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Paediatrics > Neonatal > Flashcards

Neonatal Flashcards

1
Q

3 definitions of a premature baby

A

Small for Gestational Age
Intrauterine Growth Restriction
Hypotrophy

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2
Q

2 types of hypotrophy in premature babies

A

Symmetric- all values the same

Asymmetric

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3
Q

Causes of prematurity

A

Maternal - smoking, pre-eclampsia/toxaemia
Foetal - Chromosomal (Edward’s), Infection (CMV)
Placental
Twin pregnancy
- Recipient and donor - receipient has circulation overload

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4
Q

Common problems in premature babies

A 
Perinatal hypoxia
Hypoglycaemia
Hypothermia
Polycythaemia
Thrombocytopenia
Gastrointestinal (feed, NEC)
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5
Q

Why is the gut more susceptible to ischaemia in premature babies?

A

Sympathetic compensation to vital organs

Blood flow to skin, gut and muscle implicated

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6
Q

What can happen if the gut wall becomes ischaemic in premature babies?

A

Perforation

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7
Q

Long term issues for premature babies

A

Hypertension
Reduced growth
Obesity
Ischaemic Heart Disease

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8
Q

What causes respiratory distress syndrome in the newborn>

A

Not enough surfactant

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9
Q

At what stage does a baby begin producing surfactant?

A

24-28 weeks of pregnancy

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10
Q

When might respiratory distress syndrome occur in babies who were delivered at term?

A

Mother is diabetic
Baby is underweight
Lungs not developed

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11
Q

Symptoms of Newborn Respiratory Distress Syndrome?

A

Cyanosed - blue lips, fingers, toes
Rapid, shallow breathing
Flaring nostrils
runting when breathing

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12
Q

Investigations for Newborn Respiratory Distress Syndrome

A

Physical examination
Bloods - exclude infection
Pulse oximetry
Chest x-ray

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13
Q

How will lungs of a premature baby with NRDS appear on x-ray?

A

Cloudy

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14
Q

Treatment for Newborn Respiratory Distress Syndrome

A

Surfactant
Early extubation
Non-invasive support
Minimal ventilation (low tidal, good inflation)

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15
Q

Complications of Newborn Respiratory Distress Syndrome

A

Pneumothorax
Bleeding
Developmental issues due to hypoxia - learning diffculties, difficulty with hearing, vision, movement problems
Bronchopulmonary dysplasia

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16
Q

Aetiology of bronchopulmonary dysplasia

A

Volume trauma in lungs leads to inflammatory changes
Scarring occurs from tissue repair
Scarring occurs from surfactant or steroids to treat NRDS
Causing atelectasis

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17
Q

What is atelectasis?

A

Loss of lung volume, failed expansion, (collapse)

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18
Q

Treatment of bronchopulmonary dysplasia?

A

Patience
Nutrients
Steroids

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19
Q

Treatment for apnoea/irregular breathing/desaturations?

A

Caffeine

N-CPAP

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20
Q

How is intraventricular haemorrhage prevented in premature babies?

A

Antenatal steroids

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21
Q

Treatment of intraventricular haemorrhage

A

Symptomatic

Drainage

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22
Q

What changes are seen at Day Of Life 7 in periventricular leukomalacia? (PVL)

A

Cystic changes

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23
Q

What DOL will show significant changes from DOL7 in periventricular leukomalacia (PVL)?

A

DOL21 -significantly worse changes

24
Q

Cause of oedema in lungs in premature baby?

A

Patent Ductus Arteriosus

25
Q

How can a patent ductus arteriosus give rise to fluid in the lungs?

A

Additional pulmonary circulation, over perfusion of lungs

26
Q

Other complications of a patent ductus arteriosus

A

Reduced systemic circulation due to overperfusion of lungs leads to ischaemia
Worsening respiratory problems
Fluid retention ( low renal perfusion)
GI symptoms

27
Q

How does necrotising enterocolitis occur (NEC)?

A

Inflammatory and ischaemic changes lead to a necrotic bowel leading to perforation

28
Q

Treatment of necrotising enterocolitis?

A

Surgery
Antibiotics
Parenteral nutrition (through vein)

29
Q

Definition of premature baby

A

Delivered before 37 weeks gestation

30
Q

Outcomes of premature babies

A

1/3 will die
1/3 normal to mild disability
1/3 moderate to severe disability

31
Q

At what week does the cardiovascular system develop in the foetus?

A

Towards end of 3rd week

32
Q

At what week is a heartbeat present in the foetus?

A

4th week

33
Q

Which days after fertilisation are critical for development of the foetus?

A

Days 20-50 after fertilisation

34
Q

Through which vessel does the foetus receive oxygenated blood?

A

Umbilical vein - Ductus venosus

35
Q

How does blood enter the Aorta in the foetus>

A

Foramen ovale to left atrium, to left ventricle to aorta

36
Q

How does blood enter the pulmonary artery in the foetus?

A

Right ventricle, to pulmonary artery, via patent ductus arteriosus to aorta

37
Q

What is the SaO2 in a foetal body?

A

60-70%

38
Q

What is the function of the ductus arteriosus?

A

Protects lungs from circulatory overload
Allows the right ventricle to strengthen
Carries low oxygen saturated blood

39
Q

Function of the ductus venosus?

A

Foetal blood vessel connecting umbilical vein to IVC

Carrie oxygenated blood

40
Q

How is the blood flow regulated in the ductus venosus?

A

Via sphincter

41
Q

What is the normal heart rate of a full term newborn?

A

120-160 beats per minute
Tachycardic > 160
Bradycardic <100

42
Q

What is the normal respiratory rate of a full term newborn?

A

30-60 per min

Periodical breathing

43
Q

What is the normal blood pressure of a full term newborn?

A

At 1 hour 70/44
At day One : 70 +/-9 over 42+/- 12 diastolic
Day Three : 77+/- 12, over 49 +/- 10 diastolic

44
Q

Around which days are signs of physiological jaundice common?

A

DOL 2-3, disappear DOL 7-10 up to DOL 21 in preterm infants

45
Q

What percentage of babies develop visible jaundice?

A

60% term

80% preterm

46
Q

What is kernicterus?

A

High levels of bilirubin

Can cross BBB leading to irreversible changes

47
Q

Treatment for physiological jaundice

A

Blue light

converts bilirubin to water soluble form - increasing bilirubin oxidation

48
Q

3 features of increased fluid loss in the kidney in premature infants

A

Slower GFR
Reduced Na absorption
Decreased ability to concentrate/dilute urine

49
Q

Reason for increased insensible water loss in premature infants

A

Immature skin

Breathing

50
Q

At DOL 7, what percentage of previous production in the uterus is the production of red blood cells in the infant?

A

10%

51
Q

What is the haemoglobin level normally at birth?

A

12-20 g/l

52
Q

What is the haemoglobin by week 11 in the infant?

A

11.4 g/l

53
Q

What is increasingly produced between week 10 and week 20 in the infant?

A

Erythropoeitin

54
Q

What is the haemoglobin level by week 20?

A

12 g/l

55
Q

3 causes of anaemia in prematurity

A

Reduced erythropoiesis
Infection
Blood letting

Paediatrics (10 decks)

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