Neonatal/Infant Flashcards by lynne C

What are the causes of physiological neonatal jaundice?

Increased bilirubin production in neonates due to shorter RBC lifespan.
Decreased bilirubin conjugation due to hepatic immaturity.
Absence of gut flora impedes elimination of bile pigment.
Exclusive breastfeeding - especially if there are feeding difficulties –> reduced intake –> to dehydration
- -> reduced bilirubin elimination and increased enterohepatic circulation of bilirubin.

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What is the complication of neonatal jaundice?

Kernicterus - a permanent form of brain damage

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When is jaundice normal and abnormal?

Normal - after 24 hours of birth

Abnormal - within 24 hours of birth

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How long is prolonged jaundice?

Not fading after 14 days (term babies)

Not fading after 21 days (pre-term babies

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What are the causes of prolonged jaundice?

1) Breastfeeding
2) Sepsis (UTI, TORCH)
3) hypothyroidism
4) Cystic fibrosis
5) Biliary atresia ( if conjugated and pale stools)
6) Galactosaemia

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What are the causes of visible jaundice within 24 hours of birth?

1) Sepsis
2) Rhesus haemolytic disease
3) ABO incompatibility
4) Red cell anomalies

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What are the symptoms of kernicterus?

Features of acute bilirubin encephalopathy

1) Lethargy
2) Poor feeding
3) hypertonicity
4) Opisthotonus (Spasm of the muscles causing backward arching of the head, neck and spine)

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What are the treatments for jaundice?

Phototherapy

- Exchange blood transfusion in severe hyperbilirubinaemia.

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What is breast milk jaundice?

Jaundice that develops/ prolonged after 4-7 days of life,
Persists longer than physiologic jaundice
Has no other identifiable cause

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What is the probable cause of breast milk jaundice?

It was thought to be due to a complex steroid in breast milk, 3-alpha, 20-beta pregnanediol, which inhibits hepatic glucuronyl transferase but no definitive cause has been identified.

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What is haemolytic disease in newborn (HDN)?

Is an alloimmune condition that develops in a fetus, when the IgG molecules (one of the five main types of antibodies) produced by the mother pass through the placenta.

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What are the signs and symptoms of haemolytic disease in newborn (HDN)?

Jaundice
Yellow vernix
Combined cardiac failure (oedema, ascites)
Hepatosplenomegaly
Progressive anaemia
Bleeding
CNS signs
kernicterus

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What is hydrops fetalis?

Accumulation of fluid, or edema, in at least two fetal compartments.
Locations can include:
- subcutaneous tissue/scalp
- pleura (pleural effusion)
- pericardium (pericardial effusion)
- abdomen (ascites)

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What is neonatal hypoglycaemia?

serum glucose concentration < 2.2 mmol/L in term neonates or < 1.7 mmol/L in preterm neonates.

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What are the risk factors for neonatal hypoglycaemia?

Prematurity
Small for gestational age
Maternal diabetes
Perinatal asphyxia (body deprived of O2)

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What are the common causes of transient neonatal hypoglycaemia?

Deficient glycogen stores (prematurity, small for dates, perinatal asphyxia)
Delayed feeding
Hyperinsulinemia

What are the common causes of persistent neonatal hypoglycaemia?

Hyperinsulinism
Defective counter-regulatory hormone release (growth hormone, corticosteroids, glucagon, catecholamines)
Inherited disorders of metabolism (eg, glycogen storage diseases, disorders of gluconeogenesis, fatty acid oxidation disorders)

What are the common signs of neonatal hypoglycaemia?

Tachycardia
Cyanosis
Seizures
Apnea

Define small for dates (small for gestational age)

Refers to birth weight,

Infant born with a birth weight less than the 10th centile.

What are the symptoms of neonatal intestinal obstruction?

Polyhydramnios in uterus
Bilious vomiting
Failure to pass meconium (1st day of life)
Abdominal distension

What are the risk factors of SGA?

Low pregnancy weight
Under-nutrition
Severe anaemia
Substance abuse

What are the causes of SGA?

Main cause: Poverty / poor social support

Malformation twins
Congenital infection
Placental insufficiency
Maternal heart disease
Smoking
Diabetes

Define

1) low birth weight at birth,
2) very low birth weight
3) extremely low birth weight

Low Birth weight: < 2500g
Very low birth weight: < 2000g
Extremely low birth weight <1500g

Classification of newborn infant according to gestational age.
Extremely preterm, preterm, term, post-term

Extremely preterm: < 28 weeks
Preterm: <37 weeks
Term 37 - 42 weeks
Post term > 42 weeks

What is necrotising enterocolitis (NEC)? When does it usually occur?

An inflammatory bowel necrosis | First 2 weeks of life

What are the main risk factors of NEC? | What are other causes of NEC?

``` Main risk factors - Prematurity - Low birth weight Other causes: - Enteral feeds - Bacterial colonisation - Mucosal injury ```

What are the symptoms and signs of NEC?

- Feeding difficulties - Abdominal distension - Abdominal tenderness - Vomiting - A little PR blood or mucus - Gas in the gut wall seen on x-ray ( Pneumatosis intestinalis)

- Affect pre-term babies - Most common in second week after birth - Abdominal tenderness - Abdominal distension - Vomiting - Blood and mucus in stool - One of the most common neonatal surgical emergency

Necrotising enterocolitis

At what stage of gestation does meconium aspiration occur?

Term or near term babies

What are the symptoms of meconium syndrome?

- Obvious presence of meconium or dark green staining of the amniotic fluid. - Green or blue staining of the skin at birth. - Baby appears limp, with a low Apgar score. - Breathing is rapid, laboured, or absent. - Signs of postmaturity (eg, peeling skin) are present. - Fetal monitor may show bradycardia.

- Fetal monitor may show bradycardia. - Baby appears limp, with a low Apgar score. - Breathing is rapid, laboured, or absent. - Signs of postmaturity (eg, peeling skin) are present. - Obvious presence of meconium or dark green staining of the amniotic fluid. - Green or blue staining of the skin at birth.

Meconium aspiration syndrome

What are the complications of meconium aspiration syndrome?

- Airway obstruction - Surfactant dysfunction - Inflammation - Lung oedema - Pulmonary vasoconstriction and bronchoconstriction.[1]

Define meconium aspiration syndrome.

A respiratory distress that develops shortly after birth, with radiographic evidence of aspiration pneumonitis and presence of meconium-stained amniotic fluid.