Neonate Flashcards
Define preterm
A birth that occurs before 37 completed weeks of gestation
Define term
A birth between 37 weeks and 42 weeks of gestation
Define post term
A birth that occurs after 42 completed weeks of gestation
Over half of deaths in childhood occur when and are strongly influenced by which factors?
- 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
Which babies are most at risk for death in the first year?
- 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
Name causes of preterm birth from most to least common
- spontaneous preterm labour - multiple pregnancy
- preterm prelabour rupture of membranes
- pregnancy associated hypertension
- cervical incompetence / uterine malformation
- antepartum haemorrhage
- intrauterine growth restriction
Name risk factors for pre term birth
- > 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
Name common problems of prematurity
- temperature control
- feeding / nutrition
- sepsis
- system immaturity / dysfunction; RDS, patent ductus arteriosus, intraventricular haemorrhage, necrotising enterocolitis
- others; metabolic, ROP
Why is thermal regulation ineffective in the neonate?
- low BMR
- minimal muscular activity
- subcutaneous fat insulation is negligible
- high ratio of surface area to body mass
Name reasons why there is an increased risk of nutritional compromise in the neonate
- limited nutrient reserves
- gut immaturity
- immature metabolic pathways
- increased nutrient demands
When can neonatal sepsis be acquired?
- early onset; mainly due to bacteria acquired before and during delivery
- late onset; acquired after delivery (nosocomial or community sources)
Name organisms causing neonatal sepsis
Early onset;
- group B streptococcus
- gram negatives
Late onset;
- coagulase negative staphylococci
- gram negatives
- staph aureus
Name respiratory complications of prematurity
- respiratory distress syndrome (RDS)
- apnoea of prematurity
- bronchopulmonary dysplasia
Describe respiratory distress syndrome - hyaline membrane disease
- 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
Describe the clinical features of RDS
- respiratory distress
- tachypnoea; grunting, intercostal recessions, nasal flaring, cyanosis
- worsen over minutes to hours
Describe the management of RDS
- maternal steroid
- surfactant
- ventilation; invasive / non-invasive
Name the grades and outcomes of intraventricular haemorrhage
- Grade 1 and 2; neurodevelopmental delay up to 20%, mortality 10%
- grade 3 and 4; neurodevelopmental delay up to 80%, mortality 50%
What is the normal weight for a term newborn?
- 2.5 kg - 4 kg
- over 4kg large for gestational age
- under 2.5kg small for gestational age
What is the average daily weight gain of the neonate in the 3rd trimester?
24 g per day
How much iron is transferred across the placenta?
Enough to last the first year of life
Name causes of placental insufficiency
- pregnancy induced hypertension
- pre-eclampsia
- mother used drugs or alcohol during pregnancy
What is the apgar score a measure of?
A measure of perinatal adaptation
Describe haemorrhagic disease of the newborn
- 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
Name the screening tests performed on the new born
- newborn examination
- universal hearing screening
- hip screening
- blood spot day 5; cystic fibrosis, haemoglobinopathies, metabolic disease
- thyroid function testing
How does the new born blood spot aid a CF diagnosis?
- not a direct diagnosis
- blood sport would be abnormal for immuno-reactive trypsin
- refer for further tests
What is looked for on the head in the new born exam?
- OFC
- overlapping sutures (normal after birth)
- fontanelles
- ventouse / forceps marks
- moulding
- cephalohematoma
- caput succedaneum
What is a cephalohematoma ?
- 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
What is caput succedaneum?
- swelling and oedema of the outer layer of the skin
- can be dramatic
- leaves quickly, within 48 hours
What is looked for in the eyes in the new born exam?
- size
- red reflex (if absent, cataract until proven otherwise)
- conjunctival haemorrhage
- squints (frequent)
- iris abnormality
What is looked for in the ears in the new born exam?
- position
- external auditory canal
- tags / pits
- folding
- family history of hearing loss
What is looked for in the mouth in the new born exam?
- 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
What is looked for in the face for the new born exam?
- facial palsy
- dysmorphism
What respiratory signs are looked for in the new born exam?
- chest shape
- nasal flaring
- grunting
- tachypnoea
- in drawing
- breath sounds
What cardiovascular signs are looked for in the new born exam?
- colour / saturation (SaO2)
- femoral pulse
- apex
- thrills / heaves
- heart sounds
What abdominal signs are looked for in the new born exam?
- moves with respiration
- distension
- hernia
- umbilicus
- bile stained vomiting
- passage of meconium
- anus
What genitourinary signs are looked for in the new born exam?
- normal passage of urine
- normal genitalia
- undescended testes
- hyposapdius
What MSK signs are looked for in the new born exam?
- movement and posture
- limbs and digits
- spine
- hip examination
What neurological signs are looked for in the new born exam?
- alert, responsive
- cry
- tone
- posture
- movement
- primitive reflexes; suck, rooting, moro, ATNR, stepping, grasp
Describe the apgar score
- out of 10
- 2 for heart rate
- 2 for resp effort
- 2 for tone
- 2 for colour
- 2 for response
What are the normal ranges for vital signs of the new born?
- RR; 40 - 60 / minute
- HR; 120-140 BPM
- cap refill - 2-3 seconds
- SaO2 95%
What is the blood volume of a newborn?
80ml per kilo
Describe therapeutic chemotherapy
- 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
Name common bacteria for infection of the new born
- group B streptococcus (most common)
- e coli
- listeria mycocytogenes
- staph aureus
- staph epidermidis
Name common viruses infecting the new born
- cytomegalovirus
- parvovirus
- herpes viruses
- enteroviruses
