Neonatal and newborn Flashcards
Why do approximately 60% of newborns get jaundice?
- There is a marked physiological release of bilirubin from the breakdown of RBCs due to the high RBC concentration at birth
- The RBC lifespan of newborn infants is about 70 days rather than the usual 120 days
- Hepatic bilirubin metabolism is less efficient in the first few days of life.
Why is it important to recognise and where necessary treat neonatal jaundice?
Too high levels of unconjugated bilirubin can be deposited in the brain, causing Kernicterus.
What are some causes of conjugated bilirubin jaundice?
Usually due to neonatal liver disease e.g. Biliary atresia or hepatitis. Also TORCH infections, hypothyroidism.
What is classed as prolonged jaundice?
Term babies: > 14 days
Preterm babies: > 21 days
What are some causes of early jaundice (<24 hours; almost always pathological)?
Sepsis. ABO incompatibility. Haemolytic disease of the newborn (Rhesus). TORCH infections. G6PDH deficiency. Spherocytosis.
How is neonatal jaundice managed?
If a neonate’s bilirubin level (from transcutaneous bilirubinometer) is above the treatment threshold graph, Phototherapy to convert unconjugated bilirubin to harmless water soluble pigment excreted in urine. If levels are very high, exhange transfusion may be indicated
How is hypoxic ischaemic encephalopathy managed?
Supportive measures as needed (e.g. resp support, anticonvulsants for seizures, fluid restriction for renal impairment, inotropes, correcting hypoglycaemia and electrolyte disturbance). Cool to 33-34 degrees for moderate/severe HIE to reduce death and disability.
How can you differentiate cephalhaematomas from caput succudeneum?
Cephalhaematomas do not cross skull sutures whereas caput succedenum do
Where are Mongolian blue spots commonly seen?
Sacral/buttocks area
What condition may a baby have if several patches of cafe au lait spots > 0.5cm are present?
Neurofibramotosis
What test is used to help detect the cause of haemolytic anaemia in a newborn?
Direct antiglobulin test/Coomb’s test
How is respiratory distress syndrome managed?
If preterm delivery is anticipated, glucocorticoids are given to the mother to stimulate fetal surfactant production. Surfactant therapy given to the neonate via tracheal tube. Oxygenation and mechanical ventilation may be required.
What is the cut off for defining a Small for Gestational Age baby?
< 10th centile birthweight
What is the difference between symmetrical (proportional SGA) and asymmetric (disproportional SGA) IUGR?
Symmetrical: All growth parameters are symmetrically small. Suggests fetus affected from early pregnancy - may be due to a chromosomal abnormality or constitutionally small
Asymmetric: Length and head circumference not abnormally small but weight may be. Usually due to IUGR resulting from late pregnancy insult e.g. pre-eclampsia.
