Care of the newborn Flashcards
1
Q
How many neonates end up on NICU?
A
10%
2
Q
How many childhood deaths in 1st year of life?
A
25%
3
Q
How many mums Rhesus neg?
A
10%
4
Q
Placenta and Ig
A
IgG from mum to fetus
5
Q
HbF has what?
A
gamma instead of beta chains
shifts oxygen curve to LEFT
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)
7
Q
Umbilical vein
A
blood placenta to fetus
oxygenated
8
Q
umbilical artery
A
fetus to placenta
deoxygenated
9
Q
First breath
A
contraction
beta adrenaline
oxygenation
respiration
10
Q
umbilical vein becomes
A
ligamentum teres
liver
11
Q
umbilical artery becomes
A
constricted as the bladder starts working
12
Q
ductus venosis
A
constricts and all the blood pases the hepatic sinusoids
13
Q
ductus arteriosus becomes
A
ligamentum arteriosis
14
Q
Cephalhaematoma
A
blood under periosteum
from operative delivery
or prolonged labour
15
Q
erythema toxicum
A
common
lasts days- week
central papule surround by erythema
baby is usually well (if not well think staph)
16
Q
cornelia de lange
A
low birth weight delayed growth developmental delay microcephaly long eyelashes and thick eyebrows
17
Q
club foot
A
talipes
18
Q
swelling of dorsum of foot
A
turners
noonans
19
Q
early onset haemorrhagic disease of the newborn
A
a few days
vit K deficiency
20
Q
late onset haemorrhagic disease of the newborn
A
4-6 weeks
21
Q
Neonatal jaundic within
A
24 hours
22
Q
Biblrubin brain damage
A
kernicterus
dyskinetic CP
23
Q
Breast milk contains
A
macrophages lymphocytes IgA IgG Lysozymes Lactoferrin Lipase Prebiotics Hormones
24
Q
Contraindications for breast feeding
A
HIV
Anti-psychotics
Chemo/Radio therapy
Heroin/Methadone
25
Heb B/C and breast feeding
should still breast feed
26
How many breast feed in UK at birth?
81%
27
How many breast feed at 6 months
25%
28
Benefits to mum for breast feeding
decrease breast cancer
decrease ovarian cancer
bone protection
29
macrosomia
>4500mg
30
LBW
<2500
31
vlbw
<1500
32
Extremely! LBW
<1000mg
33
Shivering and newborns
they can't do it
34
Resp support for the newborn
```
O2
CPAP
intubation
surfactant
methyl xanthine
```
35
NGT and newborns
introduce food SLOWLY!
| delay for 48 hours
36
other name for necrotising enterocolitis
pneumotosis intestinalis
37
Avoid sats over:
95%
| Retinopathy of prematurity
38
Fundoscopy screening for
all under 32 weeks and vlbw
| repeat 2 weekly until complete vascularisation
39
treatment for retinopathy of prematurity
ablate vessels
| they will lose their peripheral vision
40
SGA definition
<10th percentile
41
SGA at risk of (immediately)
still birth
intrapartum hypoxia
neonatal hypoglycaemia
polycythemia
42
SGA at risk of later in life
T2DM, hyperlipid, hypertensive, ischaemic heart disease.
43
APGAR stands for
Activity, Pulse, Grimace, Appearance, Resps
44
Activity in APGAR
2: moves around, flexed, flaccid
1: rigid
0: none
45
Pulse in APGAR
2: over 100
1: under 100
0: absent
46
Grimace in APGAR
2: sneeze, cough, pull away
1: flexed
0: absent
47
Appearance in APGAR
2: pink
1: pink with blue limbs
0: blue
48
Resp in APGAR
2: normal
1: irregular and slow
0: absent
49
surfactant starts being made at
34/35 weeks
50
Brown glass on CXR
RDS
51
Congenital pneumonia associated with
prolonged rupture of membrane
52
Congenital pneumonia caused by:
group B strep
53
Onset of congenital pneumonia
can be 1-2 days later.
54
Treatment for congenital pneumonia
Benzyl penicillin and gentamycin
55
Transient tachypnoea
amniotic fluid still in lungs
| presents 1-3 hours after birth
56
Treatment for transient tachypnoea
oxygen
CPAP
stop feeds
57
Transient tachypnoea on xray
coarse streaking
| looks wet
58
Meconium aspirate on xray
coarse streaking
| hyperinflated lungs
59
Neonatal gasping
meconium aspirate
60
Pneumothorax in infant caused by:
RDS
Meconium
Pneumonia
61
Treatment for pneumothorax
Positive pressure ventilation
| Chest drain!
