SlideShare une entreprise Scribd logo
1  sur  45
Basic Neonatology course
A Road Map
By: Karim El-ghanam
k.elghanam@med.menofia.edu.eg
01068950053
ILOS
1. Why !
2. Job Description.
3. How to deal with your team.
4. Component of NICU
5. Road map for most common cases.
6. What do you need to learn to be qualified.
7. History taking.
Money :D :D
Doctors are not poor !
«ْ‫ن‬ِ‫م‬َ‫ل‬َ‫ع‬ ‫ا‬َ‫ن‬ْ‫ب‬َ‫ت‬َ‫ك‬ َ‫ك‬ِ‫ل‬ََٰ‫ذ‬ ِ‫ل‬ْ‫ج‬َ‫أ‬َ‫أ‬ َ‫ل‬‫ي‬ِ‫ئ‬‫ا‬َ‫ر‬ْ‫س‬ِ‫إ‬ ‫ي‬ِ‫ن‬َ‫ب‬ َٰ‫ى‬‫ن‬َ‫م‬ ُ‫ه‬َّ‫ن‬
َ‫أ‬ ٍ‫س‬ْ‫ف‬َ‫ن‬ ِ‫ر‬ْ‫ي‬َ‫غ‬ِ‫ب‬ ‫ا‬ً‫س‬ْ‫ف‬َ‫ن‬ َ‫ل‬َ‫ت‬َ‫ق‬ِ‫ض‬ْ‫ر‬َ ْ‫اْل‬ ‫ي‬ِ‫ف‬ ٍ‫د‬‫ا‬َ‫س‬َ‫ف‬ ْ‫و‬‫ا‬َ‫م‬َّ‫ن‬َ‫أ‬َ‫ك‬َ‫ف‬
ْ‫ح‬َ‫أ‬ ْ‫ن‬َ‫م‬َ‫و‬ ‫ا‬ً‫ع‬‫ي‬ِ‫م‬َ‫ج‬ َ‫اس‬َّ‫ن‬‫ال‬ َ‫ل‬َ‫ت‬َ‫ق‬َ‫ي‬ْ‫ح‬َ‫أ‬ ‫ا‬َ‫م‬َّ‫ن‬َ‫أ‬َ‫ك‬َ‫ف‬ ‫ا‬َ‫ه‬‫ا‬َ‫ي‬َ‫اس‬َّ‫ن‬‫ال‬ ‫ا‬
‫ا‬ً‫ع‬‫ي‬ِ‫م‬َ‫ج‬«
‫الجـــهل‬!..
‫والتقصــير‬!!..
There is No Precious baby, All Babies are precious .
Job Description
You are a neonatologist resident !
1- Your consultant eyes !
2- Follow the instruction.
3- Emergency situations.
1- Your consultant eyes !
Good, Full detailed description of the cases !
Read More And More
2- Follow the instruction.
3- Emergency situations.
1. Medical Emergencies according to each case:
- Arrest
- Cyanosis
- Convulsion
- Hemorrhage … etc.
2. New cases admission.
•‫الشيتات‬ ‫كتابة‬!
•‫األهل‬ ‫مقابلة‬.
•‫التقارير‬ ‫كتابة‬.
2- Communication with your team
1- Nurses
2- Doctors
3- Consultant
Relatives
Components Of NICU
Incubator
Ventilator CPAP
.1‫األكسجين‬ ‫شبكة‬.
.2‫المخارج‬.
.3Suction!
Most Common Cases
I. Respiratory distress.
II. Neonatal Jaundice.
III.Neonatal Sepsis
IV.Pre-term.
V. Hemorrhagic diseases.
VI.CNS problems.
VII.Pre and post -operative cases.
VIII. .. Etc.
• Grades?
• X.Ray?
• TTT?
• Ventilator Setting?
RDS
• How to diagnose?
• TTT?TTN
• Vigorous or not?
• Resuscitation.
• Discharge or not?
• Ventilator setting?
Meconium
Aspiration
• Grades?
• X.ray?
• TTT?
Congenital
Pneumonia
1- Respiratory Distress (RD)
‫أكسجين‬ ‫:حالة‬D
- Pulmonary Hypertension
- Pneumothorax
1.Downs’ score
2.Oxygen toxicity
3.Chronic lung ( Bronco-pulmonary dysplasia )
2- Neonatal Jaundice (NJ)
