Neonatal Medicine Flashcards
features of respiratory distress of the newborn
tachypnoea (>60 breaths/min), grunting, intercostal recession, nasal flare, cyanosis
what is meconium aspiration syndrome?
how is it investigated?
how is it treated?
Aspiration of meconium during delivery causing pneumonitis
Chest x ray – patchy infiltrates
Tx : surfactant
what causes persistent pulmonary hypertension of the newborn (PPHN)
high pulmonary vascular pressure causing left-right shunting + poor oxygenation
tx of PPHN
nitric oxide (pulmonary vasodilator)
chest xray findings in heart failure secondary to congenital heart disease
cardiomegaly and pulmonary oedema
ground glass appearance on CXR
acute respiratory distress syndrome
tx of acute respiratory distress syndrome
steroids
exogenous surfactant
respiratory support (Invasive ventilation/continuous positive airway pressure/oxygen)
what causes transient tachypnoea of newborn
delay in resporption of lung fluid
what is seen on CXR in transient tachypnoea of newborn
how is it treated?
fluid in horizontal fissure
resolves spontaneously in a few days
what is a patent ductus arteriosus (PDA)
failure of ductus arterious to close between descending aorta and pulmonary trunk leading to left-right shunting and fluid overload – heart failure
features of PDA
continuous machine like murmur
bounding pulse
wide pulse pressure
what closes PDA in majority of cases?
indomethacin - inhibits prostaglandin synthesis
what is given if surgical repair required for congenital heart defect?
prostaglandins- keep duct open until surgical repair
organism responsible for conjunctivitis in newborns
chlamydia
what does jaundice within 24hrs indicate
PATHOLOGY
- rhesus / ABO incompatibility
- glucose 6 phosphate deficiency
- hereditary spherocytosis
when are rhesus -ve mothers offered prophylactic anti- D
28 + 34 weeks
15000 units
what events in pregnancy would a rhesus -ve mother get anti-D
ectopic pregnancy
amniosentisis
trauma e.g. any vaginal bleeding/miscarriage
dose of anti-D given after delivery to rhesus -ve mother
500 units
when should anti-D not be given after delivery
if Coombs test +ve / infant bilirubin raised
it is too late
what is G6PD
lack of glutathione which combats oxidative stress
- intravascular haemolysis
inheritance of G6PD
X linked recessive
what is seen on blood film of G6PD
heinz bodies
most common cause of jaundice day 2-14
physiological
presentation of cephalohaematoma
swelling of head 24-48 hours post birth
- clear edges that end at suture lines
- most common parietal region
- discolouration of the swollen site due to presence of coagulated blood – may need transfusion/phototherapy if significant
- can take months to resolve
presentation of caput succedaneum
swelling of head present at birth
- diffuse boggy swelling that crosses suture lines
- typically seen at vertex
- resolves within days
most common cause of meningitis in neonate
Group B strep
ratio of compression to ventilation in newborn resuscitation
3:1
death in the neonatal period is defined as what ?
death in first 28 days of life
what injection is given shortly after birth + why?
One off IM Vit K injection to prevent haemorrhage disease of the newborn
when is the heel-prick test performed
between 5 - 9 days old
what is the heel-prick test looking for
Cystic fibrosis
- if raised immunoreactive trypsinogen (IRT) the baby will then get a sweat test
causes of hypotonia in a neonate
sepsis
hypothyroidism
Prader-Willi syndrome
most common causative organism in neonatal sepsis
Group B strep
steps of neonatal resus
- dry baby
- assess tone, breathing, HR
- open airway – 5 inflation breaths
- 3:1 compressions to breaths
what hearing test is offered to newborns?
what test is then offered if findings are abnormal?
otoacoustic emissions test
- offered auditory brainstem response if abnormal
features of shaken baby syndrome
retinal haemorrhages
subdural haematoma
encephalopathy
causes of pulmonary hypoplasia
pulmonary hypoplasia = underdeveloped lungs
causes
- oligohydramnios
- congenital diaphragmatic hernia
signs of a congenital diaphragmatic hernia
scaphoid (concave) abdomen
displaced apex beat
decreased air entry
what is meconium aspiration syndrome
respiratory distress as a result of meconium in the trachea
increased risk if:
post term
lateral HTN / pre-eclampsia
presentation of choanal atresia
cyanosis when feeding that improves when baby cries
features of fetal alcohol syndrome
IUGR microcephaly microganthima smooth / absence philtre thin lip short palpebral fissures
