Neonatal Flashcards
What is the definition of a preterm birth?
Birth before 37 completed weeks of gestation
What is the gestational age range for a term birth?
37 to 42 weeks of gestation
What is a post-term birth?
Birth after 42 weeks of gestation
What is the normal birth weight range for a healthy term infant?
2.5kg to 4.0kg
What is considered Large for Gestational Age (LGA)?
Birth weight over 4.0kg
What is considered Small for Gestational Age (SGA)?
Birth weight under 2.5kg
How much weight does a baby gain daily in the 3rd trimester?
24g per day
How long is a baby considered a neonate?
First 28 days of life
How much fat does a baby gain daily in the last 4 weeks of pregnancy?
7g per day
What key nutrients and substances are transferred transplacentally in the 3rd trimester?
Iron, vitamins, calcium, phosphate, and antibodies
What helps the baby cope with hypoxia during labour?
Foetal haemoglobin (HbF) releases oxygen efficiently
What triggers the switch from foetal to newborn circulation?
The first breath/cry, which expands the alveoli
What score is used to measure perinatal adaptation?
Apgar score
Why is vitamin K given to newborns?
To prevent haemorrhagic disease of the newborn
What are two early interventions that support perinatal adaptation?
Immediate skin-to-skin contact and early suckling
What is the preferred route for vitamin K administration?
Intramuscular (IM), though some parents prefer oral
What does the Preterm Infant mean?
a birth that occurs before 37 completed weeks of gestation
What is the Apgar score used for?
It assesses a newborn’s condition at birth on a scale from 1 to 10. the higher the score the better the baby is doing after birth
What is transient tachypnoea of the newborn (TTN)?
A condition where fluid in the lungs does not clear away after birth
What is a pneumothorax in a newborn?
Air leaks into the pleural space, causing lung collapse
What can cause a pneumothorax in a newborn?
spontaneous or secondary to active resuscitation
Name two congenital respiratory conditions
- Tracheo-oesophageal fistula
- Diaphragmatic hernia
What is hydrops foetalis?
A severe heart failure condition in utero, caused by rhesus disease or chromosomal abnormalities
What is persistent pulmonary hypertension of the newborn (PPHN)?
Failure to adapt to postnatal circulation, causing severe hypoxia
What are three causes of neonatal hypoglycaemia?
- Low birth weight (LBW) or small for gestational age (SGA) → reduced energy reserves
- Infant of diabetic mother (IDM) → excessive insulin production
- Metabolic disorder → underlying complex condition
What can cause metabolic acidosis in a newborn?
Inborn errors of metabolism
What is the target temperature range for a newborn?
36.5 - 37.4°C
What are the first steps in managing airway and breathing in a sick newborn?
Open the airway gently, provide oxygen if needed
What is neonatal jaundice?
Yellow colouring of the skin and sclera due to bilirubin accumulation
What percentage of term and preterm infants develop neonatal jaundice?
What percentage of term breastfed babies are still jaundiced at 1 month?
- 60% of term and 80% of preterm infants
- 10%
What type of hyperbilirubinaemia is always pathological?
Conjugated hyperbilirubinaemia
When does physiological jaundice typically occur?
Between day 2 and 14 in a healthy term baby
Name a pathological cause of neonatal jaundice due to haemolysis.
Rhesus incompatibility
What is a common infectious cause of neonatal jaundice in the first 24 hours of life?
sepsis
Name two inherited conditions that can cause jaundice
- G6PD deficiency
- Hereditary spherocytosis
What is biliary atresia? and what are 2 signs
A cause of obstructive jaundice where the bile ducts fail to develop properly
= Pale stools and dark urine
When is jaundice considered prolonged in a
- term baby?
- Pre-term baby?
- After 14 days
- After 21 days
What is the main treatment for neonatal jaundice?
Phototherapy + hydration
A baby boy is born at 36 weeks gestation via emergency caesarean section following the mother developing symptoms of eclampsia. At birth, the baby has no respiratory effort and a very weak pulse of 50 bpm despite multiple attempts to improve, and the decision is made to start chest compressions
What is the rate at which chest compressions should be given?
3:1
A boy born at 31 weeks gestation is admitted to neonatal intensive care following a ventricular haemorrhage. The boy is at risk of central apnoeas. On the ward round, there is a pause in his breathing that is lasting 15 seconds
What is the most appropriate course of action?
Physical stimulation
A three-day-old Caucasian infant becomes jaundiced. Past medical history and birth history are both unremarkable. The infant is breastfed and appears well. What is the most appropriate management?
