Neonatal Medicine Flashcards
What is neonatal respiratory distress syndrome?
A syndrome in premature infants caused by developmental insufficiency of surfactant production and structural immaturity of the lungs
Surfactant deficiency leads to widespread alveolar collapse and inadequate gas exchange
How does neonatal respiratory distress syndrome present?
Symptoms at deliver - up to 4 hours afterwards
Tachypnoea, Increased work of breathing, expiratory grunting and cyanosis if severe
Prognosis of neonatal respiratory distress syndrome has improved dramatically in recent years, why is this?
Development of postnatal surfactant therapy.
Describe transient tachypnoea of the newborn.
Term infants
Caused by a delay in the resorption of lung liquid, more common after birth by c-section
Usually settles within the first day/few days of life
May require ambient O2
How many babies pass meconium before birth?
Between 8-20%
What effect does meconium aspiration have on the lungs?
Mechanical Obstruction of the airways
Chemical Pneumonitis
Predisposes to infection
What other lung complications are associated with meconium aspiration
Pneumothroax
Pneumomediastinum
Persistant Pulmonary Hypertension of the Newborn
What events during/shortly after the birth can lead to Hypoxic Ischaemic Encephalopathy
Placenta - abruption, prolonged uterine contractions, poor maternal blood flow
Cord - Prolapse, Compression
Compromised Fetus - Anaemia, IUGR
Failure to breathe at birth
When do the clinical manifestations of HIE present?
Can be immediately if primary neuronal death
Can be up to 48 hours if reperfusion causing injury = secondary neuronal death
If you suspect delayed neuronal death, how might you prevent it?
Mild Hypothermia
HIE can be graded on severity, what is the prognosis for each severity?
Mild - complete recovery expected
Moderate - If have fully covered on neuro exam and feeding normally by 2 weeks, should make a full recovery, if not full recovery is unlikely
Severe - mortality of 30-40%, Of survivors 80% have neurodevelopmental disability, particularly cerebral palsy
Describe early onset neonatal sepsis.
Describe late onset neonatal sepsis.
> 48 hours after birth
The source of the infection is from the infants environment, NICUs are high risk environments especially with indwelling central lines, tracheal tubes etc…
What two types of babies are at risk of symptomatic hyoglycemia at birth?
Growth restricted and preterm infants have poor glycogen stores
Infants of diabetic mother has significant glycogen stores, but hyperplasia of the islet cells of the pancreas causes high insulin levels - leading to hypoglycemia
What symptoms might a neonate with hypoglycemia have?
Irritability
Drowsiness
Seizures
Apnoea
