FETAL MALPRESENTATION AND MALPOSITION the pelvic inlet, the fetal

head typically lies in 1

maternal iliac fossa, and
Malpositions are abnormal positions of the vertex of
the breech lies in the other
the fetal head (with the occiput as the reference
point) relative to the maternal pelvis.  further classified
Malpresentations are all presentations of the fetus based on
other than vertex.  which maternal
side the fetal
acromion rests
(right or left
Definitions
acromial)
 presentation - refers to the fetal anatomic  position of the
part which is the first part to proceed into
fetal back
and through the pelvic inlet
(dorsoanterior or
 fetal lie - describes the relationship dorsoposterior)
between the long axis of the fetus and the
long axis of the mother
 fetal position - describes the orientation of
the fetal presenting part relative to the
pelvis of the mother
 fetal presenting part - refers to the part of
the fetus which is the first to proceed into
and through the pelvic inlet
 fetal vertex - refers to area defined
between anterior fontanel and posterior
fontanel
 vertex presentation - fetal vertex is
presenting part o sinciput presentation
 malpresentation - occurs when the fetal  front part of head is
presenting part is other than the fetal presenting part
vertex  fetal head is neither
 persistent - when malposition or flexed nor extended
presentation is maintained during second o face and brow presentation
stage of labor and until delivery  fetus is cephalic
Types presenting but the
 fetal malpresentations types include fetal neck is extended
o breech - most common so that the fetal brow
malpresentation; buttocks or or face present rather
feet of fetus are fetal presenting than the vertex
part  brow presentation
 frank breech - hips occurs when the fetal
flexed and legs head is partially
extended over anterior extended
surface of body  face presentation
 complete breech - feet occurs when the fetal
presenting but flexed head is completely
hips and knees extended
 footling breech  vertex presentation
 at least 1 occurs, in
extended fetal comparison, when the
hip fetal head is
 contraindicatio completely flexed
n to labor

o transverse/oblique lie - often o compound presentation -

results in shoulder or arm occurs when there is an
presentation extremity preceding or adjacent
to the presenting fetal head
 in transverse lie, the
shoulder is typically over
  right occiput
transverse - occiput
is transverse but
deviates from the
midline of the
maternal pelvis up to
o 45 degrees to the
asynclitism - occurs when a right
cephalic fetus has its head bent  left occiput
toward its shoulder causing transverse - occiput
malalignment of the central axes is transverse but
of the fetal head and maternal
pelvis
 anterior asynclitism
results from anterior
tilting of the fetal head
(most common)
 posterior
asynclitism occurs
with posterior tilting of deviates from the
the fetal head (rare) midline of the
maternal pelvis up to
45 degrees to the left

IDIOPHATIC THROMBOCYTOPENIC
PURPURA (ITP)

