Neonataology Flashcards
Define preterm
<37 weeks
define very preterm
<32 weeks
define extremely preterm
<28 weeks
define term
37-42 weeks
define post term
> 42 weeks
define foetal loss
<23 weeks
define low birth weight
<2.5kg
define very low birth weight
<1.5kg
define extremely low birth weight
<1kg
define small for gestational age
<10th centile in weight for expected gestation
define appropriate for gestational age
10-90th centile in weight for gestation
define large for gestational age
> 90th centile in weight expected for gestation
RF for preterm births
multiple pregnancy uterine/cervical pathology chronic health conditions in mother e.g. BP, DM, clotting infections in pregnancy smoking, alcohol, illicit drugs idiopathic
most preterm babies <28wk will need help with transitioning to air breathing, this is called resuscitation, true or false
false, not resuscitation
what is the difference between preterm and term babies when they are born
preterm: get colder faster more fragile lungs dont breathe effectively fewer reserves
why is cord clamping delayed for a minute in premature babies
to allow placental transfusion
‘optimal cord clamping’
how can you keep the preterm baby warm during cord clamping
place them in a plastic bag while still wet under a radiant heater
reduces heat loss from convection and evaporation
how do you manage the airway in a premature newborn
neutral head positioning - over extension will block the airway
jaw thrust
suction, gentle and only if secretions are present
what can happen if the premature newborns lungs are overinflated
damage leading to inflammation and long term morbidity (broncho pulmonary dysplasia)
common concerns in the preterm infant
temp control feeding and nutrition - late sucking reflex sepsis system immaturity - RDS - PDA - IVH - NEC Metabolic ROP
hypothermia in a preterm infant increases severity of all preterm morbidities, true or false
true
why is thermal regulation in preterm babies ineffective
low BMR
minimal muscular activity
SC fat negligible
high SA:bodymass ratio
methods of warming a preterm baby
skin to skin
plastic bag / wrap
transwarmer mattress
prewarmed incubator
why are preterm babies at risk of nutritional compromise
lower reserves
immature metabolic pathways
increased nutritional demands
what is gestational correction
adjusts the measurements to account for the number of weeks a baby was born early
how do calculate gestational age for a preterm baby
corrected age = chronological age - weeks of prematurity
where weeks of prematurity = 40-gestational age at birth
which gestation do you correct gestational age
<37 weeks
how long to do you continue to correct gestational age
1 year for 32-36/40wk
2 years for <32/40wk
causes of infections in premature babies
septicaemia meningitis resp infections diarrhoea neonatal tetanus line infections
how can neonatal sepsis be classified
early onset - bacteria acquired before/during delivery
late onset - after delivery
organisms causing neonatal sepsis
GBS
Gram negatives: klebsiella, E coli, pseudomonas, salmonella
Gram positives: coag - Staph (especially with lines/plastic), staph A, strep pneumoniae, strep pyogenes
Incubators Increase Infection, true or false
true!
respiratory complications of prematurity
resp distress syndrome
apnoea of prematurity
bronchopulmonary dysplasia
what is resp distress syndrome/hyalline membrane disease
alveoli are immature and dont produce surfactant, this and structural immaturity resulting in alveolar damage, exudate, inflammation and resulting in fibrosis
clinical features of RDS
tachypnoea grunting intercostal recession nasal flaring cyanosis worsens over min-hours
management of RDS
maternal steroids
surfactant
ventilation - invasive/noninvasive
there is a hazy appearance of the lungs in RDS CXR, true or false
true
due to poor aeration of alveoli = ground glass appearance
also, presence of bronchograms
CVS concerns in a preterm infant
PDA
systemic hypotension
features of intraventricular haemorrhage
begins with bleeding in the germinal matrix
most occur in the first day of life
how can you investigate an intraventricular haemorrhage
USS through the fontanelle
what are the major RF for intraventricular haemorrhage
prematurity
RDS - hypoxia, unstable cerebral circulation
clinical presentation of intraventricular haemorrhage
clinically silent
intermittent deterioration: hypoxia, pallor, hypotension, irritable, apnoea
CVS collpase
preventing intraventricular haemorrhage
antenatal steroids prompt resus avoid: hypoxia hypercapnia hyperoxia hypocarbia swinging BP
