Neonatal Flashcards
What are the RF of NEC?
Preterm
Hyperosmolar feeding
Inf, ABX use
Gut ischemia e.g. hypoxia, polycythemia
What is the age of onset of NEC?
Term: 7d
Preterm: 14d
Extreme preterm: 21d
What are the S/S of NEC?
General: poor feeding, lethargy, tachypnea, bradycardia, unstable temperature
Abdominal distention, everted umbilicus, dusky abdominal skin
Fecal blood
How to Ix NEC?
AXR: intramural gas, portal venous gas, pneumoperitoneum
How to Mx NEC?
NPO, TPN, fluid, NG tube suction
Broad-spectrum ABX: amp + gen + mtz
Surg
What are the Cx of NEC?
Acute: perforation, peritonitis, septicemia, shock, DIC
Long term: short gut syndrome, TPN-related cholestasis, FTT
What is prolonged jaundice?
Term: 14d
Preterm: 21d
What are the causes of prolonged jaundice?
Breast milk
GI: biliary obst, neonatal hepatitis syndrome, GI obst
Inf (UTI)
Endocrine: congenital hypothyroidism
What is early onset jaundice?
Within 24hr
What are the DDx of early onset jaundice?
Unconjugated: hemolysis -> G6PD, Rh, ABO incompatibiltiy
Conjugated: inf -> congenital, early onset sepsis
What is intermediate onset jaundice?
Between 2d & 2w
What are the DDx of intermediate onset jaundice?
Physiological Breast milk (ihb), breast-feeding (dehydration) Hematoma, polycythemis Liver disorder Inf (UTI)
What is BPD?
O2 dependence at 36w of gestation or 28d post natal age
How to Ix BPD?
CXR: cystic & fibrotic changes, widespread areas of opacification
How to Mx BPD?
O2 supplement
Steroid (IV dexamethasone)
General: high calorie diet, restrict fluid + diuretics
What is considered significant conjugated hyperbilirubinemia?
Conjugated (direct) >20% of total
What is kernicterus?
Encephalopathy caused by deposition of unconjugated bilirubin in BG
What are the S/S of kernicterus?
Lethargy, poor feeding, seizure, ophisthotonus
What are the Cx of kernicterus?
Choreoathetoid CP, SNHL
What are the S/S of neonatal sepsis?
Fever / hypothermia
Apnea, bradycardia
Poor feeding, vomiting
What is the cause of physiological jaundice?
Decreased glucoronyl transferase activity
Increased RBC turnover but immature liver function
What is cephalohematoma
Epidural bleeding
Confined by sutures
Resolves spontaneously
Higher risk in ID
What is caput succadenum?
Edema of scalp at subdural layer
Crosses sutures
Resolves spontaneously
Higher risk in prolonged labour & vacuum extraction
What is subgaleal hemorrage?
Between periosteum & aponeurosis
Diffuse swelling, massive blood loss b/c large potential space
Mx: resuscitate, monitor, FFP
Higher risk in vacuum extraction
What are the effects of GDM on neonate?
Macrosomia
Polycythemia
HypoCa -> jittery, apnea
What is Erb’s palsy?
C5-7 nerve root injury
What are the S/S of Erb’s palsy?
Waiter’s tip sx
Asymmetrical moro reflex & limb movement
How to Mx Erb’s palsy?
Reassure (resolve by 3mo)
PT (prevent contracture)
What is the cause of ARDS?
Surfactant deficiency (e.g. preterm, GDM)
What are the S/S of ARDS?
Respiratory distress within 4hr of delivery
How to Ix ARDS?
CXR: diffuse reticulogranular ground glass appearance w/ air bronchograms
SpO2, ABG
How to Mx ARDS?
O2 supp
Surfactant
Assisted ventilation e.g. CPAP, BiPAP
Supportive care
How to prevent ARDS?
AN steroids if risk of preterm <34w
What is CDH?
Herniation of abdominal viscera into chest -> pulmonary hypoplasia
How to Dx CDH?
AN: morphology scan
PN: PE, AXR/CXR
What are the Sx of CDH?
Barrel chest
Scaphoid abdomen
Asymmetrical chest expansion
CN despite respiratory support
How to Ix CDH?
AXR/CXR
- bowel loop in thorax, x bowel loop in abdomen
- shifting of heart shadow, NG tube, ET tube, umbilical arterial catheter
How to Mx CDH?
NG tube suction
Intubation (low pressure ventilation to prevent PTX)
Surg