 fetal malposition types include

o occiput posterior - fetal occiput
is oriented toward the posterior
aspect of the maternal pelvis
 direct occiput posterior -
occiput is posterior and does
not deviate from the midline
of the maternal pelvis
 right occiput posterior Idiopathic thrombocytopenic purpura is a blood
 occiput is posterior but disorder characterized by an abnormal decrease in
deviates from the the number of platelets in the blood. Platelets are
midline of the maternal cells in the blood that help stop bleeding. A decrease
pelvis up to 45 in platelets can result in easy bruising, bleeding
degrees to the right gums and internal bleeding.
 observed more
frequently than left  "Idiopathic" means the cause is unknown.
occiput posterior and
direct occiput in the  "Thrombocytopenia" means a decreased number of
second stage of labor platelets in the blood.
 left occiput posterior  "Purpura" refers to the purple discoloring of the skin,
as with a bruise.
 occiput is posterior but
deviates from the
midline of the maternal There are two forms of ITP:
pelvis up to 45
degrees to the left
 observed more  Acute thrombocytopenic purpura — This
is most commonly seen in young children (2
frequently than right
to 6 years old). The symptoms may follow a
occiput posterior and
viral illness, such as chickenpox. Acute ITP
direct occiput posterior
usually has a very sudden onset and the
in the first stage of
symptoms usually disappear in less than six
labor
months (often within a few weeks). The
o occiput transverse - fetal disorder usually does not recur. Acute ITP is
sagittal suture and fontanels are the most common form of the disorder.
aligned in the transverse
maternal pelvis
 Chronic thrombocytopenic purpura — The
onset of the disorder can happen at any age,
and the symptoms can last a minimum of six  Purpura - the purple color of the skin after
months to several years. Adults have this blood has "leaked" under it. A bruise is blood
form more often than children, but it does under the skin. Children with ITP may have
affect adolescents. Females are two to three large bruises from no known trauma. Bruises
times as likely as males to contract this form can appear at the joints of elbows and knees
of the disease. Chronic ITP can recur often just from movement.
and requires continual follow-up care with a  Petechia - tiny red dots under the skin that are
blood specialist (hematologist). a result of very small bleeds.
 Nosebleeds
 Bleeding in the mouth and/or in and around
Causes the gums
 In most cases, the cause of ITP is unknown. It  Blood in the vomit, urine or stool
is not contagious, meaning a child cannot  Bleeding in the head - this is the most
"catch it" from playing with another child with dangerous symptom of ITP. Any head trauma
ITP. It is also important to know that nothing that occurs when there are not enough
the parents, nor the child, did caused the platelets to stop the bleeding can be life
disorder. threatening.
 Often, the child may have had a virus or viral
infection about three weeks before developing
ITP. It is believed that the body, when making
antibodies against a virus, "accidentally" also
made an antibody that can stick to the platelet DISSEMINATED INTRAVASCULAR
cells. The body recognizes any cells with COAGULATION
antibodies as foreign cells and destroys them.
That is why ITP is also referred to as immune
thrombocytopenic purpura.
 The bone marrow is the soft, spongy center of
the long bones and is responsible for making
blood cells, including platelets. The bone
marrow responds to the low number of
platelets and produces many more to send out
to the body. A physician can look at the cells in
the bone marrow and, in a child with ITP,
would see many young platelets that have
been produced. However, the blood test
results of the circulating blood would show a
very low number of platelets. The body is
producing the cells normally, but the body is
also destroying them. In most cases, other
blood tests are normal except for the low
number of platelets. ITP platelets usually
survive only a few hours, in comparison to Disseminated intravascular coagulation (DIC) is a
normal platelets which have a lifespan of 7 to rare but serious condition that causes abnormal
10 days. blood clotting throughout the body’s blood
 Platelets are essential for the formation of a vessels. You may develop DIC if you have an
blood clot. Blood clots consist of a mass of infection or injury that affects the body’s normal
fibers and blood cells. Platelets travel to a blood clotting process.
damaged area and stick together to form a When you are injured, proteins in the blood that form
plug, whenever a person is cut, for example. If blood clots travel to the injury site to help stop
there are not enough platelets, a clot cannot bleeding. If these proteins become abnormally
be formed, resulting in more bleeding. active throughout the body, you could develop
DIC. The underlying cause is usually due to
inflammation, infection, or cancer.
Signs and symptoms In some cases of DIC, small blood clots form in the
blood vessels. Some of these clots can clog the
 Normal platelet count is in the range of vessels and cut off the normal blood supply to
150,000 to 450,000. In a child with ITP, the organs such as the liver, brain, or kidneys. Lack
platelet count is generally less than 100,000. of blood flow can damage and cause major
By the time significant bleeding occurs, the injury to the organs.
child may have a platelet count of less than In other cases of DIC, the clotting proteins in your
10,000. The lower the platelet count, the blood are consumed. When this happens, you
greater the risk of bleeding. may have a high risk of serious bleeding, even
 Because platelets help stop bleeding, the from a minor injury or without injury. You may
symptoms of ITP are related to increased also have bleeding that starts spontaneously (on
bleeding. However, each child may experience its own). The disease can also cause your
symptoms differently. healthy red blood cells to fragment and break up
when they travel through the small vessels that
Symptoms may include: are filled with clots.
 DIC progresses through two stages: overactive UTIs are common infections that happen when
clotting followed by bleeding. bacteria, often from the skin or rectum, enter the
urethra, and infect the urinary tract. The
infections can affect several parts of the urinary
 In stage one, overactive clotting leads to blood tract, but the most common type is a bladder
clots throughout the blood vessels. The clots can infection (cystitis).
reduce or block blood flow, which can damage Kidney infection (pyelonephritis) is another type of
organs. UTI. They’re less common, but more serious
 In stage two, as DIC progresses, the overactive than bladder infections.
clotting uses up platelets and clotting factors that
help the blood to clot. Without these platelets and
clotting factors, DIC leads to bleeding just Causes
beneath the skin, in the nose or mouth, or deep
inside the body.
UTIs typically occur when bacteria enter the urinary
What causes DIC? tract through the urethra and begin to spread in the
DIC is usually caused by inflammation from an bladder. The urinary system is designed to keep out
infection, injury, or illness. Some common causes bacteria. But the defenses sometimes fail. When that
include: happens, bacteria may take hold and grow into a full-
blown infection in the urinary tract.

 sepsis: This is a body-wide response to infection The most common UTIs occur mainly in women and
that causes inflammation. Sepsis is the most affect the bladder and urethra.
common risk factor for DIC.  Infection of the bladder. This type of UTI is
 Major damage to organs or tissues: This may usually caused by Escherichia coli (E.
be caused by cirrhosis of the liver, pancreatitis, coli). E. coli is a type of bacteria commonly
severe injury, burns, or major surgery. found in the gastrointestinal (GI) tract. But
 Severe immune reactions: Your body may sometimes other bacteria are the cause.
overreact because of a failed blood transfusion, Having sex also may lead to a bladder
rejection of an organ transplant, or a toxin such infection, but you don't have to be sexually
as snake venom. active to develop one. All women are at risk
 Serious pregnancy-related problems: These of bladder infections because of their
include the placenta separating from the uterus anatomy. In women, the urethra is close to
before delivery, amniotic fluid entering the the anus. And the urethral opening is close to
bloodstream, or serious bleeding during or after the bladder. This makes it easier for bacteria
delivery. around the anus to enter the urethra and to
travel to the bladder.
 Cancer

 Infection of the urethra. This type

of UTI can happen when GI bacteria spread
from the anus to the urethra. An infection of
URINARY TRACT INFECTION the urethra can also be caused by sexually
transmitted infections. They include herpes,
gonorrhea, chlamydia and mycoplasma. This
can happen because women's urethras are
close to the vagina.

