anything that can cause asphyxia - maternal shock - intrapartum haemorrhage - prolapsed cord - nuchal cord (cord wrapped around neck)

Child Health - Neonatal Problems Flashcards by Joanne McEwan

what is neonatal abstinence syndrome (NAS)?

withdrawal symptoms that happen in neonates of mothers that used substances in pregnancy

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what substances can cause neonatal abstinence syndrome?

opiates
methadone
benzodiazepines 
cocaine
amphetamines
nicotine or cannabis
alcohol
SSRI antidepressants

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when do symptoms of NAS start?

opiates, diazepam, SSRI and alcohol = between 3-72 hrs after birth
methadone and other benzos = 24 hrs and 21 days

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CNS symptoms of NAS?

irritability
increased tone
high pitched cry
not settling
tremors
seizures

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vasomotor and resp symptoms of NAS?

yawning
sweating
unstable temp and pyrexia
tachypnoea

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metabolic and GI symptoms of NAS?

poor feeding
regurgitation or vomiting
hypoglycaemia
loose stools and sore nappy area

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how are babies with NAS monitored?

mothers known to use substances should have alert on notes so baby can have extra care after birth
babies kept in hospital with monitoring on a NAS chart for at least 3 days to monitor for withdrawal symptoms
urine sample can be taken from baby to test for substances

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conservative measures for managing NAS?

keep neonate in quiet and dimly lit environment
gentle handling and comforting
breastfeeding can help by giving small amounts of the substance if present in breast milk

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medical treatment of NAS?

oral morphine sulphate for opiate withdrawal
oral phenobarbitone for non-opiate withdrawal
SSRI withdrawal doesnt really benefit from medical treatment

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what is hypoxic ischaemic encephalopathy (HIE)?

result of prolonged hypoxia during birth which leads to ischaemic brain damage causing encephalopthy
can lead to permanent brain damage causing cerebral palsy or death in severe cases

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what problems during perinatal or intrapartum period may cause you to suspect HIE?

acidosis (pH <7) on umbilical artery blood gas
poor apgar scores
multi organ failure
features of mild, mod or severe HIE after birth

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what can cause HIE?

anything that can cause asphyxia

maternal shock
intrapartum haemorrhage
prolapsed cord
nuchal cord (cord wrapped around neck)

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features of mild HIE (sarnat staging)?

poor feeding
general irritability and hyper-alertness
resolves after 24 hrs
normal prognosis

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features of mod HIE?

poor feeding
lethargic
hypotonic 
seizures
can take weeks to resolve
up to 40% develop cerebral palsy

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features of severe HIE?

reduced consciousness
apnoeas
flaccid and reduced/absent reflexes
up to 50% mortality
up to 90% develop cerebral palsy

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how is HIE managed supportively?

neonatal resuscitation
ongoing optimal ventilation 
circulatory support
nutrition
acid base balance
treat seizures

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what is therapeutic hypothermia used in HIE?

option in certain circumstances to help protect brain from hypoxic injury
used in babies near or at term
involves cooling core temp to 33-34 degrees for 72 hrs after which the baby is gradually warmed up to normal temp over 6 hrs

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what is the intention of therapeutic hypothermia?

to reduce inflammation and neurone loss after acute hypoxic injury
reduces risk of cerebral palsy, developmental delay, learning disability, blindness and death

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what is caput succedaneum?

collection of fluid under the scalp outside of the periosteum

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what causes caput succedaneum?

caused by pressure to a specific area of the scalp during a traumatic, prolonged or instrumental delivery

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what is the periosteum?

layer of dense connective tissue that lines the outside of the skull and does not cross the suture lines

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presentation of caput succedaneum?

scalp swelling which crosses the suture lines (as fluid is on top of the periosteum)
usually no or only mild discoloration of the skin

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how does caput succedaneum?

doesnt need treatment

will resolve in a few days

what is cephalohaematoma?

collection of blood between the skull and the periosteum

can be described as a traumatic subperiosteal haematoma

what causes cephalohaematoma?

caused by damage to blood vessels during a traumatic prolonged or instrumental delivery

presenting features of cephalohaematoma?

