2. Neonatal Unit Flashcards by Tadah M

State 5 objectives of examination of a newborn

To initiate health promotion
Detect congenital problems
Detect non acute neonatal problems
To ensure appropriate plan for outpatient monitoring
To check for problems arising from maternal disease, family disorders and problems during pregnancy

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State 5 Down syndrome features

Pronounced sandal gap
Bilateral single palmar creases
Flat occiput and nasal bridge
Low set ears
Hypotonia

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State 8 neonatal benign self limiting skin lesions

Ranula
Epulis
Milia
Epstein pearls
Mangolian sots
Vermix caseosa
Neonatal urtricaria
Neonatal pustular melanosis

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State 5 Ts of cyanotic heart disease

Tetralogy of fallot
Transposition of great vessels
Tricuspid valve anomalies
Total anomalous pulmonary venous return
Persistent Truncus arteriosus

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Define tetralogy of fallot

Simultaneous occurrence of 4 of the following
Right ventricular outflow tract obstruction (RVOTO) due to pulmonary infundibular stenosis
Right ventricular hypertrophy (RVH)
Ventricular septal defect (VSD)
Overriding aorta (the aorta is displaced above the VSD)

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Define neonatal jaundice concentration

Serum bilirubin concentration >5mg/dL OR >85.5 micromol/L

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Describe the pathophysiology of breastfeeding jaundice

Decreased feeing > reduced bowel movements > decreased bilirubin excretion > enterohepatic circulation > increased reabsorption > unconjugated hyperbilirubinemia

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State 2 causes of physiologic jaundice

Increased fetal hemolysis due to short lifespan of fetal erythrocytes
Insufficient hepatic metabolism of bilirubin

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State 4 causes of pathologic jaundice

Increased production of bilirubin eg conditions with increased hemolysis
Decreased hepatic uptake due to liver immaturity
Decreased conjugation- crigler najjer syndrome
Increased enterohepatic circulation

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Define asphyxia and what causes it

Failure to initiate and maintain spontaneous and adequate breathing within 60 seconds of birth
Caused by a decrease of oxygen in the blood and an excess of carbon dioxide resulting in acidosis

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State 4 clinical features of birth asphyxia

Bradycardia <100 beats per minute
Failure to breathe at 1 minute after birth
Floppy baby or poor muscle tone
Central cyanosis

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State 5 predisposing maternal factors of asphyxia

Pre-eclampsia or eclampsia
Previous neonatal deaths
Prolonged rupture of membranes
Placenta Insufficiency
Placenta abruption
Placenta previa- placenta covers the cervix

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State 5 labour and delivery predisposing factors of asphyxia

Operative vaginal delivery
Prolonged labour
Caesarean section
Breech or abnormal presentation
Prolapsed umbilical cord or cord compression

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State 5 fetal predisposing factors of asphyxia

Prematurity
Postmaturity
Fetal distress
Intra uterine growth restriction
Meconium aspiration
Cerebral damage

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Describe 4systems affected by birth asphyxia

Neuro- hypoxic ischemic encephalopathy > seizures abnormal tone and posture
GIT- necrosis > abdominal distension, bloody stools and food intolerance
Cardiac- arrhythmias and cardiac arrest
Kidney- acute tubular necrosis with hematuria, anuria, oliguria

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Describe 4systems affected by birth asphyxia

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Define hypoxic ischemic encephalopathy HIE

A condition when a neonate has experienced acute brain injury as expressed by encephalopathy (altered mental state) as a consequence of hypoxia (reduced oxygen supply)

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Diagnostic criteria for HIE x4

Metabolic acidosis and pH <7
APGAR score of 5 at 10 minutes with continued need for resuscitation
Clinical evidence of encephalopathy - hypotonia
Presence of multiple organ system failures

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State 2 maternal predisposing factors for early bacterial sepsis

Foul smelling amniotic fluid
Intrapartum maternal fever during birth

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3 labour and delivery predisposing factors for early bacterial sepsis

Prolonged rupture of membranes
Spontaneous prematurity
Born before arrival to labour room

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State 3 common bacterial infections in neonates

E.coli
Staphylcoccus
Streptococcus pneumonia Group B

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Define cephalohematoma, its cause and characteristics x2

An unusual bulging that occurs under the scalp of an infant which gets harder over times
It is caused by rupture of the diploic or emissary veins
Limited by suture lines hence usually unilateral

Define caput succedaneum

It is diffuse edematous swelling of the scalp caused by prolonged or abnormal vaginal delivery