Risk factors for UTIs that are specific to women

include:

 Female anatomy. Women have a shorter

urethra than men do. As a result, there's less
distance for bacteria to travel to reach the
bladder.
 Sexual activity. Being sexually active tends
to lead to more UTIs. Having a new sexual
A urinary tract infection (UTI) is an infection in any partner also increases risk.
part of the urinary system. The urinary system  Certain types of birth control. Using
includes the kidneys, ureters, bladder and diaphragms for birth control may increase the
urethra. Most infections involve the lower urinary risk of UTIs. Using spermicidal agents also
tract — the bladder and the urethra. can increase risk.
Women are at greater risk of developing a UTI than  Menopause. After menopause, a decline in
are men. If an infection is limited to the bladder, circulating estrogen causes changes in the
it can be painful and annoying. But serious urinary tract. The changes can increase the
health problems can result if a UTI spreads to risk of UTIs.
the kidneys Other risk factors for UTIs include:
  Urinary tract problems. Babies born with problems that last a short time. When
problems with their urinary tracts may have incontinence lasts longer, it may be due to:
trouble urinating. Urine can back up in the
urethra, which can cause UTIs.
 Weak bladder or pelvic floor muscles
 Blockages in the urinary tract. Kidney
 Overactive bladder muscles
stones or an enlarged prostate can trap urine
in the bladder. As a result, risk of UTIs is  Damage to nerves that control the bladder
higher. from diseases such as multiple
 A suppressed immune system. Diabetes sclerosis, diabetes, or Parkinson’s disease
and other diseases can impair the immune  Diseases such as arthritis that may make
system — the body's defense against germs. it difficult to get to the bathroom in time
This can increase the risk of UTIs.  Pelvic organ prolapse, which is when
 Catheter use. People who can't urinate on pelvic organs (such as the bladder,
their own often must use a tube, called a rectum, or uterus) shift out of their normal
catheter, to urinate. Using a catheter place into the vagina or anus. When pelvic
increases the risk of UTIs. Catheters may be organs are out of place, the bladder and
used by people who are in the hospital. They urethra are not able to work normally,
may also be used by people who have which may cause urine to leak.
neurological problems that make it difficult to Most incontinence in men is related to the prostate
control urination or who are paralyzed. gland. Male incontinence may be caused by:
 A recent urinary procedure. Urinary
surgery or an exam of your urinary tract that  Prostatitis, a painful inflammation of the
involves medical instruments can both prostate gland
increase the risk of developing a UTI.  Injury or damage to nerves or muscles
from surgery
 An enlarged prostate gland, which can
URINARY INCONTINENCE lead to benign prostate hyperplasia, a
condition in which the prostate grows as
men age
Types of urinary incontinence include:

 Stress incontinence. Urine leaks when you

exert pressure on your bladder by coughing,
sneezing, laughing, exercising or lifting
something heavy.
 Urge incontinence. You have a sudden,
intense urge to urinate followed by an
involuntary loss of urine. You may need to
urinate often, including throughout the night.
Urge incontinence may be caused by a minor
condition, such as infection, or a more
severe condition such as a neurological
 Urinary incontinence means a person leaks disorder or diabetes.
urine by accident. While it can happen to
anyone, urinary incontinence, also known as
 Overflow incontinence. You experience
frequent or constant dribbling of urine due to
overactive bladder, is more common in older
a bladder that doesn't empty completely.
people, especially women. Bladder control
issues can be embarrassing and cause people  Functional incontinence. A physical or
to avoid their normal activities. But mental impairment keeps you from making it
incontinence can often be stopped or to the toilet in time. For example, if you have
controlled. severe arthritis, you may not be able to
 What happens in the body to cause bladder unbutton your pants quickly enough.
control problems? Located in the lower  Mixed incontinence. You experience more
abdomen, the bladder is a hollow organ that is than one type of urinary incontinence —
part of the urinary system, which also includes most often this refers to a combination of
the kidneys, ureters, and urethra. During stress incontinence and urge incontinence.
urination, muscles in the bladder tighten to
move urine into the tube-shaped urethra. At Causes of urinary incontinence
the same time, the muscles around the urethra  Stress incontinence is usually the result of
relax and let the urine pass out of the body. the weakening of or damage to the
When the muscles in and around the bladder muscles used to prevent urination, such as
don’t work the way they should, urine can leak, the pelvic floor muscles and the urethral
resulting in urinary incontinence. sphincter.
 Incontinence can happen for many reasons,  Urge incontinence is usually the result of
including urinary tract infections, vaginal overactivity of the detrusor muscles, which
infection or irritation, or constipation. Some control the bladder.
medications can cause bladder control
  Overflow incontinence is often caused by Symptoms of baby blues — which last only a few
an obstruction or blockage in your bladder, days to a week or two after your baby is born — may
which prevents it from emptying fully. include:
 Total incontinence may be caused by a
problem with the bladder from birth, a  Mood swings
spinal injury, or a small, tunnel like hole
that can form between the bladder and a
 Anxiety
nearby area (fistula).  Sadness
 Irritability
Certain things can increase the chances of urinary  Feeling overwhelmed
incontinence, including:  Crying
 Reduced concentration
 pregnancy and vaginal birth  Appetite problems
 obesity  Trouble sleeping
 a family history of incontinence
Postpartum depression symptoms
 increasing age – although incontinence is not
an inevitable part of ageing
Postpartum depression may be mistaken for baby
blues at first but the symptoms are more intense and
last longer. These may eventually interfere with your
ability to care for your baby and handle other daily
tasks.

