Hematology of a newborn

Hematology of a newborn (1)
Hematology of a newborn

Hematology is the study of blood and tissue that forms blood. Blood is an important part of the transport system. Blood is a tissue in the form of a liquid that consists of two major parts, namely the blood plasma and the grains of blood. Blood plasma is a liquid part of the blood. It is mostly large consisting of water, electrolytes, and blood proteins. Whereas blood corpuscles consist of these components:

  • Erythrocytes, red blood cells
  • Leukocytes (white blood cells)
  • Platelets (blood clots or platelets)

In another sense, hematology is also known as a branch of medicine concerning blood cells, blood-forming organs, and abnormalities associated with cells and blood-forming organs. Everyone knows that bleeding will eventually stop when a wound occurs. There is an old wound that bleeds back. When the bleeding continues to progress, a clot of frozen blood will immediately form and harden, and the wound will recover soon. Continue reading “Hematology of a newborn”

The gastrointestinal system in newborn

The gastrointestinal system in newborn

The gastrointestinal system in newborn (2)
The gastrointestinal system in newborn

Gastrointestinal is a digestive tract starting from the mouth to the anus, including oropharynx, esophagus, stomach, small intestine, and large intestine. The digestive tract (gastrointestinal),  food is a channel receiving food from the outside and preparing it to be absorbed by the body of the system digestion (mastication, ingestion, and mixing). It is processed with enzymes and liquid substances that stretch from the mouth to the anus. Newborns must begin to feed, digest and absorb food after birth, as the placenta has done this function.

Before birth, the fetus is quite a month to practice sucking and swallowing behavior. At birth, advanced vomiting and cough reflexes have disappeared. The ability of a newborn baby to swallow and digest food from outside is quite limited. Most of these limitations require various enzymes and digestive hormones that can be found in the digestive tract (starting from the mouth to the intestine).

The ability of carbohydrate absorption in newborns is less efficient, while monosaccharide (glucose) absorption has been efficient. Regurgitation in newborns is caused by an incomplete heart sphincter, lower esophageal junction, and stomach. Gastric capacity in term infants is very limited, the size is less than 30cc. This is because the newborn’s intestine is relatively immature and the muscular system that makes up the organ is thinner and less efficient compared to adults. As a result, peristaltic waves are difficult to predict.

The folds and villi of the intestinal wall have not fully developed. Epithelial cells that line the small intestine of newborns do not change rapidly, thus increasing the most effective absorption. Early oral feeding stimulates the intestinal lining to mature by increasing rapid cell turnover and the production of microvillus enzymes. Immature epithelial cells affect the intestine to protect themselves from very dangerous substances.

In early life, newborns face the process of closing the intestine (the intestinal epithelial surface becomes not permeable to the antigen). Before closing the baby’s intestine it will be susceptible to viral/bacterial infections and also to allergen stimulation through absorption of large molecules by the intestine. Colon newborns are less efficient at storing fluids than the colon of adults so babies tend to experience fluid loss compilation, such as diarrhea disorders.

 

Important factors in the neonatal digestion system

  • Digestive Organs

Here are several the digestive tract. They are oris (mouth), pharynx, esophagus (esophagus),  small intestine, colon, rectum, and anus.

  • Establishment of Digestive Enzymes in Infants

Important enzymes for digesting carbohydrates, proteins, and simple fats are formed in week 36-38 of gestational age. Newborns are sufficient if they can swallow, digest, metabolize and absorb simple proteins and carbohydrates and emulsify fat. Pancreatic amylase is deficient for the first 3 – 6 months after birth. As a result, newborns cannot digest complex types of carbohydrates such as in cereals.

The intestine of the newborn is relatively immature. The muscular system that makes up the organ is thinner and less efficient than in adults so that the peristaltic wave cannot be predicted. The folds and villi of the intestinal wall have not been completely developed. Epithelial cells as small line intestine of newborns do not change rapidly, thus increasing the most effective absorbs. Starting of oral feeding stimulates the lining of the intestine to mature by increasing rapid cell turnover. There are some of the products of the enzymatic enzyme, such as amylase, trypsin, and pancreatic lipase. The midwife’s support for immediate feeding of newborns helps the maturation of the ability of this small intestine.

