Neonatal Tutorial Flashcards
list 5 common neonatal problems?
hypoglycaemia jaundice respiratory distress infection NAS
criteria for neonatal hypoglycaemia?
BM <2.6
signs of neonatal hypoglycaemia?
hypothermia feeding infection/sepsis lethargy jitteriness seizure activity
how is neonatal hypoglycaemia managed?
keep baby warm (36.5 - 37.5)
early feeding
minimise handling (do minimise energy expenditure)
consider change in environment to avoid stressors
risk factors for neonatal hypoglycaemia?
preterm small for dates low birth weight diabetic mother maternal use of beta blockers infant who suffered asphyxia at delivery or needed resuscitation
feeding in neonatal hypoglycaemia?
bottle feeds
cup/syringe feeds
NG feeds
when is jaundice considered physiological and hence not a concern?
between 24 hrs and 2 weeks
- if jaundiced under 24 hrs potentially pathological
investigations in neonatal jaundice?
uncongugated vs conjugated
FBC
serum bilirubin (SBR)
coombs test (DCT) to check rhesus status etc
how is neonatal jaundice managed?
phototherapy (blue light)
adequate hydration
identify and treat underlying cause
risk factors for neonatal jaundice?
bruising during birth (forceps delivery etc)
twin to twin transfusion
FH of jaundice, blood disorders etc
features of neonatal jaundice?
yellow tinged skin and eyes sleepiness not waking for feeds > seizures hepatomegaly splenomegaly dark urine and pale stools
how is light used to treat neonatal jaundice?
blue light used for photo-isomerization of bilirubin
converts trans-bilirubin to the more water soluble cis form which is excreted in the bile without conjugation
can be done via biliblanket or phototherapy light unit
side effects of phototherapy for neonatal jaundice?
dehydration
skin rash
eye damage
when in jaundice considered prolonged?
lasting >14 days in term baby
lasting >21 days in preterm baby
important features to check for in prolonged jaundice?
feeding weight loss family history stool/urine colours behaviour organomegaly
initial investigations in prolonged jaundice?
FBC LFTs serum bilirubn (SBR) thyroid function tests (TFTs) further investigations for specifics
causes of unconjugated jaundice in newborn?
physiological breast milk haemolysis infection inherited causes intestinal obstruction
causes of conjugated jaundice in newborn?
biliary atresia total parenteral nutrition (TPN) hypothyroidism alpha 1 antitrypisn galactosaemia CF down's syndrome dubin johnson alagile syndrome
unonjugated vs conjugated jaundice?
conjugated always patholoical
uncongugated can by physiological or pathological
when does physiological jaundice peak?
day 3
what is breastmilk jaundice?
develops after day 4 -7
peaks around end of 2nd week
may last longer time but still not pathological
what can cause haemolysis in a newborn?
ABO (haemolytic disease of the newborn)
rhesus
specific antibody incompatibility
haemoglobinopathies (e.g sickle cell)
causes of respiratory distress in newborn?
TTN Respiratory distress syndrome (RDS) infection/sepsis pneumonia pneumothorax metabolic haematological cardiac neurological congenital lung malformations anatomical abnormalities
investigations in respiratory distress?
check airway (position, patency, abnormal anatomy, blockage) check breathing )work of breathing, chest wall movement, efficiency/efficacy, SpO2) could also do CBG, CXR and cold light examination
management of respiratory distress?
respiratory support surfactant stop feeds antibiotics if needed suction to remove blockage (yankeur or fine bore suction tube)
maternal risk factors for neonatal infection?
mother has received IV antibiotics for confirmed or suspected invasive bacterial infection at any time during labour or in 24 hrs before and after birth
any pyrexia during labour
multiple birth if other baby has infection
group B strep in this pregnancy
mother has had previous baby with group B strep disease
in which circumstaces are blood cultures taken and antibiotics started regardless of risk factors and clinical suspician?
if mother has previous baby with group B strep disease
neonatal risk factors for infection?
prolonged rupture of membranes
preterm birth
chorioamnionitis
what drugs are common causes of neonatal withdrawal/abstinence?
opiate based drugs (heroin, methadone, cannabis, benzodiazepines, alcohol etc)
how is opiate withdrawal in neonate managed?
oramorph
can also use phenobarbital if there are worries about the use of CNS depressants
what dangerous condition can occur as a result of consistently high/increasing bilirubin?
kernicterus (encephalopathy) which can lead to cerebral palsy
