Applied Neonatology R Arvind
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1General Considerations2

Introduction1

  • Introduction
  • Nomenclature
    • – Live Birth
    • – Death of the Fetus
    • – Birth Weight
    • – Perinatal Period
    • – Neonatal Period
    • – Gestational Age
  • Measures of Outcome
    • – Infant Mortality Rate
    • – Neonatal Mortality Rate
    • – Perinatal Mortality Rate
 
INTRODUCTION
Neonatology means knowledge of the human newborn. It is a recognized subspeciality of the pediatrics. The newborn is with so many problems, the physiology is so unique and rapidly changing, that all conditions of the newborn should come within the concern of the field of neonatology. Detailed knowledge of the newborn physiology can help in the management of the congenital anomalies, surgical conditions, failure to thrive, nutritional problems, neurological problems.
This field must also grow in its relationship with obstetrics and fetal biology. This helps in the management of the high-risk pregnancies and newborn. At the clinical level, the interdependence of the obstetrics and neonatology is obvious. In the maintenance of greater mutual understanding and daily interaction are needed for the optimal care of the mother and their infant.
 
NOMENCLATURE
 
Live Birth
It is defined as a complete expulsion or extraction of a product of conception from the mother, irrespective of the duration of the pregnancy. Babies weighing less than 500 gms at birth, should show signs of life for atleast one hour to be designated as a live born. The baby should show the signs of life such as breathing, heart beating, pulsation of the umbilical cord or definitive movements of the voluntary muscles. This is again irrespective of attachment of placenta or cord.
Fetus is the term applied to the product of conception irrespective of duration of pregnancy.
 
Death of the Fetus
Death of the fetus is the death of a product of conception, prior to complete expulsion or extraction from its mother, irrespective of duration of pregnancy. Death of the fetus means that there are no signs of life.
Early fetal death occurs at a gestational age less than 22 weeks or a fetus weighing 500 gms or less. This is called as abortion. Intermediate fetal death occurs at the age of 22 to 27 weeks. The fetus weighs between 501-1000 gms. This is termed as stillbirth. Late fetal death occurs at a gestational age of 28th week or more. Fetus weighs more than 1000 gms. Here the crown-heel length is 35 cm or more. The body may be fresh or macerated. This is also called stillbirth.
 
Birth Weight
Birth weight of the baby is recorded preferably within 1 hour of life. If it is recorded after 24 hours, the age should be mentioned. The baby is said to be of low birth weight if it is less the 2500 gms or less.
In low birth weight, weight is less than 2000 gm. In very low birth weight, weight is less than 1500 gm. In extremely low birth weight, weight is less than 1000 gm.
 
Perinatal Period
4Perinatal period starts from 28th week of gestation to seventh day of life. The extended perinatal period is from 20 weeks of gestation to seventh day of life.
 
Neonatal Period
Neonatal period starts from the seventh day of life to 28th day of life. Early neonatal death includes the death within 7 days of life. Neonatal death includes 28 days of life.
 
Gestational Age
It is calculated from the first day of last menstrual period to the date of birth.
 
Gestational Age Maturity Groups
  1. Preterm Infant is defined as a baby with the gestational age maturity less than 37 weeks.
  2. Term Infant is defined as gestational age maturity between 37 and 41 weeks.
  3. Post-term Infant is defined as the gestational age maturity of 42 weeks or more.
 
MEASURES OF OUTCOME
 
Infant Mortality Rate
It is defined as the number of death occurring within the first year of life per thousand live birth. Infant mortality rate can be divided further into neonatal mortality, i.e. death before 28 days of life and post neonatal mortality, i.e. death between 28 days and one year of age.
Neonatal mortality is the result of factors related to pregnancy and birth. Post neonatal mortality is the result of environmental factors such as trauma, infection, nutrition, sudden infant death syndrome, gastroenteritis, congenital anomalies and respiratory infection.
 
Neonatal Mortality Rate
It refers to the number of deaths occurring at less than 28 days after the birth per thousand live birth. This accounts for 67 percent of the infant death. Fifty percent of the neonatal death can be attributed to LBW, acute perinatal asphyxia, congenital anomalies, perinatal infections, difficult labor, respiratory distress syndrome and gastroenteritis.
 
Perinatal Mortality Rate
It is defined as the number of the fetal death, i.e. fetal deaths of 28 weeks or more. Gestation plus early neonatal deaths, i.e. deaths of the infants of 0-6 days of life per 1000 live birth. The major causes of the fetal deaths are chronic asphyxia, congenital malformations, superimposed complications of the pregnancy such as placental abruption, diabetes mellitus, intrauterine infection and unexplained deaths.
  1. Neonatal Mortality Rate
  2. Post Neonatal Mortality Rate
  3. Perinatal Mortality Rate
  4. Infant Mortality
BIBLIOGRAPHY
  1. Hess JH, Lundeen EC. The premature infant: its medical nursing care. JB, Lipincott Co.,  Philadelphia  1941.
  1. Human development report 1997, United Nations Development Program, New York 1997.
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  1. Klaus MH, Kennel JH. Parent−infant bonding. CV Mosby,  St. Louis  1982.
  1. Nightingale F notes on nursing, what it is and what it is not (A fascimile of the first edition printed in London, 1859. With foreword by Annie W. Goodrich). JB, Lipincott Co.,  Philadelphia  1969.

  1. 5 Smith CA. The physiology of the newborn infant. Charles C. Thomas,  Springfield IL  1945.
  1. Silverman WA, Anderson DH, Blanc WA, Crazier DN. A difference in mortality rate and incidence of kernicterus among premature infants allotted to two prophylactic antibiotic regimens. Pediatrics 1956; 18: 614.
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  1. The World Health Report. World Health Organization, Geneva, 1995.