Symptoms usually develop within the first few weeks

after giving birth. But they may begin earlier during
POSTPARTUM DEPRESSION
pregnancy or later up to a year after birth.
Postpartum depression symptoms may include:

 Depressed mood or severe mood swings

 Crying too much
 Difficulty bonding with your baby
 Withdrawing from family and friends
 The birth of a baby can start a variety of powerful  Loss of appetite or eating much more than
usual
 Inability to sleep, called insomnia, or sleeping
too much
emotions, from excitement and joy to fear and  Overwhelming tiredness or loss of energy
anxiety. But it can also result in something you
might not expect — depression.
 Less interest and pleasure in activities you
used to enjoy
 Most new moms experience postpartum "baby
 Intense irritability and anger
blues" after childbirth, which commonly include
mood swings, crying spells, anxiety and  Fear that you're not a good mother
difficulty sleeping. Baby blues usually begin  Hopelessness
within the first 2 to 3 days after delivery and  Feelings of worthlessness, shame, guilt or
may last for up to two weeks. inadequacy
 But some new moms experience a more  Reduced ability to think clearly, concentrate
severe, long-lasting form of depression known or make decisions
as postpartum depression. Sometimes it's  Restlessness
called peripartum depression because it can  Severe anxiety and panic attacks
start during pregnancy and continue after  Thoughts of harming yourself or your baby
childbirth. Rarely, an extreme mood disorder
called postpartum psychosis also may develop
 Recurring thoughts of death or suicide
after childbirth.
Untreated, postpartum depression may last for many
 Postpartum depression is not a character flaw
months or longer.
or a weakness. Sometimes it's simply a
complication of giving birth. If you have
Postpartum psychosis
postpartum depression, prompt treatment can
help you manage your symptoms and help you
With postpartum psychosis — a rare condition that
bond with your baby.
usually develops within the first week after delivery
— the symptoms are severe. Symptoms may
Symptoms
include:
Symptoms of depression after childbirth vary, and
they can range from mild to severe.  Feeling confused and lost
 Having obsessive thoughts about your baby
Baby blues symptoms  Hallucinating and having delusions
  Having sleep problems Sometimes there is relief in symptoms after the
 Having too much energy and feeling upset infant passes gas or has a bowel movement. Gas is
 Feeling paranoid likely the result of swallowed air during prolonged
crying.
 Making attempts to harm yourself or your
baby Shaken baby syndrome

COLIC  The stress of calming a crying baby has

sometimes prompted parents to shake or
otherwise harm their child. Shaking a baby can
cause serious damage to the brain and death.
 The risk of these uncontrolled reactions is
greater if parents don't have information about
soothing a crying child, education about colic
and the support needed for caring for an infant
with colic.

SUDDEN INFANT DEATH SYNDROME

(SIDS)
 Colic is frequent, prolonged and intense crying
or fussiness in a healthy infant. Colic can be
particularly frustrating for parents because the
baby's distress occurs for no apparent reason
and no amount of consoling seems to bring
any relief. These episodes often occur in the
evening, when parents themselves are often
tired.
 Episodes of colic usually peak when an infant
is about 6 weeks old and decline significantly
after 3 to 4 months of age. While the excessive
crying will resolve with time, managing colic
adds significant stress to caring for your  Sudden infant death syndrome (SIDS) is the
newborn child. unexplained death, usually during sleep, of a
 You can take steps that may lessen the seemingly healthy baby less than a year
severity and duration of colic episodes, old. SIDS is sometimes known as crib death
alleviate your own stress, and bolster because the infants often die in their cribs.
confidence in your parent-child connection.  Although the cause is unknown, it appears
that SIDS might be associated with defects in
Symptoms the portion of an infant's brain that controls
breathing and arousal from sleep.
Babies have been known to fuss and cry, especially  Researchers have discovered some factors
during the first three months of life. The range for
that might put babies at extra risk. They've
what's considered typical crying is difficult to pin
also identified measures you can take to help
down. In general, colic is defined as crying for three
protect your child from SIDS. Perhaps the
or more hours a day, three or more days a week, for
most important is placing your baby on his or
three or more weeks.
her back to sleep.
Features of colic may include the following:
Physical factors
Physical factors associated with SIDS include:
 Intense crying that may seem more like
screaming or an expression of pain  Brain defects. Some infants are born with
 Crying for no apparent reason, unlike crying problems that make them more likely to die
to express hunger or the need for a diaper of SIDS. In many of these babies, the portion
change of the brain that controls breathing and
 Extreme fussiness even after crying has arousal from sleep hasn't matured enough to
diminished work properly.
 Predictable timing, with episodes often  Low birth weight. Premature birth or being
occurring in the evening part of a multiple birth increases the
 Facial discoloring, such as skin flushing or likelihood that a baby's brain hasn't matured
blushing completely, so he or she has less control
 Body tension, such as pulled up or stiffened over such automatic processes as breathing
legs, stiffened arms, clenched fists, arched and heart rate.
back, or tense abdomen
  Respiratory infection. Many infants who died  Breast-feed your baby, if possible. Breast-
of SIDS had recently had a cold, which might feeding for at least six months lowers the risk
contribute to breathing problems. of SIDS.
 Don't use baby monitors and other
Sleep environmental factors commercial devices that claim to reduce
The items in a baby's crib and his or her sleeping the risk of SIDS. The American Academy of
position can combine with a baby's physical Pediatrics discourages the use of monitors
problems to increase the risk of SIDS. Examples and other devices because of ineffectiveness
include: and safety issues.
 Sleeping on the stomach or side. Babies  Offer a pacifier. Sucking on a pacifier
placed in these positions to sleep might have without a strap or string at naptime and
more difficulty breathing than those placed bedtime might reduce the risk of SIDS. One
on their backs. caveat — if you're breast-feeding, wait to
 Sleeping on a soft surface. Lying face down offer a pacifier until your baby is 3 to 4 weeks
on a fluffy comforter, a soft mattress or a old and you've settled into a nursing routine.
waterbed can block an infant's airway. If your baby's not interested in the pacifier,
 Sharing a bed. While the risk of SIDS is don't force it. Try again another day. If the
lowered if an infant sleeps in the same room pacifier falls out of your baby's mouth while
as his or her parents, the risk increases if the he or she is sleeping, don't pop it back in.
baby sleeps in the same bed with parents,
siblings or pets.
 Immunize your baby. There's no evidence
 Overheating. Being too warm while sleeping that routine immunizations
can increase a baby's risk of SIDS. increase SIDS risk. Some evidence indicates
immunizations can help prevent SIDS.
Prevention