Continue breastfeeding, look out for red flag symptoms
A 21-day-old bottle-fed baby boy presents with worsening yellow skin and eyes since day 7 of life. He has had poor feeding, 8 wet nappies of dark urine daily, and chalky white stools for the past week. The baby was born at 39 weeks via spontaneous vaginal delivery after a normal pregnancy and has been otherwise well, with no fever, abnormal movements, or rash.
On examination his abdomen is soft and the liver is palpable 2cm below the costal margin. Blood tests show normal haemoglobin, raised ALT and ALP and raised total bilirubin (predominantly conjugated). An abdominal ultrasound scan shows echogenic fibrosis in the liver.
What investigation will definitively diagnose the likely condition in this case?
Cholangiography
A 4-day-old male, born at term, presents to Accident and Emergency as his parents have noticed a yellowing of the skin around his face and neck. He has been otherwise generally well, with no complications during pregnancy or birth. After examination, a blood serum sample is taken to investigate. The findings of this test were suggestive of mild physiological jaundice and the baby was discharged to home
What routinely tested for substances is raised in physiological jaundice?
Unconjugated bilirubin
A mother attends the emergency department with a 26-day-old boy. The boy is breastfed but shows poor weight gain. He is jaundiced and lethargic and is passing dark urine and pale stool.
What is the most likely diagnosis?
Biliary atresia
A two-month-old boy is brought to the emergency department following two temperatures at home measuring 38.6C and 39C. He is off his feeds. He was born to term and has been well since birth. The examination is unremarkable.
In light of his presentation, which of the following investigations is required?
All babies under 3 months old must have a Lumbar puncture if increase in temperature
What is the correct definition of a neonatal stillbirth?
Death of a baby after 24 weeks gestation, before or during birth
‘bubbly’ appearance of the intestine with a lack of air-fluid levels suggests what disease?
Meconium Ileus
= neonatal bowel obstruction of the distal ileum due to abnormally thick and impacted meconium relation to cystic fibrosis
A 21-day-old baby presents with jaundice. He was full-term, of normal birth weight and appeared well until recently. Blood results show a conjugated hyperbilirubinaemia.
What is the most likely diagnosis?
Biliary atresia
A 6-week-old girl is brought to the GP with discolouration of the skin. This was first noted 1 week ago, but has got worse. She is passing a normal frequency of pale-coloured stools and is producing an appropriate number of wet nappies. She is feeding and growing well, with no signs of developmental delay
On examination, you note a jaundiced baby who appears otherwise well, with normal physical observations, good interaction and normal chest and abdominal examination. On exposure, you note multiple small bruises on the torso
What is the most appropriate next step?
Serum total bilirubin and conjugated bilirubin
= The most concerning underlying condition here is biliary atresia. The jaundice (later than that of physiological, breast milk or breastfeeding jaundice) and bruising support a diagnosis of biliary atresia
Biliary atresia is characterised by
progressive fibrosis and destruction of the biliary tree
An 18-day-old baby is brought to the paediatric A&E by her mother. The baby is visibly jaundiced, and the mother reports the baby has been very irritable and off her feeds since yesterday morning. On examination, there is hepatomegaly. Blood tests show normal full blood count and normal thyroid function tests, but raised liver transaminases and a very high conjugated bilirubin level. A diagnosis of biliary atresia is suspected
What is the most appropriate first-line management for this condition?
Surgical intervention
The APGAR score should be performed when on neonates?
1 + 5 minutes post birth
Wha does APGAR stand for?
appearance
pulse
grimace
activity
respiration
How to calculate APGAR score
Appearance
= relates to the colour of the child
2 is for a pink baby
1 If the baby is blue peripherally but pink centrally
0 if the baby is blue all over
Pulse:
2 for >100 beats per minute
1 for <100 beats per minute
0 for a non-detectable heart rate
Grimace
= relates to the response to stimulation
2 for crying on stimulation scores
1 for a grimace
0 for no response
Activity:
2 for flexed limbs that resist extension
1 for some flexion
0 for a floppy baby
Respiration:
2 for a strong cry
1 for a weak cry / irregular breathing
0 for no respiratory effort/ absent breath
A baby girl has just been born by emergency caesarean section.
On assessment, she is blue peripherally but pink centrally; her heart rate is 120 beats/min; she cries in response to stimulation; her limbs are somewhat flexed but do not resist extension, and she has a strong cry.
What is her APGAR score?
8
A 2-week-old infant is referred by their health visitor to the GP. The child’s parents are concerned about a yellow tinge to the skin. The child is exclusively breastfed and has had difficulties feeding since birth.