I. DD?
II. Specific cause?
III.General condition?
IV.Levels of TTT?
V.Pathophysiology?
3- Neonatal Convulsions.
4- Hemorrhagic disease of the newborn.
5- Necrotizing enterocolitis (NEC)
Neonatal Sepsis
Early signs of Sepsis
ABs Regimen
Infection control
 CRP
Complementary Topics
Fluid Balance.
Drugs.
Feeding.
Normal values of:
- Blood pressure
- Blood sugar
- Temperature
 Infection control.
Complementary Topics
Interpretation of CBC
Interpretation of ABG
Reading X-Ray
Procedures
1.Endotracheal tube (ET).
2.Chest butterfly.
3.Chest cannula.
4.Umbilical catheter.
5.Chest tube.
6.Blood Exchange.
History taking
1.Name: Mother name
‫مدام‬ ‫ابن‬...:
‫مدام‬ ‫بنت‬... :
Medico-legal !
2.Sex:
Male, Female or ambiguous genitalia!
Medico-legal !
3. Sibling:
- History of other siblings.
- IUFD
- Abortions
- RH,ABO incompatibility
- Metabolic, genetic diseases
- Precious baby or not?
- Similar condition
- Mother experience !
G…… P….. + ….
4. Consanguinity :
- For congenital abnormalities.
- Degree of consanguinity.
5. Mode of delivery? NVD or CS
6. Full term, NT or preterm.
- Calculation of the gestational age.
- ‫الـ‬ ‫الشهر‬ ‫لنهاية‬ ‫وصلت‬ ‫اللي‬8‫يبقي‬ ‫كده‬36‫كاملين‬ ‫أسبوع‬!
- Ballard Maturational Assessment
7. Age of the Baby:
DOB: ‫امتي‬ ‫مولود‬
TOB: ‫؟‬ ‫كام‬ ‫الساعة‬
Jaundice
8. Maternal risk factors: ..
9. Parent history:
- Name:
- Age:
- Blood group:
5. Mode of delivery? NVD or CS
NVDCS
• Obstructed labor
• Traumatic Labor
• Less liable for RD
• Cause ?
• Anesthesia
• More Liable for RDS
1- Maternal age:
less than 18 years or more than 35 years old
2- Socio-demographic factors:
• Low educational status
• Cigarette smoking
• Drug addiction
• Poor nutrition
• Poverty
3- Obstetric factors:
• Previous cesarean section
• Multiple pregnancies
• Prior infertility
• Blood transfusion
8. Maternal risk factors:
4- Medical conditions:
• Diabetes mellitus
• Hypertension
• Pregnancy induced hypertension (PIH)
• Pre-eclamsia
• Congenital heart disease
• Auto-immune diseases
• Infections
8. Maternal risk factors:
Referral Reports
Thanks
Hope Happiness finds you every
where !

