Neonates Flashcards
Main principles of neonatal resuscitation
Warm the baby
Calculate APGAR scores
Stimulate breathing
Inflation breaths
Chest compression
What is assessed in APGAR score
Appearance
Pulse
Grimmace
Activity
Respiration
APGAR score A1
Appearance
0 - blue/pale centrally
1 - Blue extremities
2 - Pink
APGAR score P
Pulse
0 - Absent
1 - <100
2 - >100
APGAR score G
Grimmace
0 - No response
1 - Little response
2 - Good response
APGAR score A2
Activity
0 - Floppy
1 - Flexed arms and legs
2 - Active
APGAR score R
Respiration
0 - Absent
1 - slow irregular
2 - strong/crying
What is assessed in blood spot screening
9 congenital condition
Sickle cell disease
Cystic fibrosis
Congenital hypothyroidism
Phenylketonuria
MCADD
MSUD
IVA
GA1
Homcystin
Define port wine stain
Pink patches of skin often on the face caused by abnormalities of the capillaries - they dont fade and often turn a darker red or purple.
Rarely related to sturge-weber syndrome
Define caput succedaneum
Fluid collection on the scalp outside the periosteum - results from a traumatic, prolonged or instrumental delivery
Fluid is ably to cross the suture lines and theses are benign with no treatment required
Define cephalohaematoma
Collection of blood between the skull and periosteum - lump does not cross suture line
Slight risk of anaemia or jaundice but should resolve without intervention
Define Erbs palst
Results from injury to C5/C6 nerves during birth
Associated with shoulder dystocia, traumatic or instrumental delivery
Waiters tip appearance - internally reotated, extended elbow, flexed wrist facing backwards, lack of movement
Define neonal sepsis
Sepsis caused by an infection in the neonatal period
Common causative organisms in neonatal sepsis
Group B streptococcus!!!
E. coli
Listeria
Klebsiella
Staphylococcus aureus
Risk factors for neonatal sepsis
Vaginal GBS
GBS in previous baby
Maternal sepsis
Prematurity
Early rupture of membrane
Prolonged rupture of membrane
Presentation of sepsis
Fever
Reduce tone and activity
Poor feeding
Respiratory distress
Vomiting
Tachycardia or brady cardia
Hypoxia
Jaundice
Seizures
Hypoglycaemia
Red flags of sepsis
Confirmed or suspected sepsis in mother
Signs of shock
Seizures
Term baby needing mechanical ventilation
Respiratory distress starting more than 4 hours after birth
Presumed sepsis in another baby in multiple pregnancy
Management of sepsis
Antibiotics - benzylpenicillin
Blood cultures
FBC and CRP
Lumbar puncture
Define hypoxic ischaemic encephaopathy
Occurs in neonates as a result of hypoxia during birth - can lead to damage to the brain causing cerebral palsy
Causes of hypoxic ischaemic encephalopathy
Maternal shock
Intrapartum haemorrhage
Prolapsed cord
Nuchal cord - around neck
Management of hypoxic ischaemic encephalopathy
Supportive neonatal resuscitation
Therapeutic hypothermia
Lots of follow up!
Define physiological jaundice
Due to high levels of fetal haemoglobin there is high turnover of RBCs resulting in lots of bilirubin leading to mild yellowing of skin and sclera - presents at 2-7 days. Normally resolves within 10 days
When is jaundice pathological
When presenting within the first 24 hours of life
When does physiological jaundice present
2-7 days of life
Causes of jaundice - increased bilirubin
Haemolytic disease of the newborn
ABO incompatibility
Haemorrhage
Intraventricular haemorrhage
Cephalo-haematoma
Polycythaemia
Sepsis and DIC
G6PD deficiency
Causes of jaundice - decreased clearance
Prematurity
Breast milk jaundice
Neonatal cholestasis
Extrahepatic biliary atresia
Endocrine - hypothyroid, hypopituitary
Gilbert syndrome
Define breast milk jaundice
Components of breast milk inhibit processing of bilirubin, more likely to become dehydrated by inadequate feeding, poor feeding leads to slow stools worsening excretion of bilirubin
Define haemolytic disease of the newbord
Caused by incompatibility between the rhesus antigens on the surface of the red blood cells of the mother and fetus.
