19 Neonatology 3 Flashcards
How does the heart develop in infants?
begins to develop towards the end of the third week
Heart starts to beat at the beginning of the fourth week
Critical period of heart development is from day 20- day 50 after fertilisation
What is the job of the ductus arteriosus in a fetus?
Protects lung against a circulatory overload
Allows the right ventricle to strengthen
Carries low oxygen and saturated blood
What is the job of the ductusvenosus?
Foetal blood vessel connecting the umbilical vein to the IVC
Blood flow regulated via sphincters carries mostly oxygenated blood
What are the normal vital signs of a newborn?
BP- 70/40
RR- 30-60
HR- 120-160BPM
How do babies thermoregualte themselves?
Newborn babies lack shivering thus need metabolic production of heat
Brown fat is well innervated by sympathetic neurons and cold stress leads to lipolysis an heat production
How do babies lose heat
If the environment around them is cold
When exposed to moving air
Evaporation from water on the skin
Heat loss to the surfaces the babies lie on
How can you assess if a baby is breathing?
Difficult to assess spontatneous breathing Research rather than clinical devices Blood gas Flow volume loo Capnogrpahy
What is physiological jaundices complications?
How are they treated?
Appears on the 2nd to 3rd day of life. Lasts until the 10th
At high concentrations bilirubin can lead to kernicterus
Blue light converts bilirubin to water soluble form and increase oxidation
other main therapy is exchange transfusion
How is fluid balance affected in premature infants?
less body fat
Increased kidney loss due to reduced GFR, reduced Na reabsorbtion
Decreased ability to concentrate or dilute urine
Increased insensible water loss
What is meant by the term physiological anaemia of the newborn?
RBC production is 10% of in uterus
Increased eryropoetin production as baby matures in the womb
Premature babies are born with reduced erythropoesis
Can also have anemia through infection or blood letitng
What is the threshold for hypoglycaemia?
Who is at risk of hypoglycaemia?
Blood sugar less than 2.0 mmol/l
Premature babies Perinatal stress Macrosomnia/trimming syndrome Hypothermia Sepsis
What are the signs of hypoglycaemia
Jittireness
Temperature instability
Lethargy
Poor feeding
What are the adverse outcomes of hypoglycaemia?
Seizures
Apnoea, irregular breathing
Vomiting
Why do babies get cold?
Lose heat through evaporation
Lose heat through conduction (the material they lie on)
Convection- Lose heat from draughts
Radiation- loss hear from cold things in the vicinity
How do you resuscitate a baby?
Dry quickly
Remove wet lines
Use warm towels blankets and put on a hat
ABC
Why is breast feeding good?
Less risk of leukaemia
Allergy development is reduced
Increased antibodies
Form microbiome (skin to skin)
More sustenance
What is heamorrhagic disease of the newborn?
Babies are born vitamin K deficient
Without Vitamin K they would get large GI bleeds and intracranial bleeds
Give Vit K injection
Green vomiting equals?
Obstruction until proven otherwise
Bilious vomiting
What areas do retractions occur in laboured breathing?
Subcostal
Sub sternal
Intercostal
Suprasternal
Discuss cleft lips?
Failure of the maxillary and medial nasal processes to fuse
Associated with cleft palate
Do ECHO and hearing test
What do you look for in the baby’s eyes when they are born?
Cataracts- lens opacification, if undirected leads to blindness
Retinoblastoma- rare eye cancer which is treated successfully if picked up early
Both present with loss of red eye reflex
What is pseudomenstraution?
Baby gets menstrual bleeding after oestrogen withdrawl
What’s us urate?
Crystals in the babies urine, look orange. Can be mistaken for blood
What is a suspicious spinal dimple
If the dimple is large,
off midline,
high or with other cutaneous maker (e.g. hairy tuft)
Go onto do spinal imaging
What are cephaloheamatomas?
Bilateral swelling on one ore both sides of the head
Caused by heamorrhage beneath the pericardium
Not to do with intercranial bleeding, will resolve within a week
What are talipes?
Club foot
Can you manipulate feet? Is it fixed? Manipulated- physio Fixed- ortho
Babies with significant talipes may have DDH
What is developmental dysplasia of the hip?
Slipping of the acetabulum?
Can either be dislocated
Higher risk in girls and newborns
What tests do yiu do for developmental dysplasia of the hip?
Barlows Test- hands on babies knees, bring into midline, push backwards. Does hip dislocate
Ortolans Test- do straight after, put hand on femoral head and abduct hip. If hip did dislocate then it will pop back in
How do you treat DDH?
Pavlik harness- left on for 6 months and not taken off
Need surgery if it doesn’t resolve