scalp swelling which does not cross suture lines (as blood is underneath periosteum) blood can cause discolouration of the skin in the affected area

how is cephalohaematoma managed?

usually doesnt need treatment and resolves within a few months should monitor for anaemia, jaundice and resolution of the haematoma

why should babies with cephalohaematoma be monitored?

risk of anaemia and jaundice due to the blood that collects within the haematoma and breaks down releasing bilirubin

how can facial paralysis occur in neonates?

delivery can cause damage to facial nerve | usually associated with a forceps delivery

how is facial paralysis managed in neonates?

``` function normally returns in a few months if function doesnt return they may need neurosurgical input ```

erbs palsy results from damage to which nerves?

C5 and C6 in brachial plexus

erbs palsy is associated with what problems in delivery?

shoulder dystocia traumatic instrumental delivery large birth weight

features of erbs palsy?

waiters tip posture (internally rotated shoulder, extended elbow, flexed wrist facing backwards) lack of movement in affected arm

how is erbs palsy managed?

``` function normally returns within a few months may need neurosurgical input if it doesnt ```

what causes resp distress syndrome (RDS)?

occurs in premature infants born before lungs produce adequate surfactant (usually below 32 weeks)

CXR in RDS?

"ground glass" appearence

how does RDS develop?

inadequate surfactant leads to high surface tension within the alveoli this causes alveoli to collapse in and leads to atelectasis (lung collapse) as it is more difficult for the alveoli to expand this leads to inadequate gas exchange resulting in hypoxia, hypercapnia and resp distress

how is RDS prevented?

steroids (dexamethasone) are given to mother with suspected or confirmed pre-term labour

how does dexamethasone prevent RDS?

increases production of surfactant | reduces incidence and severity of RDS

how is RDS managed in neonate?

``` may need: - intubation and ventilation if severe - endotracheal surfactant - CPAP via nasal mask - supplementary oxygen breathing support gradually stepped down as baby develops and is able to maintain own breathing and support self in air ```

oxygen sats should be maintained between what levels in preterm neonates?

91-95%

short term complications of RDS?

``` pneumothorax infection apnoea interventricular haemorrhage pulmonary haemorrhage necrotising enterocolitis ```

long term complications of RDS?

chronic lung disease of prematurity retinopathy of prematurity (more common and severe in RDS) neuro, hearing and visual impairment

what is transient tachypnoea of the newborn (TTN)?

condition where the newborn doesnt clear fluid from the lungs or clears it too slowly causes more rapid and laboured breathing as gas exchange is impaired

what can increase risk of TTN?

C-section delivery diabetic mother asthmatic mother small for gestational age

how is fluid usually cleared from the foetal lungs?

lungs begin to clear fluid towards end of pregnancy as hormones change some fluid squeezed out during vaginal birth as baby passes trough birth canal more fluid pushed out as baby takes first breaths

signs of TTN?

``` rapid, laboured breathing (>60 breaths per min) grunting nostril flaring head bobbing indrawing cyanosis usually otherwise healthy ```

how is TTN diagnosed?

usually in hours following birth clinical features X-ray usually done (may show streaks and fluid but otherwise normal) oxygen sats etc

how is TTN managed?

close monitoring (sometimes in NICU) some need supplemental oxygen, CPAP or ventilation depending on severity may need hydration and nutritional support

how quickly does TTN resolve?

usually 24-48 hrs | all symptoms should have resolved by 72 hrs

what is haemorrhagic disease of the newborn?

bleeding disorder caused by vit K deficiency | happens in first days - weeks of life

what causes haemorrhagic disease of the newborn?

babies usually born with low levels of vit K | if born with v low levels can cause HDN

risk factors for HDN?

not getting vit K injection at birth (all babies should get this) babies born to mothers taking certain anticonvulsants or some anticoagulants

symptoms of HDN?

can vary, basically any excess bleeding - eg bloody stool, bloody urine, oozing around umbilical cord, easy bruising (often around head and face) can cause unusual sleepiness or fussiness (if bleeding around brain)

how is HDN diagnosed?

may need bloods for clotting times