Neonates Flashcards
Is neonatal jaundice more common in breast or bottle-fed babies?
Breast-fed
What is meant by pathological neonatal jaundice?
< 24 hrs after birth
What is meant by prolonged neonatal jaundice?
> 2 weeks in term baby or > 3 weeks in pre-term
Give causes of pathological jaundice.
Sepsis
Rhesus / ABO haemolytic disease
Hereditary spherocytosis
G6PD deficiency
Why does physiological jaundice occur?
Due to a number of factors including immature liver function and fragile RBCs
Give causes of prolonged neonatal jaundice.
Biliary atresia
Hypothyroidism
UTI
Breast milk jaundice
Galactosaemia
Prematurity
Congenital infections
What is the normal volume of amniotic fluid for a term birth?
~600mls
What is meant by neonatal hypoglycaemia?
BM < 2.6 in first 24h of life or < 3 thereafter
Give some risk factors for neonatal hypoglycaemia.
Diabetic mothers
Small/large for dates
Preterm
Give some causes of neonatal hypoglycaemia.
Hyperinsulinism
Endocrine disorders
Metabolic conditions
Sepsis
What is the immediate treatment for mild neonatal hypo?
Breast feed
What is the most common cause of persistent neonatal hypoglycaemia?
congenital hyperinsulinism
Which drug taken in late pregnancy may increase the risk of kernicterus?
Sulphonamides
What are the components of newborn screening in the UK?
Physical Exam
Newborn bloodspot
Newborn hearing screening
Which conditions does the newborn bloodspot screen for?
Cystic fibrosis, congenital hypothyroidism, sickle cell disease, MCADD, PKU, MSUD, IVA, GA1, homocystinuria
What is the first-line test used in newborn hearing screening?
Automated otoacoustic emission test
If a baby does not pass the first newborn hearing screening test, which test is used?
Automated auditory brainstem response
What is the largest component of surfactant?
Phosphatidylcholine
What is the main risk factor for neonatal sepsis?
Prematurity
What is the most common cause of early-onset neonatal sepsis?
GBS
Give common causes of late-onset neonatal sepsis.
Staph epi, Klebsiella, Pseudomonas, Enterobacter
What investigations would typically be done in a neonatal sepsis screen?
Bloods & gas
Blood & urine cultures
LP
What is the empiric antibiotic treatment for neonatal sepsis?
IV benpen and gentamicin
What are the key risk factors for NEC?
Prematurity/ low birth weight
Formula-fed
Sepsis
CHD
Ventilated
What are the key features of NEC on AXR?
Dilated/thickened bowel loops
Pneumatosis (gas in bowel wall)
Pneumoperitoneum
Gas in portal veins
What is the immediate management for NEC?
Refer to Paeds Surgeons
Make NBM, IVF, TPN, insert NGT and treat with antibiotics
Parietal bone swelling, does not cross suture lines suggests…
Cephalohaematoma
Boggy swelling crossing suture lines suggests…
Caput seccundum
What is the target growth velocity for a baby receiving adequate nutrition?
15g/kg/day
Lung hypoplasia and poor cartilage development suggests…
Jeune Syndrome
What are common causes of neonatal rash?
Erythema neonatorum toxicum
Acne neonatorum
Milia
Miliaria
How long does neonatorum toxicum typically take to resolve?
5 - 14 days
Dermal melanosis / Mongolian blue spot tends to resolve by what age?
6 years
What is the natural history of a port wine stain / naevus flammeus?
Tend to get thicker and darker over time
What is the recommended treatment for port wine stain?
Early laser therapy
Pink/red birthmark darker on child crying suggests…
Naevus simplex / salmon patch
What is the natural history of salmon patches?
95% regress by age 2
If treatment is indicated for an infantile haemangioma, what medical treatment may be considered?
Beta blockers
What is meant by ‘early’ neonatal hypoglycaemia?
< 48h of age
Give causes of early neonatal hypoglycaemia.
HIE, diabetic mother, small babies
Capillary haemangiomas are formed from…
Proliferating endothelial cells
What is the main protein in breast milk?
Whey
Boiling milk can lead to…
Thiamine deficiency
Which study supports neonatal saturations 91-95%
BOOST IIH
How should HR be measured in a neonate?
Stethoscope
Which antenatal problem is associated with renal agenesis?
Oligohydramnios
What is the standard treatment for persistent pulmonary HTN of the newborn/>
Inhaled NO
Neonate with vesicular rash, coagulopathy and hepatomegaly suggests…
Disseminated herpes simplex infection
When does surfactant production begin in-utero?
~ 24 weeks
Which hormone contributes to RDS in babies of diabetic mothers?
IGF-1
Which babies need screening for retinopathy of prematurity?
Born before 31 weeks or birth weight < 1.5kg
For babies born before 31 weeks, when should screening for ROP take place?
Within week 31 or at 4 weeks post-natal age (whichever is later)
Scaphoid abdomen suggests…
Congenital diaphragmatic hernia
Failure of which structure to regress causes Meckel’s diverticulum?
Vitelline duct
Duodenal atresia occurs due to…
Recanalisation error
Cyanotic baby, pink when crying suggests…
Choanal atresia
Which breastmilk component aids with iron metabolism?
Lactoferrin
Which breastmilk component helps to regulate metabolism?
Leptin
Maternal active herpes disease at which point in pregnancy is potentially most detrimental to the foetus?
1st trimester
Anhydramnios with resp distress suggests…
Pulmonary hypoplasia
What are the 5 stages of embryonic lung development?
Embryonic > Pseudoglandular > Canalicular > Saccular > Alveolar
Where are pre-ductal sats measured?
Right hand
Where are post-ductal sats measured?
Foot
What are normal values for pre and post ductal sats?
Both > 95%, differential of <3 %
A pre and post ductal sats differential suggests…
Mixing of arterial and venous blood through duct
How should infants with CDH be managed at birth?
Intubation and ventilation
What is the most prevalent condition tested for on the Guthrie card?
Congenital hypothyroidism
At what gestational age does the skin mature?
34 weeks
What is the main cause of ROP?
Hyperoxaemia
Which antibiotic should be added if early-onset neonatal sepsis is found to be gram negative?
Cefotaxime
