Neonatal Conditions Flashcards
What does phototherapy do in a newborn with jaundice?
UV light breaks down bilirubin to biliverdin which is excreted in the kidneys
What are the main causes of unconjugated hyper-bilirubinaemia?
- Prematurity
- Rhesus incompatibility
- ABO incompatibility
- Infection
- Brusing
- Hypothyroidism
- Breast milk jaundice
- Physiological
What are the main causes of conjugated hyper-bilirubinaemia?
- Hepatitis
- Biliary atresia
- CF
- Choledocal cyst
What tests would you perform in neonatal jaundice?
- SBR
- FBC
- Group and Coomb’s
- Thyroid function
- TORCH screen
- Liver ultrasound
- Infection screen
- Liver isotope scan
- Coagulation
What would you need to obtain for a history of neonatal jaundice?
- At what age did it begin - <24hrs of birth requires investigation
- Risk factors for infection
- Family history - CF, spherocytosis
- Is the baby alert, active and feeding well or the opposite?
How would you perform an examination on a jaundiced baby?
- Extent of jaundice
- Other features of congenital viral infection: anaemia, petechiae, hepatosplenomegaly
- Dehydration - established breast-feeding?
- Signs of other infection
- Stool - pale stool = obstructive jaundice
What steps would you take in order to manage neonatal jaundice?
- Identify cause and severity of jaundice
- <24hrs birth, SBR, FBC, TORCH and then phototherapy if SBR > treatment line or rising fast
- > 24hrs: low SBR = observation. high SBR = Blood tests then phototherapy
- Prolonged jaundice - total and conjugated SBR = blood tests plus obstruction investigations. Also coagulation screen and Vit K supplements
What is Kernicterus?
Deposits of unconjugated bilirubin in the basal ganglia of the brain.
- Causes acute encephalopathy with irritability, high-pitched cry or coma
- Neurotoxic damage can lead to athetoid cerebral palsy
How would you treat neonatal jaundice?
- Phototherapy
- Transfusion if Rh to remove mother’s IgG antibodies from circulation
What is breast milk jaundice?
- Inhibition of liver conjugation enzymes by substances in breast milk
- Rule out all other causes before this
What is biliary atresia?
- Rare condition
- Absence of intra- or extrahepatic bile ducts
Develop conjugated hyperbilirubinaemia
What is the Kasai Procedure?
- Hepatoporto-enterostomy
- If biliary atresia detected within first 6 weeks of life
- Surgical method to bypass biliary ducts
Name 3 risk factors for birth Asphyxia
- Cord prolapse/impaction
- Placental abruption
- Drop in maternal BP
What can severe asphyxia cause?
Hypoxic Ischaemic Encephalopathy
Name 5 types of birthmark?
- Stork mark
- Port wine stain
- Strawberry nevus
- Mongolian blue spot
- Pigmented nevus
What is classed as a premature birth?
Born before 37 weeks
What is the minimum birth weight a baby should be before it is classed as being low?
<2500g
Give 4 risk factors for a premature birth
- Young maternal age
- Infection
- Maternal illness
- Cervical incompetence
What main respiratory problem is caused by prematurity?
Respiratory distress syndrome
At which week of gestation does the suck reflex develop?
34 weeks
What brain problems can be caused from prematurity?
- Hypoxic-iscaemic encephalopathy
- Intraventricular haemorrhage
- Periventricular leucomalacia
What is the most common cause of cerebral palsy?
Periventricular leucomalacia
What causes respiratory distress syndrome?
Surfactant deficiency
How would you conservatively manage GORD?
- Less volume of feeds, more often
- Position at 30degrees
What are the complications of GORD?
- Oesophagitis
- Failure to thrive
- Respiratory problems
How would you medically manage GORD?
- H2 receptor antagonist - ranitidine
- PPI - omeprazole
- Motility stimulants - domperidone
- Feed thickener
- Paste to give before breast feeding
