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
What is talipes usually secondary to?
Oligohydramnios
How do you manage talipes?
splint/strapping for 3 months. If persists >3 months operative reduction is required.
What is the minimum level of billirubin (micro-mols/L) in the blood required for a diagnosis of neonatal Jaundice?
> 80micro-mols/L
What is the cause of physiological neonatal Jaundice and when would you be concerned there is a pathological cause?
Immaturity of the liver - low levels of liver enzymes and increased RBC turnover as HbF –> HbA
If jaundice occurs <24 hrs or >14 days this would be worrying
What is kernicterus?
When bilirubin >360micro-mols unconjugated bilirubin stains the basal ganglia –> acute encephalopathy with irritability, high pitched cry or v.sleepy/coma
What are the long-term complications of kernicterus?
Neurotoxic damage to the basal ganglia –> nerve deafness, athetoid cerebral palsy and mental retardation
What are the pre-hepatic causes of neonatal jaundice?
Rh/ABO incompatibility, breat-milk jaundice, bacterial infection, bruising, internal haemorrhage, prematurity, hypothyroidism
What are the hepatic causes of neonatal jaundice?
Neonatal heaptitis, CMV, congenital disorders e.g. Wilson’s disease
What would test for Rh incompatibility?
Coombes test
What would indicate there is an obstructive (post-hepatic) cause of jaundice?
Pale stools - caused by biliary atresia. Early recognition and management is essential
At what levels of bilirubin would you treat jaundice?
> 250micro-mols at 48 hrs = phototherapy
>350micro-mols at 48 hrs = exchange transfusion
Opthalmia neonatorum
Conjunctivitis in first 28 days
Most common cause = chlamydia, then gonorrhoea
