Child Health - Neonatal Problems Flashcards
what is neonatal abstinence syndrome (NAS)?
withdrawal symptoms that happen in neonates of mothers that used substances in pregnancy
what substances can cause neonatal abstinence syndrome?
opiates methadone benzodiazepines cocaine amphetamines nicotine or cannabis alcohol SSRI antidepressants
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
CNS symptoms of NAS?
irritability increased tone high pitched cry not settling tremors seizures
vasomotor and resp symptoms of NAS?
yawning
sweating
unstable temp and pyrexia
tachypnoea
metabolic and GI symptoms of NAS?
poor feeding
regurgitation or vomiting
hypoglycaemia
loose stools and sore nappy area
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
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
medical treatment of NAS?
oral morphine sulphate for opiate withdrawal
oral phenobarbitone for non-opiate withdrawal
SSRI withdrawal doesnt really benefit from medical treatment
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
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
what can cause HIE?
anything that can cause asphyxia
- maternal shock
- intrapartum haemorrhage
- prolapsed cord
- nuchal cord (cord wrapped around neck)
features of mild HIE (sarnat staging)?
poor feeding
general irritability and hyper-alertness
resolves after 24 hrs
normal prognosis
features of mod HIE?
poor feeding lethargic hypotonic seizures can take weeks to resolve up to 40% develop cerebral palsy
features of severe HIE?
reduced consciousness apnoeas flaccid and reduced/absent reflexes up to 50% mortality up to 90% develop cerebral palsy
how is HIE managed supportively?
neonatal resuscitation ongoing optimal ventilation circulatory support nutrition acid base balance treat seizures
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
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
what is caput succedaneum?
collection of fluid under the scalp outside of the periosteum
what causes caput succedaneum?
caused by pressure to a specific area of the scalp during a traumatic, prolonged or instrumental delivery
what is the periosteum?
layer of dense connective tissue that lines the outside of the skull and does not cross the suture lines
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
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
