18. Neonatology Flashcards
What are some terms for small for date babies?
Small for gestational age (SGA)
Inter uterine growth restrictive
Hypotrophy
How do you define IUGR?
IUGR <10th centile
Severe IUGR<0.4th centile
What causes a baby to be small for dates?
Maternal drug use e.g. smoking
Maternal pre-eclamptic toxemia (pet)
Chromosomal abnormalities e.g. edwards syndrome
Foetal infection e.g congenital cytomegalovirus
Placental abruption
Twins
What Complications do small fro date babies have?
Perinatal problems Hpoglycaemia Hypothermia Polycythaemia Thrombocytopenia Hypoglycamia GI problems RDS, infection
What long term problems do small for date babies have?
Hypertension
Reduced growth
Obesity
Ischaemic heart disease
What are the different classes of preterm babies?
Late preterm- 34-37 weeks
Very preterm<32 weeks
Extremely preterm<28 weeks of pregnancy
How can weight help class a premature baby?
low B/w- 2500g
very low B/w- <1500g
Extremely low birth weight<1000g
What is infant respiratory distress syndrome and how is it treated?
Respiratory distress syndrome, caused by reduced surfactant at birth
Treated with antenatal steroids to prevent and surfactant is given to the child.
They are given non invasive support (N-CPAP)
What is bronchiopulmonary dysplasia and how is it treated?
Overstretched lungs due to volubaro- trauma
Infection
O2 toxicity
Inflammatory changes
Treated with time, nutrition and growth and steroids
What are common minor respiratory problems children get?
How are they treated?
Apnoea/irregular breathing/desaturations
Treated with caffeine
What is intraventricular haemorrhage and how is it treated?
most common limiting factor in preterm babies
prevented with antenatal steroids
Symptoms are treated and the head drained
Describe the physiology of a patent ductus arteriousus
change in pressure from aorta to pulmonary artery. Causes a left to right shunt
This causes over perfusion of he lungs and lung oedema
This can lead o low renal perfusion and GI ischaemia
How do you treat patent ductus arteiosus?
Time
NSAIDS
Surgical closure
Catheter procedures
How do you treat someone with necrotising entero-colitis
ischaemic and inflammatory changes Necrosis of the bowel Surgical intervention is often required Conservative management is sometimes possible Antibiotics and parental nutrition
explain why nutrition is a major aspect of neontal care
Enormous requirements
Patients often triple in size during hospital stay
Building new tissues
What are the commonest reasons for term admissions
Sepsis- very common! Respiratory- very common! Neonatal abstinence syndrome- common Low sugar, low temp, Jaundice Birth asphyxia Cardiology
What are risk factors for sepsis in neonates?
prolonged rupture of membranes (prom)
Maternal pyrexia
Maternal GBS carriage
What are the symptoms of sepsis in neonates?
Baby pyrexia or hypothermia Poor feeding Lethargy or irritable Early jaundice Floppy Hypo or hyperglycaemia Tachypnoea- good sign
What is the commonest cause of early onset sepsis (85%)
Group B strep- most common
E.coli- makes up remainder of 85%
(Less common listeria, co-ag neg staph, haem. Influenzae)
How do you manage presumed sepsis in a neonate?
Admit to NNU
Septic screen- FBC, CRP, Blood cultures, blood gas
CXR,LP
IV fluids and treat acidosis
Monitor vital signs closely
What antibiotics should you take for suspected sepsis?
IV penicillin and gentamicin first line
2nd line vancomycin and gentamicin
If abdo concerns add in metronidazole
Discuss the pathological process of group B strep?
Early onset 48 hours- 1 week
Late onset/recurrence after 3 months
Crashingly septic within 12 hours
DIC, resp collapse, pneumonia, hypotension,shock
What are the common congenital infections?
TORCH!
Toxoplasmosis
Rubella
Cytomegalovirus (CMV)-deafness (give antivirals)
Herpes
What do congenital infections result in?
IUGR Brain calcification Neurofevelopmental delay Visual impairment Recurrent infection
Discuss the symptoms of children with Torch?
Hydrocephalus Cataracts Hepatomegaly, jaundice, hepatitis, splenatomegaly Anemia, neutropenia, thrombocytopenia Rash Deafness (CMV) Small head
What is blueberry muffin baby?
Blood forming cells set up in skin. If they have this rash then they probably have cancer or TORCH
