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RHCN > Care of the newborn > Flashcards

Care of the newborn Flashcards

1
Q

How many neonates end up on NICU?

A

10%

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2
Q

How many childhood deaths in 1st year of life?

A

25%

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3
Q

How many mums Rhesus neg?

A

10%

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4
Q

Placenta and Ig

A

IgG from mum to fetus

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5
Q

HbF has what?

A

gamma instead of beta chains

shifts oxygen curve to LEFT

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6
Q

Blood transfer from mum to baby 3 factors

A

Mum oxygen levels higher than fetes
HbF has a higher affinity of oxygen than HbA
Fetal blood doesn’t bind DPG easily (can carry more o2)

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7
Q

Umbilical vein

A

blood placenta to fetus

oxygenated

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8
Q

umbilical artery

A

fetus to placenta

deoxygenated

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9
Q

First breath

A

contraction
beta adrenaline
oxygenation
respiration

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10
Q

umbilical vein becomes

A

ligamentum teres

liver

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11
Q

umbilical artery becomes

A

constricted as the bladder starts working

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12
Q

ductus venosis

A

constricts and all the blood pases the hepatic sinusoids

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13
Q

ductus arteriosus becomes

A

ligamentum arteriosis

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14
Q

Cephalhaematoma

A

blood under periosteum
from operative delivery
or prolonged labour

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15
Q

erythema toxicum

A

common
lasts days- week
central papule surround by erythema
baby is usually well (if not well think staph)

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16
Q

cornelia de lange

A 
low birth weight
delayed growth
developmental delay
microcephaly
long eyelashes and thick eyebrows
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17
Q

club foot

A

talipes

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18
Q

swelling of dorsum of foot

A

turners

noonans

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19
Q

early onset haemorrhagic disease of the newborn

A

a few days

vit K deficiency

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20
Q

late onset haemorrhagic disease of the newborn

A

4-6 weeks

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21
Q

Neonatal jaundic within

A

24 hours

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22
Q

Biblrubin brain damage

A

kernicterus

dyskinetic CP

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23
Q

Breast milk contains

A 
macrophages
lymphocytes
IgA
IgG
Lysozymes
Lactoferrin
Lipase
Prebiotics
Hormones
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24
Q

Contraindications for breast feeding

A

HIV
Anti-psychotics
Chemo/Radio therapy
Heroin/Methadone

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25
Q

Heb B/C and breast feeding

A

should still breast feed

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26
Q

How many breast feed in UK at birth?

A

81%

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27
Q

How many breast feed at 6 months

A

25%

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28
Q

Benefits to mum for breast feeding

A

decrease breast cancer
decrease ovarian cancer
bone protection

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29
Q

macrosomia

A

> 4500mg

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30
Q

LBW

A

<2500

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31
Q

vlbw

A

<1500

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32
Q

Extremely! LBW

A

<1000mg

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33
Q

Shivering and newborns

A

they can’t do it

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34
Q

Resp support for the newborn

A 
O2
CPAP
intubation
surfactant
methyl xanthine
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35
Q

NGT and newborns

A

introduce food SLOWLY!

delay for 48 hours

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36
Q

other name for necrotising enterocolitis

A

pneumotosis intestinalis

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37
Q

Avoid sats over:

A

95%

Retinopathy of prematurity

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38
Q

Fundoscopy screening for

A

all under 32 weeks and vlbw

repeat 2 weekly until complete vascularisation

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39
Q

treatment for retinopathy of prematurity

A

ablate vessels

they will lose their peripheral vision

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40
Q

SGA definition

A

<10th percentile

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41
Q

SGA at risk of (immediately)

A

still birth
intrapartum hypoxia
neonatal hypoglycaemia
polycythemia

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42
Q

SGA at risk of later in life

A

T2DM, hyperlipid, hypertensive, ischaemic heart disease.

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43
Q

APGAR stands for

A

Activity, Pulse, Grimace, Appearance, Resps

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44
Q

Activity in APGAR

A

2: moves around, flexed, flaccid
1: rigid
0: none

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45
Q

Pulse in APGAR

A

2: over 100
1: under 100
0: absent

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46
Q

Grimace in APGAR

A

2: sneeze, cough, pull away
1: flexed
0: absent

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47
Q

Appearance in APGAR

A

2: pink
1: pink with blue limbs
0: blue

48
Q

Resp in APGAR

A

2: normal
1: irregular and slow
0: absent

49
Q

surfactant starts being made at

A

34/35 weeks

50
Q

Brown glass on CXR

51
Q

Congenital pneumonia associated with

A

prolonged rupture of membrane

52
Q

Congenital pneumonia caused by:

A

group B strep

53
Q

Onset of congenital pneumonia

A

can be 1-2 days later.

