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neonatal medicine Flashcards

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1
Q

Cause of HIE

A 
Caused by reduced cardiac output essentially
Failure of gas exchange across placenta:
rupture, abruption, prolonged contractions
interuption of umbilical blood flow:
cord compression, shoulder dystocia
compromised foetus:
anaemia, IUGR
failure of cardio-resp adaptation:
don't start breathing
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2
Q

What are three clinical grades of HIE

A

mild:
irritable and excessive response to stimuli
increased reflexes
may be staring

Moderate:
slight abnormalities of tone and posture
increased reflexes
NOT FEEDING
may have seizures

severe:
no reflexes, unresponsive to pain
no tone or movement

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3
Q

Mx of HIE

A 
mild:
resuscitate (ABC)
therapeutic hypothermia
ventilate 
cardiovascular support (consider inotropes)
fluids 
moderate:
same as above
tx seizures
normoglycaemia
GIVE VIT K 
monitor liver
withhold feeding for 48 hours (at increased risk of NEC)H

severe:
as above +
cranial US to exclude other causes of haemorrhage
MRI brain

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4
Q

What are some injuries during birth

A

extracranial haemorrhage
caput succadeneum - bruising + oedema of presenting part BEYOND margins of skull bones
cephalhaematoma - haematoma below periosteum (confined to sutures)
Nerve palsies from breech birth
humerus+ clavicle fractures from breech birth

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5
Q

Signs of RDS

A 
see at birth or within 4 hours
Tachypnoea (>60)
subcostal recession w/ nasal flaring
grunting
cyanosis if severe
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6
Q

Mx RDS

A

ABC resus
resp support:
headbox/nasal cannulae
OR nasal continuous positive airway pressure OR positive pressure ventilation if baby doesn’t meet any of those criteria

Fluids
IV Abx (BSA)
URGENT CXR

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7
Q

How does pneumothorax happen

A

in ventilated RDS babies air leaks into pleural cavity

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8
Q

Mx pneumothorax

A

Small - observation + 100% o2
needle drainaige if urgent
chest drain - for all tension pneumothorax

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9
Q

what are causes of pneumothorax in term babies

A

Secondary to:
meconium aspiration
RDS
ventilation

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10
Q

Why are neonates prone to hypothermia

A

Thin skin
high SA:vol
no subcutaneous fat
often naked

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11
Q

What are the signs of PDA

A

it causes apnoea, bradycardia, increaed o2 requirements

can see bounding pulse, precordial impulse, systolic murmur

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12
Q

mx of PDA

A 
Close duct using IV indomethacin
or surgery (ligation or percutaneous catheter closure)
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13
Q

When can infants feed (suck and swallow)

A

35-36 weeks - before then NG

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14
Q

What are common causes of preterm brain injury

A

perinatal asphyxia and RDS

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15
Q

What is most severe kind of preterm brain injury

A

unilateral haemorrhagic infarction involving parenchyma - leaves you hemiplegic

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16
Q

What are other complications of preterm brain injury

A

intraventricular haemorrhage can lead to hydrocephalus

Ventricular involvement = 50% chance of neurodevelopmental problems

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17
Q

What is perventricular leukomalacia

A

multiple bilateral cysts on US (these cysts develop 2-4 weeks after injury)
high risk of spastic diplegia (stiff CP)

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18
Q

what is NEC

A

bacterial infection of ischaemic bowel wall

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19
Q

signs of NEC

A

infant can’t feed
distended abdo
bile stained vomiting
may get rectal bleeding

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20
Q

X-ray signs of NEC

A

distended bowel

thickened bowel wall cause of intramural gas (pneumatosis intestinalis)

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21
Q

Mx of NEC

A

stop feed (need TPN if stop for >24 hours, if confirmed NEC stop for 7 days)
BSA
NG tube and check aspirates
fluids
ventilation
Surgery if: perforation or child doesn’t respond to medicine

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22
Q

What causes retinopathy of prematurity

A

high o2 conc on NNU

can lead to retinal detachment

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23
Q

What is bronchopulmonary dysplasia

A

Damage to newborn’s lungs (often happen as a reuslt of ventilation or trauma)
CXR can show opacification
if they get RSV or pertussis they can go into resp failure

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24
Q

What are benign causes of neonatal jaundice

Study These Flashcards
A

Too many RBC when born so they break down
RBC lifespan is shorter (70 days)
hepatic metabolism is slow

