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obstetrics > 11. diseases of the newborn. Clinical and morphological assessment of the newborn. > Flashcards

11. diseases of the newborn. Clinical and morphological assessment of the newborn. Flashcards

1
Q

what are the main diseases of new borns ?

A

asphyxia
hypoglycaemia
hyperbilirubinemia

CNS
seizures

malformation : 
choanal atresia
herniation of diaphragm
oesophageal atresia 
omphalocele
gastrochisis
heart anomalies
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2
Q

there are three types of asphyxias what are they ?

A

prepartum -

intrauterine

during labour
postnatally

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3
Q

what causes prepartum intrauterine asphyxia ?

A

placental abnormalities placental abruption

maternal diseases like diabetes
drop in blood pressure
anemia ,

foetus has the umbilical cord wrapped around the neck
knotting of umbilical cord

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4
Q

what causes asphyxia during labour ?

A

due to umbilical cord compression

umbilical cord prolapse

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5
Q

what causes asphyxia postnatally

A

respiratory distress -
RDS / hyaline membrane disease

meconium aspiration

amniotic aspiration

=====
this can cause respiratory distress: 
metabolic acidosis 
hypothermia 
hypoglycaemia
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6
Q

what is the most severe outcome of asphyxia

A

hypoxic -ischemic encephalopathy - leads to irreversible neurological damage
manifested as intellectual disability
developmental delay
spasticity

or multiple organ failure

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7
Q

how is intrauterine asphyxia diagnosed

A

done through blood being drawn from the umbilical cord and running blood gas analysis on it
Profound metabolic acidosis

fetal distress
Tachycardia : > 160 beats / min. due to sympathetic stimulation caused by mild
hypoxia.

ii) Bradycardia: < 100 beats / min due to vagal stimulation caused by moderate hypoxia.
iii) Cardiac arrhythmia (irregular FHR) : due to severe hypoxia. It is the most dangerous one.
iv) Late deceleration.

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8
Q

signs and symptoms for respiratory distress syndrome/

A

tachypnea > 60 breaths per min (30-60 is normal)

nasal flaring

expiratory grunting

Rib retraction

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9
Q

diagnosis of respiratory distress syndrome ?

A

low apgar score
in auscultation decreased breath sounds

blood gas analysis of fetes -
for respiratory distress syndrome - respiratory and metabolic acidosis
pco2 80 mmhg in severe cases

chest x ray - fine reticular granular lung opacities

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10
Q

what is the treatmnet for respiratory distress syndrome ?

A

CPAP with with Positive end expiratory pressure of 3-8cm h20

start intubation with mechanical ventiation if Respiratory acidosis with a PaCO2 > 50 mm Hg, a PaO2 < 50 mm Hg or O2 saturation <90% persists

Acidosis should be corrected by intravenous administration of sodium bicarbonate

endotracheal administration of exogenous surfactant within 2 hours postpartum

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11
Q

what is a big complication of respiratory distress syndrome ?

A

bronchopulmonary dysplasia chronic lung disease primarily found in premature infants exposed to prolonged mechanical ventilation and oxygen therapy for neonatal RDS

increased chance in neonates treated with more than 21% oxygen for at least 28 days

Diagnostics
Chest x-ray: diffuse, fine, granular densities,
areas of atelectasis interspersed with areas of hyperinflation

Therapy: controlled oxygenation, bronchodilators diuretics, possibly glucocorticoids

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12
Q

what are other complication of HMD?

A

infection and pneumothorax

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13
Q

to whom does meconium aspiration syndrome occur ?

A

term or post-term babies who are small for gestational age (IUGR)

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14
Q

diagnosis of meconium aspiration ?

A

Aspiration of meconium from the trachea at birth
or visualised in vocal cords

meconium in amniotic fluid

in auscultation - rales and rhonchi

Radiologically hyperinflated lung fields, flattened diaphragm with coarse and patchy infiltration

blood gas - hypoxemia and hypercapnia

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15
Q

management of meconium aspiration syndrome ?

A

Airway and oral suctioning may be needed

Liberal oxygen supply

Mechanical ventilation is required where PO2 is less than 50 mm Hg and PCO2 is above 50 mm of Hg.

Antibiotic coverage

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16
Q

there are 5 different types of post natal icterus what are they ?

