Admission to NICU Flashcards
3 DDxs for neonatal resp distress [3]
- Transient tachypnoea of Newborn (TTN)
- Sepsis
- Meconium Ileus via aspiration
What is TTN? [1]
Clinical features [4]
Transient tachypnoea of new born due to delay in clearance of foetal lung fluid
More common in C-section as birth canal doesn’t push out
- First few hours of life
- Grunting, Tachypnoea
- Increased oxygen requirement
- Normal blood gas
How can you test [2] for and treat TTN [5]
CXR can spot the fluids & hyperinflation
Self limiting - 24-48 hours Abx Fluids O2 Airway support
Risk factors of Meconium Aspiration? [4]
LBW
Post due date, Difficult labour
Foetal distress / hypoxia
Maternal DM, hypertension
How would meconium Aspiration present? [7]
Cyanosis, Floppiness
Low APGAR score
High work of breathing + grunting
Apnoea, respiratory distress
Pneumonitis (if aspiration occurred before/during delivery)
Green/yellow amniotic fluid
Meconium staining of neonate on skin, nails
What would do if you suspect meconium aspiration? [3]
Blood gas
CXR - hyperinflation, flat diaphragm & patchy, atelectasis
Septic screen jic
Whats in a septic screen? [5]
FBC, U&Es, urine dipstick Glc Blood culture, urine culture CXR LP
How do you treat meconium aspiration? [5]
Endotracheal suction meconium Intubate & ventilate IV fluids & Abx Surfactant Inhaled NO ECMO if all else fails
Any complications of meconium aspiration? [4]
Persistant Pulm HTN of Newborn (PPHN)
Infection
Surfactant dysfunction
Airway obstruction
How can you treat neonatal hypoglycaemia? [5]
Enteral Feeds IV 10% glc Fluids Glucagon Hydrocortisone
Birth Asphyxia is a serious problem in which low O2 at birth –> Multiorgan failure. What could cause it? [5]
- Placental problems
- Cord Prolapse
- Infection
- Neonatal Airway abnormality, anaemia
- Long, difficult delivery
What are the phases of birth asphyxia? [2]
Stage 1 = cell damage occurring within minutes of no oxygen
Stage 2 or latent phase = reperfusion injury due to toxins from damaged cells (Days or weeks)
How do you classify birth asphyxia? [3]
What is secondary phase of birth asphyxia and what does it lead to? [3]
Mild
Mod
Severe
Delayed injury
Secondary energy failure
Leads to hypoxic ischaemic encephalopathy
How do you manage a baby with birth asphyxia? [5]
Treat seizure Cardiac and respiratory support (O2, airway support), Fluid resus Monitor renal and liver function Therapeutic hypothermia Cranial USS, MRI at 7-10 days, Neuro f/u
Diaphragmatic hernias
Epidemiology [1]
L or R more common?
Associated with [2]
Male > Female
Mostly left
Also associated with pulm hypoplasia
Can be part of a syndrome
How do you manage a diaphragmatic hernia? [3]
Intubate at birth
Resp support (O2, ventilation, ECMO)
Surgery
What is Persistant Pulm HTN of Newborn (PPHN)
Failure to change from antenatal circulation to normal circulation resulting in hypertension
What are the RF for hypothermia [2]
Management of newborn hypothermia [2]
Premature, LBW
Prolonged resus
Heated oxygen + incubator
Dry quicker warm towel and radiant heater
What does hypothermia lead to [3]
How do you investigate hypothermia [3]
Increased energy and oxygen
Decreased surfactant
Metabolic acidosis as perfusion decreased
Sepsis screen
TFT
Blood glucose
Neonatal seizures causes [7]
HIE secondary to hypoxia / birth asphyxia / resp difficulties
Infection
Metabolic distubance: Decreased glucose, Ca, Mg, Increased Na
Intracranial haemorrhage
Neonatal withdrawal
Kernicterus
Features of neonatal seizures [3]
Most common 12-48 hours after brith
Generalised or focal
Tonic, clonic, myoclonic
How do you treat neonatal seizure [7]
ABC Treat underlying cause eg infection Treat seizure if prolong or repeated Cardio and respiratory support Monitor renal and liver function Fluid resus Therapeutic hypothermia Follow up neurodevelopment
Causes of neonatal hypotonia [9]
Sepsis Hypothyroid Prader-WIlli / Downs Maternal drugs HIE Cerebral palsy Spina bifida Maternal Myasthenia gravis Spinal muscular atrophy
DMD - but doesn’t present till later
What are surgical causes of admission [5]
Oesophageal atresia Duodenal atresia Failure to pass stool Abdominal wall defect Diaphragmatic hernia
Cyanosis in the neonatal period: peripheral
Cause
Peripheral cyanosis, for example of the feet and hands, is very common in the first 24 hours of life
- may occur when the child is crying or unwell from any cause
What is acrocyanosis?
Cause?
How to differentiate from peripheral cyanosis?
Acrocyanosis is often seen in healthy newborns and refers to the peripheral cyanosis around the mouth and the extremities (hands and feet). It is a common finding and may persist for 24 to 48 hours.
- It is caused by benign vasomotor changes that result in peripheral vasoconstriction and increased tissue oxygen extraction and is a benign condition [4].
- DDX: it occurs immediately after birth in healthy infants.
How do we recognize central cyanosis?
Investigation of choice
Central cyanosis: concentration of reduced haemoglobin in the blood exceeds 5g/dl
The nitrogen washout test (also known as the hyperoxia test) may be used to differentiate cardiac from non-cardiac causes.
- The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken.
- A pO2 of less than 15 kPa indicates cyanotic congenital heart disease