25
Signs of kernicterus
acute- lethargy and poor feeding severe - irritability increased tone and arched back (opisthotonos) seizures
26
Causes of acute neonatal jaundice <24 hours
``` Haemolytic: Rhesus haemolytic disease ABO incompatibility (less severe than Rhd) G6PD spherocytosis ``` Congenital infection
27
Causes of neonatal jaundice 2 days - 2 weeks
``` physiological Breast milk jaundice dehydration infection polycythaemia ```
28
Causes of neonatal jaundice >2 weeks
``` unconjugated: infection breast milk jaundice hypothyroidism physiological ``` conjugated: biliary atresia neonatal hepatitis
29
Which drugs can cause jaundice
Diazepam and sulfonamides displace bili from albumin so avoid in babies
30
assessment of neonatal jaundice
measure bili: if jaundice developed in less than 24 hours or baby is less than 35 weeks do serum bili if not do transcutaenously assess risk of kernicterus: serum bili >340 in >37 weeks bili rising >8.5 per hour clinical signs ``` Ix for underlying cause: haematocrit blood group DAT test consider G6PD ```
31
Tx of neonatal jaundice
Physiological: reassure use threshold table to see what tx they need ``` Pathological unconj: acute bili encephalopathy- 1 exchange transfusion 2 phototherapy 3 hydrate 4 IVIg ``` bili .>95th centile for photo 1 photo 2 hydrate ``` bili >95th centile for exchange 1 exchange 2 photo 3hydration 4 IVIg ``` Breast milk jaundie: temporary cessation of BF photo+hydration exchange transfusion
32
What happens if baby is on borderline for jaundice treatment
If >38 weeks and > 24 hours and within 50micromol of phototherapy threshold repeat bili measurements (within 18 hours if RF present, 24 if not present)
33
What causes transient tachypnoea of newborn
caused by delay in reabsorption of fluid, most common cause of RDS
34
mx for transient tachypnoea of newborn
supportive therapy | if tachypnoea goes on for more than 4-6 hours begin Abx
35
What are the consequences of meconium aspiration
Infection at increased risk of pneumothorax increased risk of persistent pulmonary HTN
36
Mx of meconium aspiration
if meconium staining but no Hx of GBS observe if infection give Abx (IV ampicillin and gentamicin) and O2
37
What is persistent pulmonary HTN associated with
RDS Asphyxia meconium aspiration septicaemia
38
mx of persistent pulmonary HTN
``` urgent echo to check for congenital defects oxygen ventilate surfactant suction secretions fluids and inotropes inhaled NO ECMO ```
39
How does diaphragmatic hernia presetn
generally L sided herniation so: | absent breath sounds on L and apex beat shifted R
40
mx of diaphragmatic hernia
intubate positive pressure ventilation large NG tube + suction to prevent distension of intrathoracic bowel Then go for surgical repair
41
Consequence of diaphragmatic hernia
pulmonary hypoplasia due to compression from bowel loops
42
What are early onset infections (<48 hours)
GBS listeria e.coli
43
Late onset infections (>48 hours) causative organisms
coagulase negative staph (staph epidermidis) staoh a klebsiella pseudomonas
44
GBS mx
Intrapartum abx (IM benzylpenicillin) if: previous baby w/ GBS asymptomatic bacteriuria infection during current pregnancy give penicillin and gentamicin to babies if it's inc CSF change to benzylpenicillin and gentamicin
45
Signs of listeria infection
these babies are often preterm neonatal signs: meconium staining (rare in preterm) widespread rash pneumonia etc.
46
mx of neonatal listeria
amoxicillin and gentamicin
47
Causes of conjunctivitis
Bacterial - staph and strep present w/ discharge and redness, gonococcal is purulent + swelling viral is more relaxed
48
RF for neonatal hypogylceamia
``` IUGR Preterm maternal DM Polycythaemia large ```
49
Mx of neonatal hypoglycaemia
Prevention - feed baby within 30 mins of birth aim for glucose >2.6 if BM <1.5 admit and give IV glucose if BM 1.5-2.5 feed and then reassess in 30 mins if it's due to hyperinsulinism give glucagon infusion
50
features of neonatal seizures
repetitive movements that continue when restrained | accompanied by eye movements and respiration changes
51
Causes of neonatal seizures
neuro causes (HIE etc.) metabolic (hypoglycaemia) kernicterus withdrawal (maternal opiates)
52
Mx of cleft lip/palate
feeding assessment refere to MDT surgery at risk of pierre robin sequence
53
definition of failure to thrive
weight falls below 5th percentile multiple times or crosses 2 percentile lines
54
Features of oesophageal atresia
Get transoesophageal fistula associated with polyhydramnios persent with salivation
55
Causes of small bowel obstruction
``` atresia/ stenosis of duodenum (down's) atresia/stenosis of jejunum or ileum volvulus malrotation meconium ileus/plug ```
56
Causes of large bowel obstruction
Hirschprung | Rectal atresia
57
mx chronic lung disease of prematurity
prophylaxis: steroids if established preterm labour <34 weeks resp support : high flow o2, CPAP, invasive ventilation medication: dexamethasone if > 8 days, give NO only if pulmonary hypoplasia or pulmonary HTN
58
Group b strep mx
prevention: itrapartum benzylpenicillin if: previous you've had previous invasive group B strep, group b strep colonisation, bacteriuria or infection in current pregnancy
59
haemolytic disease of newborn mx
maternal: anti-D Ig - give at 28 and 34 wks and at birth baby: Resusc (A+E) exchange transfusion if (bili rising >8 per hour despite phototherapy, severe hyperbilirubinaemia unresponsive to phototherapy, significant anaemia <100) phototherapy IVIg - only for immune haemolysis

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