Neonatal/ prematurity Flashcards
Causes of elevated unconjugated bilirubin
Physiological (1-2 weeks)
- First 24 hours
- Due to low UGT enzyme activity at birth
Breastmilk jaundice (most common)
Infection
Haemolytic anaemia
Congenital hypothyrodism
Investigations for prolonged physiological jaundice [8]
Coombs test
- Assess hameolysis
ABO typing
Haemoglobin
- Low = blood collection outside the blood vessels
Reticulocyte/ LDH count
- haemolysis
Blood smear
- spherocytes or elliptocytes = hereditary spherocytosis or elliptocytosis
G6PD
- Deficiency
TFTs
Abdominal ultrasound
Breastfeeding jaundice
- Description
Causes unconjugated jaundice
Starts during first 7 days
- Due to infrequent/ inadequate breastfeeding
- Conjugated builds up in bowel and reabsorbed before being converted back to unconjugated
Breastmilk jaundice treatment
1st- Increased breast milk uptake
2nd- formula feeding
Prevention of haemolytic disease of the newborn
Anti-D injections in in RhD negative mother 28-weeks and 72 hours post-partum.
Definition of prolonged jaundice
> 14 days in term babies
> 21 days in premature babies
Causes of conjugated hyperbilirubinaemia
Biliary atresia and other bile duct obstruction
Neonatal heptatitis
Alagille syndrome
Kernicterus
- Definition
- Signs
Encephalopathy caused by excess unconjugated bilirubin deposition
Signs
- lethargy
- poor feeding
- stupor
- hypotonia
- seizures
Signs of conjugated hyperbilirubinaemia
- Dark urine
- Pale stools
- Poor weight gain
- Hepatomegaly
Management of unconjugated hyperbilirubinaemia
1st line= Phototherapy (blue-green light)
2nd line= Exchange transfusion (if severe)
Crigler Najjar syndrome
UGT deficiency leading to inability to conjugated bilirubin
- Causing unconjugated hyperbilirubinaemia
The wavelength of light use in phototherapy to treat jaundice is…
460-490nm (blue-green light)
Alagille syndrome
- Definition
Genetic syndrome
- Presents with characteristic facial features and cholestasis by disrupting bile flow from liver to gallbladder.
- Can progress to cirrhosis
Breastfeeding jaundice
- Description
Cause of unconjugated hyperbilirubinaemia
- Due to breastmilk inhibiting conjugation
- Typically occurs in 2nd week of life
______ is a monoclonal antibody used to prevent RSV and is recommended for ______
Palivizumab
- Recommended for prematurity/ chronic lung/heart disease
All newborns should receive IM ______ to prevent bleeding
Vitamin K
Blood spot screening tests for ____ congenital conditions and is taken on day ___
Tests 9 conditions
Taken on day 5 (to 8)
Congenital conditions tests for in the blood spot screening
Sickle cell disease
Cystic fibrosis
Congenital hypothyroidism
Phenylketonuria
Medium chain ADD
Maple syrup urine disease
Isovaleria acidaemia
Glutaric aciduria type 1
Homocystin
______ is the hearing test carried out in newborns
Otoacoustic emission test
- Computer generated click is played through ear piece.
The ______ test is carried out if the otoacoustic emission test is abnormal
Auditory brainstem response test.
Common causes of neonatal sepsis
Group B strep (most common)
E.coli
Listeria
Klebsiella
S. aureus
Risk factors for neonatal sepsis
Maternal GBS vaginal colonisation
GBS sepsis in previous baby
Maternal sepsis, chorioamnionitis/ fever >38
Prematurity
p-PROM
Red flags for neonatal sepsis
Confirmed/ suspected sepsis in mother
Shock
Seizure
Term, needing ventilation
Resp distress > 4 hours after birth
Antibiotics in neonatal sepsis is indication when…
1 or more red flag features
2+ risk factors/ Clinical features
Risk factors for necrotising enterocolitis
Low birth weight
Prematurity
Formula fed
Respiratory distress + assisted ventilation
Sepsis
PDA/ congenital heart disease
Investigations for necrotising enterocolitis
Bloods
- FBC
- CRP
- Blood gas
- Blodo culture
Imaging
- Abdominal X ray
X-ray findings in necrotising enterocolitis
Dilated bowel loops
Bowel wall oedema
Pnuematosis intestinalis (has in bowel wall)
Pneumoperitoneuum
Management of necrotising enterocolitis
NBM, IV fluids
TPN nutrition
Antibitoics
Surgery referral
______ describes fluid outside the cranial periosteum crossing the suture lines
Caput Succedaneum
_________ describes a collection of blood between the skull and periosteum.
Cephalohaematoma
Cephalohaematoma carries a risk of ______ and ______
Anaemai and jaundice
Features of congenital rubella syndrome
Cataracts
Congenital heart disease
Hearnin loss
Learning disabilities
Features of congenital varicella syndrome
Microcephaly/ Hydrocephalus
Skin contractures
Limb hypoplasia
Chorioretinitis / cataracts
Features of congenital CMV infection
Growth restriction
Microcephaly
Hearing loss, vision loss
Seizures
Learning disability
Features of congenital toxoplasmosis
Triad
- Intracranial calcification
- Hydrocephalus
- Chorioretinitis
Management of symptomatic neonatal hypoglycaemia
Admit to neonatal unit
IV 10% dextrose
