Common Neonatal Issues Flashcards
List the risk factors for neonatal hypoglycaemia in first 24hrs of life
- IUGR
- Preterm
- Maternal DM
- Large-for-dates
- Hypothermic
- Polycythemic
- Ill
How does prematurity and IUGR cause hypoglycaemia?
These infants have poor glycogen stores which leads to hypoglycaemia
What is the mechanism of hypoglycaemia in infants of diabetic mothers?
These infants have sufficient glycogen stores but have hyperplasia of the islet cells due to exposure to high levels of blood glucose in utero, which leads to high insulin levels and hypoglycaemia
What are the symptoms of neonatal hypoglycaemia?
- Jitteriness
- Irritability
- Apnoea
- Lethargy
- Drowsiness
- Seizures
What are the consequences of prolonged symptomatic hypoglycaemia?
Permanent neurological disability
How can we prevent neonatal hypoglycaemia?
Early and frequent feeding with regular monitoring of blood glucose in at risk infants
At what point do we need to consider management of neonatal hypoglycaemia?
- Asymptomatic infants:
- 2 low glucose values (<2.6mmol/L) despite adequate feeding
- One very low value (<1.6mmol/L) - Symptomatic infants
How is neonatal hypoglycaemia managed?
- IV glucose infusion with aim to keep above 2.6mmol/L
(in form of dextrose) - High concentration of glucose given via CVC - avoid extravasation into tissues
- Give glucagon if unsatisfactory response
How do neonatal seizures present?
- Repetitive, rhythmic (clonic) movements of limbs that persist despite restraint
- Eye movements
- Changes in respiration
List the investigations you would perform if you suspected neonatal seizures
- Continuous single-channel encephalogram (aEEG)
- Cerebral ultrasound (can identify haemorrhage or cerebral malformation)
- MRI (identifies some abnormalities)
What are the causes of neonatal seizures?
- Hypoxic-ischaemic encephalopathy
- Cerebral infarction
- Septicaemia/meningitis
- Metabolic causes
- Intracranial haemorrhage
- Cerebral malformations
- Drug withdrawal
- Congenital infection
- Kernicterus
How are neonatal seizures managed?
Management depends on cause
Ongoing and repeated seizures are managed with anticonvulsants (efficacy poor in infants)
What are the causes of perinatal stroke?
- Ischaemia of middle cerebral artery (most common)
2. Haemorrhage or venous thrombosis in dural venous sinuses
What are the presenting features of perinatal stroke?
- Seizures at 12-48hrs in term infant
No other abnormal clinical features
What is the diagnostic test for perinatal stroke?
MRI
