soles of feet
Minimal fat deposits
Green, brown, or yellow coloring
of skin from meconium staining
(the first stool passed while in the womb)
More alert and "wide-eyed"

How is post maturity diagnosed?

baby's physical appearance
The length ofyour pregnancy
How old your baby appears to be

Treatment of post maturity

Ultrasound
Nonstress testing (how the fetal heart rate

responds to fetal activity)

Checking the amount of amniotic fluid

Why is post maturity a concern?

The doctor may decide to start the labor early,

depending on several things. During labor, the

baby's heart rate may be watched with an
electronic monitor. This will help tospotchanges
in the heart rate due to low oxygen levels.
Changes inyour baby's condition may require a
cesarean delivery.
Special care of the post mature baby may include:
Checking for breathing problemscaused
bymeconium (baby's first bowel movement)
aspiration
Blood tests for low blood sugar (hypoglycemia)

assessment of Prematurity

Overall health
The health care provider will check the babys
muscle tone activity
alertness,
and skin colour,
and will assess whether she appears to be in

good health overall which include:

Temperature
Gestational age
ABDOMEN and etc.

Assessment findings

Prematurity
Posture:
Infant

lies in a relaxed attitude

Limbs are more extended
The body size is small
The head may appear somewhat
larger in proportion to the body size.

.
Ear:
a. Ear cartilages are poorly developed and
the ear may fold easily
b. Hair is fine and feathery
c. Lanugo may cover the back and the face

sole :
a. Sole of the foot of the preterm
infant appears more turgid and may
have only fine wrinkles.

 female genitalia:
a. Preterm female infants clitoris is
prominent

b.Labia majora are poorly developed

and
gaping

Male genitalia:

a. Scrotum is undeveloped and not

pendolous, minimal rugae (ridges) are
present
b. Testes maybe in the inguinal canals or in
the abdominal cavity.

Scarf sign

:sign used in Dubowitz scoring (q.v.) to

assess developmental age and muscle tone in
neonates. The infant's arm is pulled laterally across
the chest; in the hypotonic infant, the elbow will
cross the midline; in a term infant with normal tone,
the elbow will not reach the midline.
a. infants elbow maybe easily brought across the
chest with little or no resitance.
Grasp reflex:
a.Grasp is weak
Heel- to- ear maneuver:
a. infants heel is easily brought to the ear, meeting
with no resistance

Your role in your infant's care

At first sight, you may question whether and even how to touch

your tiny infant. Unless your newborn is very sick or immature,

you will be allowed to touch and possibly hold him or her. But
your infant's nurse or doctor will first need to show you how to
work around the technology and to alert you to your infant's
special needs. When visiting with your premature newborn,
remember that:
A premature infant has limited energy for recovering and
growing. Try not to wake your infant fromsleep.
A premature newborn'sbrain isn't quite readyfor the world. Be
alert tosigns that your infant is being overstimulatedby your
gaze, voice, or touch, or by sound and light in the room.
A stable, more mature preemie will thrive on periods of
cuddling (kangaroo care), infantmassage, and calming music.

Postmaturity
Alert, wide eyed look
Absence of vernix caseosa
Long finger nails
Profuse scalp hair
Long, thin body
Decrease or absent subcutaneous fat
Loose, dry skin
meconium

causes
It is not known why some pregnancies last

longer than others. Post maturity is more

likely when a mother has had one or more
previous post-term pregnancies. Sometimes a
mother's pregnancy due date is miscalculated
because she is not sure of her last menstrual
period. A miscalculation may mean the baby
is born earlier or later than expected.

Why is postmaturity a concern?

Postmature babies are born at the very end, or past, the normal

length of pregnancy.
The placenta, which supplies babies with the nutrients and
oxygen from the mother's circulation, begins to age toward the
end of pregnancy, and may not function as efficiently as before.
Other concerns include the following:
Amniotic fluid volume may decrease and the fetus may stop
gaining weight or may even lose weight.
Risks can increase during labor and birth for a fetus with poor
oxygen supply.
Problems may occur during birth if the baby is large.
Postmature babies may be at risk for meconium aspiration,
when a baby breathes in fluid containing the first stool.
Hypoglycemia (low blood sugar) can also occur because the
baby has too little glucose-producing stores.

