6c. Neonates Flashcards
Sections of APGAR score?
Appearance, Pulse, Grimace, Activity, and Respiration
each either 2/1/0
Appearance/Colour: pink, peripheral blue, all blue
Pulse: >100, <100, absent
Grimace: cries on stimulation/sneeze/cough, grimace, nil
Acitivity :active movement, limb flexion, flaccid
Respiratory effort:Strong crying, weak irregular, nil
newborn resus steps
- Dry baby and maintain temperature
- Assess tone, respiratory rate, heart rate
- If gasping or not breathing give 5 inflation breaths*
- Reassess (chest movements)
- If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
hyperinflation and fluid in the horizontal fissure
transient tachypnoea of new born - usually supportive care
most common diaphragmatic hernia type
left-sided posterolateral Bochdalek hernia
What is hydrops fetalis
fluid in >2 compartments
non-immune
infections before birth
heart or lung defects
liver disease
immune
rhesus
a thalassemia
main components NIPE
Heart
Hip
Eyes
Testes
presentation talipes
ankles are in a supinated position, rolled inwards
what birth mark may require propanolol
hemangioma if obstructing visual fields etc
risk fatcors ddh
First degree family history
Breech presentation from 36 weeks onwards
Breech presentation at birth if 28 weeks onwards
Multiple pregnancy
female sex: 6 times greater risk
firstborn children
oligohydramnios
birth weight > 5 kg
congenital calcaneovalgus foot deformity
Ortolani and barlows
The Ortolani test is done with the baby on their back with the hips and knees flexed. Palms are placed on the baby’s knees with thumbs on the inner thigh and four fingers on the outer thigh. Gentle pressure is used to abduct the hips and apply pressure behind the legs with the fingers to see if the hips will dislocate anteriorly.
Barlow test is done with the baby on their back with the hips adducted and flexed at 90 degrees and knees bent at 90 degrees. Gentle downward pressure is placed on knees through femur to see if the femoral head will dislocate posteriorly. (barlow push joint back)
who gets routine uss at 6 weeks regardless of ortolan and barlow
first-degree family history of hip problems in early life
breech presentation at or after 28 weeks gestation, irrespective of presentation at birth or mode of delivery
multiple pregnancy
what is staging for HIE called
Sarnat Staging
Sarnat staging
Mild
Poor feeding, generally irritability and hyper-alert
Resolves within 24 hours
Normal prognosis
Moderate
Poor feeding, lethargic, hypotonic and seizures
Can take weeks to resolve
Up to 40% develop cerebral palsy
Severe
Reduced consciousness, apnoeas, flaccid and reduced or absent reflexes
Up to 50% mortality
Up to 90% develop cerebral palsy
when to suspect HIE
acidosis (pH < 7) on the umbilical artery blood gas, poor Apgar scores, features of mild, moderate or severe HIE (see below) or evidence of multi organ failure.
what is chignon
oedema and bruising from Ventouse delivery
Rubins and woodscrew
Rubins manoeuvre - pressure on the posterior aspect of the baby’s anterior shoulder to help it move under the pubic symphysis.
Wood’s screw manoeuvre is performed during a Rubins manoeuvre. The other hand is used to put pressure on the anterior aspect of the posterior shoulder.
If this does not work, the reverse motion can be tried, pushing the top shoulder backwards and the bottom shoulder forwards.
managemnet meconium aspiration
Gentamicin + ampicillin
Respiratory support
when are corticosteroids offered preterm
before 35 weeks
when is magnesium sulphate offered pre term
before 34 weeks
what is Newborn respiratory distress syndrome (NRDS) ?
Affects premature neonates, born before the lungs start producing adequate surfactant. Respiratory distress syndrome commonly occurs below 32 weeks.
