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RHCN > Care of the newborn > Flashcards

Care of the newborn Flashcards

1
Q

Risk factors for preterm birth

A 
High or low BMI
Previous preterm birth
Maternal comorbidities
Cone biopsy, cervical trauma
Smoking, alcohol, drugs
Maternal infection: sepsis, cervicitis, STI, UTI, BV
Short pregnancy interval 
Uterine abnormalities
Domestic violence
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2
Q

What gestational age do foetus’ begin producing surfactant

A

36 weeks

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3
Q

Role of maternal steroids in preterm labour

A

Promote foetal lung maturity

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4
Q

What is a tocolytic drug and examples

A

Drugs to reduce contractions

Atosiban, nifedipine

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5
Q

Role of magnesium sulphate in preterm labour

A

Foetal neuroprotection

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6
Q

Imaging modalities useful for preterm infants

A 
CXR
Cerebral ultrasound (IVH)
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7
Q

Source of bleeding in premature neonatal intraventricular haemorrhage

A

Germinal matrix

Gives origin to cerebral neuroblasts and glia therefore is highly cellular and vascularised

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8
Q

Neurological complications of neonatal intraventricular haemorrhage

A 
Seizures
Developmental delay
Cerebral palsy (40%)
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9
Q

Grades of IVH

A

Grade I - bleed occupies <10% of ventricle
Grade II - bleed occupies 10-50% of ventricle
Grade III - bleed occupies >50% of ventricle
Grade IV - parenchymal involvement (periventricular venous infarction)

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10
Q

Risk factors for neonatal intraventricular haemorrhage

A 
Prematurity (<32 weeks especially)
Low birth weight
RDS
Hypoxia
Sepsis
Hypotension, hypertension
Hypovolaemia
Altered cerebral blood flow
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11
Q

Investigations for IVH

A 
ABG - metabolic acidosis
FBC - low Hb doesn't improve with transfusion
Transfontanelle USS (gold-standard)
MRI to assess brain injury
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12
Q

Surgical management of IVH

A

Ventriculoperitoneal and ventriculosubgaleal shunts for post-haemorrhagic hydrocephalus

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13
Q

Pharmacological management of IVH

A

Anticonvulsants for seizures

Acetazolamide to decrease CSF production to limit hydrocephalus

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14
Q

Common causes of neonatal meningitis

A

Bacteria

Group B Strep, E. coli, Listeria monocytogenes

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15
Q

Complications of neonatal meningitis

A 
Sensorineural hearing loss
Memory difficulties
Brain damage
Gait problems
Kidney failure
Decreased visual acuity
Reduced growth
Cerebral palsy
Global developmental delay
Death
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16
Q

Treatment of neonatal bacterial meningitis when organism is unknown

A

IV amoxicillin and cefotaxime

17
Q

Role of dopamine infusion in preterm infants

A

Iatrogenic - increases myocardial contractility to correct haemodynamic imbalance

18
Q

2 main complications of oxygen toxicity in preterm babies

A

Bronchopulmonary dysplasia

Retinopathy of prematurity

19
Q

Definition of bronchopulmonary dysplasia

A

Oxygen dependence at 36 weeks postmenstrual age

20
Q

Common presentation of BPD

A

Preterm infant with respiratory distress who responds well to initial surfactant and ventilation treatment but then increases need for oxygen/ventilation over first 2 weeks of life

21
Q

Prenatal risk factors for BPD

A

Foetal inflammatory response
Amnion infection
Growth restriction

22
Q

Postnatal risk factors for BPD

A 
Congenital and nosocomial infections
Oxygen toxicity
Mechanical ventilation 
Malnutrition
Persistent ductus arteriosus
Fluid overload
Hormonal deficiency
23
Q

Signs of BPD on CXR

A

Diffuse haziness and coarse interstitial pattern

24
Q

Pharmacological management of BPD

A 
Dexamethasone 
Furosemide
Inhaled bronchodilators
Caffeine
Nitric oxide (?)
25
Q

Definition of necrotising enterocolitis (NEC)

A

Inflammation and necrosis of the bowel which may lead to perforation

26
Q

Aetiology of NEC

A

Unknown for sure - adverse reaction of immature gut/immune system related to enteral nutrition and bacterial presence

27
Q

Common presentation of NEC

A

Premature baby with feeding difficulties, vomiting or abdominal distension after initial progress on enteral feed

28
Q

Signs of NEC on examination

A

Abdominal distension
Visible intestinal loops
Altered stool pattern, blood mucoid stool, bilious vomiting
Decreased bowel sounds with abdo erythema
Palpable abdo mass or ascites
Systemic symptoms of malaise

29
Q

Bell’s criteria for NEC

A

Stage I - suspected NEC
Stage II - proven NEC (medical)
Stage III - proven NEC (surgical)

30
Q

AXR findings in medical NEC

A 
Pneumatosis intestinalis (gas cysts in bowel wall)
Portal venous gas
31
Q

AXR findings in surgical NEC

A

Pneumoperitoneum

32
Q

Management of medical NEC

A

NBM
Supportive management - IV fluids, TPN, IV abx for 10-14 days, antifungals if abx not working
Slow return to feeding

33
Q

Management of surgical NEC

A 
Peritoneal drain (ascites)
Exploratory laparotomy and resection of necrotic bowel
34
Q

Complications of NEC

A

Perforation
Acquired short bowel syndrome (malabsorption)
DIC, sepsis, shock
Intestinal strictures (bowel obstruction)
Enterocolic fistulae
Abscess
Neurodevelopmental complications

35
Q

Prevention of NEC

A

Feeding with human milk

RHCN (5 decks)

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