Contenu connexe

Tendances

Assesment of the newborn baby kuliah
Assesment of the newborn baby kuliahAssesment of the newborn baby kuliah
Assesment of the newborn baby kuliahamel015
 
Examination of the newborn.
Examination of the newborn. Examination of the newborn.
Examination of the newborn. Taher Kagalwala
 
Images ppt new born assessment
Images ppt new born assessmentImages ppt new born assessment
Images ppt new born assessmentKHUSHBU PATEL
 
Newborn & Pediatric Care
Newborn & Pediatric CareNewborn & Pediatric Care
Newborn & Pediatric CareJulyna Cordovez
 
Characteristics of a Healthy Newborn
Characteristics of a Healthy NewbornCharacteristics of a Healthy Newborn
Characteristics of a Healthy Newbornrittikadas7
 
The preterm infant
The preterm infantThe preterm infant
The preterm infantShepard Joy
 
Newborn assessment
Newborn assessmentNewborn assessment
Newborn assessmentHafiza Afrin
 
Power point -_assessment_of_the_neonate (1)
Power point -_assessment_of_the_neonate (1)Power point -_assessment_of_the_neonate (1)
Power point -_assessment_of_the_neonate (1)Stephen Collins
 
Assessment of the newborn
Assessment of the newbornAssessment of the newborn
Assessment of the newbornAde Pratiwi
 
Neonatal examination
Neonatal examinationNeonatal examination
Neonatal examinationMohamed Abass
 
Characteristic of newborn and reflexes
Characteristic of newborn and reflexesCharacteristic of newborn and reflexes
Characteristic of newborn and reflexesChinna Chadayan
 

Tendances (19)

Newborn assessment
Newborn assessmentNewborn assessment
Newborn assessment
 
Assesment of the newborn baby kuliah
Assesment of the newborn baby kuliahAssesment of the newborn baby kuliah
Assesment of the newborn baby kuliah
 
Examination of the newborn.
Examination of the newborn. Examination of the newborn.
Examination of the newborn.
 
Images ppt new born assessment
Images ppt new born assessmentImages ppt new born assessment
Images ppt new born assessment
 
Normal newborn
Normal newborn Normal newborn
Normal newborn
 
Newborn & Pediatric Care
Newborn & Pediatric CareNewborn & Pediatric Care
Newborn & Pediatric Care
 
Newborn Assessment
Newborn AssessmentNewborn Assessment
Newborn Assessment
 
Newborn examination
Newborn examinationNewborn examination
Newborn examination
 
Characteristics of a Healthy Newborn
Characteristics of a Healthy NewbornCharacteristics of a Healthy Newborn
Characteristics of a Healthy Newborn
 
The preterm infant
The preterm infantThe preterm infant
The preterm infant
 
Newborn assessment
Newborn assessmentNewborn assessment
Newborn assessment
 
Abortion
AbortionAbortion
Abortion
 
Power point -_assessment_of_the_neonate (1)
Power point -_assessment_of_the_neonate (1)Power point -_assessment_of_the_neonate (1)
Power point -_assessment_of_the_neonate (1)
 
Assessment of the newborn
Assessment of the newbornAssessment of the newborn
Assessment of the newborn
 
Assessment of normal newborn
Assessment of normal newbornAssessment of normal newborn
Assessment of normal newborn
 
Newbornexamination
NewbornexaminationNewbornexamination
Newbornexamination
 
Infertility
InfertilityInfertility
Infertility
 
Neonatal examination
Neonatal examinationNeonatal examination
Neonatal examination
 
Characteristic of newborn and reflexes
Characteristic of newborn and reflexesCharacteristic of newborn and reflexes
Characteristic of newborn and reflexes
 

En vedette

Neonatology Basics - Gestation & Birth Weight
Neonatology Basics - Gestation & Birth WeightNeonatology Basics - Gestation & Birth Weight
Neonatology Basics - Gestation & Birth WeightSonali Paradhi Mhatre
 
79088 a4 girls_low_birth_weight_april09
79088 a4 girls_low_birth_weight_april0979088 a4 girls_low_birth_weight_april09
79088 a4 girls_low_birth_weight_april09mero Adam
 
Common neonatal problems
Common neonatal problemsCommon neonatal problems
Common neonatal problemsVarsha Shah
 
career powerpoint neonatology
career powerpoint neonatologycareer powerpoint neonatology
career powerpoint neonatologydculmer94
 
Neonatology (cambridge)
Neonatology (cambridge)Neonatology (cambridge)
Neonatology (cambridge)Nidia Davila
 