Investigations in jaundice
FBC and film
Bilirubin
Blood typing
Direct coombs test
Thyroid function
Blood and urine cultures
G6PD deficiency
Management of jaundice
Treatment graphs
Phototherapy
Exchange transfudion
When should bilirubin be measured following phototherapy
12-18 hours after stopping
What is associated with preterm birth
Social deprivation
Smoking
Alcohol
Drugs
Over or under weight
Maternal co-morbidities
Twins
Personal or FH
Short term complications of preterm delivery
Respiratory distress
Hypothermia
Hypoglycaemia
Poor feeding
Apnoea
Bradycardia
Neonatal jaundice
Intraventricular haemorrhage
Retinopathy or prematurity
Necrotising enterocolitis
Immature immune system and infection
Long term complications of premature delivery
Chronic lung disease of prematurity
Learning and behavioural difficulties
Susceptibility to infections - particularly resp
Hearing and visual impairment
Cerebral palsy
Define apnoea of prematurity
Define as period where breathing stops spontaneously for more than 20 seconds or shorter periods with oxygen desaturation or bradycardia.
Causes of apnoea or prematurity
Immature autonomic nervous system
Infection
Anaemia
Airway obstruction
CNS pathology
Gastro-oesophageal reflux
Neonatal abstinence
Management of apnoea of prematurity
Monitoring
Tactile stimulation
Intravenous caffiene
Settle as development happens
Define retinopathy of prematurity
Condition affecting preterm babies - abnormal development of blood vessels in the retina can lead to scarring, retinal detachment and blindness.
Management of retinopathy of prematurity
Systematically targeting areas of the retina to stop new blood vessels developing
Transpupillary laser photocoagulation
Cryotherapy
Injections of VEGF inhibitors
Surgery for complications
Define necrotising enterocolitis
NEC is a disorder affecting premature neonates, where part of the bowel becomes necrotic leading to perforation, peritonitis and shock.
Risk factors for NEC
Very low birth weight
Very premature
Formula feeds
Respiratory distress
Assisted ventilation
Sepsis
Patent ductus arteriosus
Presentation of NEC
Intolerance to feeds
Vomiting - green bile
Generally unwell
Distended tender abdomen
Absent bowel sounds
Blood in stools
Peritonitis and shock
Investigations in NEC
Bloods - FBC, CRP, gas, culture
Abdo xray
What is seen on xray in NEC
Dilated loops of bowel
Bowel wall oedema
Pnumatosis intestinalis - gas in bowel wall
Pneumoperitoneum - perforation
Gas in portal veins
Management of NEC
Nil by mouth
IV fluids
TPN
Antibiotics
NG to remove gas
Surgical emergency - removal of dead bowel
Complications of NEC
Perforation
Peritonitis
Sepsis
Death
Strictures
Abscess formation
Recurrence
Long term stoma
Short bowel syndrome
Define neonatal abstinence syndrome
Withdrawal symptoms that happen in neonates of mothers that used substances during pregnancy
Substances causing neonatal abstinence syndrome
Opiates
Methadone
Benzodiazepines
Cocaine
Amphetamines
Nicotine or cannabis
Alcohol
SSRI
Clinical signs of abstinence syndrome
Irritability
Icreased tone
High pitched cry
Not settling
Tremors
Seizures
Yawning
Sweating
Unstable temp
Tachypnoea
Poor feeding
Regurgitating
Hypoglycaemia
Loose stools
Sore nappy area
Management of abstinence syndrome
Lots of monitoring
replacement of substance - morphine
Define fetal alcohol syndrome
Certain effects and characteristics that are found in children of mothers that consumed significant amounts of alcohol during pregnancy
Features of fetal alcohol syndrome
Microcephaly
Thin upper lip
Smooth flat philtrum
Short palpebral fissure
Learning disability
Behavioural difficulties
Hearing and vision problems
Cerebral palsy
Features of congenital rubella syndrome
Cataracts
Congenital heart disease
Learning disability
Hearing loss
Features of congenital varicella syndrome
Severe - pneumonitis, hepatitis or encephalitis
Fetal varicella syndrome
Neonatal varicela
Fetal growht restriction
Microcephaly
Hydrocephalus
Learning dificulties
Scars and skin changes - following dermatomes
Limb hypoplasia
Cataracts and inflammation in eye
Features of congenital cytomegalovirus
Fetal growth restriction
Microcephaly
Hearing loss
Vision loss
Learning disability
Seizures
Clasic triad in congenital toxoplasmosis
Intracranial calcification
Hydrocephalus
Chorioetinitis
Define sudden infant death syndrome
A sudden unexplained death in an infant - cot death, uaually within the first six months
Risk factors for SIDS
Prematurity
Low birth weight
Smoking during pregnancy
Male baby
How to minimise risk of SIDS
Put baby on back when not supervised
Keep head uncovered
Place feet at foot of bed to prevent sliding down under blanket
Keep cot clear of toys and blankets
Maintain comfortable room temperature - 16-20
Avoid smoking - dont handle after smoking
Avoid sleeping in the same bed - especially if drinking alcohol, drugs smoking sleeping tablets or sleep disorders