There's no guaranteed way to prevent SIDS, but you

can help your baby sleep more safely by following
these tips:
 Back to sleep. Place your baby to sleep on PNEUMONIA
his or her back, rather than on the stomach
or side, every time you — or anyone else —
put the baby to sleep for the first year of life.
This isn't necessary when your baby's awake
or able to roll over both ways without help.
Don't assume that others will place your baby
to sleep in the correct position — insist on it.
Advise sitters and child care providers not to
use the stomach position to calm an upset
baby.

 Keep the crib as bare as possible. Use a  Pneumonia is a form of acute respiratory
firm mattress and avoid placing your baby on infection that affects the lungs. The lungs are
thick, fluffy padding, such as lambskin or a made up of small sacs called alveoli, which
thick quilt. Don't leave pillows, fluffy toys or fill with air when a healthy person breathes.
stuffed animals in the crib. These can When an individual has pneumonia, the
interfere with breathing if your baby's face alveoli are filled with pus and fluid, which
presses against them. makes breathing painful and limits oxygen
 Don't overheat your baby. To keep your intake.
baby warm, try a sleep sack or other sleep  A variety of organisms, including bacteria,
clothing that doesn't require additional viruses and fungi, can cause pneumonia.
covers. Don't cover your baby's head.
 Have your baby sleep in in your Symptoms
room. Ideally, your baby should sleep in your
room with you, but alone in a crib, bassinet The signs and symptoms of pneumonia vary from
or other structure designed for infant sleep, mild to severe, depending on factors such as the
for at least six months, and, if possible, up to type of germ causing the infection, and your age and
a year. overall health. Mild signs and symptoms often are
Adult beds aren't safe for infants. A baby can similar to those of a cold or flu, but they last longer.
become trapped and suffocate between the Signs and symptoms of pneumonia may include:
headboard slats, the space between the  Chest pain when you breathe or cough
mattress and the bed frame, or the space  Confusion or changes in mental awareness
between the mattress and the wall. A baby (in adults age 65 and older)
can also suffocate if a sleeping parent  Cough, which may produce phlegm
accidentally rolls over and covers the baby's
nose and mouth.
 Fatigue
 Fever, sweating and shaking chills
  Lower than normal body temperature (in often caused by antibiotic-resistant bacteria, like
adults older than age 65 and people with methicillin-resistant Staphylococcus aureus (MRSA).
weak immune systems) This means HAP can make you sicker and be harder
 Nausea, vomiting or diarrhea to treat.
 Shortness of breath
Healthcare-associated pneumonia (HCAP)
You can get HCAP while in a long-term care facility
Newborns and infants may not show any sign of the
(such as a nursing home) or outpatient, extended-
infection. Or they may vomit, have a fever and
stay clinics. Like hospital-acquired pneumonia, it’s
cough, appear restless or tired and without energy,
usually caused by antibiotic-resistant bacteria.
or have difficulty breathing and eating.
Ventilator-associated pneumonia (VAP)
What’s the difference between viral and bacterial
If you need to be on a respirator or breathing
pneumonia?
machine to help you breathe in the hospital (usually
in the ICU), you’re at risk for ventilator-associated
While all pneumonia is inflammation caused by an
pneumonia (VAP). The same types of bacteria as
infection in your lungs, you may have different
community-acquired pneumonia, as well as the drug-
symptoms depending on whether the root cause is a
resistant kinds that cause hospital-acquired
virus, bacteria or fungi.
pneumonia, cause VAP.
Bacterial pneumonia tends to be more common and
Aspiration pneumonia
more severe than viral pneumonia. It’s more likely to
Aspiration is when solid food, liquids, spit or vomit go
require a hospital stay. Providers treat bacterial
down your trachea (windpipe) and into your lungs. If
pneumonia with antibiotics. Viral pneumonia causes
you can’t cough these up, your lungs can get
flu-like symptoms and is more likely to resolve on its
infected.
own. You usually don’t need specific treatment for
viral pneumonia.

