Neonates Flashcards
APGAR - pulse scores
> 100 = 2
< 100 = 1
Absent = 0
Second A in APGAR
score:
Activity
Active motion = 2
Some muscle tone = 1
Loose/floppy = 0
Respiratory effort in APGAR
Cries well = 2
Slow irregular breathing = 1
Not breathing = 0
Respiratory distress syndrome in preterm infant prevention
Pre-natal STEROIDS
2 doses, 12 hours apart
Long term complication associated w/ ventilation of babies
Broncho-pulmonary dysplasia
Necrotising enterocolitis px.
Poor feeding
Mucous and blood stained diarrhoea
Abdominal distension and tenderness
Necrotising enterocolitis ix.
Abdominal X-ray
Necrotising enterocolitis ix. findings:
Asymmetrical dilated loops of bowel
Oedema and pneumostasis intestinalis - air cysts in the bowel wall.
Pre-term delivery head injury
Periventricular haemorrhage
Periventricular haemorrhage may progress to:
Intra-ventricular and intra cerebral haemorrhage
Neonatal sepsis antibiotics:
Benzyl penicillin
Gentamicin
Antibiotics required for:
Neonatal pneumonia
Neonatal meningitis
UTI
Amoxicillin
Cefotaxime + Amoxicillin
Amoxicillin + Gentamicin
Ophthalmia neonatorum causative organism
Chlamydia from mother to baby
Transient tachypnoea of the newborn - main cause
C-section delivery
Failure to adequately clear fluid from the lungs following delivery.
Mx. TTN
Rule out other causes of increased RR
Monitor - most resolve w/in 24 hours
Meconium aspiration syndrome occurs due to either:
Fetal distress
Post-term baby
Meconium aspiration syndrome mx:
Suctioning and supportive care
Main causes of neonatal heart failure:
TORCH infections
Chromosome abnormalities
Rhesus Haemolytic disease
Mx. Persistent pulmonary hypertension of newborn:
Supportive care
Inotropes to increase systemic pressure while foetal circulation naturally adapts
Haemorrhagic disease of the newborn: px.
2-7 days post partum bleeding and bruising
Haemorrhagic disease of the newborn: Mx
Vitamin K at birth - given by the midwife
Physiological jaundice bilirubin level
Must be below 200
Causes of pathological jaundice w/in the first 24 hours of life:
Sepsis
Haemorrhagic disease of the new born
Red cell incompatibility: Rhesus disease.
Inherited conditions: G6PD, Hereditary spherocytosis
Prolonged jaundice duration:
> 14 days
Prolonged jaundice causes:
Hypothyroidism
Infection: UTI, TORCH
Biliary atresia, CF, hypothyroidism
Mx. of prolonged jaundice:
Plot bilirubin on graph
High: Phototherapy
Very high: Exhange transfusion
Prolonged jaundice: investigate for conditions such as:
G6PD
Galactosaemia
Hypothyroidism
What is Kernicterus
Bilirubin induced encephalopathy
Kernicterus management:
Exchange transfusion + phototherapy
Cyanotic congenital heart defects are associated with a ___ shunt
Right to left shunt
Cyanotic defects examples:
Tricuspid atresia Pulmonary atresia Severe pulmonary stensosis Severe Ebstein's anomaly Tetralogy of Fallot Transposition of the great arteries
Transposition of great vessels - shape of cardiomegaly:
‘egg-shaped’
Tetralogy of Fallot shape of cardiomegaly:
‘Boot-shaped’
Most common congenital heart defect:
Cyanotic or acyanotic
VSD
Acyanotic
Patent ductus arteriosus mx.
To close
To keep patency: before surgery:
Indomethacin will close
Prostaglandins will keep patency
Oesophageal atresia: describe -
Narrowing of oesophagus and formation of fistula w/ the trachea
Oesophageal atresia px.
Frothy secretions, drooling and difficult passing catheter into stomach
Gastrochisis vs. Exomphalos
Gastrochisis = Extrusion of abdominal viscera Exomphalos = herniation of viscera covered w/ peritoneum - para-umbilical
Congenital adrenal hyperplasia raised marker:
17 - hydroxyprogesterone
21-a hydroxylase deficiency
Meconium ileus commonest assoc.
CF
Meconium ileus ix.
Large distended loops of small bowel on ABDOMINAL XRAY
Mx. meconium ileus:
Conservative = wash-out and NG tube
Surgical - removal of compacted bowel
Jejunal atresia px.
Vomiting, unable to pass meconium
Jejunal atresia px.
Few bowel loops w/ distended proximal small bowel
Causes of jitteriness in baby
Hypoglycaemia
Hypernatraemia (dehydration)
SUFE classically features loss of:
Internal rotation of the leg
Undescended testes mx.
Review at 3 months
Refer for surgery at 6 months
Chest compressions: rescue breaths for neonatal CPR
3:1 ratio
