neonatal conditions Flashcards
common problems/conditions of preterm babies
hypothermia nutrition sepsis resp distress syndrome patent ductus arteriosis intraventricular haemorrhage necrotising enterocolitis
retinopathy of prematurity (ROP
describe the murmur heard in patent ductus arteriosus
continuous crescendo-decrescendo “machinery” murmur
continues during second heart sound - making difficult to hear
clinical features of respiratory distress syndrome
tachypnoea grunting intercostal recessions nasal flaring cyanosis
ground glass appearance on xray
management of respiratory distress syndrome
maternal steroid in anticipation of prematurity
–> dexamethasone or betamethasone
surfactant replacement
ventilation - bypap, cpap
intraventricular haemorrhage
bleeding inside or around ventricles in the brain
blood vessels in brain of premature infants not yet fully developed + fragile
intraventricular haemorrhage presentation
usually presents in first several days - not immediately
breathing pauses (apnoea)
decreased muscle tone + reflexes
weak suck
sleepy
intraventricular haemorrhage investigation + treatment
Ix = head US
prevention - pregnant women at risk early given corticosteroids, if bleeding risk given vit K pre delivery
necrotising enterocolitis
part of bowel becomes necrotic - can lead to perforation which can lead to peritonitis + shock
affects premature neonates
life threatening emergency
necrotising enterocolitis presentation
jaundice green bile vomit distended + tender abdomen intolerance to feeds absent bowel sounds blood in stool
necrotising enterocolitis investigation
abdo xray
dilated loops of bowel
bowel wall oedema = thickened bowel walls
pneumatosis intestinalis = gas in bowel wall
pneumoperitoneum = free gas in peritoneal cavity
gas in portal veins - liver
necrotising enterocolitis management
nil by mouth
IV fluids
total parenteral nutrition
antibiotics
surgical emergency
necrotising enterocolitis complications
perforation, peritonitis sepsis recurrence long term stoma short bowel syndrome
retinopathy of prematurity (ROP)
abnormal development of blood vessels in retina
typically affects <32weeks preterm
vessel development uncomplete + is stimulated hypoxia (in womb), stimulant removed at birth + if supplementary o2 given
what needs to be covered in the history in prolonged jaundice?
pale stools?
dark urine?
vomiting/loose stools
feeding/nutrition
Ix = split bilirubin level - is it conjugated?, also need to rule out biliary atresia
when is treatment indicated in NAS?
moderate to severe symptoms
3 finnegan scores > 8 measure 4hrs back
why might breastmilk be beneficial in NAS?
if the mum is still taking a bit of the substance will come through in the milk + help with withdrawal
breast milk generally good too - weight gain, antibodies
signs of hypoglycaemia in newborn
sleepy jitteriness pale floppy muscles poor feeding
contraindications to breastfeeding in mums with hep C?
nope - hep C blood borne transmission
cracked nipple though !!
investigations needed in mum with hep C
HCV RNA level determines vertical transmission to baby
4% transmission rate - depends on viral load
HIV infection increases risk of hep C transmission
biggest causes of being small for gestational age?
smoking !
others -
- pregnancy induced hypertension (PIH)
- infection
- genetic condtion
neonatal abstinence syndrome (NAS) scoring
modified finnegan neontal abstinence score sheet (NAS chart)
commence within 2hrs of birth
repeated every 3-4 hrs
for min of 4 days
substances that cause NAS
opiates methadone benzodiazepines cocaine amphetamines nicotine or cannabis alcohol SSRIs
NAS investigation
urine sample - check nonate for substances
