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RNH > Neonatal > Flashcards

Neonatal Flashcards

1
Q

Clinical outcomes of haemolytic disease of newborn

A

haemolytic anaemia - jaundice, dark urine

kernicterus

high output heart failure

hepatosplenomegaly

death

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2
Q

management of rhesus disease of newborn

A

phototherapy
pRBC transfusion
IVIg
exchange transfusion

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3
Q

etiology of neonatal deaths

A 
prematurity
congenital anomalies
infection (pneumonia, sepsis)
neuro (periventricular haemorrhage, hypoxic brain injury)
resp (RDS, MAS, PTX)
SIDS
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4
Q

risk factors for perinatal mortality

A 
extremes of maternal age
low SES
ATSI
smoking
obesity
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5
Q

foetal circulation in utero

A

UV –> ductus venosus –> IVC (or hepatic vein to IVC) –> RA –> foramen ovale –> LA –> LV –> aorta –> systemic circulation

some blood goes from RA to RV –> pulmonary artery –> ductus arteriosus –> descending thoracic aorta

umbilical artery from internal iliac arteries –> placenta

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6
Q

HbF and vit K in a neonate

A

HbF has high O2 affinity - effective for O2 transfer across placenta

  • changes to HbA by 6 months
  • physiological anaemia 8-12 weeks of life

vit K - low in neonate

  • no vit K synthesis by gut bacteria and breast milk is low in vit K
  • give vit K prophylactically to avoid haemorrhage disease
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7
Q

renal function in the neonate

A

nephrons are immature - limited concentrating ability
- more susceptible to dehydration and fluid overload

U/O increases in first 5 days - removes excess total body water –> weight loss

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8
Q

liver function in the neonate

A

hepatic enzyme pathway takes 3 months to activate

physiological unconjugated hyperbilirubinemia within first 48 hours of life
- stabilises by 2 weeks

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9
Q

components of the APGAR score, when it is done and how to interpret the score

A 
appearance (colour)
pulse
grimace (reflex grimace to stimulation)
activity (tone)
respiration

1 minute and 5 minutes after birth

0-3 significant illness
4-6 moderate
7-10 reassuring

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10
Q

components of routine newborn exam

A
  1. general appearance - respiratory effort, behaviour, colour, posture and tone, injury, gross abnormalities
  2. vitals
  3. growth
  4. auscultate heart, lungs, bowel
  5. head - fontanelles, ears, mouth (suck and rooting reflex), jaw
  6. clavicles, arms, hands - grasp reflex
  7. chest
  8. abdomen - organs, umbilicus
  9. genitourinary
  10. hips, legs, feet
  11. back
  12. reflexes - moro, stepping walking
  13. eyes
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11
Q

neonatal resuscitation

A

DRS - PPE, response, send for help

airway - patent, suction, PPV if apnoea, ETT if PPV doesn’t work

breathing - increased WOB give CPAP, apnoea or gasping give PPV, add O2 if no improvement with PPV

circulation - IV access UV, HR <100 give O2 room air, HR <60 start CPR and 100% O2, no improvement after 30s consider IV adrenaline

3:1 chest compressions and breaths

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12
Q

transient tachypnoea of the newborn (TTN)

  • common age
  • risk factors
  • clinical
  • Rx
A

age: term
risk factors: C/S, maternal asthma, GDM, macrosomia
clinical: presents at birth, resolves 48 hours, hypoxia and cyanosis are uncommon
Rx: supportive, should recover 48 hours

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13
Q

respiratory distress syndrome

  • common age
  • risk factors
  • clinical
  • Rx
A

age: pre term
RF: prematurity, LBW, GDM, 2nd born twin
clinical: presents at birth, worsens over 72 hours, hypoxia and cyanosis often present
Rx: O2, CPAP, +/- ETT, IV access, keep warm and dry, surfactant through ETT, Abx, NGT feeds or TPN

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14
Q

bronchopulmonary dysplasia / chronic neonatal lung disease

  • definition
  • common age
  • risk factors
  • clinical
  • Rx
  • CXR features
A

O2 requirements at 36 weeks corrected + characteristic CXR

age: 36 weeks corrected
RF: RDS, mechanical ventilation, genetics
clinical: chronic respiratory distress after RDS requiring long term O2, pulmonary HTN +/- CHF
Rx: O2 and resp support, increase caloric intake, inhaled bronchodilators