مقارنة بين موقعين اخباريين
مقارنة بين موقعين اخباريينمقارنة بين موقعين اخباريين
مقارنة بين موقعين اخباريينmohamad farhat
 
Extravasation in neonate
Extravasation in neonateExtravasation in neonate
Extravasation in neonateMohammed Said
 
Neonatal Intensive Care Unit - Resource Orientation
Neonatal Intensive Care Unit - Resource OrientationNeonatal Intensive Care Unit - Resource Orientation
Neonatal Intensive Care Unit - Resource OrientationRobin Featherstone
 
Examination of newborn.
Examination of newborn.Examination of newborn.
Examination of newborn.Vinod Gandhi
 
Common neonatal problems
Common  neonatal    problemsCommon  neonatal    problems
Common neonatal problemsAbdul Ghaffar
 
Immunosuppressants [autosaved]
Immunosuppressants [autosaved]Immunosuppressants [autosaved]
Immunosuppressants [autosaved]B.Devadatha datha
 
Handbook of neonatology
Handbook of neonatologyHandbook of neonatology
Handbook of neonatologyvruti patel
 
Treatment of neonatal hypoglycemia
Treatment of neonatal hypoglycemia  Treatment of neonatal hypoglycemia
Treatment of neonatal hypoglycemia mandar haval
 
Danger signs in newborns
Danger signs in newbornsDanger signs in newborns
Danger signs in newbornsVarsha Shah
 
Neonatal respiratory diseases
Neonatal respiratory diseasesNeonatal respiratory diseases
Neonatal respiratory diseasesTheva Thy
 

En vedette (19)

Neonatology Basics - Gestation & Birth Weight
Neonatology Basics - Gestation & Birth WeightNeonatology Basics - Gestation & Birth Weight
Neonatology Basics - Gestation & Birth Weight
 
79088 a4 girls_low_birth_weight_april09
79088 a4 girls_low_birth_weight_april0979088 a4 girls_low_birth_weight_april09
79088 a4 girls_low_birth_weight_april09
 
Neonatal Problems
Neonatal ProblemsNeonatal Problems
Neonatal Problems
 
Neonatal jaundice final
Neonatal jaundice  finalNeonatal jaundice  final
Neonatal jaundice final
 
Common neonatal problems
Common neonatal problemsCommon neonatal problems
Common neonatal problems
 
career powerpoint neonatology
career powerpoint neonatologycareer powerpoint neonatology
career powerpoint neonatology
 
Neonatology (cambridge)
Neonatology (cambridge)Neonatology (cambridge)
Neonatology (cambridge)
 
مقارنة بين موقعين اخباريين
مقارنة بين موقعين اخباريينمقارنة بين موقعين اخباريين
مقارنة بين موقعين اخباريين
 
Direct jaundice
Direct jaundiceDirect jaundice
Direct jaundice
 
Extravasation in neonate
Extravasation in neonateExtravasation in neonate
Extravasation in neonate
 
Neonatal Intensive Care Unit - Resource Orientation
Neonatal Intensive Care Unit - Resource OrientationNeonatal Intensive Care Unit - Resource Orientation
Neonatal Intensive Care Unit - Resource Orientation
 
Ballard scor1
Ballard scor1Ballard scor1
Ballard scor1
 
Examination of newborn.
Examination of newborn.Examination of newborn.
Examination of newborn.
 
Common neonatal problems
Common  neonatal    problemsCommon  neonatal    problems
Common neonatal problems
 
Immunosuppressants [autosaved]
Immunosuppressants [autosaved]Immunosuppressants [autosaved]
Immunosuppressants [autosaved]
 
Handbook of neonatology
Handbook of neonatologyHandbook of neonatology
Handbook of neonatology
 
Treatment of neonatal hypoglycemia
Treatment of neonatal hypoglycemia  Treatment of neonatal hypoglycemia
Treatment of neonatal hypoglycemia
 
Danger signs in newborns
Danger signs in newbornsDanger signs in newborns
Danger signs in newborns
 
