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Core clinical problems > 6c. Neonates > Flashcards

6c. Neonates Flashcards

1
Q

Sections of APGAR score?

A

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

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2
Q

newborn resus steps

A
  1. Dry baby and maintain temperature
  2. Assess tone, respiratory rate, heart rate
  3. If gasping or not breathing give 5 inflation breaths*
  4. Reassess (chest movements)
  5. If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
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3
Q

hyperinflation and fluid in the horizontal fissure

A

transient tachypnoea of new born - usually supportive care

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4
Q

most common diaphragmatic hernia type

A

left-sided posterolateral Bochdalek hernia

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5
Q

What is hydrops fetalis

A

fluid in >2 compartments

non-immune
infections before birth
heart or lung defects
liver disease

immune
rhesus
a thalassemia

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6
Q

main components NIPE

A

Heart
Hip
Eyes
Testes

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7
Q

presentation talipes

A

ankles are in a supinated position, rolled inwards

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8
Q

what birth mark may require propanolol

A

hemangioma if obstructing visual fields etc

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9
Q

risk fatcors ddh

A

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

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10
Q

Ortolani and barlows

A

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)

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11
Q

who gets routine uss at 6 weeks regardless of ortolan and barlow

A

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

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12
Q

what is staging for HIE called

A

Sarnat Staging

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13
Q

Sarnat staging

A

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

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14
Q

when to suspect HIE

A

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.

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15
Q

what is chignon

A

oedema and bruising from Ventouse delivery

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16
Q

Rubins and woodscrew

A

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.

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17
Q

managemnet meconium aspiration

A

Gentamicin + ampicillin
Respiratory support

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18
Q

when are corticosteroids offered preterm

A

before 35 weeks

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19
Q

when is magnesium sulphate offered pre term

A

before 34 weeks

20
Q

what is Newborn respiratory distress syndrome (NRDS) ?

A

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

21
Q

CXR NRDS?

A

ground-glass

22
Q

Risk factors NRDS

A

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

23
Q

CXR bronchopulmonary dysplasia

A

widespread areas of opacification, sometimes with cystic changes(Fig. 10.17). Areas of both hyperexpansion and atelectasis are seen.

24
Q

what is bronchopulmonary dysplasia/ chronic lung disease of prematurity

A

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.

25
Q

define apnoea

A

Apnoea are defined as periods where breathing stops spontaneously for more than 20 seconds, or shorter periods with oxygen desaturation or bradycardia.

26
Q

pathophysiology apnoea in neonates

A

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

27
Q

Management apnoea in neonates

A
  1. apnoea monitor –> tactile stimulation

If recurrent
+ IV caffiene

28
Q

Causes jaundice in first 24 hours

A

Haemolytic disorders (Rhesus incompatibility, ABO incompatibility, G6PD deficiency, spherocytosis)

Sepsis (TORCH screen is indicated)

29
Q

Most common cause jaundice 2-14 days of life

A

physiological

30
Q

Invetsigations for prolonged jaundice

A
  1. 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
31
Q

most common form of ABO incompatibility

A

mother is blood group O and the baby is either A or B

32
Q

when can trancutaneous bilirubin be measured

A

over 35 weeks gestation and over 24 hours of age.

33
Q

graph for plotting bilirubin

A

nomograms

34
Q

managemnet jaundice above tretament thresholds

A

phototherapy or an exchange transfusion

35
Q

managemnet cleft lip/palate

A

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

36
Q

associations with bowel wall defects eg gastroschisis and oophamocele

A

Beckwith-Wiedemann syndrome
Down’s syndrome
cardiac and kidney malformations

37
Q

managemnet neonatal sepsis

A

benzylpenicillin and gentamycin

38
Q

characteristic featres rubella infection

A

Sensorineural deafness
Congenital cataracts
Congenital heart disease (e.g. patent ductus arteriosus and pulmonary stenosis))
Glaucoma

39
Q

Characteristic features toxoplasmosis infection

A

Toxoplasma gondii parasite

Cerebral calcification
Chorioretinitis
Hydrocephalus

40
Q

Characteristic features CMV

A

Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly

41
Q

woman planning to get pregnant - nots ure if had MMR

A

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.

42
Q

features foetal alcohol syndrome

A

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

43
Q

what brain injury can happen in first 72 hours after birth

A

intraventricular haemorrhage

rising icp is infdicatin for shunting

44
Q

what are the torch infections

A

(T)oxoplasmosis
(O)ther Agents
(R)ubella (or German Measles)
(C)ytomegalovirus
(H)erpes Simplex.

45
Q

Newborn normal resp rate and heart rate

A

RR 40-60
HR 120-160

Core clinical problems (94 decks)

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