Neonatal Flashcards
Clinical outcomes of haemolytic disease of newborn
haemolytic anaemia - jaundice, dark urine
kernicterus
high output heart failure
hepatosplenomegaly
death
management of rhesus disease of newborn
phototherapy
pRBC transfusion
IVIg
exchange transfusion
etiology of neonatal deaths
prematurity congenital anomalies infection (pneumonia, sepsis) neuro (periventricular haemorrhage, hypoxic brain injury) resp (RDS, MAS, PTX) SIDS
risk factors for perinatal mortality
extremes of maternal age low SES ATSI smoking obesity
foetal circulation in utero
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
HbF and vit K in a neonate
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
renal function in the neonate
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
liver function in the neonate
hepatic enzyme pathway takes 3 months to activate
physiological unconjugated hyperbilirubinemia within first 48 hours of life
- stabilises by 2 weeks
components of the APGAR score, when it is done and how to interpret the score
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
components of routine newborn exam
- general appearance - respiratory effort, behaviour, colour, posture and tone, injury, gross abnormalities
- vitals
- growth
- auscultate heart, lungs, bowel
- head - fontanelles, ears, mouth (suck and rooting reflex), jaw
- clavicles, arms, hands - grasp reflex
- chest
- abdomen - organs, umbilicus
- genitourinary
- hips, legs, feet
- back
- reflexes - moro, stepping walking
- eyes
neonatal resuscitation
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
transient tachypnoea of the newborn (TTN)
- common age
- risk factors
- clinical
- Rx
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
respiratory distress syndrome
- common age
- risk factors
- clinical
- Rx
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
bronchopulmonary dysplasia / chronic neonatal lung disease
- definition
- common age
- risk factors
- clinical
- Rx
- CXR features
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
meconium aspiration syndrome
- common age
- risk factors
- clinical
- Rx
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
short term and long term complications for prematurity
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
classification of pre term neonate
late pre term 34-37
moderate 32-34
very 28-32
extreme <28
classification of BW in pre term
LBW <2500g
VLBW <1500g
ELBW <1000g
what is the newborn screening program and what is it testing
heel prick blood sample at birth
tests for: CF, congenital hypothyroidism, phenylketonuria, galactosemia
when is neonatal jaundice considered pathological
conjugated hyperbilirubinemia
develops <24 hours after birth
lasts >10 days (unless breastfeeding jaundice)
excessive or rises rapidly
cause of physiological jaundice
physiological - immature liver + hemolysis due to reduced RBC lifespan (foetal Hb) + increased enterohepatic circulation
etiology of unconjugated bilirubinemia in neonate
physiological
breast feeding - glucuronosyl transferase inhibitor in breast milk
sepsis
cephalohematoma
ABO or Rh incompatibility
hypothyroidism
causes of conjugated bilirubinemia (neonate)
hepatic - alpha1AT deficiency, galactosemia
post hepatic - biliary atresia, choledochal cyst
risk factors for physiological jaundice
prematurity infection family hx breastfeeding complications of pregnancy maternal GDM
kernicterus - cause, clinical features, treatment
cause - unconjugated bilirubin exceeds albumin binding capacity –> deposits in brain
clinical - neuro deficit
Rx - phototherapy and exchange transfusion
biliary atresia - cause, clinical features, treatment
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
Ix for all babies with jaundice
FBC + film + reticulocytes bilirubin LFTs Coombs test blood group
management of unconjugated high bilirubin
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
necrotising enterocolitis
- clinical
- Ix
- Rx
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
AXR findings for NEC
dilated bowel loops
bowel wall oedema
pneumatosis intestinalis
pneumoperitoneum
retinopathy of prematurity
- RF
- Rx
vasoproliferative retinopathy
RF: prematurity, LBW, high O2 exposure after birth
Rx: laser therapy, antiVEGF intravitreal injection
intraventricular haemorrhage
- RF
- clinical
- Ix
- Rx
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