What are the types of pneumonia?

We categorize pneumonia by which pathogen (virus,
bacteria or fungi) caused it and how you got it —
community-acquired, hospital-acquired or ventilator-
associated pneumonia. INTUSSUSCEPTION
Community-acquired pneumonia (CAP)
When you get pneumonia outside of a healthcare
facility, it’s called community-acquired pneumonia.
Causes include:
 Bacteria: Infection with Streptococcus
pneumoniae bacteria, also called
pneumococcal disease, is the most
common cause of CAP. Pneumococcal
disease can also cause ear infections,
sinus infections and meningitis.
Mycoplasma pneumoniae bacteria causes
atypical pneumonia, which usually has  Intussusception (in-tuh-suh-SEP-shun) is a
milder symptoms. Other bacteria that
serious condition in which part of the intestine
cause CAP include Haemophilus
slides into an adjacent part of the intestine. This
influenza, Chlamydia
telescoping action often blocks food or fluid from
pneumoniae and Legionella (Legionnaires’
passing through. Intussusception also cuts off
disease).
the blood supply to the part of the intestine that's
 Viruses: Viruses that cause the common affected. This can lead to infection, death of
cold, the flu (influenza), COVID-19 and bowel tissue or a tear in the bowel, called
respiratory syncytial virus (RSV) can perforation.
sometimes lead to pneumonia.  Intussusception is the most common cause of
 Fungi (molds): Fungi, intestinal obstruction in children younger than 3
like Cryptococcus, Pneumocystis years old. The cause of most cases of
jirovecii and Coccidioides, are uncommon intussusception in children is unknown. Though
causes of pneumonia. People with intussusception is rare in adults, most cases of
compromised immune systems are most adult intussusception are the result of an
at risk of getting pneumonia from a fungus. underlying medical condition, such as a tumor.
 Protozoa: Rarely, protozoa  In children, the intestines can usually be pushed
like Toxoplasma cause pneumonia. back into position with a minor procedure. In
adults, surgery is often required to correct the
Hospital-acquired pneumonia (HAP) problem.
You can get hospital-acquired pneumonia (HAP)  Intussusception is most common in babies 5 to 9
while in a hospital or healthcare facility for another
months old, but older children also can have it.
illness or procedure. HAP is usually more serious
Boys get intussusception more often than girls.
than community-acquired pneumonia because it’s
Causes
 Cerebral palsy is a group of disorders that
Your intestine is shaped like a long tube. In affect movement and muscle tone or
intussusception, one part of your intestine — usually posture. It's caused by damage that
the small intestine — slides inside an adjacent part. occurs to the immature, developing brain,
This is sometimes called telescoping because it's most often before birth.
similar to the way a collapsible telescope slides  Signs and symptoms appear during
together.
infancy or preschool years. In general,
cerebral palsy causes impaired movement
associated with exaggerated reflexes,
Complications
floppiness or spasticity of the limbs and
trunk, unusual posture, involuntary
Intussusception can cut off the blood supply to the
movements, unsteady walking, or some
affected portion of the intestine. If left untreated, lack
combination of these.
of blood causes tissue of the intestinal wall to die.
Tissue death can lead to a tear in the intestinal wall,  People with cerebral palsy can have
called a perforation. This can cause an infection of problems swallowing and commonly have
the lining of the abdominal cavity, known as eye muscle imbalance, in which the eyes
peritonitis. don't focus on the same object. They also
might have reduced range of motion at
various joints of their bodies due to muscle
stiffness.
What Are the Signs & Symptoms of  The cause of cerebral palsy and its effect
Intussusception? on function vary greatly. Some people with
cerebral palsy can walk; others need
Babies and children with intussusception have assistance. Some people have intellectual
intense belly pain that: disabilities, but others do not. Epilepsy,
 often begins suddenly blindness or deafness also might be
 makes the child draw the knees up toward present. Cerebral palsy is a lifelong
the chest disorder. There is no cure, but treatments
 makes the child cry very loudly can help improve function.

As the pain eases, the child may stop crying for a There are different types of CP. Some people have
while and seem to feel better. The pain usually one type, or a mix of:
comes and goes like this, but can be very strong
when it returns.
Symptoms also can include: 1. spastic cerebral palsy, which causes
stiffness and trouble moving
 a swollen belly 2. dyskinetic (athetoid) cerebral palsy,
 vomiting which causes uncontrolled movements
 vomiting up bile, a bitter-tasting yellowish- 3. ataxic cerebral palsy, which causes a
green fluid problem with balance and depth
 passing stools (poop) mixed with blood perception (judging the distance between
and mucus, known as currant jelly stool two objects)
 grunting due to pain
There is no cure for CP, but a child's quality of life
As the illness continues, the child may: can improve with:
 get weaker
 develop a fever
 appear to go into shock. In this life-  treatment that may involve medicine or
threatening problem, a lack of blood flow surgery
to the body's organs makes the heart beat  therapy, including physical
quickly and blood pressure drop therapy, occupational therapy, and speech
therapy
 special equipment to help kids get
CEREBRAL PALSY around and communicate with others

What Causes Cerebral Palsy?