Treatment of postmaturity
Specific treatment for postmaturity will be

determined by your baby'sdoctor based on:

Your baby's gestational age, overall health,
and medical history
Extent of the condition
Your baby's tolerance for specific medications,
procedures, or therapies
Expectations for the course of the condition
Your opinion or preference

Special care of the postmature baby may

include:
Checking for respiratory problems related to
meconium (baby's first bowel movement)
aspiration.
Blood tests for hypoglycemia (low blood
sugar).

Prevention of postmaturity
Accurate pregnancy due dates can help

identify babies at risk for postmaturity.

Ultrasound examinations early in pregnancy
help establish more accurate dating by
measurements taken of the fetus. Ultrasound
is also important in evaluating the placenta
for signs of aging.

GESTATIONAL WEIGHT
Gestational size variation
A. Large for gestational age
B. Small for gestational age
C. Appropriate for gestational age

Definition
Large for gestational age (LGA)

- neonate are above the 90th

percentile for weight on the intra
uterine growth chart.
- also called macrosomia
- the weight is 4,000g. (8 lbs. 13 oz.)
- at risk to injury during birth. CS
is usually indicated.

Pathophysiology/ causes:
LGA may result from a genetic factor

- male neonates tend to be larger than females

- neonates of large parents tend to be large
- neonates of multiparous women tend to be
larger
- neonates of a diabetic mothers

Assessment Findings
Weight more than 4,000g (8lbs. 13 oz.)
Appear plump and full-faced
Fractures or intracranial hemorrhage due to

exposure to trauma during vaginal delivery

Hypoglycemia maybe noted

Treatment:
Close observation
Episiotomy
Glucose monitoring
Evaluation of jaundice
Management of trauma

Nursing Interventions:
Supporting respiratory effort
Providing a neutral thermal environment
Protecting the neonate from infection
Providing appropriate nutrition
Maintaining adequate hydration
Conserving the neonates energy
Assessing glucose level
Preventing skin breakdown

Definition:
Small for gestational age( SGA)

- birth weight at or below the 10th percentile on

intrauterine growth chart

Pathophysiology:
The underlying problem is intrauterine growth

retardation
Conditions in the mother may contribute to
the birth of SGA neonate
a. perinatal asphyxia
b. hypoglycemia
c. hypocalcaemia
d. aspiration syndrome

e. Increase heat loss

f. Feeding difficulties
g. polycythemia

Assessment Findings:
Wide-eyed look
Sunken abdomen
Loose dry skin
Decreased chest and abdomen

circumferences
Decrease subcutaneous fat
Thin, dry umbilical cord
Sparse scalp hair

Causes:
Factors that contribute to a neonate being

SGA:
a. Congenital malformation
b. Chromosomal anomalies
c. Maternal infections
d. Gestational hypertension
e. Advanced maternal diabetes

f. Intrauterine malnutrition
g. Maternal smoking
h. Maternal drug or alcohol use
i. Multiple gestation

Acute Conditions:
1.
2.
3.
4.
5.

ARDS(acute respiratory distress syndrome)

Meconmium aspiration
Sepsis
Hyperbillirubinemia
SIDS

Definition
1. ARDS(acute respiratory distress syndrome)
Refers to a condition of surfactant deficiency
and physiologic immaturity of the thorax.
A complex disorder manifested by signs of
respiratory distress
- May also be called Hyaline membrane
disease

Review of the anatomy and

physiology of respiratory system

Pathophysiology:
Lack of surfactant in the lungs
Leads to atelectasis as well as labored

breathing, respiratory acidosis, and

hypoxemia
Blood flow to the lungs decreases
Alveoli become necrotic
Capillaries are damaged
Hyaline membrane forms

