Neonate Flashcards

1
Q

Define preterm

A

A birth that occurs before 37 completed weeks of gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define term

A

A birth between 37 weeks and 42 weeks of gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define post term

A

A birth that occurs after 42 completed weeks of gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Over half of deaths in childhood occur when and are strongly influenced by which factors?

A
  • in the first year
  • strongly influenced by pre-term delivery and low birth weight
  • other risk factors include; mothers maternal age, smoking and disadvantaged circumstances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which babies are most at risk for death in the first year?

A
  • black or black british, asian or asian british >50% higher risk
  • teenage mother and mothers over 40 39% higher risk
  • mothers living in poverty 57% higher risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name causes of preterm birth from most to least common

A
  • spontaneous preterm labour - multiple pregnancy
  • preterm prelabour rupture of membranes
  • pregnancy associated hypertension
  • cervical incompetence / uterine malformation
  • antepartum haemorrhage
  • intrauterine growth restriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name risk factors for pre term birth

A
  • > 2 preterm deliveries previously (70% risk)
  • abnormally shape uterus increases by 19%
  • 9 times more likely if multiple pregnancy
  • interval of <6 months between pregnancies
  • conceiving through in vitro fertilisation
  • smoking, drinking alcohol and using illicit drugs
  • poor nutrition, some chronic conditions
  • multiple miscarriages or abortions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name common problems of prematurity

A
  • temperature control
  • feeding / nutrition
  • sepsis
  • system immaturity / dysfunction; RDS, patent ductus arteriosus, intraventricular haemorrhage, necrotising enterocolitis
  • others; metabolic, ROP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why is thermal regulation ineffective in the neonate?

A
  • low BMR
  • minimal muscular activity
  • subcutaneous fat insulation is negligible
  • high ratio of surface area to body mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name reasons why there is an increased risk of nutritional compromise in the neonate

A
  • limited nutrient reserves
  • gut immaturity
  • immature metabolic pathways
  • increased nutrient demands
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When can neonatal sepsis be acquired?

A
  • early onset; mainly due to bacteria acquired before and during delivery
  • late onset; acquired after delivery (nosocomial or community sources)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name organisms causing neonatal sepsis

A

Early onset;

  • group B streptococcus
  • gram negatives

Late onset;

  • coagulase negative staphylococci
  • gram negatives
  • staph aureus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name respiratory complications of prematurity

A
  • respiratory distress syndrome (RDS)
  • apnoea of prematurity
  • bronchopulmonary dysplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe respiratory distress syndrome - hyaline membrane disease

A
  • primary pathology; surfactant deficiency, structural immaturity
  • secondary pathology
  • alveolar damage; formation of exudate from leaky capillaries, inflammation, repair
  • common; 75% of infants born before 29 weeks, 10% in infants born after 32 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the clinical features of RDS

A
  • respiratory distress
  • tachypnoea; grunting, intercostal recessions, nasal flaring, cyanosis
  • worsen over minutes to hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the management of RDS

A
  • maternal steroid
  • surfactant
  • ventilation; invasive / non-invasive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name the grades and outcomes of intraventricular haemorrhage

A
  • Grade 1 and 2; neurodevelopmental delay up to 20%, mortality 10%
  • grade 3 and 4; neurodevelopmental delay up to 80%, mortality 50%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the normal weight for a term newborn?

A
  • 2.5 kg - 4 kg
  • over 4kg large for gestational age
  • under 2.5kg small for gestational age
19
Q

What is the average daily weight gain of the neonate in the 3rd trimester?

A

24 g per day

20
Q

How much iron is transferred across the placenta?

A

Enough to last the first year of life

21
Q

Name causes of placental insufficiency

A
  • pregnancy induced hypertension
  • pre-eclampsia
  • mother used drugs or alcohol during pregnancy
22
Q

What is the apgar score a measure of?

