Child health- neonatology Flashcards
what is considered as a preterm pregnancy
a birth that occurs before 37 completed weeks of gestation
what is considered as a term pregnancy
a birth that occurs between 37 and 42 weeks of gestation
what is considered as a post term pregnancy
a birth that occurs after 42 weeks gestation
what is the normal weight of a new born baby
2.5kg-4kg
during the 3rd trimester there is a daily weight gain of what?
24g per day
APGAR score-
taken 1 minute and 5 minutes after birth
appearance- colour
pulse
grimace (reflex)
activity (muscle tone)
respiration
what care should a baby receive immediately after birth
skin to skin contact
keep baby warm
it is important to give vitamin k to newborns to prevent what
hemorrhagic disease
babies are born deficient of what
vitamin K
what is classified as extreme, very preterm, and moderate-late preterm birth
extreme- under 28 weeks
very preterm- 28-32 weeks
moderate-late- 32-37 weeks
risk factors for premature births
> 2 preterm pregnancies increase risk of another by 70%
abnormal shaped uterus
multiple pregnancy (9x more likely)
interval of <6 months between pregnancies
IVF
smoking, alcohol, illicit drugs
poor nutrition, some chronic conditions (high bp, diabetes), multiple miscarriages or abortions
issues early in life of premature babies
respiratory distress syndrome
hypothermia
hypoglycaemia
poor feeding
poor growth and nutrition
apnoea and bradycardia
neonatal jaundice
intraventricular haemorrhage
long term effects of premature babies
chronic lung disease of prematurity
learning and behavioural difficulties
Susceptibility to infections, particularly respiratory tract infections
hearing and visual impairment
cerebral palsy
osteopenia of prematurity
what is a stillbirth
baby dies after 24 weeks pregnancy and before or during birth
risk factors for stillbirths
placental causes
intrauterine growth restriction
congenital abnormalities
common causes
nutrition and lifestyle factors
extremes of age
low socioeconomic class
multiple pregnancy
smoking, obesity
previous stillbirth
common causes of stillbirths
placental abruption
maternal and fetal infection
cord prolapse
idiopathic hypoxia-acidosis
uterine rupture
most important modifiable risk factors for stillbirths
obesity
smoking
lifestyle advice to reduce stillbirth risk
sleep on side during 3rd trimester
quit smoking, avoid alcohol and drugs
stay a healthy weight during pregnancy
‘look after yourself’- attend checkups, get flu vaccine etc
If experiencing leaking fluid/vaginal discharge during pregnancy contact the hospital immediately
early onset neonatal sepsis causative organisms
group b streptococcus
gram negatives
late onset neonatal sepsis causative organisms
coagulase negative staphylococcus
gram negatives
staph aureus
what is jaundice
jaundice is the yellow colouring of the skin and sclera caused by excess bilirubin
how many babies are born with neonatal jaundice
60% of term babies
80% of preterm babies
how many term breastfed babies are jaundiced at 1 month
10%
causes of unconjugated neonatal jaundice
physiological- normal
breast milk jaundice- healthy baby, resolves 1.5-4months
haemolysis
infections- sepsis
inherited causes
intestinal obstruction
causes of conjugated neonatal jaundice
biliary atresia
TPN
hypothyroidism
genetic conditions eg cystic fibrosis, trisomy 21
when is neonatal jaundice classed as prolonged jaundice
over 14 days in term babies
over 21 days in a preterm baby
jaundice in the first 24 hours of life=
pathological- needs urgent investigations and management
management of early neonatal jaundice
phototherapy
adequate hydration
treat underlying cause
what is the biggest risk factor for stillbirth
intrauterine growth restriction
what is biliary atresia
paediatric condition involving either obliteration or discontinuity within the extrahepatic biliary system, which results in an obstruction of the flow of bile
is biliary atresia more common in females/males
females
when do the perinatal and postnatal forms of biliary atresia occur
perinatal- first two weeks of life
postnatal- first two to eight weeks of life
types of biliary atresia
type I- common duct
type ii- common hepatic ducts
type iii- entire extrahepatic biliary system
symptoms of biliary atresia
jaundice extending longer than 2 weeks
dark urine and pale stools
appetite and growth disturbance
signs of biliary atresia
jaundice
hepatomegaly with splenomegaly
abnormal growth
cardiac murmurs
conjugated/unconjugated bilirubin is high in biliary atresia?
conjugated bilirubin high
definitive treatment of biliary atresia
surgical intervention
respiratory distress syndrome affects how many infants born before 29 weeks
75%- born before the lungs start producing adequate surfactant
clinical features of respiratory distress syndrome in newborns
tachypnoea
grunting
intercostal recessions
nasal flaring
cyanosis
management of respiratory distress syndrome in newborns
maternal steroid
surfactant replacement
ventilation (non-invasive preferred over invasive)
what is neonatal abstinence syndrome
refers to the withdraw symptoms that happens in neonates of mothers that used substances in pregnancy
substances that cause neonatal abstinence syndrome
opiates
methadone
benzodiazopines
cocaine
amphetamines
nicotine/canabis
alcohol
SSRI antidepressants
clinical features of neonatal abstinence syndrome
CNS- irritability, tremors, seizures
vasomotor and resp- sweating, unstable temperature, tachypnoea
metabolic and GI- poor feeding, regurgitation/vomiting, hypoglycaemia
NAS- how long are babies kept in hospital after birth to monitor
at least 3 days (48 hrs for SSRI antidepressants) to monitor for signs of withdrawal
what is neonatal hypoglycaemia defined as
BGL <2.6mmol/l
risk factors for neonatal hypoglycaemia
pre term
small for age
low birth weight
infants of diabetic mothers
hypothermia
feeding
infection/sepsis
neontal abstinence syndrome
clinical features of neonatal hypoglycaemia
lethargy
jitteriness
seizure activity
what helps prevent hypoglycaemia
early feed and keeping baby warm
what is birth asphyxia
occurs when a baby doesn’t receive enough oxygen before, during, or just after birth
causes of birth asphyxia
maternal shock
intrapartum haemorrhage
prolapsed cord
nuchal cord- cord wrapped round neck of baby
complication of birth asphyxia
hypoxic ischaemic encephalopathy
neonatal hypotonia aka
floppy baby- baby with low muscle tone
language milestones- no of letters each month!
2 months- co
4 months- haha
6 months- babble
9 months- mummy dada
12 months- 1+ words
gross motor milestones- tune of happy birthday!
2 months old raise your head, 4 months old roll over Fred, 6 months sit up, 9 months crawl, 12 months walk and that’s all
social milestones- first letter in each milestone!
2 months- twinkle (smile)
4 months- focuses on sound
6 months- stranger anxiety
9 months- name (responds)
12 months- told commands (responds)