Assessment findings:
Increase respiratory rate
Retractions
Labored breathing
Fine crackles on auscultations
Expiratory grunting
Nasal flaring
cyanosis

Infant with ARDS

If getsworse: S/S
Worsening cyanosis
Flaccidity
Unresponsiveness
Apneic episode
Decrease breath sounds

Treatment:
Prevent preterm delivery
Thermoregulation
Oxygen administration
Mechanical ventilation if needed
Prevention of hypotension
Prevention of hypovolemia

Correcting respiratory acidosis

Nursing interventions:
Collecting blood samples
Monitoring pulse oximetry
Suctioning
Implementing thermoregulation
Monitoring nutrition
Administering medication
Providing moth and skin care

2. Meconium aspiration syndrome

Meconium- is a thick, sticky, greenish black

substance that constitutes the neonates first

feces.
- results when the neonate inhales meconium
thats mixed with amniotic fluid.

Pathophysiology:
Asphyxia in utero leads to increase peristalsis,

relaxation of the anal sphincter, passage of

meconium into the amniotic fluid and reflex
gasping of amniotic fluid into the lungs.

cause
Inhalation of meconium

Risk factor for MAS

Maternal diabetes
Maternal hypertension
Difficult delivery
Fetal distress
Intra uterine hypoxia
Advanced gestational age
Poor intra uterine growth

Assessment findings
Dark greenish staining or streaking of the

amniotic fluid
Obvious presence of meconium in the
amniotic fluid
Limp appearance at birth
Cyanosis
Rapid breathing
Labored breathing

Apnea
Signs of post maturity
Low heart rate before birth
Low apgar score
Hypothermia
Hypoglycemia
Hypocalcaemia
Nasal flaring
Grunting
Tachypnea
Irregular gasping respiration

Treatment:
Chest physiotherapy
Antibiotics
Use of radiant warmer

Nursing interventions:
During labor, continuously monitor the fetus

for signs and symptoms of distress

Immediately inspect any fluid passed with
rupture of membrane
Assist with endotracheal suctioning during
delivery as indicated
Monitor lung status closely
Frequently assess the neonates vital signs

Institute measures to maintain a neutral

thermal environment
Supporting family members by providing
education and reassurance
Promoting parents-neonate attachment.

SEPSIS /septicemia
Definition
Occurs when pathogenic microorganisms or

their toxins occur in the blood or tissues

Occurs before, during or after delivery

ALTERNATIVE NAMES
Sepsis neonatorum; Neonatal septicemia;

Sepsis - infant

Causes

A number of different bacteria, including Escherichia coli (E.coli),

Listeria, and certain strains of streptococcus, may cause neonatal

sepsis.

Early-onset neonatal sepsis most often appears within 24 hours of

birth. The baby gets the infection from the mother before or during
delivery. The following increases an infant's risk of early-onset
sepsis:

Group B streptococcus (group b strep) infection during pregnancy

Preterm delivery

Rupture of membranes (placenta tissue) that lasts longer than 24

hours

Infection of the placenta tissues and amniotic fluid

(chorioamnionitis)

Babies with late-onset neonatal sepsis get infected after delivery.

The following increase an infant's risk of sepsis after delivery:

Having a catheter in a blood vessel for a long time

Staying in the hospital for an extended period of time

Symptoms
Infants with neonatal sepsis may have the following symptoms:
Body temperature changes
Breathing problems
Diarrhea
Low blood sugar
Reduced movements
Reduced sucking
Seizures
Slow heart rate
Swollen belly area
Vomiting
Yellow skin and whites of the eyes (jaundice)

Exams and test

Laboratory tests can help diagnose neonatal sepsis and

identify the bacteria that is causing the infection. Blood

tests may include:
Blood culture
* Complete blood count (CBC)
A lumbar puncture (spinal tap) will be done to examine
the cerebrospinal fluid for bacteria.
If the baby has a cough or problems breathing, a chest
x-ray will be taken.
Urine culture tests are done in babies older than several
days.