A 
icterus neonatal simplex 
icterus praecox
icterus gravis
kernicterus 
prolonged icterus
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17
Q

describe icterus neonatal simplex / physiological

A

starts at 2/3rd day of birth and not before - reaches peak at 5th day - vanishes in two weeks

physiological icterus from the not fully functioning liver
the levels of indirect bilirubin should not exceed 15mg/d

usually 12mg/dl in term
premature <15mg/dl

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18
Q

describe icterus praecox

A

mild jaundice presents first day of birth

it usually clears rapidly and spontaneously

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19
Q

what causes icterus praecox ?

A

due to RH ABO blood group incompatibility ( mother and fetus has different blood group and mother’s immune system may attack it causing hemolytic anemia

cephalohematoma (hemorrhage between skull and periosteum) or other traumas during birth
occasionally resulting in haemolytic disease but it quickly clears

intraventricular hemorrhage

neonatal - eccoli infection

USUALY NOT TREATMENT REQUIRED

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20
Q

what is icterus gravis

A

bilirubin is higher than 16mg/dl

DEVELOPS JAUNDICE WITHIN 24 HOURS

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21
Q

what causes icterus gravis ?

A

often the cause erythroblastosis fetalis - haemolytic anemia caused by transplacental transmission of maternal antibodies to red blood cells of fetus often due to the RhD antigens

defect in conjugation of bilirubin
Crigler-Najjar syndrome (autosomalrecessive), Gilbert syndrome(autosomaldominant),

Preterm babies with impaired liver function

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22
Q

describe kernicterus ?

A

higher than critical level of 20mg/dl where indirect bilirubin starts to deposit in the basal ganglia - leads to brain damage and retardation

CONJUGATED BILIRUBIN CANNOT CAUSE KERNICTERUS

23
Q

what causes kernicterus ?

A

again due to haemolytic anemia - erythroblasts fetalis ,

liver enzymes present but not active

administration of aspirin - displaced bilirubin attached to albums

24
Q

signs and symptoms of kernicterus ?

A

lethargy, hypotonia, poor feeding

severe illness is manifested by prostration, respiratory distress and finally opisthotonos, hyperpyrexia, convulsions, enlarged liver, spleen

25
Q

quick diagnosis of kernicterus is ?

A

diagnosis is through - assymetrical moro reflex (spreading out arms , pulling arms in , crying)
asymmetrical moro reflex - (spreading out of arms , pulling arms in and crying -

rapidly lowering the infant while supported to a sudden stop and pinching the skin of the abdomen or head is tilted suddenly a few cm lower

26
Q

every icterus except prolonged icterus can be treated with ?

A

treatments is introduced when bilirubin above 13mg/dl in term
11mg/dl in preterm

Adequate hydration

  • put phototherapy (double from above and below )
    using blue light rays convert the unconjugated bilirubin to conjugates

Phenobarbital therapy induces hepatic microsomal enzymes and increases bilirubin conjugation and excretion

Metalloporphyrins decreases bilirubin production by inhibiting heme oxygenase. Tin and zinc metalloporphyrins a

27
Q

diagnosis of neonatal hyperbilirubinemia ?

A

clinical

dermal zone 1 - face and neck = 5mg/dl

dermal zone 2 - chest and back - 10mg/dl

dermal zone 3 - abdomen and below umbilicus to knees - 12mg/dl

dermal zone 4 - arms ad legs below knees- 15mg/dl

dermal zone 5 - feet and have - >15mg/dl

======
serum bilirubin level and total blood test

blood group status of mother and child

antibody screening of mother
direct coombs test for rh incompatibility

28
Q

what is breast milk jaundice ?

A

The activity of the enzyme-glucuronyl transferase is inhibited by a specific steroids fatty acids of breast milk.

level rises from the 7th day after birth to max by 14th day. but less than 15mg/dl

rarely causes kernicterus.

no treatment.
If the bilirubin level is high temporary withdrawal of breastfeeding cures.

29
Q

what causes CNS seizures ?

A

traumatic
hypoxic ischemicncephalopathy
neonatal asphyxia
intra cranial hemorrhage

metabolic
hypoglycemia
kernicterus
hypo/hypercalcemia

infective -high fever , cns strep b ore
coli

iatrogenic - narcotic withdrawl

premature and low birth weight

30
Q

how do we treate sezuires in new borns ?

A

control convulsion :phenobarbitural

but be ready to intubate the newborn

31
Q

what empirical treatment for neonatal sepsis

A

ampicillin and gentamicin

32
Q

what are the causes for neonatal sepsis

A

Early-onset neonatal sepsis (within 1 week of birth) is typically caused by vertical or perinatal transmission to the fetus

most commonly caused by group b strep and ecoli

hsv

33
Q

who are at high risk for neonatal sepsis ?

