Neonatal Symposium Flashcards
describe how the first breath after birth occurs?
hypoxic conditions trigger the respiratory centres which creates low pressure in the lungs and increases blood flow and reduces the fluid in the lungs
what is the normal heart rate in babies?
120-160
state some ways of measuring resp rate in babies?
blood gas determination
transcutaneous PCO2/O2 measurement
capnography
tidal volume
what is the normal RR in babies?
30-60
is babies BP lower or higher than adults?
lower
70/44
can new borns shiver ?
no
after birth how much weight loss is classed as normal ?
10%
what is weight loss in new borns caused by?
shift of interstitial fluid to intravascular
dieresis
- slower GFR, reduced Na reabsorption, decreased ability to concentrate urine
increased insensible water loss
does Hb increase or decrease after birth in the first 10 weeks?
decreases until week 10
after week 10, what is produced in the body to increase Hb?
erythropoietin
state some skin colours of newborns?
jaundice
pallor
cyanosis
plethora
what is plethora?
redness due to excess blood
at what level of deHb does cyanosis occur?
more than 5g/dl of deoxyhaemoglobin
state some skin rashes of newborns
milia
infections
sebaceous naevus
what is milia ?
white papules on nose due to hyperplastic sebaceous glands due to the effect of transplacental hormones
do sebaceous naevus have any complications?
risk of malignant change so consider elective removal
state some different birth marks?
capillary haemangiomas mixed haemangioma mongolian blue spots port wine spots stork marks cafe au lait spots
if there are many large cafe au lait spots what DD should be considered?
neurofibromatosis
do capillary haemangioma need treatment?
no they disappear
what can cause stork marks to flare up?
crying
- gradually fades by 2 yrs
what causes cafe au lait spots?
melanin in melanocytes
what glucose level is hypoglycaemia?
<2.6mmol/l
what risk groups of hypoglycaemia?
premature newborns with low birth weight
diabetic mothers
hypothermia
sepsis
state some symptoms of hypoglycaemia in new borns
irritable hypothermia lethargy hypotonia vomiting seizures
what problems can arise with tongue tied new borns/
feeding
- may require frenotomy
what evaluating respiratory function what can be measured?
RR respiratory effect - retractions colour of skin O2 sats
state three causes of resp problems in new borns
laryngomalacia
trachaemalacia
bronchomalacia
state four locations where retraction of breathing can occur>
subcostal
substernal
suprasternal
intercostal
what is the main DD for cyanosis?
sepsis
what investigations should be done for cyanosis ?
ECG BP O2 sats CXR Echo
what is Chonanal atresia
nasal obstruction
what signs are seen in pierre robin sequence ?
small jaw with tongue obstruction and possible cleft palate
what examining the eyes of a newborn what always has be looked for?
red reflex
what is the rare eye cancer that has no red reflex ?
retinoblastoma
what is chordee?
ventral curvature of the penis
what is hypospadias?
urethra opens in wrong place
are inguinal hernias common ?
yes
what investigations should be done for ambigious genitilia?
serum electrolytes and glucose
chromosome analysis
pelvis and abdo US (to look for testis or ovaries)
serum testosterone
what is Cephalohaematomas ?
hemorrhage of blood between the skull and the periosteum
- contained between sutures
what is Caput succedaneum ?
Subcutaneous fluid with poorly defined margins under the scalp caused by pressure to the presenting part of scalp to the dilated cervix
state the two brachial plexus palsies?
erbs
klumpkes
what is medial deviation of the foot called?
varus
what is lateral deviation of the foot called?
valgus
Does talipes require treatment ?
just PT
state four ways in which heat can be lost?
convection
conduction
evaporation
radiation
what causes developmental dysplasia of the hips?
shallow acetabulum resulting in femur slipping out of the socket
state some risk factors for DDH?
breech >36 weeks female 1st child large birth weight multiple birth
what two tests can be done for DDH?
ortolani
barlow
is barlow or ortolani more gentle?
ortolani
what happens during the ortolani test ?
• abduction of the hip while applying anterior force on the femur to reduce the joint
what happens during the barlow test ?
• adduction of the hip while applying posterior force on femur to promote dislocation
what is 21 trisomy?
downs
what is 18 trisomy?
edwards
what is 13 trisomy?
patau
state some features of downs syndrome?
hypotonia cardiac defect learning problems thyroid problems dysmorphism
as well as ortolani and barlow test, what else can be examined for DDH?
leg length
general movements of the legs
groin creases
US
state some causes of preterm labour?
maternal smoking, pre eclampsia foetal chromosomal condition, infection placental abruption twin twin sydrome hypoglycaemia polycythaemia
state some complications of being born premature?
respiratory distress syndrome broncho-pulmonary dysplasia intraventricular haemorrhage post-haemorrhagic hydrocephalus PDA necrotising entero-colitis
state some long term problems of being pre term
reduced growth
obesity
ischaemic heart disease
polycythaemia
what is the treatment for RDS?
antenatal steroids
surfactant
early extubation
what is the treatment for IVH?
antenatal steroids
what is a complication of polycythaemia?
Increased blood flow and the lungs want low blood flow so increase resistance and when muscles start to form, pulmonary stenosis can occur
what is periventricular leucomalacia ?
ischemia of the white matter adjacent to the lateral ventricles.
what is the prognosis of periventricular leucomalacia
very poor
what is the treatment for jaundice in newborns?
blue light therapy
state some organisms that can cause sepsis ?
group B strep E coli listeria coag negative staph haemophilus influenza
state 3 risk factors for sepsis ?
PROM
maternal pyrexia
maternal group strep B carriage
what investigations should be done for sepsis ?
FBC, CRP, blood culture, blood gases, CXR
what is the treatment for sepsis?
penicillin and gentamicin
what are some complications of sepsis?
DIC
shock and hypotension
meningitis
pneumonia
state some risk factors for meconium aspiration ?
post date
maternal DM/hypotension
difficult labour
what is the management of Hypoxic ischaemic encephalopathy ?
- Treat seizures
- Supportive (resp and cardio)
- Fluid restriction
- Monitor for renal and liver failure
- Baby cooled to 33 degress for 72 hours then slowly rewarmed over 12 hours
state some causes of failure to pass stool?
- Constipation
- Large bowel atresia
- Imperforate anus
- Hirschsprungs disease
- Meconium ileus
what condition is meconium ileum associated with?
CF
what gender are diaphragmatic hernias associated with?
Males
what is the purpose of ductus arteriosus?
Protects lungs against circulatory overload
what is the purpose of ductus venosus?
Foetal blood vessel connecting the umbilical vein to the IVC
what is miliaria?
immature sweat glands obstruction
what is the commonest organism to cause skin infections?
staph aureus