Treatment
Babies in the hospital and those younger than 4

weeks old are started on antibiotics before lab

results are back. (Lab results may take 24-72
hours.) This practice has saved many lives.
Older babies may not be given antibiotics if all
lab results are within normal limits. Instead, the
child may be followed closely on an outpatient
basis.
Babies who do require treatment will be admitted
to the hospital for monitoring.

Possible Complications
Disability
Death

Nursing Interventions
Collect specimens to identify causative

organisms
Assess the neonates vital signs at least once
per hour or more frequently as indicated
Expect to administer a brad spectrum
antibiotic before culture results are receive
and switch to specific antibiotic therapy after
result are recieve

Provide supportive care, including of a neutral

thermal environment
Administer nutritional support
Assist respiratory support
Monitor electrolyte balance

Sudden Infant Death

Syndrome(SIDS)
Definition
Sudden infant death syndrome (SIDS) is the unexplained death,

usually during sleep, of a seemingly healthy baby. For parents,

it's a devastating and shocking childhood illness there's no
warning and there's no definitive cause.
Most SIDS deaths occur in children between 2 months and 4
months of age. Sudden infant death syndrome rarely occurs
before 1 month of age or after 6 months.
Researchers have discovered some factors that may put babies
at risk for sudden infant death syndrome. They've also
identified some measures you can take to help protect your
child from sudden infant death syndrome. Perhaps the most
important is placing your baby on his or her back to sleep.

Preterm birth and/or low birth weight SIDS RISK

FACTORSThere are a number of factors that

can increase the risk of SIDS. The most commonly
identified risk factors include the following:
Prone (stomach) sleeping position
Sleeping on a soft surface
Overheating
Young maternal age (under 20 years)
Maternal smoking during pregnancy
Late or no prenatal care

Precautions to reduce the chance of

SIDS
Have good medical care and adequate nutrition during pregnancy.
Keep baby in smoke-free surroundings (smoking by either parent

as well as secondhand smoke are clearly linked with SIDS).

Put baby to sleep on a firm mattress.
Breastfeed, if possible.
If "blue spells" are noticed in the infant, get prompt medical
advice.
Try not to let the baby get too hot (don't over-swaddle).
Never have the infant's face covered by bedclothes.
Avoid thick blankets, pillows or bumpers in the crib.
Try not to let the infant sleep on his/her stomach.
Put the baby to sleep on his/her side or back. (A rolled-up towel
along his/her back will help to keep the baby on his/her side.)

Hyperbilirubinemia
Definition
Is an excess of bilirubin in the blood and

characterized by jaundice or icterus.

Physiologic jaundice arises more than 24
hours after birth
Serum bilirubin level reaches 5-6 mg/dl
Pathologic jaundice occurs during 1st 24 hours
of life. Serum billirubin is above 12mg/dl

Physiologic jaundice
Physiologic jaundice is caused by the inability of

the newborn's immature liver to metabolize

(conjugate) and thus excrete bilirubin, which
accumulates due to the breakdown of red blood
cells which have a shorter life-span (70 to 90 days)
than adult red blood cells (120 days). This increase
in red blood cell breakdown and decreased ability
to metabolize bilirubin overwhelms the newborns
ability to properly process and excrete bilirubin. As
the newborn's liver matures, however, the jaundice
eventually disappears after 1 to 2 weeks.

Classification:
Physiologic jaundice arises more than 24

hours after birth

Serum bilirubin level reaches 5-6 mg/dl
Pathologic jaundice occurs during 1st 24 hours

of life. Serum billirubin is above 12mgmg/dl

Red Blood Cell

Hemoglobin

Heme
Iron

Globin
Unconjugated bilirubin glucoric
acid
Conjugated bilirubin
glucoronide
Excreted through feces& urine
in the new born, the immature liver cannot conjugate bilirubin
Unconjugated bilirubin is absorbed by the subcutaneous fats

JAUNDICE