Evaluation and Management Flashcards
1
Q
Newborn bloodspot overview
A
What is it
- 25 medical conditions screened for
- > Harry Potter MAGIC
- Offered to everyone after 2-3 days
- > requires signed consent
- > refusal requires signature
- Biochemical test for screening
- DNA testing
- > only performed if positive screen
- > for CF and fatty acid oxidation disorder
Why is it done
- About 1/1000 lead to diagnosis
- False negative rate is 1/100,000
- characteristic of diseases
- > can be detected early
- > result in serious illness or developmental delay
- > early intervention is effective
Collection
- prick heel with lancet
- discard first drop
- fill three circles on screening card
- send to central laboratory
Results
- after approx 2 days
- not contacted if results are normal
- if results abnormal
- > contacted
- > more blood collected for re-testing
- if re-testing is positive
- > referred to specialist
Storage
- in a secure facility
- 2 years minimum (auditing and quality)
- after 2 years
- > request card to be returned/destroyed
- > if not, stored for 18 years (when content lapses)
- access to card
- > lab for further testing
- > anonymised research
- > court order or coroner
2
Q
SWISH overview
A
What is it
- audiology screening for all newborns
- offered to everyone in first days of life (up to 3 months)
- > requires consent
- > refusal documented in blue book
Why is it done
- incidence of permanent severe bilateral hearing loss
- > 80 births/year in NSW
- intervention before 6 months
- > prevents poor health, social and cognitive impairement
Procedure
- > automated auditory brainstem response (AABR)
- > baby asleep or resting
- > electrodes on head
- > sound introduced through earphones
- > waveform detected and compared to template
Results
- available immediately
- > parents informed of results
- if negative
- > routine surveillance
- if positive
- > second screen conducted to confirm result
- still positive
- > audiology test at john hunter, westmead or SCH
- if diagnosed, referral to australia hearing
- > different commonwealth funded interventions offered
- document screening in blue book
3
Q
RDS evaluation and management/prevention
A
Clinical manifestations
- almost always preterm infant
- presents in first minutes to hrs of life
- respiratory distress
- cyanosis (due shunting/hypoxaemia)
- decreased urine output
- peripheral oedema
- often improves over 48-72hrs with surfactant production
Investigations
- ABG
- > hypoxaemia
- > hypercarbia and respiratory acidosis
- > hyponatraemia (fluid retention)
- CXR
- > ground glass (atelectasis)
- > air bronchograms (pulmonary oedema)
Management
- CPAP
- > associated with long term morbidity
- Consider caffeine therapy
- > indicated extremely low birth weight
- > prevents apnea of prematurity
- Intubation
- > indications = pH <7.2/FiO2>0.4/apnea
- > associated with higher mortality and BPD
- > complications = placement in right main/air leak
- Exogenous surfactant
- > given with intubation
- > reduces mortality and morbidity
- Supportive care
- > maintain thermoneutral temp
- > monitor BP
- > suspect PDA
- > maintain slight negative fluid balance
- > avoid diuretics
- > adequate nutrition (may require enteral)
Prevention
- Antenatal corticosteroids
- > accelerate development of type I and II alveolar cells
- > surfactant production
- > architectural maturation
- > up regulation of eNAC = fluid resorption
- > up regulation B1 receptors = surfactant release
- Indication
- > risk of at least moderate pre-term birth in next 7 days
- > diabetes/gestational diabetes at risk of pre-term birth in next 7 days
- > multiple pregnancies at risk of pre-term birth in next 7 days
- Dose
- > 2x12mg betamethazone IM 24hrs apart
- > 4x6mg dexamethasone IM 12hrs apart
- Timing
- > greatest effect 2-7 days prior to birth
- > still indicated if delivery expected within 24hrs
