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Patho, Case Study Example

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Case Study

There exist possible complications of the new born associated to the maternal and newborn history. A number of morbidities can be present in babies born to women with diabetes, in which case it includes the type 1 and type 2 diabetes and the gestation diabetes. Such morbidities include the feta macrosomia, hypocalcaemia, hypoglycemia, infant respiratory distress syndrome, hyperviscosity, cardiomyopathy, hypomagnesaemia and the polycythaemia. In addition, there is a rare, but also serious complication that might necessitate admission to a NICU, and this include the Thrombosis. The main risk factors involve the maternal diabetes, polycythaemia and the use of intravascular catheters in the preterm babies. In the case of the history highlighted in the maternal and delivery history, the possible complications include the congenital anomalies, hyperbilirubinemia, hypocalcaemia and the respiratory distress syndrome. In addition, the complications of fatal macrosomia manifests in babies born of women with gestation diabetes. The manifestation may include the fractures of the clavicle and the humerus. The phrenic nerves or the cerebral injuries may also report. Some times cases of fracture may happen, in which case the use of chest radiograph is applicable to confirm the presence of fractures (Brodsky & Ouellette, 2007).

The rationale of the complications highlighted involves the neonate child born at 36 weeks gestation to a mother who is a type 1 diabetic. This might be associated with the complication hyperbilirubinemia and respiratory distress syndrome. The other rationale involves the delivery history, which involves the pre-term-PROM with normal, spontaneous delivery 2 days later. Hyperbilirubinemia rationale involves the use of insulin regimen by the mother. Respiratory distress syndrome rationale involves the resuscitation at delivery, in which case there was the use of oxygen bag, and the mask times 4 minutes, and also there was the continuing signs of respiratory distress syndrome, so newborn baby was sent to NICU for continuing the respiratory support.

The cause of congenital abnormalities involve the problems associated during the fetus’s development before birth. The whole of the abnormality involves categories such as chromosome abnormality, which includes structures that bear the genetic substance inherited from one generation to another. Illnesses during pregnancy that might involve the diabetes cause serious congenital abnormalities.

Neonatal hyperbilirubinemia results from the predisposition to the reduction of bilirubin in the newborn babies and it includes their limited ability to excrete it. The preterm infants contain higher rates of bilirubin production because they contain red cells with a high turnover and span of short life. The newborn babies do not excrete unconjugated bilirubin, and there is limited ability to conjugate bilirubin. The whole of these might lead to the physiologic jaundice, in which case it includes high serum bilirubin concentration during the first days of life in full term babies and up to the first week for the case of the preterm babies (Ricci & Kyle, 2009, p.736).

Hypoglycemia involves a condition, in which case the amount of blood glucose or sugar in the blood is quite lower than in normal situations. Usually this complication affects babies, who are born to diabetic mothers after delivery, and this is when there is no existence of the source of glucose for the child, and the baby’s insulin production metabolizes the existing glucose. This complication also is common in gestational age or growth restricted babies, in which case they may have too few glycogen stores. The premature babies with low birth weights also have such complications, and who often have imperfect glycogen provisions or an immature liver function. The cause of the complication might be due to surpus insulin fashioned in a baby of a diabetic mother, harsh hemolytic disease of the newborn, both defects including the congenital metabolic diseases, inadequate maternal nutrition in pregnancy among other causes. This complication might be treated by giving the baby the rapid acting source of glucose. Mother who has diabetes with high blood sugar levels can prevent such a complication by minimizing the amount of glucose that goes to the fetus (Ricci & Kyle, 2009, p.736).

Respiratory distress syndrome is quite common in premature infants. The complication and the severity of the syndrome are related inversely to the gestation age of the newborn babies. Te incidence and the severity of the compaction of respiratory distress syndrome may result in clinically significant morbidities. The advances that are  there to curb the syndrome includes the use of the antenatal steroids that enhance the pulmonary maturity appropriate resuscitation facilitated by the placental transfusion and the use of continuous positive airway pressure for the alveolar recruitment and the early administration of surfactant (Ricci & Kyle, 2009, p.736).

The lab values that are abnormal in the mentioned electrolytes include the Na, K+, Cl, Ca, Mg and Urea. The baby might be exhibiting the symptoms associated with the above abnormality of lab values. This includes the baby becoming tachypnic and exhibits some signs of respiratory stress whenever the mother tried to breastfed the child. In addition, there is the expiratory granting with some breaths, in which case there are no retractions with some breaths. Furthermore, there is the presence of full ROM, which involves tremors noted in both hands, and even the cord drying with no signs of infections.

Hyperbilirubinemia results from the predisposition to the production of bilirubin in the newborn babies and their limited ability to excrete it. Babies, especially, the preterm babies, have higher rates of bilirubin production, and this is because they have high red cells with a probability of turning over and a short life span. In newborn babies, there is no excretion of unconjugated bilirubin, and there is limited ability to conjugate bilirubin. There is limitation might result to physiologic jaundice, in which case this involves the serum bilirubin concentrations in the first days of life in the preterm infants, which is followed by the decline during some weeks to follow.

References

Ricci, S. S., & Kyle, T. (2009). Maternity and pediatric nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Brodsky, D., & Ouellette, M. A. (2007). Primary care of the premature infant. Philadelphia, Pa: Elsevier Saunders.

Song, M.K & Roufogalis, B.D. (2012).  Modulation of diabetic retinopathy pathophysiology by natural medicines through PPAR-γ related pharmacology. In Huang, Tom H W. British Journal of Pharmacology. 165 Issue 1, p4-19. 16p. DOI: 10.1111/j.14765381.2011.01411.x.

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