Neonatal Flashcards
What is cleft lip/palate the result of?
failure of fusion of maxillary and premaxillary processes
What are the causes of cleft lip/palate?
genetics
benzodiazepines
anti epileptics
rubella
What genetic disorders is cleft lip/palate found in ?
trisomy 18 (Edwards) trisomy 13 (Patau)
How can cleft lip/palate be prevented?
no smoking during pregnancy
folic acid 5mg/day
avoid AEDs
how is cleft palate managed before surgical repair?
special teats and feeding devices
dental prosthesis
When is cleft lip usually repaired?
1st week of life (cosmetic reasons)
When is cleft palate usually repaired?
several months of age
What are the complications of cleft lip/palate? what rx for this should be avoided and why
secretory otitis media
adenoidectomy as gap between normal palate and nasopharynx will exacerbate feeding problems and speech
What is meconium
faecal material that accumulates in the faetal colon
What is meconium aspiration syndrome?
resp distress in the newborn due to the presence of meconium in the trachea
What increases the risk of meconium aspiration syndrome?
post-term delivery (42w) Hx of maternal HTN Pre-eclampsia chorioamnionitis smoking substance abuse
what does meconium in the lung result in
mechanical obstruction
chemical pneumonitis
predisposition to infection
What are the complications of meconium aspiration syndrome?
may develop persistent pulmonary HTN of the newborn making it difficult to achieve adequate oxygenation despite high pressure ventilation
what is the rx of meconium aspiration?
artificial ventilation
what babies are more prone to getting necrotising enterocolitis and when?
preterm infants in the first few weeks of life
what is necrotising entercolitis?
inflammatory bowel necrosis
What are the features of necrotising enterocolitis?
→ Infant stops tolerating feeds
→ Milk is aspirated from the stomach
→ May be bile stained vomiting
→ Abdomen becomes distended and the stool sometimes contains fresh blood
What is a serious complication of necrotising enterocolitis?how is this detected?
perforation
detected on XR or transillumination of the bowel
What are ix for necrotising enterocolitis? what do they show?
XR:
distended loops of bowel
thickening of bowel wall
intramural gas (pneumatosis intestinalis)
What is rx for necrotising enterocolitis
- stop oral feeding (except probiotics)
- abs e.g. cefotaxime + vancomycin
- surgery for bowel perforation
When is jaundice normal in the neonate?
after 24hr to 14 days in term babies and 21 in poems (after this it becomes prolonged jaundice)
When is jaundice pathological in the neonate?
in 1st 24hrs of birth
What are the causes of jaundice in the first 24hrs of life
rhesus -ve disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
What are the causes of physiological neonatal jaundice?
- raised bilirubin due to short rbc lifespan
- reduced bilirubin conjugation due to hepatic immaturity
- absence of gut flora impeding elimination of bile pigment
- exclusive breastfeeding
What are the causes or prolonged jaundicE?
breastfeeding sepsis (UTI, TORCH) hypothyroidism CF biliary atresia (conjugated bilirubin, bile stools)
what is clinical jaundice classed as?
> 80µmol/L plasma bilirubin
What is a serious complication of neonatal jaundice?
KERNICTERUS as unconjugated bilirubin can be deposited in the brain (particularly basal ganglia) and cause it
How is the potentially serious complication of neonatal jaundice prevented?
measuring transcutaneous bilirubin levels in babies discharged early
What is kernicterus? what are the features?
acute bilirubin encephalopathy lethargy poor feeding hypertonicity opisthotonus (form of spasm in which head, neck and spine are arched backwards) shrill cry
What increases the risk of developing kernicterus?
bilirubin levels >360µmol/L
What are the long term consequences of kernicterus?
athetoid movements (slow, twisting, writhing movements)
deafness
reduced IQ
How is kernicterus prevented?
phototherapy
exchange transfusion
What are the investigations for jaundice presenting in the first 24 hrs of life?
FBC
blood film
blood groups (rare group incompatibility)
Coombs test
What is the direct Coombs test used for? What does a positive result mean/
confirming haemolytic anaemia
detects abs against rbc’s
positive means that there are abs detected that attack the persons rbcs
What is the indirect Coombs test used for? What does a positive result mean?
Used in prenatal testing or prior to blood transfusion means either: baby has haemolytic disease or donors blood isn't compatible it detects abs against foreign rbcs
what are the investigations for prolonged jaundice?
conjugated and unconjugated bilirubin DAT coombs TFTs FBC and blood film urine for MC&S and reducing sugars (microbial culture and sensitivity) U&Es and LFTs
When should babies be admitted to hospital w jaundice?
features of bilirubin encephalopathy jaundice appearing <24hrs of age or >7days unwell gestation <35w prolonged jaundice poor feeding pale stools and dark urine
When is no treatment required for neonatal jaundice?
well neonates
physiological jaundice
breastmilk jaundice
bilirubin below rx threshold
How does phototherapy work?
uses light energy to convert bilirubin to soluble products that can be excreted w/o conjugation
What are the SE of phototherapy?
reduced temp eye damage - cover them diarrhoea separation from mother fluid loss