Inadequate surfactant leads to high surface tension within alveoli. This leads to atelectasis (lung collapse), as it is more difficult for the alveoli and the lungs to expand. This leads to inadequate gaseous exchange, resulting in hypoxia, hypercapnia (high CO2) and respiratory distress
CXR NRDS?
ground-glass
Risk factors NRDS
The risk of SDLD decreases with gestation
50% of infants born at 26-28 weeks
25% of infants born at 30-31 weeks
Other risk factors for SDLD include
male sex
diabetic mothers
Caesarean section
second born of premature twins
CXR bronchopulmonary dysplasia
widespread areas of opacification, sometimes with cystic changes(Fig. 10.17). Areas of both hyperexpansion and atelectasis are seen.
what is bronchopulmonary dysplasia/ chronic lung disease of prematurity
Infants who still have an oxygen requirement at a post-menstrual age of 36 weeks are described as having bronchopulmonary dysplasia (BPD) or chronic lung disease.
The lung damage comes from pressure and volume trauma from artificial ventilation, oxygen toxicity and infection.
define apnoea
Apnoea are defined as periods where breathing stops spontaneously for more than 20 seconds, or shorter periods with oxygen desaturation or bradycardia.
pathophysiology apnoea in neonates
Apnoea occur due to immaturity of the autonomic nervous system that controls respiration and heart rate. This system is more immature in premature neonates.
Apnoea are often a sign of developing illness, such as:
Infection
Anaemia
Airway obstruction (may be positional)
CNS pathology, such as seizures or haemorrhage
Gastro-oesophageal reflux
Neonatal abstinence syndrome
Management apnoea in neonates
- apnoea monitor –> tactile stimulation
If recurrent
+ IV caffiene
Causes jaundice in first 24 hours
Haemolytic disorders (Rhesus incompatibility, ABO incompatibility, G6PD deficiency, spherocytosis)
Sepsis (TORCH screen is indicated)
Most common cause jaundice 2-14 days of life
physiological
Invetsigations for prolonged jaundice
- conjugated and unconjugated bilirubin
direct antiglobulin test (Coombs’ test)
TFTs
FBC and blood film
urine for MC&S and reducing sugars
U&Es and LFTs
most common form of ABO incompatibility
mother is blood group O and the baby is either A or B
when can trancutaneous bilirubin be measured
over 35 weeks gestation and over 24 hours of age.
graph for plotting bilirubin
nomograms
managemnet jaundice above tretament thresholds
phototherapy or an exchange transfusion
managemnet cleft lip/palate
cleft lip is repaired earlier than cleft palate, with practices varying from repair in the first week of life to three months
cleft palates are typically repaired between 6-12 months of age
associations with bowel wall defects eg gastroschisis and oophamocele
Beckwith-Wiedemann syndrome
Down’s syndrome
cardiac and kidney malformations
managemnet neonatal sepsis
benzylpenicillin and gentamycin
characteristic featres rubella infection
Sensorineural deafness
Congenital cataracts
Congenital heart disease (e.g. patent ductus arteriosus and pulmonary stenosis))
Glaucoma
Characteristic features toxoplasmosis infection
Toxoplasma gondii parasite
Cerebral calcification
Chorioretinitis
Hydrocephalus
Characteristic features CMV
Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly
woman planning to get pregnant - nots ure if had MMR
Women planning to become pregnant should ensure they have had the MMR vaccine. If in doubt they can be tested for rubella immunity. If they do not have antibodies to rubella they can be vaccinated with 2 doses of the MMR 3 months apart.
features foetal alcohol syndrome
Microcephaly (small head)
Thin upper lip
Smooth flat philtrum (the groove between the nose and upper lip)
Short palpebral fissure (short horizontal distance from one side of the eye and the other)
Learning disability
Behavioural difficulties
Hearing and vision problems
Cerebral palsy
what brain injury can happen in first 72 hours after birth
intraventricular haemorrhage
rising icp is infdicatin for shunting
what are the torch infections
(T)oxoplasmosis
(O)ther Agents
(R)ubella (or German Measles)
(C)ytomegalovirus
(H)erpes Simplex.
Newborn normal resp rate and heart rate
RR 40-60
HR 120-160