A

A measure of perinatal adaptation

23
Q

Describe haemorrhagic disease of the newborn

A
  • rare 2:1,000
  • potential mortality / morbidity; GI, lungs, CNS
  • vitamin K is given in order to prevent at birth; IM or oral
  • spontaneous bleeding and coagulopathy if untreated
24
Q

Name the screening tests performed on the new born

A
  • newborn examination
  • universal hearing screening
  • hip screening
  • blood spot day 5; cystic fibrosis, haemoglobinopathies, metabolic disease
  • thyroid function testing
25
Q

How does the new born blood spot aid a CF diagnosis?

A
  • not a direct diagnosis
  • blood sport would be abnormal for immuno-reactive trypsin
  • refer for further tests
26
Q

What is looked for on the head in the new born exam?

A
  • OFC
  • overlapping sutures (normal after birth)
  • fontanelles
  • ventouse / forceps marks
  • moulding
  • cephalohematoma
  • caput succedaneum
27
Q

What is a cephalohematoma ?

A
  • common
  • bruising or bleeding between bone periosteum and the epicardial aponeurosis
  • limited to the suture line
  • often parietal
  • can take a while to heal
  • can calcify
28
Q

What is caput succedaneum?

A
  • swelling and oedema of the outer layer of the skin
  • can be dramatic
  • leaves quickly, within 48 hours
29
Q

What is looked for in the eyes in the new born exam?

A
  • size
  • red reflex (if absent, cataract until proven otherwise)
  • conjunctival haemorrhage
  • squints (frequent)
  • iris abnormality
30
Q

What is looked for in the ears in the new born exam?

A
  • position
  • external auditory canal
  • tags / pits
  • folding
  • family history of hearing loss
31
Q

What is looked for in the mouth in the new born exam?

A
  • shape
  • philtrum (if smooth can be a sign of foetal alcohol syndrome)
  • tongue tie
  • palate (teeth should be removed)
  • neonatal teeth
  • ebsteins pearls
  • sucking / rooting reflex
32
Q

What is looked for in the face for the new born exam?

A
  • facial palsy

- dysmorphism

33
Q

What respiratory signs are looked for in the new born exam?

A
  • chest shape
  • nasal flaring
  • grunting
  • tachypnoea
  • in drawing
  • breath sounds
34
Q

What cardiovascular signs are looked for in the new born exam?

A
  • colour / saturation (SaO2)
  • femoral pulse
  • apex
  • thrills / heaves
  • heart sounds
35
Q

What abdominal signs are looked for in the new born exam?

A
  • moves with respiration
  • distension
  • hernia
  • umbilicus
  • bile stained vomiting
  • passage of meconium
  • anus
36
Q

What genitourinary signs are looked for in the new born exam?

A
  • normal passage of urine
  • normal genitalia
  • undescended testes
  • hyposapdius
37
Q

What MSK signs are looked for in the new born exam?

A
  • movement and posture
  • limbs and digits
  • spine
  • hip examination
38
Q

What neurological signs are looked for in the new born exam?

A
  • alert, responsive
  • cry
  • tone
  • posture
  • movement
  • primitive reflexes; suck, rooting, moro, ATNR, stepping, grasp
39
Q

Describe the apgar score

A
  • out of 10
  • 2 for heart rate
  • 2 for resp effort
  • 2 for tone
  • 2 for colour
  • 2 for response
40
Q

What are the normal ranges for vital signs of the new born?

A
  • RR; 40 - 60 / minute
  • HR; 120-140 BPM
  • cap refill - 2-3 seconds
  • SaO2 95%
41
Q

What is the blood volume of a newborn?

A

80ml per kilo

42
Q

Describe therapeutic chemotherapy

A
  • total body cooling
  • cooled to 33 and a half degrees for 72 hours
  • shown to be protective for babies with ischaemia, can help prevent lasting damage
43
Q

Name common bacteria for infection of the new born

A
  • group B streptococcus (most common)
  • e coli
  • listeria mycocytogenes
  • staph aureus
  • staph epidermidis
44
Q

Name common viruses infecting the new born

A
  • cytomegalovirus
  • parvovirus
  • herpes viruses
  • enteroviruses