Introduction to Neonatology Flashcards
What are the categories of term admissions to NNU?
Sepsis Respiratory Cardiac Hypoglycaemia Hypothermia Jaundice Birth asphyxia Surgical problems
What are the symptoms of neonatal sepsis?
Baby pyrexia or hypothermia Poor feeding Lethargy Early jaundice Hypoglycaemia/hyperglycaemia Asymptomatic
What are the risk factors for neonatal sepsis?
PROM
Maternal pyrexia
Maternal GBS carriage
What is the management for presumed neonatal sepsis?
Admit NNU Partial septic screen and blood gas Consider CXR, LP IV penicillin and gentamicin 1st line 2nd line vancomycin and gentamicin Add metronidazole if surgical/abdominal concerns Fluid management and treat acidosis Monitor vitals and support respiratory/cardio systems if required
What are the commonest causes of neonatal sepsis?
Group B streptococcus E coli Listeria Coagulase negative staphylococci H influenzae
What are the complications of GBS sepsis?
Meningitis DIC Pneumonia Respiratory collapse Hypotension Shock
What are the most common congenital infections?
Toxoplasmosis
Rubella
CMV
Herpes
What might congenital infections result in?
IUGR Brain calcifications Neurodevelopmental delay Visual impairment Recurrent infections
What are the causes of respiratory problems?
Sepsis
Transient tachypnoea of the newborn (TTN)
Meconium aspiration
What are the signs of TTN?
Grunting
Tachpnoea
Oxygen requirement
Normal gases
How is TTN managed?
Supportive Antibiotics Fluids O2 Airway support
What is the pathophysiology of TTN?
Delay in clearance of foetal lung fluids
What are the risk factors for meconium aspiration?
Post dates (aged placenta)
Maternal diabetes
Maternal hypertension
Difficult labour
What are the symptoms of meconium aspiration?
Cyanosis Increased work of breathing Grunting Apnoea Floppiness
What investigations are done for meconium aspiration?
Blood gas
Septic screen
CXR
What is the treatment for meconium aspiration?
Suction below cord Airway support (intubation and ventilation) Fluids and IV antibiotics Surfactant NO or ECMO
What investigations should be done for “blue baby” syndrome?
Examination and history Sepsis screen Blood gas and blood glucose CXR Pulse oximetry ECG Echo
What s the differential diagnosis of “blue baby”?
TGA Tetralogy of Fallots TAPVD Hypoplastic left heart syndrome Tricuspid atresia Truncus arteriosus Pulmonary atresia
What is transposition of the great arteries?
2 separate circulations
Need to keep duct open
What is the treatment for transposition of the great arteries?
Urgent septostomy
What conditions are classified as tetralogy of fallouts?
Pulmonary stenosis
Thickened right ventricle
VSD
Overriding aorta
What is total anomalous pulmonary venous drainage?
Pulmonary veins connected to one of the veins from the main circulation instead of left atrium
Oxygenated blood goes to the right side of the heart
What are the features of a hypoplastic left heart?
Underdeveloped left heart
Poor oxygenation
Poor perfusion
Worse when duct shuts
What is tricuspid atresia?
Absence of patent heart valve
Hypoplastic right ventricle
What is truncus arteriosus?
Single blood vessel from left and right ventricles
Requires surgery to create 2 vessels
What is pulmonary atresia?
Abnormal pulmonary valve
Obstructs blood from right ventricle to lungs
Shunts and surgical repair
What is the treatment for a “blue baby”
ABC Inotropes as required Fluid resuscitation Respiratory support Prostin Nitric oxide Cardiology referral
How is neonatal hypoglycaemia managed?
Monitor blood glucose Start IV 10% glucose Increase fluids Increase glucose concentration Glucagon Hydrocortisone
How is hypothermia managed?
Admit and place in incubator
Sepsis screen and antibiotics
Consider checking thyroid function
Monitor blood glucose
What is the management for neonatal jaundice?
Intensive phototherapy or exchange transfusion
Incubator and IV fluids may be required
What are the causes of birth asphyxia?
Placental problem Long, difficult delivery Umbilical cord prolapse Infection Neonatal airway problem Neonatal anaemia
What is the 1st stage of birth asphyxia?
