Care of the newborn Flashcards
Risk factors for preterm birth
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
What gestational age do foetus’ begin producing surfactant
36 weeks
Role of maternal steroids in preterm labour
Promote foetal lung maturity
What is a tocolytic drug and examples
Drugs to reduce contractions
Atosiban, nifedipine
Role of magnesium sulphate in preterm labour
Foetal neuroprotection
Imaging modalities useful for preterm infants
CXR Cerebral ultrasound (IVH)
Source of bleeding in premature neonatal intraventricular haemorrhage
Germinal matrix
Gives origin to cerebral neuroblasts and glia therefore is highly cellular and vascularised
Neurological complications of neonatal intraventricular haemorrhage
Seizures Developmental delay Cerebral palsy (40%)
Grades of IVH
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)
Risk factors for neonatal intraventricular haemorrhage
Prematurity (<32 weeks especially) Low birth weight RDS Hypoxia Sepsis Hypotension, hypertension Hypovolaemia Altered cerebral blood flow
Investigations for IVH
ABG - metabolic acidosis FBC - low Hb doesn't improve with transfusion Transfontanelle USS (gold-standard) MRI to assess brain injury
Surgical management of IVH
Ventriculoperitoneal and ventriculosubgaleal shunts for post-haemorrhagic hydrocephalus
Pharmacological management of IVH
Anticonvulsants for seizures
Acetazolamide to decrease CSF production to limit hydrocephalus
Common causes of neonatal meningitis
Bacteria
Group B Strep, E. coli, Listeria monocytogenes
Complications of neonatal meningitis
Sensorineural hearing loss Memory difficulties Brain damage Gait problems Kidney failure Decreased visual acuity Reduced growth Cerebral palsy Global developmental delay Death
Treatment of neonatal bacterial meningitis when organism is unknown
IV amoxicillin and cefotaxime
Role of dopamine infusion in preterm infants
Iatrogenic - increases myocardial contractility to correct haemodynamic imbalance
2 main complications of oxygen toxicity in preterm babies
Bronchopulmonary dysplasia
Retinopathy of prematurity
Definition of bronchopulmonary dysplasia
Oxygen dependence at 36 weeks postmenstrual age
Common presentation of BPD
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
Prenatal risk factors for BPD
Foetal inflammatory response
Amnion infection
Growth restriction
Postnatal risk factors for BPD
Congenital and nosocomial infections Oxygen toxicity Mechanical ventilation Malnutrition Persistent ductus arteriosus Fluid overload Hormonal deficiency
Signs of BPD on CXR
Diffuse haziness and coarse interstitial pattern
Pharmacological management of BPD
Dexamethasone Furosemide Inhaled bronchodilators Caffeine Nitric oxide (?)
Definition of necrotising enterocolitis (NEC)
Inflammation and necrosis of the bowel which may lead to perforation
Aetiology of NEC
Unknown for sure - adverse reaction of immature gut/immune system related to enteral nutrition and bacterial presence
Common presentation of NEC
Premature baby with feeding difficulties, vomiting or abdominal distension after initial progress on enteral feed
Signs of NEC on examination
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
Bell’s criteria for NEC
Stage I - suspected NEC
Stage II - proven NEC (medical)
Stage III - proven NEC (surgical)
AXR findings in medical NEC
Pneumatosis intestinalis (gas cysts in bowel wall) Portal venous gas
AXR findings in surgical NEC
Pneumoperitoneum
Management of medical NEC
NBM
Supportive management - IV fluids, TPN, IV abx for 10-14 days, antifungals if abx not working
Slow return to feeding
Management of surgical NEC
Peritoneal drain (ascites) Exploratory laparotomy and resection of necrotic bowel
Complications of NEC
Perforation
Acquired short bowel syndrome (malabsorption)
DIC, sepsis, shock
Intestinal strictures (bowel obstruction)
Enterocolic fistulae
Abscess
Neurodevelopmental complications
Prevention of NEC
Feeding with human milk