 

Physiological Adaptation of the Baby’s digestive system

  • Intrauterine

The fetus begins to show swallowing movement activity for 14 weeks’ gestation. The active sucking movement appears at 26-28 weeks. Bile fluids are produced from the end of the first trimester, followed by all other digestive enzymes. The digestive process has not been active. The need for nutrition is not fulfilled with the digestive system but is obtained from the placenta. Feeding reflexes in the fetus in the uterus have begun to be seen from the activity of swallowing amnion and sucking. Meconium, the main content especially in the digestive tract of the fetus, appears to begin at the age of 16 minutes.  Meconium is not released as long as the fetus in the uterus (no defecation process occurs), only meconium urine since peristalsis is not active except in fetal distress. In experiencing fetal distress fetuses, there is pressure on the abdomen and the anal spingter relaxes so that the meconium stored in the intestine comes out and mixed with amniotic fluid. Important enzymes for digesting carbohydrates, proteins, and simple fats at 36-38 weeks of gestation have begun to be formed to prepare for birth (the life of an extrauterine fetus). The main fetal oxygenation remains from the maternal-fetal circulation through the placenta and umbilical cord.

  • Extrauterine

Preterm neonates can digest and absorb milk from birth. Specific growth factors in milk are important to promote post-natal digestion. The neonatal intestine has immature digestive and absorption capacity but there are several compensation mechanisms, especially for infants who get breast milk. The cardiac sphincter between the esophagus and stomach in the immature neonate undergoes relaxation so that it can cause food regurgitation immediately after administration. Regurgitation can also occur because of the control of not perfect innervation in the stomach.

At birth, newborn gastric capacity is around 6 ml/kg body weight, or on average around 50-60 cc, but soon increases to around 90 ml for the first few days of life. The stomach will be empty in 3 hours for food intake and empty in 2 to 4 hours.

Newborn has an intestine. This organ is longer in size than the size of a baby. This condition causes the surface area to absorb more widely. Bowel sounds in normal circumstances can be heard in the 4 abdominal quadrants especially in the first hour after birth. This process is due to the baby swallowing air while crying and the sympathetic nervous system stimulates peristaltic. At birth the gastrointestinal tract is sterile. Once the baby is exposed to the outside atmosphere and fluids begin to enter, bacteria can enter the digestive tract. Normal intestinal flora will form within the first few days of neonates. Even though the digestive tract is sterile at birth, most bacterial babies can be cultured within 5 hours after birth. This bacterium is important for digestion and the synthesis of vitamin K.

 

  • Eating Reflexes

From birth, a normal baby can suck from the nipple, get the milk to the back of the mouth and swallow it for 5-10 minutes while breathing normally. There are an innate reflex and behavior process. This is increasingly clear about one hour after delivery, including the ability to move from the mother’s abdomen to the breast. Also,  coordinated hand activities, movements to look for the nipples, attach to the breast and eat greedily before the baby sleeps.

Touch on the ceiling triggers reflexes to suck. The neonate shows the work of the rhythmic jaw, which triggers negative pressure and the work of the tongue. Then jaw peristalsis squeezes milk from the breast and removes it from the throat which then triggers the reflex to swallow. In a normal neonate, this suckling reflex is quite strong at birth and has been seen in premature infants since around 32 weeks. The very premature babies and those with the risk of illness or very low birth weight show a marked decrease or absence of reflexes. Other babies with eating problems have physical disorders such as cleft lip or palate. Also, for those affected by sedation or obstetric analgesia or severe stress during labor.

The sucking and swallowing reflexes are aided by a special morphological configuration of the neonate’s mouth where the soft palate is proportionally longer. Neonates also have an extrusion reflex in response to the presence of solid or half-solid material in its mouth. This reflex disappears at the age of 4-6 months and is replaced by a pattern of rhythmic biting movements. That coincides with the growth of the first tooth at the age of 7-9 months.

  • Defecation

The first stool excreted by a baby is called meconium. The characteristic of meconium is dark, greenish black, thick, the consistency as bitumen, soft, odorless, and sticky. Meconium release a mixture of mucus, epithelial cells, fatty acids, and bile pigments (which causes distinctive color greenish black).

Scientifically, meconium comes from:

o    mucous cells in the gastrointestinal wall experience desquamation and loss

o    A liquid/ enzyme secreted along the digestive tract, from saliva to digestive enzymes

  • Amniotic fluid is taken by the fetus, which sometimes also contains lanugo and cells from the fetal skin or the felt out the amniotic membrane.

Neonatal renal physiology

Neonatal renal physiology (1)
Neonatal renal physiology

The excretion system in humans is a system that processes the disposal of metabolic waste substances. Substance residual metabolism consists of carbon dioxide (CO2), water (H20), ammonia (NH3), urea, and bile substances. This metabolic waste product must be removed from the body. It is toxic and can cause disease.

