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Neonatal Jaundice: Jaundice is a yellow discoloration of the skin, sclera and mucous membranes caused by high serum bilirubin. Bilirubin is the main pigment formed in humans during the catabolism Pediatric Nursing and child health care 74 of the hem component of hemoglobin. Either excessive production or defective elimination of bilirubin causes jaundice. Physiologic jaundice resolves spontaneously by the end of first week in term infants and 2nd week in premature infants. Serum bilirubin is usually under 12 mg/dl in term infants and less than 15mg/dl in premature babies. Jaundice within 24 hrs of birth; conjugated bilirubin over 12mg/dl; or jaundice beyond 2nd week of life is pathological Causes: ABO/RH incompatibility Red cell membrane defects RBC enzyme defects Polycythemia Infection Management of pathological jaundice Enhancing conjugation by induction of glucuronyl transferase with phenobarbiton Changing insoluble bilirubin to a water soluble form by phototherapy Removing excess bilirubin by exchange transfusion. Pediatric Nursing and child health care 75 Study Questions 1. Discuss the role and responsibility of nurse in identifying and caring for a child with congenital abnormality at birth 2. List the most common congenital abnormalities that can be detected at birth 3. What measures would you take concerning parents who had a baby with congenital abnormality? Pediatric Nursing and child health care 76 CHAPTER SIX NORMAL GROWTH AND DEVELOPMENT Learning Objectives After studying the material in this unit, the student will be able to:- - Identify the difference between growth and development - Recognize stages of normal growth and development - Detect deviation from normal growth and development measures to be taken - Use growth-monitoring chart to assess nutritional status of under 5 children - Recognize needs of the growing child Definition: Growth means increase in size, Development means increase of function. Growth and development go together but at different speeds. The fetus: during the first trimester the main body systems are prepared. This is mainly the stage of development, when the body systems become more efficient Pediatric Nursing and child health care 77 Harmful environmental factors, such as infections like rubella (German measles) in the mother, or exposure to certain drugs or X-rays may interfere with the development of the fetus at this stage. The child may be born with certain deformities, e.g. congenital heart disease, deafness, small head and brain. During the last 6 months the fetus increases greatly in size. This is mainly stage of growth. Malnutrition or amaemia in the mother, or other disease of placenta like malaria interfering with its blood supply, will stop the fetus growing properly. The baby may thus be born small, not weighing as much as he should. The infant: growth and development is a continuous process, but it often goes fast for a while and slows down before going fast again. The infant needs a relatively large amount of water, energy, and protein while growing so fast. 6.1 Growth The body can grow only if it gets enough good food. The food must contain enough calories, protein, and other nutrients. If the body does not grow properly it can not resist diseases either. The best way to measure growth is by weighing. Other ways are by measuring length (height) and the arm circumstances. Pediatric Nursing and child health care 78 The figures below are average figures for normal growth. Table 1. Normal growth and development Age Weight Length Arm circumference Birth 3.5 kg 50 cm ½ year 7 kg 1 year 10 kg 75 cm 12.5cm 2 year 12 kg 3 year 14 kg 4 year 16 kg 100 cm 5 year 18 kg Head circumference: Below normal range-abnormally small = microcephalus Above normal range-abnormally large head = usually hydrocephalus The infant has relatively larger head than the adult. At birth the head is a quarter of the whole body length but in an adult it is only one eight. Head Circumference: The head grows 12 cm in circumference in the first 12 months, but 6 cm of this is in the first three months; during the next three months it grows 3 more cm and Pediatric Nursing and child health care 79 the rest of the
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