what is NEC
necrotising enterocolitis is the most common neonatal surgical emergency
widespread necrosis in small and large intestines
clinical presentation of NEC
usually recovering from RDS
lethargy, distended abdomen
bloody stools, temp instability, apnoea, bradycardia
when is retinopathy of prematurity evident
after 6-8 weeks
from too much oxygen therapy
what are early and late metabolic complications of prematurity
early - hypoglycaemia, hyponatraemia
late - osteopaenia of prematurity
when is a newborn examination carried out
between 6-24 hours of life
before 72 hours
reasons for carrying out the newborn examination
screen for problems
alleviate concerns
health promotion
continuity of care record
overview of the newborn exam
resp and heart - when baby is settled
head to toes
front and back
hips and moro reflexes last
important aspects of the history to ask about before carrying out a neonatal examination
gestation, weight, height, head circumference and centiles FH - hips, heart, eyes, ears... antenatal complications delivery mode - resus? presentation feeding urine and bowels
normal APGAR score
> =8/10
assistance vs resuscitation in premature babies
assistance to help transition to air breathing
resuscitation is more aggressive and uses drugs etc
neonatal life support algorithm
ABCDE Allow delayed cord clamping Keep baby warm Airway - they have small floppy airways Breathing - lungs are fragile, CPAP
what is the triad of hypothermia
hypothermia can lead to hypoglycaemia and hypoxia
hypoglycaemia exacerbates hypoxia
nutritional options for preterm babies
breast milk (mothers ideally, donor milk is available also) parenteral nutrition (TPN) - IV feed preterm formula
what do you do if there is abdominal concern in a newborn
stop feeding/putting things into tummy
examination - tense, tender
vomit? stool?
AXR features of NEC
air within the bowel wall
thickened loops of bowel
if severe: it can rupture and perforate - free air in abdomen (football sign)
risk of RDS
pneumothorax
complication of IVH
hydrocephalus
blood tries to break down and is taken up by CSF, but it is full of protein and so clogs up the CSF drainage leading to hydrocephalus
also, cerebral palsy
what is grunting
sign of resp distress
expiration against a closed glottis
2 doses of maternal steroids
RDS
sepsis
haemorrhage
NEC
Magnesium sulphate
neuroprotection
normal HR in newborn
> 100
first thing to do in a newborn resuscitation
dry them / rubbing
what do you do first in newborn resuscitation, compressions or breaths
breaths
RDS RF
male Maternal DM and HTN IUGR <29weeks Sepsis Hypothermia C-section delivery Second twin
treatment for RDS
surfactant ideally within 6 hours of birth
when is surfactant produced
naturally produced from 24 weeks but only produced in sufficient amounts by 34 weeks
what drugs are given to all preterm babies
Vit K - to prevent haemorrhagic disease of the newborn, IVH
Caffeine - preventing apnoeic episodes and neuroprotective
ABIDEC - multivitamin
Sytron - iron
features of NEC
bilious vomiting
bloody stool
abdominal distension
RF for NEC
prematurity
IUGR
formula feeding
umbilical arterial lines
what is grunting
breathing against a closed glottis giving themselves CPAP
what is surfactant
a molecule (phospholipid and apoprotein) that helps to reduce surface tension helps to keep lungs open
what gestation do babies make surfactant
around 30-32 weeks
management of pneumothorax
aspirate
chest drain
what is chronic lung disease/BPD
oxygen requirement beyond 36 weeks corrected gestation plus evidence of pulmonary parenchymal disease on CXR
what is synergis
MAB IgG against RSV in at risk babies
at what gestation do premature babies learn to suck e.g. from a bottle
~32 weeks
what is term
37-41 weeks
when babies are born, what do they breathe through, their mouth or nose?
they are obligate nose breathers
therefore have to take care with NG tube (can do an OG tube)
trophic feed
minimal enteral nutrition
tiny amount of breast feed to stimulate the gut
baby acne
present on baby’s cheek / face
mix of black comedones, pustules and papules
harmless, goes away and doesnt scar
(erythema toxicum is all over)
physiological jaundice is un/conjugated
unconjugated
water insoluble
breastfed babies are commonly jaundiced, true or false
true
Is UV light used in phototherapy for jaundice
no
it is coloured light
light therapy NOT UV therapy resulting in photoisomerisation ie breaking down bilirubin to a soluble molecule to be peed out
consequences of raised bilirubin
encepahlopathy
kernicterus
CP
waiters tip posture
erbs palsy
C5-6
