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Paed BPT Study > Neonates > Flashcards

Neonates Flashcards

1
Q

What are the electrolyte abnormalities seen in neonatal re-feeding syndrome?

A

Low phosphate, Low potassium, Low Magnesium, high calcium (secondary to PO4 + Mg2+), +/- thiamine deficiency (higher risk of death is present)

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2
Q

What are the risk factors of neonatal re-feeding syndrome?

A
  1. Preterm
  2. SGA/IUGR due to placental insufficiency
  3. ELBW (less than 1000g)
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3
Q

How do neonates develop re-feeding syndrome?

A
  1. Chronic malnutrition: low glucose + glycogen stores, low fat/ protein/ vitamins/ minerals.
  2. Nutritional replacement: High CHO load –> glucose metabolism requires phosphate for ATP, PLUS expanding extracellular fluid volume –> causing a rapid fall in phosphate/ K+/ Mg2+.
  3. Re-feeding: Low PO4, low K+, low Magnesium causes high calcium (secondary to low mg2+ and PO4 (PTH/Vit D pathway), low thiamine
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4
Q

What causes oxygen dissociation curve to shift to the left?

A 
High pH
Low CO2
Low temp
Low 2-3DPG
Foetal Hb
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5
Q

What causes oxygen dissociation curve to shift to the right?

A

Low pH
High CO2
High Temp
High 2-3 DPG

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6
Q

What are the main immune functions of oligosaccharides/ Lactoferrin (probiotic) in breast milk?

A 
Bacteriocidal
Direct anti-microbial
Increase phagocytic activity 
Anti-inflammatory
Iron absorption  
Gut trophic 
Reduces gut permeability (lactoferrin)
Have specific actions against GBS, enteropathic e.coli, campylobactor 
?Prevents NEC 
?Prevents Late onset sepsis
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7
Q

What is an Intraventricular haemorrhage?

A

Intracranial haemorrhage originating from the germinal matrix of the developing brain and often extends into the lateral cerebral ventricle

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8
Q

What are the risk factors for IVH?

A

Prenatal: multiple gestation, IVF, Mat HIV, inherited coagulation problem, Choriamnionitis, lack of prenatal steroids
Perinatal: VLBW (<1500g), <32/40, NVB, foetal distress, low APGARs, intubation/ ventilation, Male, anaemia, PDA, neonatal sepsis, meds = inotropes, boluses, metabolic (low Na+, high BSL, met acidosis)
Basically anything that could cause hypoxia

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9
Q

Why is the germinal matrix important?

A

Thin membrane that creates glial cells and neurons in foetus, involutes by 28 weeks, absent by term.

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10
Q

How does an IVH occur?

A
  1. Fragile germinal matric vasculature
  2. Fluctuations in cerebral blood flow (causing hypoxia) which promotes angiogenesis)
  3. Impaired auto-regulation of cerebral bloods flow
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11
Q

When do bleeds (IVH) occur?

A

1/2 in first 6 hours of life
2/3 in first 24 hours
Progression/ further bleeding on day 3-5

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12
Q

How does IVH present?

A
  1. Silent
  2. Non-specific Sx over hours-days (altered consciousness, hypotonia, temp instab, subtle eye movements)
  3. Rapid deterioration in mins- hours (low BP, bulging fontanelle)
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13
Q

What are grade 1 and 2 IVH?

What is the associated mortality?

A

G1: Bleeding confined to germinal atrix + up to 10% of ventricular area
G2: Occupies 10-50% of lateral ventricle
1-2 = mild
G1 = 4%
G2 = 10%, poor neurodevelopment outcome in 20%

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14
Q

What are grade 3 and 4 IVH?

A

G3: occupies > 50% of lateral ventricle volume PLUS acute ventricular distension
G4: Haemorrhage into the periventricular white matter ipsilateral to a large IVH
3-4 = severe
G3 = 20%
G4 = 40%

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15
Q

What are the long term complications of IVH?

A

Post haemorrhagic ventricular dilatation/ hydrocephalus requiring a permanent shunt.

Neurodevelopment impairment: 
Hearing + visual impairment 
Cerebral palsy
Neurodevelopmental delay
Epilepsy
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16
Q

What are the short term complications of IVH?

A

Post-haemorrhagic ventricular dilatation/ hydrocephalus.
- 40% resolve without intervention, 10% rapid progression, 50% require shunt (DRIFT catheters, ventricular reservoir, temproary shunts, permanent V-P or V-Atrial shunt)

.. Necrosis of Periventricular white matter –> damage to cortico-spinal tract of internal capsule (also LT).

17
Q

What are 3 benefits of caffeine treatment?

A
  1. Reduces incidence of CLD (reduces ventilator time, reduces PDA ligation).
  2. Increases disability free survival at 20months.
  3. Reduce incidence of severe retinopathy of prematurity.

Sadly, reduce weight gain in the neonatal period.

18
Q

When do we screen for IVH?

A

Day 5-7, then day 28, then …

19
Q

Does prophylactic endomethicin change long term outcomes in IVH>

A

No. It significantly reduced incidence of IVH, but does not change long term outcomes. Thus, is not used.

20
Q

What are 4 neonatal benefits of antenatal steroids?

A
  1. Reduce the incidence of IVH
  2. Steroids given 1 week after initial course reduces severity of CLD. But more doses associated with small head size. Thus, only give 3 doses.
  3. Reduce perinatal and neonatal death
  4. Reduce the risk of NEC
21
Q

What would the triple test antenatally show if there was a high risk of Down’s Syndrome?

A 
High AFP (alpha-fetoprotein), Low estradiol, High b-HCG. 
BUT false pos 5-7%. Don't use it now. NIPS is better.
22
Q

What would the triple test antenatally show if there was a high risk of Down’s Syndrome?

A 
High AFP (alpha-fetoprotein), Low estriol, High b-HCG. 
BUT false pos 5-7%. Screen 65% of Down's Syndrome. Don't use it now. NIPS is better. (99%) 
Screening.
23
Q

What is the NIPS test?

A

Maternal blood test, extract free foetal DNA from maternal blood (cell free DNA). If extra fragments of foetal DNA –> T21/18/13.
Picks up 99% Down’s syndrome. False positive 0.1%
Can be done from 10 weeks
Harmony Test, $400

24
Q

What is standard combined first trimester screening?

A

U/S = NT (11-14 weeks)
Blood test = PAPP-A (low), bHCG (high) (9-14 weeks)
90% sensitive, 95% specific for Down’s Syndrome, false positive = 5%
Occurs at 10 weeks
- PAPPA - large glycoprotein produced from the placenta. Prevents recognition of foetus. Assoc. with SGA/foetal demise, PET, preterm baby

25
Q

What is the difference between Gastrochesis and Omphalocele?

A

Gastrochesis:

  1. Open defect
  2. Isolated defect
  3. Umbilical cord to the left
  4. Bowel often inflammed and 10-15% have intestinal atresias
  5. SGA

Omphalocele:

  1. Membrane covered
  2. Associated with other organ problems (renal, cardiac)
  3. Umbilical cord in the centre of the membrane
  4. Normal bowel
  5. Associated with LGA/low BSL/big tongue/ ear crease = Beckworth Wiedermann Syndrome

Paed BPT Study (7 decks)

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