Common neonatal problems Flashcards
Name a few adaptations of a newborn
Cardirespiratory transition
establishment of feeding and nutrition
metabolic adaptation
temperature maintenance
what is meconium?
bile stained intestinal secretions, intestinal cells and debris
dark green colour
passed within 24 hours after birth
change of stools after 2-3 days of milk feed
yellow milk stool after 4-6 days of milk feed
When do infants pass urine?
95% of infants pass urine in the first 24hours of life
99% of infants pass urine in the first 48 hours
What causes the pink staining of urine?
urate crystals
how do fetus obtain nutrients?
transplacental route
what promotes lactogenesis?
withdrawal of progesterone and eostrogen
prolactin secretion
suckling at the breast causes prolactin production and oxytocin secretion
what is colustrum and what are its main components?
secretion from the breast in the first 72 hours
high in protein, immonuglobulins and white cells
low in volume
what are common problems of feeding?
reluctance: cleft palate, pre term baby (infant of diabetic mother), difficult delivery Tongue tie: short lingual frenulum wind colic crying poor weight gain/ excessive weight loss
what is bilous vomiting?
requires prompt assessment
what are blood stained vomits due to?
swallowed maternal blood
when is jaundice abnormal in a neonate?
first 24 hours of life
what causes pathological jaundice in neonates?
immune haemolysis
non immune heamolysis
give examples of immune haemolysis
RhD
ABO incompatablity
give examples of non immune heamolysis
G6PD deficiency
congenital sphercytosis
when is jaundice normally seen in neonates
after 24 hours
how is jaundice assessed?
serum bilirubin mother and baby blood group direct Coomb's test FBC Blood film
how is jaundice treated?
blue light phototherapy
exchange transfusion
What causes prolonged jaundice?
CONJUGATED
intrauterine infection
biliary atresia
prolonged TPN
UNCONJUGATED
breast milk jaundice
hypothyroid
What is breast milk jaundice?
unconjugated jaundice
persists beyond 2 weeks and up to 6 weeks
could be due to breast milk beta glucoronidase or increased enterohepatic circulation
How do neonates adapt to ‘fast feed cycle’ (glucose homeostasis)?
interruption of transplacental supply of glucose leads to decrease in insulin secretion and increase in glucagon and adrenaline
Glycogenolysis and gluconeogenesis is activated
Plus lipolysis and ketogenesis
neonatal brain uses ketones more efficiently than glucose
what is the defintion of hypoglycaemia?
<2.6 mmol/L
Which infants are at risk of hypoglycaemia?
infant of diabetic mother
IUGR
Perinatal hypoxia-ischaemia
sepsis
What are the symtpoms of hypoglycaemia?
pallor jitteriness difficulty feeding hypotonia tachypnea abnormal cry
how is hypoglycaemia treated in neonates?
breast feed
if low then use formula feed
dextrose infusion
what causes respiratory failure/ distress in a neonate?
meconium aspiration
transient tachypnae of newborn
sepsis
what causes persistent pulmoary hypertension of a newborn?
failure of transition from fetal to neonatal circulation
sick baby with hypoxia
associated with meconium aspiration
what is the treatment for respiratory failure?
respiratoy support
O2
pulmonary vasodilator
how are cardiac murmurs in a neonate assessed?
circulatory collapse
heart failure
absent or weak femoral pulse