The Roles of Kidney in the Excretion System

In addition to filtering the blood, controlling body fluid balance, and maintaining electrolyte levels in the body, the kidneys are very closely related to the excretion system in humans. It is responsible for removing the body’s waste and toxins. The blood entering the kidneys will be filtered, as well as body fluids. The kidneys are also responsible for maintaining the body’s water intake, salt, and mineral to a normal level. The filtered blood will flow back to other organs through the kidney blood vessels. The filtered waste substances will be removed through urine submission in the pelvic kidney (renal pelvis). Then, the ureter will transfer the urine to the bladder, where urine is stored. Finally, urine runs from the bladder and out of the body through the urinary tract. Continue reading “Neonatal renal physiology”

Physiological Adaptation of Fetus

Physiological Adaptation of Fetus (1)
Physiological Adaptation of Fetus

About growth and development of conception results

Normally, pregnancy lasts about 10 months or 9 months, or 40 weeks. The growth and development of the fetus strongly influenced by the health level of the mother. Also, the condition of the fetus itself and the placenta as the main tools providing any nutrition. The actual fetal age is calculated from the time of fertilization or at least from the time of ovulation.

The growth of conception results is divided into three important stages, namely the level of the ovum (age 0 to 2 weeks). The conception results have not yet formed any growth, the embryo between the ages of 3 to 8 weeks. They have been formed designs of instruments of the body. Later, fetus formed as humans in the age over 8 weeks. Continue reading “Physiological Adaptation of Fetus”

Hormones During Pregnancy

Hormones During Pregnancy (1)
Hormones During Pregnancy

Hormones are chemicals substances produced by certain body organs of the endocrine glands functioning to stimulate the works of certain body organs. Hormones are produced by cells found in hormonal glands that are spread in body parts. The gland is called the endocrine gland, it can produce hormones. Hormone production carried out in the endocrine glands is regulated by the hypothalamus positioned the brain. Continue reading “Hormones During Pregnancy”

Physiological Changes in Postpartum Period

Physiological Changes in Postpartum Period (2)
Physiological Changes in Postpartum Period

Normally, there are several physiological changes in some systems toward the mother after delivery. They are:

Reproductive System Change

  1. Uterus
  2. Wrinkling of the uterus (involution)

Involution is a process of returning the uterus to the normal conditions (before pregnancy). With this uterine involution, the outer layer of the decidua surrounding the placental site will become neurotic (withered or dead) Continue reading “Physiological Changes in Postpartum Period”

Weight gain during pregnancy

Weight gain during pregnancy

One of the changes experienced by pregnant women is weight gain. This weight gain is needed to support the development and the health of the fetus in the uterus. However, weight gain is not always the same for each pregnant woman. This closely depends on your body mass index and body weight before pregnancy. Body mass index is obtained from the division of body weight in kilograms with your body height in meters squared. Weight gain during pregnancy affects the health of the mother and baby at birth. Pregnant women who have excess weight during pregnancy increase the risk of experiencing diseases related to pregnancy. While pregnant women who have less weight during pregnancy can increase the risk of babies born with low weight. Gaining weight during pregnancy is very important for the baby because the baby’s weight at birth and the baby’s health status depends on the mother’s weight during pregnancy. Continue reading “Weight gain during pregnancy”

Anatomical and physiological changes in pregnancy

Anatomical and physiological changes in pregnancy (1)
Anatomical and physiological changes in pregnancy

Anatomy Changes and Physiological Adaptation in Trimester I, II, and III Pregnant Women

Reproduction system

  1. Vulva and Vagina
  2. Trimester I

In line with the influence of estrogen hormone, vulva and vagina have an increase in blood vessels so that it appears more red and bluish. The pregnancy hormone prepares the vagina for distention during labor. it is done by producing thick vaginal mucosa, tissue cells – vaginal cells that are rich in glycogen occur due to estrogen stimulation. The cells that live form a thick and white vaginal discharge called leukorrhea. During pregnancy, the pH of vaginal secretions becomes more acidic. Acidity changes from 4 to 6.5. Increased PH makes pregnant women more vulnerable to vaginal infections, especially fungi. Leukorrhea is a grayish mucoid discharge and sometimes smells bad. Continue reading “Anatomical and physiological changes in pregnancy”

Sibling rivalry

Sibling rivalry (2)
Sibling rivalry

A sibling is a child’s jealousy over the birth of a new child in a family. In other words, a sibling is a sense of competition between siblings due to the birth of the next child. It usually occurs in children aged 3-10 years. A sibling is usually indicated by rejection with the birth of his younger sibling, crying, withdrawing from his environment, staying away from parents, or even committing violence to his younger siblings (hitting, pressing, pinching, etc.). The presence of a new sister or brother can be a major crisis for a child. Continue reading “Sibling rivalry”