eMultiple gestations twins triplets fPrevious delivery of a premature infant

Emultiple gestations twins triplets fprevious

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(e)Multiple gestations (twins, triplets)
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(f)Previous delivery of a premature infant (g)Drug use (h)Trauma iii.Other factors contributing to low birth weight include: (a)Chronic maternal hypertension (b)Smoking (c)Placental abnormalities (d)Chromosomal abnormalities d.Morbidity and mortality are related to degree of prematurity. i.Most delivered after 28 weeks of gestation who receive cardiovascular support survive long term. ii.Those born at 24 weeks of gestation have high morbidity and mortality. 2.Assessment and management a.To determine prematurity, rely on: i.Physical features (a)Maturity of skin (b)Size of infant (c)Degree of respiratory distress ii.Information from family about gestational dating (a)Last menstrual period (b)Estimated due date (c)Ultrasound dating iii.Information related to maternal or fetal complications b.To optimize survival for a newborn delivered prematurely in the field: i.Provide cardiorespiratory support. ii.Provide a thermoneutral environment. iii.Use only minimum pressure necessary to move chest when providing PPV. (a)Risk of retinopathy of prematurity, worsened by long-term oxygen exposure c.Management focuses on: i.Clearing airway ii.Gentle stimulation iii.Providing supplemental oxygen and PPV if needed (a)Provide peak inspiratory pressures to maintain physiological chest rise. iv.Provide chest compressions if effective ventilation does not result in adequate heart rate. v.Maintain a warm environment. H.Seizures in the newborn 1.Most distinctive sign of neurologic disease in the newborn a.More common in premature newborns b.Identified by direct observation in the field i.Diagnosis is confirmed by electroencephalogram in the hospital. c.The following are often mistaken for seizures in the newborn: i.Normal movements when a newborn is drowsy or asleep ii.Jitteriness
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iii.Gastroesophageal reflux and choking episodes d.Seizures are usually related to an underlying abnormality. e.Seizures may interfere with: i.Cardiopulmonary function ii.Feeding iii.Metabolic function f.Prolonged seizures may cause brain injury. 2.Types of seizures a.Subtle seizure—characterized by: i.Eye deviation ii.Blinking iii.Sucking iv.Pedaling leg movements v.Apnea b.Tonic seizure—characterized by: i.Tonic limb extension ii.Possible flexion of arms and leg extension c.Focal clonic seizure—characterized by clonic, localized jerking d.Myoclonic seizure—characterized by flexion jerks of upper or lower extremities 3.Multifocal seizure: Clonic activity that involves more than one site, is asynchronous, and is usually migratory 4.Generalized seizure: Activity that is bilateral, synchronous, and nonmigratory 5.Causes of seizures a.Seizure onset up to 3 days after delivery are often caused by: i.Hypoxic ischemic encephalopathy ii.Hypoglycemia iii.Other metabolic disturbances b.Seizures that begin 3 days or longer after birth are likely from other causes: i.Intracranial infections (meningitis) ii.Epileptic syndromes iii.Intracranial hemorrhage iv.Development defects v.Hypocalcemia vi.Meningitis vii.Encephalopathy
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