The cause of CP isn't always known. But many

cases happen when a child's brain is still developing,
such as before birth or in early infancy. This may be
due to:
 infections or other medical problems
during a woman’s pregnancy
  a stroke either in the womb or after birth and epilepsy are more likely to have
 untreated jaundice (a yellowing of the skin intellectual disability.
and whites of eyes)  Delayed growth and development—
 genetic disorders Children with moderate to severe CP often
lag behind in growth and
In rare cases, CP happens because something goes development. The muscles and limbs
wrong during a child's birth. affected by CP tend to be smaller.
 Spinal deformities and osteoarthritis—
Premature babies (babies born early) have a higher Scoliosis, kyphosis, and lordosis are
chance of having CP than full-term babies. So do associated with CP. Pressure on and
other low-birthweight babies and multiple births, misalignment of the joints may result in
such as twins and triplets. pain and a breakdown of cartilage in the
joints and bone enlargement
(osteoporosis).
How Is Cerebral Palsy Diagnosed?
 Impaired vision—Many children with CP
Babies who are born early or who have health have strabismus, commonly called “cross
problems that put them at risk for cerebral palsy are eyes,” which left untreated can lead to
watched for signs of the condition. Doctors look for: poor vision and can interfere with the
ability to judge distance. Some children
 developmental delays, like not reaching with CP have difficulty understanding and
for toys by 4 months or sitting up by 7
organizing visual information. Other
months
children may have poor vision or blindness
 problems with motor skills, like being in one or both eyes.
unable to crawl, walk, or move arms and  Hearing loss—Impaired hearing is more
legs in the usual way
frequent among those with CP than in the
 uncoordinated movements general population. Some children have
 muscle tone that is too tight or too loose partial or complete hearing loss,
 infant reflexes (like the palmar grasp, or particularly as the result of jaundice or lack
"hands in fists" reflex) that stay beyond the of oxygen to the developing brain.
age at which they're usually gone  Speech and language disorders—
Speech and language disorders, such as
Symptoms difficulty forming words and speaking
clearly, are present in more than 75
All people with CP have problems with movement percent of people with CP.
and posture. The symptoms of CP differ in type and  Excessive drooling—Some individuals
severity from one person to the next and may even with CP drool because they do not
change over time. Symptoms may vary greatly have control of the muscles in the throat,
among individuals, depending on which parts of the mouth, and tongue.
brain have been injured.  Incontinence—A possible complication of
CP is incontinence, caused by poor control
Children with CP exhibit a wide variety of symptoms,
of the bladder muscles.
including:
 Difficulty with sensations and
perceptions—Some individuals with CP
 Lack of muscle coordination when experience pain or have difficulty feeling
performing voluntary movements (ataxia) simple sensations, such as touch.
 Stiff or tight muscles and exaggerated  Learning difficulties—Children with CP
reflexes (spasticity) may have difficulty processing particular
 Weakness in one or more arm or leg types of spatial and auditory information.
 Walking on the toes, a crouched gait, or a  Infections and long-term illnesses—
“scissored” gait Many adults with CP have a higher risk of
 Variations in muscle tone, either too stiff or heart and lung disease, and pneumonia.
too floppy  Contractures—Muscles can become
 Shaking (tremor) or random involuntary painfully fixed into positions,
movements called contractures, which can increase
muscle spasticity and joint deformities in
 Delays in reaching motor skill milestones
people with CP.
 Difficulty with precise movements such as
 Malnutrition—Swallowing, sucking, or
writing or buttoning a shirt
feeding problems can make it difficult for
many individuals with CP, particularly
Related conditions
infants, to get proper nutrition and gain or
maintain weight.
 Intellectual disability—Approximately  Dental problems—Many children with CP
30–50 percent of individuals with CP have are at risk of developing gum disease and
an intellectual disability. cavities because of poor dental hygiene.
 Seizure disorder—As many as half of all  Inactivity—Many children with CP are
children with CP have one or more unable to participate in sports and other
seizures. Children with both cerebral palsy activities at a level of intensity sufficient to
 develop and maintain strength and refers to the wide range of symptoms and
fitness. Inactive adults with CP often severity.
exhibit increased severity of disease and  Autism spectrum disorder includes conditions
reduced overall health and well-being. that were previously considered separate —
 Bone health—Bone mineral density is autism, Asperger's syndrome, childhood
significantly lower in individuals with CP disintegrative disorder and an unspecified form
and puts individual at risk of bone of pervasive developmental disorder. Some
fractures. people still use the term "Asperger's
 Psychological issues—People with CP syndrome," which is generally thought to be at
are at greater risk of developing anxiety, the mild end of autism spectrum disorder.
depression, and social and emotional  Autism spectrum disorder begins in early
issues. childhood and eventually causes problems
functioning in society — socially, in school and
What are the early signs? at work, for example. Often children show
Infants with CP frequently have developmental symptoms of autism within the first year. A
delays, in which they are slow in learning to roll over, small number of children appear to develop
sit, crawl, or walk. Decreased muscle tone normally in the first year, and then go through
(hypotonia) can make them appear relaxed, even a period of regression between 18 and 24
floppy. Increased muscle tone (hypertonia) can months of age when they develop autism
make their bodies seem stiff or rigid. Children with symptoms.
CP may also have unusual posture or favor one side  While there is no cure for autism spectrum
of the body when they reach, crawl, or move. disorder, intensive, early treatment can make a
big difference in the lives of many children.
Younger than 6 months of age:  People with autism have trouble with
 The head lags when you pick them up communication. They have trouble understanding
while they're lying on their back what other people think and feel. This makes it
 They feel stiff hard for them to express themselves, either with
 They feel floppy words or through gestures, facial expressions,
 Their legs get stiff and cross or scissor and touch.
when you pick them up  People with autism might have problems with
learning. Their skills might develop unevenly. For
Older than 6 months of age: example, they could have trouble communicating
 They don't roll over in either direction but be unusually good at art, music, math, or
 They cannot bring their hands together memory. Because of this, they might do
especially well on tests of analysis or problem-
 They have difficulty bringing their hands to solving.
their mouth
 They reach out with only one hand while
keeping the other fisted

