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Paediatrics > 1: Neonatal - birth asphyxia > Flashcards

1: Neonatal - birth asphyxia Flashcards

1
Q

Define birth asphyxia

A

Perinatal compromise of gas exchange

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2
Q

What may birth-asphyxia cause

A

Hypoxic-Ischemic Injury

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3
Q

Give 5 causes of birth-asphyxia

A
  • Placental abruption
  • Cord collapse - compressing umbilical flor
  • Retained lung fluid
  • Pre-mature
  • Maternal analgesia
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4
Q

When is APGAR score used to assess a child

A

1-minute

5- minutes

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5
Q

What is the one-minute APGAR score used for

A

Determine if the neonate requires resuscitation

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6
Q

What 5-minute APGAR score requires further intervention

A

<7

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7
Q

What does APGAR stand for

A

Appearance

Pulse

Grimace

Activity

Respiration

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8
Q

How will the following appear for 0-points

A.  Appearance 
B.  Pulse 
C  Grimace 
D. Activity 
E. Respiration
A 
A. Blue 
B. None 
C. None 
D. None 
E. None
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9
Q

How will the following appear for 1-point

A. Appearance
B. Pulse
C. Grimace
D. Activity 
E. Respiration
A 
A. Pink Trunk, Blue-Limbs 
B. <100 
C. Grimace 
D. Flexion 
E. Weak cry, Slow-irregular breathing, Gasping
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10
Q

How will the following appear for 2-points

A. Appearance
B. Pulse
C. Grimace
D. Activity 
E. Respiration
A 
A. Pink body, Pink extremities 
B. Pulse >100 
C. Cry, Active withdrawal 
D. Active motion 
E. Regular breathing, strong cry
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11
Q

Define hypoxic-ischaemic encephalopathy

A

Manifestation of brain-injury within 48h of birth asphyxia

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12
Q

How may birth asphyxia be detected antenatally

A

CTG:

  • Late decelerations = Placental insufficiency
  • Variable decelerations = Cord prolapse
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13
Q

What % of severe HIE will have neurological sequelae

A

80

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14
Q

If a baby has severe HIE what is ordered at 4-14days

A

MRI

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15
Q

What findings on MRI may indicate cerebral palsy

A
  • Bilateral anomalies in BG, thalamus and internal capsule
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16
Q

What is the most common reason for neonatal life support

A

Respiratory conditions causing prolonged asphyxia leading to cardiac arrest

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17
Q

What is first-line in paediatric BLS

A

Open airway:

  • Head tilt
  • Chin lift
  • Jaw thrust
18
Q

What is second-line in paediatric BLS if neonate is not breathing

A

5 Rescue breathes

19
Q

If no signs of life what is performed following rescue breathes

A

15 Chest compressions

20
Q

What is the ratio of breathes to chest compressions

A

15:2

21
Q

When should resus team be called

A

If alone perform 1-minute chest compressions prior to contacting resus team

22
Q

In infants under 1-year what position should they be in to open airway

A

Neutral position with jaw thrust

23
Q

In children over 1-year, what position should they be in to maintain airway

A

‘Sniffing air position’

With haw thrust

24
Q

How long should you wait to determine patancy of the airway

A

10-Seconds

25
Q

How many rescue breathes are given in paediatric BLS

A

5 rescuer breathes

26
Q

What pulses should be checked for life in infants and children

A

Children: carotid
Infants: brachial and femoral

27
Q

When should chest compressions be started

A

No pulse in 10-seconds

28
Q

What are indications for chest compressions

A
  • No pulse
  • Or, HR <60
  • No signs life
29
Q

What technique is used for chest compressions in infants

A

Encircling technique: place hands around lower-sternum and use thumbs for CPR

30
Q

Define hypoxic ischaemic encephalopathy

A

Clinical presentation brain injury due to hypoxic-ischaemic insult

31
Q

How can cause of HIE be divided

A

Antenatal
Perinatal
Postnatal

32
Q

What causes HIE

A

Umbilical cord prolapse

Placental abruption

33
Q

What are mild symptoms of HIE

A
  • Hyperventilation
  • Hyper-responsive
  • Irritable
  • Impaired feeding
34
Q

What are moderate symptoms of HIE

A
  • Reduced movement
  • Lethargy
  • Seizures
35
Q

What are severe symptoms of HIE

A
  • Hypotonia
  • No movement
  • Prolonged seizures
  • Multi-organ failure
36
Q

Explain management of HIE

A
  • Resuscitation
  • Therapeutic hypothermia
  • Cerebral function analysis monitoring (CFAM)
  • Withhold feeding 1-2d and re-introduce gradually
37
Q

What are the three indications for therapeutic hypothermia

A
  1. Infant >1.8Kg and >36W with one of:
    - Cord gas or ABG with acidosis (pH <7)
    - APGAR < 5 at 10-minutes
  2. Moderate to severe HIE:
    - Hypotonia
    - Seizures
    - Hyporeflexia

If criteria 1 or 2 are met, test for criteria 3

  1. 30-minutes seizure activity on cerebral function analysis monitoring
38
Q

What is standard of care of infants with moderate-severe HIE

A

Therepetic hypothermia

39
Q

What is therapeutic hypothermia

A

Uses temperature control mat to maintain infants body T between 33-34’

40
Q

How long is therapeutic hypothermia maintained for

A

72-hours

41
Q

What are 5 complications of HIE

A
  1. Spastic quadriplegia
  2. Dyskinetic cerebral palsy
  3. Low IQ
  4. Cortical blindness
  5. Hearing loss
  6. Epilepsy

Paediatrics (61 decks)

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