Neonatal 2 Flashcards
What does an APGAR consist of? and what’s a normal score/
Appearance Pulse Grimace (reflex irritability) Activity (muscle tone) Respiratory rate
Normal score is 7-10
done at 1,5 and 10 minutes
What are the symptoms of hypoglycaemia in a new born and what are some causes?
<2.6mmol in neonate
Hypotonia Lethargy Jittery Seizures Spells of Apnea
Causes:
- maternal diabetes
- low glycogen store (restricted growth)
Treatment:
- 2.5ml/kg Dextrose 10%
followed by infusion
What is the aimed for blood glucose levels in a neonate?
2.6mmol
List some risk factors for SIDS and some things that can be done to reduce the risk:
Sleeping on front
Smoking (maternal, around baby)
Reducing risk:
- sleep on back
- remove pillows
- Avoid over heating
- breast feed
Why is female virtualisation very important to check in a newborn?
Can be a sign of congenital adrenal hyperplasia which can result in adrenal crisis as they don’t produce glucocorticoids
If there is a positive Barlow and Ortonlani what is the next investigation?
Ultrasound
What are the main causes of cyanotic heart disease?
- Truncus arteries
- Transposition of great vessels
- Tricuspid Atresia
- Tetrology of Fallot
- Total anomaly of pulmonary venous return
*this is not order, just numbers help remember
In a jaundice baby what bloods do you want?
Conjugated bilirubin/ total bilirubin Direct Coombs test FBC Reticulocytes Blood film G6PD screen \+ Infection screen
What two main question do you want to ask a mother of a baby who is >2 weeks old with jaundice?
Pale stools?
Dark urine?
*helps establish biliary atresia
How often should a baby be feeding?
Every 3-4 hours
Is subconjunctiva haemorrhage normal in a new born?
Yes this can be completely normal
- needs documentation in the red book though
What is the rash called which is benign and looks like little bits of pus underneath the skin?
Erythema toxicum
- baby acne
What is the most common organism to cause early onset neonatal sepsis and what are some other common organisms?
Group B strep - Strep Agalalatie
E.Coli
Listeria monocytogenes
List the common risk factors which suggest neonatal sepsis: and what should be done if one of these risk factors is identified?
Preterm birth
Maternal colonisation of Group B strep
Rupture of membranes > 18 hours
Maternal fever
Previous Group B infection in a baby from previous birth
Risk factor:
- start prophylaxis antibiotics - IV Benzylpenicillin
- Perform examination and investigations into infections
What is the main x-ray feature of respiratory distress feature in the newborns?
Ground glass appearance
Why is physiological jaundice so common in neonate?
Higher about of Hb
RBC has 70 day overturn
Liver enzyme immaturity
*some 60% of babies have jaundice
When does biliary atresia need to be operated on by?
< 6 weeks
What investigations should be done into a jaundice baby <24 hours old? and what are the side effects of UV phototherapy?
Bloods:
- Bilirubin level (conjugate/ unconjugated?)
- FBC - anaemia/ infection?
- Blood cultures - infection?
- Direct coombs test
Side effects of UV:
- retinal damage (should be covered)
- insensible fluid loses
- removed from mother
- diarrhoea
What are the signs of respiratory distress of the newborn?
Cyanosis
Grunting
Sub-costal recession
Poor feeding
When taking sats of a baby - where do you take them and why?
Right arm
- it is pre-ductus arterioles and thus gives you sats occurring in the lungs.
Often you can do a pre- and post ductus sats
List some causes of a floppy baby:
Central nervous system:
- HIE
- Trisomy 21
- CNS infection
- Metabolic disease
- SMA
- hypoglycaemia
Peripheral nervous system:
- Congenital Myasthenia gravis
- Duchene muscular dystrophy
- Amino-glycoside toxicity
What are the complications of Down’s syndrome?
Early:
- Congenital heart disease (AVSD)
- Hirschsprung
- Duodenal atresia
- hypothyroidism
Later:
- ALL
- Early onset Alzheimer’s
- Learning difficulties
- Epilepsy
- Conductive hearing loss
- Alanto-axial instability
What are some of the features of hypothyroidism in a baby and what investigations are important?
Symptoms:
- poor feeding
- lethargy
- constipation
- prolonged jaundice
Features:
- Macroglossia
- coarse facies
- hypotonia
- Bradycardia
- goitre
Investigations:
*Guthrie test should of picked up if low TSH then:
- TFTs
- Nuclear scan of thyroid (to assess exact type)
- Pure tone audiometry (many develop sensory neuro hearing loss) - Pendred syndrome
Treatment:
- levothyroxine (started before 14 days ideally)
- follow up to assess growth and TFTs
What is the most common enzyme defect in congenital adrenal hyperplasia? what are the two main presentations of adrenal hyperplasia?
21- hydroxylase deficiency
2 main presentations:
- salt losing crisis - seen in neonates
- Virilisation of females
- precocious puberty in males