Within minutes without O2
Cell damage occurs with lack of blood flow and O2
What is the 2nd stage of birth asphyxia?
Reperfusion injury
Can last days or weeks
Toxins are released from damaged cells
What are the symptoms of mild hypoxic-ischaemic encephalopathy?
Slightly increased muscle tone Brisk deep tendon reflexes Poor feeding Irritability Excessive crying or sleepiness
What are the symptoms of moderate hypoxic-ischaemic encephalopathy?
Lethargic Hypotonia Diminished deep tendon reflexes Grasping and sucking reflexes sluggish or absent Apnoea Seizures
What are the symptoms of severe hypoxic-ischaemic encephalopathy?
Seizures
What is the management fro hypoxic-iscahemic encephalopathy?
Supportive Fluid restriction Monitor for renal and liver failure Respiratory support Cardiac support Treat seizures Therapeutic hypothermia
What is the cooling criteria for hypoxic-ischaemic encephalopathy?
Infants >/= 36 weeks with at least 1 of
(Apgar score of <=5 at 10 minutes
Continued need for resuscitation > 10 minutes, acidosis within 1st hour (pH <7), base deficit >= 16 within 1 hour)
Seizures
At least 30 minutes of abnormal electrical activity
What is the management for therapeutic hypothermia?
Baby cooled to 33C for 72 hours Rewarmed slowly over 12 hours Sedated for cooling Monitored for CFAM Cranial ultrasounds MRI at 7-10 days Neurodevelopmental follow up
What are the different types of oesophageal atresia/fistula?
Atresia with distal fistula Atresia with proximal fistula Atresia Atresia with double fistula Fistula
What is the treatment for oesophageal atresia/fistula?
IV fluids and suction
Surgical repair
What are the causes of failure to pass stool?
Constipation Large bowel atresia Imperforate anus Hirschsprungs disease Meconium ileus
How is a diaphragmatic hernia managed?
Intubation at birth
Respiratory support
Surgery
ECMO
What are some examples of abdominal wall defects?
Exomphalos
Gastroschisis
What is IUGR?
Intrauterine growth restriction
What is SGA?
Small fro gestational age
What are the causes of SGA?
Maternal
Foetal
Placental
Twin pregnancy
What are the common problems associated with SGA?
Perinatal hypoxia Hypoglycaemia Hypothermia Polycythaemia Thrombocytopenia GI problems
What are the long term problems associated with SGA?
Hypertension
Obesity
Reduced growth
Ischaemic heart disease
What is pre term?
<37 weeks
<28 weeks (extremely pre term)
How can respiratory distress syndrome be prevented?
Antenatal steroids
How can respiratory distress syndrome be prevented?
Early surfactant treatment
Early extubation
Non invasive support (NCPAP)
Minimal ventilation
What is the treatment for broncho-pulmonary dysplasia?
Nutrition and growth
Steroids
How can intraventricular haemorrhage be prevented?
Antenatal steroids
What is the pathophysiology of pulmonary ductus arteriosus?
Additional blood to circulation Over perfusion of lungs Lung oedema Steal from systemic circulation Systemic ischaemia
What are the consequences of pulmonary ductus arteriosus?
Worsening of respiratory symptoms
Retention of fluids
GI problems
When is the critical period of heart development?
Days 20-50
Where does a foetus receive circulation via?
Umbilical vein
Foramen vale (LA, LV)
Patent ductus arteriosus (RV, PA)
What is the function of the ductus arteriosus in the foetus?
Protects lungs against circulatory overload
Allows the right ventricle to strengthen
What is the ductus venosus?
Blood vessel that connects the umbilical vein to the IVC
How can a newborn’s breathing be assessed?
Blood gases Transcutaneous pCO2 Capnography Tidal volume Minute ventilation
What happens when the foetus takes it’s first breath?
Ductus arteriosus, venosus and umbilical veins and arteries become ligaments
Foramen ovale close, leaving a depression
What is the normal heart rate range for neonates?
120-160bpm
How do neonates thermoregulate?
Maternal thermoregulation in womb
Brown fat due to lack of shivering
When will physiological neonatal jaundice appear?
Day of life 2-3