54
Q

Treatment for congenital pneumonia

A

Benzyl penicillin and gentamycin

55
Q

Transient tachypnoea

A

amniotic fluid still in lungs

presents 1-3 hours after birth

56
Q

Treatment for transient tachypnoea

A

oxygen
CPAP
stop feeds

57
Q

Transient tachypnoea on xray

A

coarse streaking

looks wet

58
Q

Meconium aspirate on xray

A

coarse streaking

hyperinflated lungs

59
Q

Neonatal gasping

A

meconium aspirate

60
Q

Pneumothorax in infant caused by:

A

RDS
Meconium
Pneumonia

61
Q

Treatment for pneumothorax

A

Positive pressure ventilation

Chest drain!

62
Q

granuloma in throat

A

from suction tube

63
Q

HIE affects:

64
Q

HIE caused by:

A

low BP
low glucose
epilepsy
high calcium

65
Q

What reduces death in HIE?

A

hypothermia jacket for 72 hours

66
Q

IVH is a:

A

bleed inside the ventricles in the brain
between 24 and 32 weeks
due to fragile blood vessels

67
Q

Diagnosis of IVH

A

ultrasound through bregma fontanelle

68
Q

DRIFT

A

washes out neurotoxins after severe IVH

improves IQ in long run

69
Q

PVL matter

70
Q

HIE matter

71
Q

PVL is:

A

white matter damage from ischaemia or inflammation

72
Q

which more common? IVH or PVL?

A

IVH=1/4 of VLBW

PVL=3% of VLBW

73
Q

Early onset sepsis

A

within 48 hours

74
Q

Late onset sepsis

A

After 48 hours

75
Q

Most early onset sepsis caused by:

A

group B strep

then E.coli

76
Q

Treatment for group B strep:

A

Benzylpenicillin and gent

77
Q

treatment for meningitis in newborn

A

cefotaxime and amoxicillin

78
Q

Late onset sepsis usually caused by:

A 
CoNS- biofilms
Gram negs (e.coli, klebsiella, pseudomonas)
79
Q

Treat late onset sepsis with:

A

Flucloxacillin and gent

80
Q

purpura on jaundice

81
Q

CMV tests:

A

PCR
serology
LFTs

82
Q

most common congenital syndrome:

A

CMV

blueberry muffin and tomato ketchup

83
Q

Long term complications of CMV

A

hearing loss

vision loss

84
Q

Treatment for CMV

A

gangiclovir

85
Q

TORCH

A 
Toxoplasmosis
Other: syphillis
Rubella
CMV
Herpes and HIV
86
Q

Rubella in pregnancy

A 
small head
cataracts
deaf
heart disease
osteitis
87
Q

Hep B in pregnancy

A

only 5% become infected if mum has antibodies

otherwise up to 90% do

88
Q

Herpes in babies

A

brain
liver
adrenals
skin vesicles

89
Q

toxoplasmosis in infants

A

hydrocephalus
mental retardation
retinochoroiditis
PYRIMETHAMINE

90
Q

varicella zoster in infants

A 
miscarriage
limb scarring
eye defects
small head
IUGR
neuro problems.
91
Q

Parvovirus in infants

A

anaemia
myocarditis
hydrops
death

92
Q

HIV in fetus

A

IUGR
small head
prominent forehead
blue sclerae

93
Q

Jaundice at birth

A

Haemolytic or infection

94
Q

normal jaundice in infant

A

presents 2-5 days later
cause of low UDPGT and gut flora
less than 5mg rise

95
Q

Level of bilirubin for brain damage

A

usually bound to albumin

so need level above 25mg before it can cross BBB (unbound)

96
Q

3 typical features of kernicterus

A

limited upward gaze
deafness
dysplasia of tooth enamel

97
Q

RF for neonatal jaundice

A 
Delayed cord clamping (more RBCs)
Hypothyroidism
Polycythemia
Diabetes
IVH
Infection
Heart disease
non-fed babies
98
Q

caput succedaneum

A

bruising and oedema that crosses teh stutures.

99
Q

chignon

A

bruising and oedema from ventouse

100
Q

can get facial nerve palsy

A

from hitting the ischial spines

101
Q

surfactant cells

A

type 2 pneumocytes

102
Q

pneumothorax

A

more common as they have pulmonary interstitial emphysema

103
Q

exomphalos is covered by

A

amniotic membrane and peritoneum

104
Q

sacral agenesis

A

maternal underlying diabetes

105
Q

bile stained unless

A

above ampulla of vata

106
Q

small bowl obstruction from atresia

107
Q

Pierre Robin

A

eventually the mandible will grow and the problems will resolve

108
Q

hypoglycaemia in IUGR

A

poor glycogen store

109
Q

hypoglycaemia in babies of diabetic mums

A

beta islet hyperplasia

110
Q

umbilical cord granuloma

A

apply silver nitrate to protect around skin

or ligtation around base

111
Q

Crigler Najjar syndrome

A

glucuronyl transferase deficient

extremely high levels of unconjugated bilirubin.

112
Q

bronze discoloration of skin

A

if the baby has conjugated bilirubin and put under phototherapy

113
Q

drugs to close PDA

A

ibuprofen

indometacin

114
Q

suck and swallow develops at:

A

35-36 weeks (like surfactant)

115
Q

iron for pre terms

A

iron usually starts in the last trimester

iron supplements from several weeks of age until 6 months.

RHCN (4 decks)

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