On further questioning, the parents remark that the urine can look dark and the stools can look pale. The baby was born on the 50th centile for weight and is now on the 30th centile.
Which of the following investigations will provide a definite diagnosis?
Cholangiography provides a definitive diagnosis and involves injecting a dye to image the biliary tract
What is the most common cause of jaundice in the first week of life?
Physiological jaundice
Liver function test (LFT) results in biliary atresia
Conjugated (direct) bilirubin ↑↑
Alkaline phosphatase (ALP) ↑
Gamma-glutamyl transferase (GGT) ↑↑
AST/ALT – mildly raised
Albumin – usually normal early on
A 27-day-old neonate is brought into Accident and Emergency by his mother as she noticed that he is not feeding well. The baby is exclusively breastfed and has not had any problems with latching on before. The baby was last weighed a few days ago and has been putting on weight
On examination, the baby looks jaundiced and is lethargic. The stool is of a normal colour and consistency. The mother says that there have been fewer wet nappies over the last 12 hours.
There is some loss of skin turgor. There is no hepatomegaly on palpation of the abdomen.
What is your most appropriate management?
Perform a full septic screen
You are called to assess a 2-day-old neonate on the postnatal ward because the baby had a fit. The baby put her arms back into an abnormal position, went stiff and had some jerking movements and lip smacking for a couple of minutes.
She also appeared blue during this period. The baby has otherwise been irritable since delivery, and the mother has not had much success with breastfeeding. When you arrive 15 minutes later, the baby appears pink in the air but is irritable.
On examination, the baby is very floppy. She has another similar seizure while you are there. What could have caused this neonate’s condition?
Umbilical cord compression
= This neonate, with poor feeding, hypotonia and seizures most likely has a diagnosis of hypoxic ischaemic encephalopathy
A two-month-old is seen in the paediatric emergency department after having two temperatures above 39.0C. He is lethargic and off his feeds. As part of a septic screen, urinalysis and cultures have been requested. The parents are struggling to obtain a clean catch sample
What is the most appropriate method for obtaining a urine specimen for these investigations?
Urine collection pad
A baby boy is delivered at 41 + 3 weeks gestation via emergency caesarean section for foetal distress. At delivery, thick meconium-stained amniotic fluid is noted. The baby is hypotonic, has poor respiratory effort, and an APGAR score of 3 at one minute
What is the most appropriate initial management?
Airway suctioning and respiratory support
Unconjugated pathological clues
Jaundice in the first 24 hours
- ABO/Rh incompatibility ✅
- G6PD deficiency
- Hereditary spherocytosis
- Bruising/cephalohaematoma
- Crigler-Najjar syndrome
- Breastfeeding failure jaundice
Conjugated pathological clues
Prolonged jaundice: >14 days (term) or >21 days (preterm)
- Pale stools + dark urine
= Biliary atresia - Neonatal hepatitis
- TORCH infections
Neonatal sepsis causes what type of jaundice?
Unconjugated pathological jaundice
The most common type of jaundice in a baby, regardless of other factors, is what?
Physiological jaundice
It happens in most healthy newborns, typically:
1. After 24 hours of life
2. Days 2-14
3. Peaks days 3-5
How do you manage Jaundice in neonates?
- Phototherapy = mainly for pathological unconjugated. Potentially used for physiological too, but it would most likely resolve on its own after 14 days
- Exchange transfusions = pathological unconjugated
- . Split bilirubin (check conjugated/unconjugated) = used for conjugated pathological = if jaundice lasts longer than expected
= >14 days in term babies or >21 days in preterm babies
What is the most likely cause of a baby’s breathlessness?
Transient Tachypnoea of the Newborn
A female who was born 6 hours ago is experiencing respiratory distress. The baby girl was born via elective caesarean section at term. The pregnancy was uneventful, although her parents noticed that several hours after birth, she had been struggling to breathe. On examination, she is audibly grunting.
Chest inspection demonstrates tachypnoea, subcostal recession and nasal flaring. The infant has mild peripheral cyanosis. On auscultation, breath sounds are normal.
Her observations are as below: heart rate is 160 bpm, temperature is 37.1 °C and oxygen saturations are 92% in room air
What is the underlying pathophysiology causing this presentation?
transient tachypnoea of the newborn
A neonate is born at 36 weeks by elective caesarean section. Shortly after delivery, she develops tachypnoea and looks distressed. There was no meconium staining of the liquor. Chest x-ray shows hyperinflation of the lungs and fluid in the horizontal fissure
What is the most likely diagnosis?
Transient tachypnoea of the newborn (TTN)