CXR:
Bilateral reticular opacification
Hyperinflation
Cardiomegaly - pulmonary HTN

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15
Q

meconium aspiration syndrome

  • common age
  • risk factors
  • clinical
  • Rx
A

age: term or post term
RF: increased gestational age
clinical: apnoea, resp distress and cyanosis at birth, mec stained amniotic fluid (MSAF)
Rx: suction if thick meconium, PPV with O2, ETT, inhaled nitric oxide, Abx

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16
Q

short term and long term complications for prematurity

A

short term

  • RDS
  • bronchopulmonary dysoplasia
  • retinopathy of newborn
  • PDA
  • sepsis
  • NEC
  • intraventricular haemorrhage

long term

  • cerebral palsy
  • chronic illness
  • visual, hearing and cognitive impairment
  • recurrent resp infection
  • SIDS
17
Q

classification of pre term neonate

A

late pre term 34-37
moderate 32-34
very 28-32
extreme <28

18
Q

classification of BW in pre term

A

LBW <2500g
VLBW <1500g
ELBW <1000g

19
Q

what is the newborn screening program and what is it testing

A

heel prick blood sample at birth

tests for: CF, congenital hypothyroidism, phenylketonuria, galactosemia

20
Q

when is neonatal jaundice considered pathological

A

conjugated hyperbilirubinemia
develops <24 hours after birth
lasts >10 days (unless breastfeeding jaundice)
excessive or rises rapidly

21
Q

cause of physiological jaundice

A

physiological - immature liver + hemolysis due to reduced RBC lifespan (foetal Hb) + increased enterohepatic circulation

22
Q

etiology of unconjugated bilirubinemia in neonate

A

physiological

breast feeding - glucuronosyl transferase inhibitor in breast milk

sepsis
cephalohematoma
ABO or Rh incompatibility
hypothyroidism

23
Q

causes of conjugated bilirubinemia (neonate)

A

hepatic - alpha1AT deficiency, galactosemia

post hepatic - biliary atresia, choledochal cyst

24
Q

risk factors for physiological jaundice

A 
prematurity
infection 
family hx 
breastfeeding
complications of pregnancy 
maternal GDM
25
Q

kernicterus - cause, clinical features, treatment

A

cause - unconjugated bilirubin exceeds albumin binding capacity –> deposits in brain

clinical - neuro deficit

Rx - phototherapy and exchange transfusion

26
Q

biliary atresia - cause, clinical features, treatment

A

cause - congenital atresia of extra hepatic bile ducts

clinical - occurs after one week of life, jaundice, dark urine, pale stool, distended abdomen, FTT

Rx - surgery, ADEK vitamins, modified TPN

27
Q

Ix for all babies with jaundice

A 
FBC + film + reticulocytes 
bilirubin
LFTs
Coombs test 
blood group
28
Q

management of unconjugated high bilirubin

A

refer to nomogram

total bilirubin treatable - phototherapy

below threshold - reassure parents it will resolve by 2 weeks

if it doesn’t resolve in 2 weeks - urine MCS, TFT, G6PD

29
Q

necrotising enterocolitis

  • clinical
  • Ix
  • Rx
A

clinical

  • presents 2-3 weeks age
  • distension, bile vomit, haematochezia, ileum, reduced bowel sounds

Ix

  • FBC, ABG, lactate, BSL, blood cultures, UEC
  • AXR

Rx

  • NBM 1 week
  • IVF
  • TPN
  • NGT decompression
  • ampicillin + gentamicin + metronidazole
30
Q

AXR findings for NEC

A

dilated bowel loops
bowel wall oedema
pneumatosis intestinalis
pneumoperitoneum

31
Q

retinopathy of prematurity

  • RF
  • Rx
A

vasoproliferative retinopathy

RF: prematurity, LBW, high O2 exposure after birth

Rx: laser therapy, antiVEGF intravitreal injection

32
Q

intraventricular haemorrhage

  • RF
  • clinical
  • Ix
  • Rx
A

RF: prematurity, LBW, resus at birth, ventilation, coagulopathy, RDS, PTX

clinical: bradycardia, apnoea, altered LOC, bulging fontanelle, changed activity

Ix: head USS

Rx: O2, IVF, blood products, maintain BP

RNH (9 decks)

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