Older than 10 months of age Social communication and interaction

 They crawl in a lopsided manner, pushing
off with one hand and leg while dragging A child or adult with autism spectrum disorder may
the opposite hand and leg have problems with social interaction and
 They cannot stand even while holding on communication skills, including any of these signs:
to support
 Fails to respond to his or her name or
appears not to hear you at times
AUTISM  Resists cuddling and holding, and seems to
prefer playing alone, retreating into his or her
own world
 Has poor eye contact and lacks facial
expression
 Doesn't speak or has delayed speech, or
loses previous ability to say words or
sentences
 Can't start a conversation or keep one going,
or only starts one to make requests or label
items
 Speaks with an abnormal tone or rhythm and
 Autism spectrum disorder is a condition related may use a singsong voice or robot-like
speech
to brain development that impacts how a
person perceives and socializes with others,  Repeats words or phrases verbatim, but
causing problems in social interaction and doesn't understand how to use them
communication. The disorder also includes  Doesn't appear to understand simple
limited and repetitive patterns of behavior. The questions or directions
term "spectrum" in autism spectrum disorder
  Doesn't express emotions or feelings and  Some children with autism spectrum
appears unaware of others' feelings disorder have difficulty learning, and some
 Doesn't point at or bring objects to share have signs of lower than normal
interest intelligence. Other children with the
 Inappropriately approaches a social disorder have normal to high intelligence
interaction by being passive, aggressive or — they learn quickly, yet have trouble
disruptive communicating and applying what they
 Has difficulty recognizing nonverbal cues, know in everyday life and adjusting to
social situations.
such as interpreting other people's facial
expressions, body postures or tone of voice  Because of the unique mixture of
symptoms in each child, severity can
Patterns of behavior sometimes be difficult to determine. It's
A child or adult with autism spectrum disorder may generally based on the level of
have limited, repetitive patterns of behavior, interests impairments and how they impact the
or activities, including any of these signs: ability to function.

 Performs repetitive movements, such as What Are the Types of Autism Spectrum
rocking, spinning or hand flapping Disorders?
 Performs activities that could cause self-
harm, such as biting or head-banging
 Develops specific routines or rituals and These types were once thought to be separate
becomes disturbed at the slightest change conditions. Now, they fall under the range of autism
spectrum disorders including:
 Has problems with coordination or has odd
movement patterns, such as clumsiness or
walking on toes, and has odd, stiff or
 Asperger's syndrome. These children don't
exaggerated body language have a problem with language; in fact, they
tend to score in the average or above-
 Is fascinated by details of an object, such as
average range on intelligence tests. But they
the spinning wheels of a toy car, but doesn't have social problems and a narrow scope of
understand the overall purpose or function of interests.
the object
 Autistic disorder. This is what most people
 Is unusually sensitive to light, sound or
think of when they hear the word "autism." It
touch, yet may be indifferent to pain or refers to problems with social interactions,
temperature communication, and play in children younger
 Doesn't engage in imitative or make-believe than 3 years.
play  Childhood disintegrative disorder. These
 Fixates on an object or activity with abnormal children have typical development for at least
intensity or focus 2 years and then lose some or most of their
 Has specific food preferences, such as communication and social skills.
eating only a few foods, or refusing foods  Pervasive developmental disorder (PDD
with a certain texture or atypical autism). Your doctor might use
this term if your child has some autistic
As they mature, some children with autism spectrum behavior, like delays in social and
disorder become more engaged with others and communications skills, but doesn’t fit into
show fewer disturbances in behavior. Some, usually another category.
those with the least severe problems, eventually may
lead normal or near-normal lives. Others, however,
continue to have difficulty with language or social
skills, and the teen years can bring worse behavioral
and emotional problems.

Symptoms

 Some children show signs of autism

spectrum disorder in early infancy, such as
reduced eye contact, lack of response to
their name or indifference to caregivers.
Other children may develop normally for
the first few months or years of life, but
then suddenly become withdrawn or
aggressive or lose language skills they've
already acquired. Signs usually are seen
by age 2 years.
 Each child with autism spectrum disorder
is likely to have a unique pattern of
behavior and level of severity — from low
functioning to high functioning.