62
granuloma in throat
from suction tube
63
HIE affects:
2/1000
64
HIE caused by:
low BP
low glucose
epilepsy
high calcium
65
What reduces death in HIE?
hypothermia jacket for 72 hours
66
IVH is a:
bleed inside the ventricles in the brain
between 24 and 32 weeks
due to fragile blood vessels
67
Diagnosis of IVH
ultrasound through bregma fontanelle
68
DRIFT
washes out neurotoxins after severe IVH
| improves IQ in long run
69
PVL matter
GRAY
70
HIE matter
WHITE
71
PVL is:
white matter damage from ischaemia or inflammation
72
which more common? IVH or PVL?
IVH=1/4 of VLBW
| PVL=3% of VLBW
73
Early onset sepsis
within 48 hours
74
Late onset sepsis
After 48 hours
75
Most early onset sepsis caused by:
group B strep
| then E.coli
76
Treatment for group B strep:
Benzylpenicillin and gent
77
treatment for meningitis in newborn
cefotaxime and amoxicillin
78
Late onset sepsis usually caused by:
```
CoNS- biofilms
Gram negs (e.coli, klebsiella, pseudomonas)
```
79
Treat late onset sepsis with:
Flucloxacillin and gent
80
purpura on jaundice
CMV
81
CMV tests:
PCR
serology
LFTs
82
most common congenital syndrome:
CMV
| blueberry muffin and tomato ketchup
83
Long term complications of CMV
hearing loss
| vision loss
84
Treatment for CMV
gangiclovir
85
TORCH
```
Toxoplasmosis
Other: syphillis
Rubella
CMV
Herpes and HIV
```
86
Rubella in pregnancy
```
small head
cataracts
deaf
heart disease
osteitis
```
87
Hep B in pregnancy
only 5% become infected if mum has antibodies
| otherwise up to 90% do
88
Herpes in babies
brain
liver
adrenals
skin vesicles
89
toxoplasmosis in infants
hydrocephalus
mental retardation
retinochoroiditis
PYRIMETHAMINE
90
varicella zoster in infants
```
miscarriage
limb scarring
eye defects
small head
IUGR
neuro problems.
```
91
Parvovirus in infants
anaemia
myocarditis
hydrops
death
92
HIV in fetus
IUGR
small head
prominent forehead
blue sclerae
93
Jaundice at birth
Haemolytic or infection
94
normal jaundice in infant
presents 2-5 days later
cause of low UDPGT and gut flora
less than 5mg rise
95
Level of bilirubin for brain damage
usually bound to albumin
| so need level above 25mg before it can cross BBB (unbound)
96
3 typical features of kernicterus
limited upward gaze
deafness
dysplasia of tooth enamel
97
RF for neonatal jaundice
```
Delayed cord clamping (more RBCs)
Hypothyroidism
Polycythemia
Diabetes
IVH
Infection
Heart disease
non-fed babies
```
98
caput succedaneum
bruising and oedema that crosses teh stutures.
99
chignon
bruising and oedema from ventouse
100
can get facial nerve palsy
from hitting the ischial spines
101
surfactant cells
type 2 pneumocytes
102
pneumothorax
more common as they have pulmonary interstitial emphysema
103
exomphalos is covered by
amniotic membrane and peritoneum
104
sacral agenesis
maternal underlying diabetes
105
bile stained unless
above ampulla of vata
106
small bowl obstruction from atresia
downs
107
Pierre Robin
eventually the mandible will grow and the problems will resolve
108
hypoglycaemia in IUGR
poor glycogen store
109
hypoglycaemia in babies of diabetic mums
beta islet hyperplasia
110
umbilical cord granuloma
apply silver nitrate to protect around skin
| or ligtation around base
111
Crigler Najjar syndrome
glucuronyl transferase deficient
| extremely high levels of unconjugated bilirubin.
112
bronze discoloration of skin
if the baby has conjugated bilirubin and put under phototherapy
113
drugs to close PDA
ibuprofen
| indometacin
114
suck and swallow develops at:
35-36 weeks (like surfactant)
115
iron for pre terms
iron usually starts in the last trimester
| iron supplements from several weeks of age until 6 months.