Neonatal respiratory diseases
Neonatal respiratory diseasesNeonatal respiratory diseases
Neonatal respiratory diseases
 

Similaire à Basic neonatology course

Investigations for iufd & sb, how to select?
Investigations for iufd & sb, how to select?Investigations for iufd & sb, how to select?
Investigations for iufd & sb, how to select?Wafaa Benjamin
 
Cryptorchidism (Undescended Testes)
Cryptorchidism (Undescended Testes)Cryptorchidism (Undescended Testes)
Cryptorchidism (Undescended Testes)Alexander Small
 
Congenital_abnormalities,_prenatal_diagnosis_&_fetal_surveillance.pptx.ppt
Congenital_abnormalities,_prenatal_diagnosis_&_fetal_surveillance.pptx.pptCongenital_abnormalities,_prenatal_diagnosis_&_fetal_surveillance.pptx.ppt
Congenital_abnormalities,_prenatal_diagnosis_&_fetal_surveillance.pptx.pptssuseree565d
 
Genetics Series Prenatal Diagnosis.pptx
Genetics Series Prenatal Diagnosis.pptxGenetics Series Prenatal Diagnosis.pptx
Genetics Series Prenatal Diagnosis.pptxMathew Joseph
 
Prenatal diagnosis
Prenatal diagnosisPrenatal diagnosis
Prenatal diagnosisobgymgmcri
 
Obstetric History and Examination
Obstetric History and ExaminationObstetric History and Examination
Obstetric History and ExaminationWalid Ahmed
 
Pediatric endocrine revesion (part 1)
Pediatric endocrine revesion (part 1) Pediatric endocrine revesion (part 1)
Pediatric endocrine revesion (part 1) Abdulmoein AlAgha
 
Pediatric endocrine revesion (part 1)
Pediatric endocrine revesion (part 1) Pediatric endocrine revesion (part 1)
Pediatric endocrine revesion (part 1) Abdulmoein AlAgha
 
WISSEN MEDIQUIZ 2018 MAINS
WISSEN MEDIQUIZ 2018 MAINSWISSEN MEDIQUIZ 2018 MAINS
WISSEN MEDIQUIZ 2018 MAINSSAABAIIMSBBSR
 
Stage IV Thoracic Neuroblastoma (Morning Report)
Stage IV Thoracic Neuroblastoma (Morning Report)Stage IV Thoracic Neuroblastoma (Morning Report)
Stage IV Thoracic Neuroblastoma (Morning Report)Yohaimi Cosme Ayala
 
Obstructed labour
Obstructed labourObstructed labour
Obstructed labourNaila Memon
 
Still Birth:An Update : Dr Sharda Jain
Still Birth:An Update : Dr Sharda JainStill Birth:An Update : Dr Sharda Jain
Still Birth:An Update : Dr Sharda JainLifecare Centre
 
prenatal diagnosis.pptx
prenatal diagnosis.pptxprenatal diagnosis.pptx
prenatal diagnosis.pptxReshop Nanda
 
Active management of infertility - a guide for gynecologists
Active management of infertility  - a guide for gynecologistsActive management of infertility  - a guide for gynecologists
Active management of infertility - a guide for gynecologistsDr Aniruddha Malpani
 

Similaire à Basic neonatology course (20)

Investigations for iufd & sb, how to select?
Investigations for iufd & sb, how to select?Investigations for iufd & sb, how to select?
Investigations for iufd & sb, how to select?
 