State 4 risk factors of prematurity

Multiple pregnancy
Cervical insufficiency
Previous preterm birth
Short cervical length

Define bronchopulmonary dysplasia and it's requirement

When the lungs and the airways (bronchi) are damaged, causing tissue destruction (dysplasia) in the tiny air sacs of the lung (alveoli) The need for at least 28 days of oxygen therapy for infants born at < 32 weeks gestational age

Define periventricular leukomalacia

It is the symmetrical periventricular injury of cerebral white matter by necrosis and cystic formation caused by ischemia and infections

State 3 sequelae for periventricular leukomalacia

Spastic cerebral palsy Visual disturbances Intellectual impairment

State 4 indications for cerclage in cervical insufficiency

History indicated Physical exam indicated Ultra sound indicated Unsuccessful cerclage

Define bronze baby syndrome

A complication of phototherapy for neonatal jaundice occurring due to modified liver function. Common in direct hyperbilirubinemia

State 5+ complications of prematurity

1. Neonatal RDS and apneic attacks 2. Jaundice, anemia, infections, retinopathy 3. Necrotizing enterocolitis and food intolerance 4. Cerebral and intraventricular hemorrhage 5. Periventricular Leukomalacia 6. Bronchopulmonary dysplasia

Maternal predisposing factors of prematurity x5

Teenage pregnancy Infection Anemia Poor nutrition Hard labour

Categories of birth weight x5

<750g Extremely LBW <1000g Very LBW <1500 LBW <2500 Macrosomia >4000

State 4 nutrients that may cause prematurity if low in quantity

Selenium iron zinc folate

State 3 signs of food intolerance

Vomiting of feeds tinged with bile Abdominal distension Bloody stools

Define prolonged pathological jaundice, clinical presentation (2) and causes (3)

Jaundice lasting for more than 2 weeks in full term and 3 weeks in premature babies Clay colored stool and dark yellow urine Biliary atresia, hypothyroidism, neonatal hepatitis

When to administer antibiotics on preterms x3

Spontaneous birth Foul smelling amniotic fluid PROM

Define prematurity

A baby born between the gestational age of 28< 37weeks

Describe management for a preterm baby x4

Tetracycline eye ointments Chlorhexidine for cord care Warmth + skin to skin contact Vitamin K administration to prevent hemorrhagic disease

State the family of complications x4

Neonatal sepsis> hypoglycemia and hypothermia> jaundice

Benefits of Kangaroo mother care x5

Promotes psychosocial benefits Decrease neonatal mortality Decreases risk of infections Improves brain development Improves cardiopulmonary circulation

Causes of convulsions x4

HIE Hypoglycemia Hypocalcemia CNS infection

Management of convulsions, in hypoglycemia and hypocalcemia

15ml/kg phenobarbital If hypoglycemic- 2ml/kg of 10% glucose iv or ng If Hypocalcemic- 2ml/kg of 10% calcium gluconate

State 3 important growth monitoring parameters

Weight Height or length Head circumference

State non nutritional factors affecting linear growth x6

Endocrine - growth hormone, thyroid hormone, steroids Non endocrine - genetic disorders, chronic illness, undernutrition

State 4 causes of microcephaly

Familial Autosomal recessive condition with dvt delay Congenital infection ie CMV Acquired- hypoglycemia, perinatal hypoxia

Causes of macrocephaly x5

Hydrocephalus Cerebral tumor Cerebral gigantism Familial macrocephaly Raised intracranial pressure

Define growth spurt, catch up and catch down

Growth spurt is increase in growth velocity Catch up - increase in growth rate to return to normal size Catch down - weight falls down lower a genetically determined growth centile

Causes of failure to thrive x5

Inadequate food Vomiting Malabsorption Renal - UTI Congenial heart disease

Define short stature and differentials

Height < 2-2.5 standard deviations below the mean for age Ddx: Normal ie familial Medical problems ie chronic illness, psychosocial dwarfism, LBW, small for gestational age

State 4 constitutional causes of failure to thrive

Perinatal infections Congenital syndromes Chromosomal disorders Inborn errors of metabolism

Investigations for short stature x4

CBC, ESR Bone age radiography Insulin like growth factor Free T4 and TSH levels

Investigations for Screening for neonatal sepsis x4

Lumbar puncture Blood culture Urine culture FBC- WBC

4 signs of neurological problems in neonates

Rapid change in head size Changes in muscle tone Changes in body temperature Feeding difficulties