A

for preterm and low birth weight neonates ,

PROM

34
Q

what are the symptoms for neonatal sepsis ?

A

symptoms -
fluctuations in temp

respiratory abnormalities

decreased milk drinking

diarrhea and decreased bowl movements

35
Q

what is choanal atresia ?

A

back of nasal passage blocked usually by bony tissue or soft tissue due to failed recanalisation of the nasal fossa during fetal development

36
Q

what are the signs and symptoms of choanal atresia

A

bilateral - cyanosis the baby through feeding

continuous stream of mucus draining from one or both noses

37
Q

what is the treatment for choanal atresia ?

A

endotracheal tubing
extracorporeal membrane oxygenation

if bone obstruction then its drilled through drilled through and stent is placed

38
Q

how is hernia of diaphragm diagnosed

A

routine ultrasound

Otherwise, it is diagnosed soon after birth when a baby shows signs of breathing difficulties

39
Q

clinical management f herniation of diaphragm ?

A

nano gastric tube inserted - release any excess air in stomach and intestine which relives pressure on lungs
ventilator f respiration problems , extracorporeal membrane oxygenation if severe
then operation when everything is stable

40
Q

what is omphalocele ?

A

abdominal wall defect in which intestines , lover and other abdominal organ may be outside in sac , failure of them going back into the abdominal cavity during 9th week of of gestation

41
Q

what is the diagnosis of omphalocele ?

A

fetal ultrasond , elevated AFP

42
Q

what is the treatment of omphalocele ?

A

Immediately after birth a nasogastric tube is required to decompress the intestines and an endotracheal intubation is needed to support respiration. The exomphalos sac is kept warm and covered with a moist saline gauze and plastic transparent bowel bag to prevent fluid loss.
surgery required

43
Q

what is gastroschisis ?

A

baby’s intestines extend outside of the abdomen through a hole next to the belly button.
in gastroschisis the umbilical cord is not involved and the intestinal protrusion is usually to the right of the midline. Parts of organs may be free in the amniotic fluid and not enclosed in a membranous (peritoneal) sac

44
Q

what is the diagnosis of gastroschisis ?

A

ultrasound and raised AFP

45
Q

what is the clinical management of gastroschisis ?

A

same as omphalocele

46
Q

heart defects which are cyanotic ?

A

tricuspid atresia

tetralogy of fallout - ventricular septal defect
pulmonary valve stenosis
right ventricular hypertrophy
overriding aota

transposition of great arteries

truncus arteriosus - the pulmonary arteries and aorta do not separate - one trunk arising from the heart with mixed blood supplied to coronary artery , lungs , and rest of body (perisirant - cyanotic)

47
Q

what is a long term complication of hypoglycaemia ?

A

mental retardation
seizures
development delay

48
Q

why is there physiological hypoglycaemia in new born ?

A

glucose is transferred from the mothers placenta but not insulin , the continuous glucose supply stops once after delivery

during last trimester glucose is stores in liver , heart and skeletal muscles

all new born experience glucose decline 2-3 hours after birth then maintained through regular feedings

49
Q

how is hypoglycaemia defined ?

A

below 30mg/dl first 24 hours then glucose levels are below 45mg/dl

50
Q

what are symptoms of hypoglycaemia ?

A 
can show no symptoms 
hypothermia 
tremor 
hypotonia
if severe seizures
51
Q

what are the risk factors for hypoglycaemic baby ?

A

premature hypotrophic - not enough glycogen stores

hyperinuslinemic hypoglycaemia
gestational diabetes
type 1 diabetes in of mother
high level of glucose in fetes , thus high levels of insulin - when the umbilical cord gets cut the source of glucose is gone however the insulin levels are still high and need some time to decrease

decreased gluconeogensisis - adrenal insuffieicneecy , errors of metabolism , glycogen storage disease

increased glucose use - hyperthermia , polycethmia , spespsis, hypoxia

52
Q

how is hypoglycaemia diagnosed ?

A

heel prick and blood analysis

53
Q

what is the clinical management go hypoglycaemia ?

A

dextrose gel applied directly to infant’s mouth / intravenous infusion of glucose
less severe - beast feeding regularly

54
Q

Jaundice presenting in the first 24 hours of life is more likely to have a serious underlying cause such as ?

A

infection, haemolytic disease or metabolic disorder

obstetrics (44 decks)

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