Neonates Flashcards
Risks to newborn of maternal DM with insulin
2-3x greater risk of congenital abnormality
- Sacral agenesis (caudal regression syndrome)
- Situs inversus
- Holoprosencephaly
- Congenital heart disease
Risks to newborn of maternal HTN
Before 20/40: miscarriage
After 20/40:
- IUGR
- placental insufficiency
- placental abruption or previa
Risk to newborn of maternal hyperthermia
Days 14-30 after conception increases the risk of NTDs
Risk to newborn of SLE
Before 20/40: miscarriage
After 20/40:
- still birth
- prematurity
- congenital heart block
Risk of maternal parvovirus B19 (causes erythema infectiosum - 5th disease)
Infection btwn 10 & 24 wks can result in 10% risk of foetal severe anaemia, heart failure, hydrops fetalis, and death
Risk of maternal varicella
Infection during 1st trimester (8-20wks) can result in 1-2% risk of limb reduction defects, IUGR, microphthalmia, chorioretinitis, skin scarring, DD, microcephaly
Risk of maternal CMV
Before 27 wks, 5% risk of symmetric IUGR, microcephaly, periventricular calcifications, intellectual disability, hearing loss
Risk of maternal rubella
0-8 wks - deafness (85%)
9-12 wks - cataracts (52%)
12-30 wks - heart defects (16%)
Toxoplasmosis
Increasing risk as GA increases
- Hydrocephalus
- Blindness
- Intellectual disability
Maternal syphilis -> congenital syphilis
Esp after 5 mths GA
- Abnormal teeth and bones
- Intellectual disability
- Proteinuria
Maternal HSV -> neonatal HSV
Local infection - skin, eyes, mouth
CNS - HSV encephalitis
Both local and CNS
TORCH
Toxoplasmosis
Other (syphilis, parvovirus)
Rubella
CMV
HSV
Most common causes of neonatal sepsis
GBS, E Coli
Clinical features of neonatal sepsis
APGARS <6
Temperature instability
Resp distress
Lethargy
Irritability
Poor feeding
Tachycardia
Bradycardia - uncommon
Describe TTN
In late pre-term infants 34-37 wks
Inadequate clearance of lung fluid at birth
Present with tachypnoea, grunting, nasal flaring, mild intercostal/subcostal recessions, cyanosis
OE: chest clear
CXR: prominent pulmonary vasculature, fluid in the fissures, flattening of the diaphragms (from overaeration), plural fluid
NO air bronchograms or reticular granularity (present in RDS)
CXR TTN
Prominent pulmonary vasculature, fluid in the fissures, flattening of the diaphragms (from overaeration), plural fluid
NO air bronchograms or reticular granularity (present in RDS)
Incidence of RDS
Inversely proportional to gestational age
White males > F
Describe RDS
Due to surfactant deficiency and immature alveoli
Surfactant reduces alveolar surface tension, which decreases the pressure which is required to keep alveoli inflated
Alveoli don’t expand adequately -> atelectsis, less functional RC, inadequate ventilation of the lungs, hypercapnia, hypoxaemia
Surfactant constituents and production
1) Lecithin (65%)(dipalmitoylphosphatidylcholine)
2) Surfactant proteins SP-A, -B, -C, -D (phosphatidylglycerol, apoproteins)
3) Cholesterol
As GA increases, more surfactant is synthesised and stored in Type II alveolar cells.
Mature levels at >35 wks GA
CXR RDS
Low lung volumes
Air bronchograms
Diffuse, fine, reticulogranular ground glass haziness
DDx RDS
In setting of hypoxia, hypercapnia and metabolic acidosis -
GBS sepsis
Congenital heart disease
Ante and perinatal corticosteroid treatment to prevent RDS
Given at 23-24 wks if risk of preterm labour
+/- 34-36 wks - betamethasone or dexamethasone
Intratracheal surfactant therapy within 30-60 mins of delivery
Indications for prophylactic abx for GBS
- Positive 36 wk vaginal/rectal culture
- Prior infant with GBS
- GBS bacteruria during pregnancy
- Unknown culture in setting of fever, preterm labour or PROM
Neonatal resp syndromes
TTN - wet lungs
RDS - surfactant def.
GBS
PPHN
Apnoea - CNS/ob/mixed
MAS
CDH
PTX
Pneumomediastinum
BPD
Pulm haemorrhage
