18.1 Neonatology 2 Flashcards
What causes respiratory distress?
Sepsis
Transient Tachypnoea of the newborn
Meconium aspiration
What is grunting?
Breathing against a partially closed glottis causing back pressure
What are the signs of respiratory distress?
Grunting
Intercostal recession
Nasal flaring
What is transient tachypnoea of a newborn?
Self limiting and common, present in 1st few hours of life
Delay of clearance of fluid in the first few days of life
Clinically- grunting, tachypnoea, oxygen requirement, normal blood gases
On x-Ray- fluid in the horizontal fissure
More common in children with planned c section
What is the management of transient tachypnoea of the newborn?
Antibiotics and fluids (incase it’s actually sepsis)
Oxygen
Airway support
What is meconium aspiration?
Babies poo as they are stressed during delivery
They inhale this into their lungs
What are the risk factors for meconium aspiration?
Post dates
Maternal diabetes
Maternal hypertension
Difficult labour
What are the symptoms of meconium aspiration?
Cyanosis
Increased work of breathing
Grunting
Apnoea
Floppiness
What are the investigations for meconium aspiration?
Chest x Ray
Septic screen
Blood gas
What is the treatment of meconium aspiration?
Do suction, intubate and ventalate (if v unwell)
Fluids and antibiotics IV, need surfactant,
If you’re very ill they need inhaled nitrous oxide
How do you investigate a blue baby?
Sepsis screen
Blood gas and glucose
CXR, ECG, ECHO
Pulse oximetry
Hyperoxia Test- breathe 100% o2 for 10 mins. Does this improve blood gas? If not cardiac problem
How do you remember the major heart conditions?
- Truncus arteriosus- 1 big vessel
- TGA- 2 main vessels are switched
- Tricuspid atresia- tricuspid has 3 flaps
- Tetralogy of fallot- 4 abnormalities
5- TAPVD- 5 letters in this one
How do you manage hypoglycaemia of the newborn?
Admit to NNU and monitor
Start IV 10% glucose
Increase fluids
Increase glucose concentration (IV access)
What gives you hypoglycaemia in a new born?
Twins- twin to twin transfusion- smaller one doesn’t have glycogen
Macrosomnia- used to high glucose, then they don’t have it. Uh oh
How do you treat hypothermia?
Admit to NNU and incubate
Septic screen and antibiotics
Consider checking thyroid function
Monitor blood glucose
What do you do for severe jaundice in a baby?
Incubate and IV fluids
Phototherapy and rarely exchange transfusion
What is brith asphyxia?
Lack of oxygen at birth leads to multi organ dysfunction
What are the causes of birth asphyxia?
Placental problem
Long difficult delivery
Umbilical cord prolapse
Infection
Neonatal airway problem
Neonatal anaemia (rhesus negative)
What are the two stages of hypoxic damage in birth asphyxia?
Stage 1- within minutes, cell damage due to lack of blood flow and O2
Stage 2- repercussion injury, can last days or weeks, toxins released form damaged cells
What is hypoxic ischemic encephalopathy?
Damage to the baby due to birth asphyxia
Loss of reflexes
Clonus
What is the management of hypoxic ischemiac encephalopathy
Rectal thermometer
Intubator- for morphine
Kept at 33-34 degrees then gradually rewarmed
Manage seizures, cardio and resp problems
Fluid restriction (cerebral oedema)
What surgical problems should we know about
Oesophageal atresia
Duodenal atresia and other GI atresias (polyhydraminos)
Failure to pass stool
Abdo wall defects
Diaphragmatic hernia
What are the causes of failure to pass stool (48 hours no poo)
Constipation
Large bowel atresia
Imperforate anus (+/- fistula)
Hirschprungs disease- not enough nerves is lower bowel
Meconium ileum (think CF)
What are the common abdo wall defects they get
Exophalemous hernia?- hernia into umbilical cord (multiple defects)
Gastrochesis- abdo wall doesn’t close property (isolated)
What are the complications of abdo wall defects?
Heat loss
Need fluid
Discuss a diaphragmatic hernia?
How is it treated?
Usually occurs on left
Bowel (or abdo organs) move through diaphragm causes lung problems
Need intubated, surgery,
What is neonatal abstinence syndrome
Withdrawl from maternal addictive substances
Usually opioids, benzodiazepines, cocaine, amphetamine
How do you treat neonatal abstinence sydrome?
Monitor/ diagnosis
Finnegan score
Urine toxicology
Give Morphine or Phenobarbitone
Discharge planning
Babies may have BBV or other diseases
