Neonatal Flashcards
Where are calcifications in CMV?
periventricular
What are long term complications of CMV?
sensorineural deafness
learning disabilties
What is characteristic of herpes simplex infection?
Hepatosplenamegly
Cranail USS with diffuse oedema
What is fetal varicella syndrome?
Low birth weight
Cicatrical skin - pale yellow dermatomal scars
Limb hypoplasia
Microcephaly
Chorioretinitis
Which treatment should a non-immune pregnant woman receive if contacts chicken pox?
Varicella zoster immunoglobulin
When does polycyntheia occur in neonates?
Venous haematocrit >65%
When do you treat neonatal polycyaethmia ?
Symptomatic
Venous haematocrit > 70 with no symptoms
What is treatment for polycytheamia ?
partial exchange transfusion with removal of blood and replacement of 0.9% sodium chloride to reduce haemocrit to 50%
Which medication is first line to treat neonatal seizure
phenobarbital
What is phenobarbital MoA
activating the gamma-aminobutyric acid GABA A receptor
When and where is surfactant produced
lipoprotein syntethesize in type 11 pneumocystis from 24 weeks
What organisms cause early onset sepsis
Group B strep
E.coli
Listeria monocytes
Haemophilus
non-bacteria - herpes, enterovirus
Cause of late onset sepsis
coagulase-negative staphylococci
E.Coli
Klebsiella
S.aurues
Risk factors for sepsis
Forceps delivery
Chorioamniotisis
Intrauterine monitoring
Maternal GBS colonisation
Intrapartum fever
Preterm delivery
Prolonged rupture of membranes >18 hours
Meconium-stained fluid
What does a blood test in NEC show?
Metabolic acidosis
What causes respiratory distress syndrome?
Defiency of surfactant - higher surface tension at the alveolar surface
Preterm infant airways - lack sufficient cartilage to remain patent = collapse lungs an increased airway resistance
Prevention of RDS
Antenatal glucocorticoid to induce endogenous surfactant formation
Exogenous surfactant replacement therapy
Resp. support - CPAP
What benefits are there to human breast milk in neonates
Reduced risk of NEC
Reduced risk of systemic infection
What is patency of PDA maintained by
High blood flow
Hypoxia
Locally derived prostaglandin E2
What type of shunt is a PDA
left to right
Increased pulmonary blood flow
Pulmonary oedema a
CCF
What type of murmur is a PDA
pan systolic at left sternal edge \
loud second heart soul
gallop rhythm
bounding pulse from wide pulse pressure
Management of pDA
Most close spontaneously
Restricted fluid
Indomethacin or ibuprofen - decrease production of pGE2
What is indomethacin ass. with
more nephrotoxicity
NEC
GI heamorrhage
platelet dysfunction
Impaired cerebral blood flow
Do neonates have more IgG antibodies then mum
Yes - transplacental transfer of antibodies
Which antibody does breast milk contain
IgA - passive immune protection
No igG
What are the clinical diagnostic factors for NEC
Abdominal distension and tenderness
Bilious aspirates
Bloody stools
Intramural air (pneumatosis intestinal) on abod Xray
WHAt are risk factors of NEC
Prematurity
HIE - IUGR, PDA
Feeding - rapid increase in enteral feeds, formula milk
Infection
Management of NEC
Stop feeds and place lore bore nano tube for intestinal decompression
Braod spectrum ABX
Surgery - bowel perforation
What causes periventricular-intraventicular haemorrhage
Rupture of fragile capillary network in subependymal matriculates of developing brain
When is transient tachypnoea of newborn more common
C-section
Why is TTPN more common in c-sections
Absence of thoracic squeezing of lung liquid from chest
Clearance of metal lung fluid dependent on rebasorption of alveolar flu via sodium channels - influcend by level of circulation catecholamines.
There are lower catecholamines following elective delivery
What conditions increase risk of thoracic air leaks?
RDS
Meconium aspiration syndrome
Congenital diaphragmatic hernia
Previous pneumothorax
Pulmonary hypoplasia
Why do air leaks syndrome occur?
Damage to respiratory epithelium - allows the air to enter interstitial space causing pulmonary interstitial emphysema
What affects pulmonary development in gestational diabetes mums
IGF - 1 - potentiated undifferentiated cells In lungs
What is Hirchsprung disease
Congenital absence of submucosa or myenteric plexus
Meissner - submuscosal
Auerback - myenteric is muscular layer between circular and longitudinal layers
what are the conditions tested in newborn screening
sickle cell disease
CF
congenital hypothyroidism
maple syrup urine disease
phenylyketonuria
MCADD
isovaleric acidemia
glutamic acuduria type 1
homocysturia
When does screening for CF on newborn screening test become unreliable
after 8 weeks
can test others up to 1 year
What is forced vital capacity
total amount of air exhaled with forced expiration
what is forced expiratory in first second FEV1
measures large airway obstruction
Risk factors for hemorrhagic disease of newborn
Prematurity
Complicated deliveries
Delayed feeding
Breast fed
Pathophysiology of hemorrhagic disease of newborn
Vit K dependent clotting factors are deficient at birth - don’t cross placenta (2, 7, 9, 10)
Vit K given to activate them
Clinical presentation of haemorrhagic disease of newborn
Bleeding - intracranial (Seizure) , meleana
Umbilical stump bleeding
Management of hemorrhagic disease of newborn
Prevention - iM vit K
Treatment - IV vit K +/- FFP if severe
Meconium aspiration syndrome cause
Causes mechanical obstruction of bronchioles
preventing gas exchange
Cause inflammatory pneumonitis
Types of congenital diaphragmatic hernias
Posterolateral Bockdarek hernia - most common, left side
Anterior Morgani hernia
Hiatus hernia
Clinical presentation of congenital diaphragmatic hernias
polyhydramnios
significant respiratory depression
reduced breath sounds on side of hernia
pulmonary hypoplasia
displaced heart sounds
How do you increase Co2 clearance on a ventilator
Decrease ventilator rate
What is the max of PIP in preterm and normal
not max 25
not max 30
When do cerebral blood vessels strengthen?
After 30 weeks
What results will neonatal allomune thrombocytopenia show
Low PLT
Normal anticoagulant study
Types of ToF
A - oesophageal atresia
B - proximal fistula, distal atresia
C - proximal atresia, distal fistula - most common
D - proximal and distal fistula with both atresia
H - double fistula