Cryptorchidism (Undescended Testes)
Cryptorchidism (Undescended Testes)Cryptorchidism (Undescended Testes)
Cryptorchidism (Undescended Testes)
 
Congenital_abnormalities,_prenatal_diagnosis_&_fetal_surveillance.pptx.ppt
Congenital_abnormalities,_prenatal_diagnosis_&_fetal_surveillance.pptx.pptCongenital_abnormalities,_prenatal_diagnosis_&_fetal_surveillance.pptx.ppt
Congenital_abnormalities,_prenatal_diagnosis_&_fetal_surveillance.pptx.ppt
 
Genetics Series Prenatal Diagnosis.pptx
Genetics Series Prenatal Diagnosis.pptxGenetics Series Prenatal Diagnosis.pptx
Genetics Series Prenatal Diagnosis.pptx
 
Prenatal diagnosis
Prenatal diagnosisPrenatal diagnosis
Prenatal diagnosis
 
Obstetric History and Examination
Obstetric History and ExaminationObstetric History and Examination
Obstetric History and Examination
 
O en
O enO en
O en
 
Fetal autopsy
Fetal autopsyFetal autopsy
Fetal autopsy
 
Pediatric endocrine revesion (part 1)
Pediatric endocrine revesion (part 1) Pediatric endocrine revesion (part 1)
Pediatric endocrine revesion (part 1)
 
Pediatric endocrine revesion (part 1)
Pediatric endocrine revesion (part 1) Pediatric endocrine revesion (part 1)
Pediatric endocrine revesion (part 1)
 
Future of pnd - Eurocat 2011
Future of pnd - Eurocat 2011Future of pnd - Eurocat 2011
Future of pnd - Eurocat 2011
 
WISSEN MEDIQUIZ 2018 MAINS
WISSEN MEDIQUIZ 2018 MAINSWISSEN MEDIQUIZ 2018 MAINS
WISSEN MEDIQUIZ 2018 MAINS
 
Abnormal Uterine Bleeding
Abnormal Uterine BleedingAbnormal Uterine Bleeding
Abnormal Uterine Bleeding
 
Stage IV Thoracic Neuroblastoma (Morning Report)
Stage IV Thoracic Neuroblastoma (Morning Report)Stage IV Thoracic Neuroblastoma (Morning Report)
Stage IV Thoracic Neuroblastoma (Morning Report)
 
Obstructed labour
Obstructed labourObstructed labour
Obstructed labour
 
Still Birth:An Update : Dr Sharda Jain
Still Birth:An Update : Dr Sharda JainStill Birth:An Update : Dr Sharda Jain
Still Birth:An Update : Dr Sharda Jain
 
prenatal diagnosis.pptx
prenatal diagnosis.pptxprenatal diagnosis.pptx
prenatal diagnosis.pptx
 
Active management of infertility - a guide for gynecologists
Active management of infertility  - a guide for gynecologistsActive management of infertility  - a guide for gynecologists
Active management of infertility - a guide for gynecologists
 
3 pregnancy monitoring
3 pregnancy monitoring3 pregnancy monitoring
3 pregnancy monitoring
 
Pna mas
Pna masPna mas
Pna mas
 

Dernier

Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...saminamagar
 
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service JaipurHigh Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipurparulsinha
 
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service LucknowVIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknownarwatsonia7
 
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking ModelsMumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking Modelssonalikaur4
 
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...narwatsonia7
 
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000aliya bhat
 
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...rajnisinghkjn
 
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...narwatsonia7
 
Glomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxGlomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxDr.Nusrat Tariq
 
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original PhotosBook Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photosnarwatsonia7
 
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...narwatsonia7
 
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowKolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowNehru place Escorts
 
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceCollege Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceNehru place Escorts
 
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Miss joya
 
Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024Gabriel Guevara MD
 
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Miss joya
 
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original PhotosCall Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photosnarwatsonia7
 

Dernier (20)

Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
 
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
 
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service JaipurHigh Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
 
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service LucknowVIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
 
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking ModelsMumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
 
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
 
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000
 
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
 
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Electronic City Just Call 7001305949 Top Class Call Girl Service A...
 
Glomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxGlomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptx
 
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
 
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original PhotosBook Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
 
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
 
sauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Service
sauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Servicesauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Service
sauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Service
 
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowKolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
 
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceCollege Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
 
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
 
Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024
 
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
 
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original PhotosCall Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
 

Basic neonatology course