Neonatal Flashcards
What are the causes of hypoxic ischaemic encephalopathy?
- Inadequate blood flow/gas exchange across placenta - placental abruption, cord compression
- Poor maternal perfusion - hypo/hypertension
- compromised foetus - anaemia, IUGR, failure to breathe at birth
- Inborn error of metabolism / kerniticus
Describe mild symptoms of hypoxic ischaemic encephalopathy
Irritable, staring eyes, hyperventilation, v. sensitive to stimulation
How can you tell mild hypoxic ischaemic encephalopathy is worsening?
moderate = abnormal tone/posture, feeding refusal, +/- seizure Severe = unresponsive to pain, prolonged seizures
What type of cerebral palsy can be a complication of hypoxic ischaemic enecephalopathy?
Athetoid - damage to basal ganglia - hypotonia, irregular unwanted movements
Management of hypoxic ischaemic encephalopathy?
Fluids to correct hypotension
Respiratory support - high flow oxygen
Seizures = benzodiazepines/anticonvulsants (buccal/IV)
Where are ‘stork bites’ normally located
Naevus flammeus are normally found on the face - eyelids, forehead and neck - usually fade
What is erythema toxicum?
a rash (white pin-point papules) around trunk that occurs 2-3 days after birth - 50% of newborns - resolves after 2 weeks - do not use oitnments
What is a mongolian bluespot?
Birth mark in sacral region - normally african/asian - most disappear after few years
What is a port-white stain?
red/purple lesion on face - caused by vascular abnormality, persists and grows with child - may refer for laser treatment
What is a cavernosus haemangioma?
aka strawberry naevus - bright red lesion that appears after 3 weeks - usually fades years later
For haemolytic disease to occur what Rh status does the mother need to be?
Negative - also requires previous pregnancy with Rh+ve baby (rarely caused within same pregnancy with threatened miscarriage, amniocentesis etc.)
Given anti-D prophylactically during pregnancy
What are the symptoms/signs of haemolytic disease?
Hydrops foetalis - severe oedema and hepatomegaly + Jaundice, yellow vernix, kernicterus, anaemia, congestive heart failure
How is it the baby managed if the haemolytic disease?
Aggressive phototherapy
Exchange transfusion
Follow-up for late onset anaemia if all the maternal Abs haven’t been flushed out
What is a cephalohaematoma?
Bleeding within periosteum (superficial to the skull) - resolves within a few weeks
When should anti D abs be given to a Rh -ve pregnant woman?
500U 28 weeks and a booster at 34 weeks
If baby delivered is Rh +ve give postnatally as well
In broad terms what is the management of prematurity <32weeks?
Transfer to specialized neonatal unit
Humidified and warm chamber - prevents fluid loss
Support with oxygen
Give surfactant and steroids to promote lung development
Supplement feeds with formula
What long-term complications can arise from prematurity?
Intra-ventricular haemorrhage (IVH) Retinopathy of prematurity (ROP) Cerebral palsy PDA Necrotising Enterocolitis Chronic lung disease
What is RDS and what is it’s cause?
Respiraotry distress syndrome - affects most babies born <28 weeks (M>F)
Cause = surfactant dificiency
What are the symptoms/signs of RDS?
Tachypnoea
Increased work of breathing - grunting, nasal flaring
cyanosis
Decreased O2 sats
What would you see on a CXR in RDS?
Ground glass appearance
Management of RDS?
Surfactant ia endotracheal tube
O2 therapy - vapotherm
Corticosteroids - given antenatally to promote lung maturity
What is the definition of small for gestational age?
<10th centile for height or weight
What is clifford’s syndrome?
Babies affected by IUGR but are >10th centile
What is talipes (equinovarus)?
aka clubfoot - Inversion, heel adducted relative to abducted forefoot
‘Equinus’ - foot cannot be dorsiflexed or everted in normal range
