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neonates Flashcards

1
Q

what is the difference between gestational age and corrected gestational age?

A

Gestational is the amount of weeks the baby has been developing in the womb-from the first day of the mums last period to the baby’s birth. While corrected gestational is the age of a preterm baby based on their due date, rather than their birth date.

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2
Q

What is the importance of corrected gestational age?

A

it’s crucial for appropriate drug dosing, as premature babies have different developmental milestones compared to full-term babies.

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3
Q

Why are premature neonates weighed every day?

A

To monitor weight changes, which are essential for adjusting drug dosages accurately. Preterm babies grow very fast, so doses have to be re-calculated at regular intervals.

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4
Q

What is the purpose of an initial assessment in neonates?

A

To check the baby’s overall health and determine if further investigation or intervention is necessary.

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5
Q

What are the key elements in the initial assessment of a newborn?

A

APGAR score (measured at 1, 5, and 10 minutes after birth)birth weight and ageobstetric historydrug history of the mother-drug misuse, high dose beta blockerbaby’s drug history.Identify if vitamin k is needed

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6
Q

What is an APGAR score, and when is it taken?

A

a quick assessment of a newborn’s health, taken at 1, 5, and 10 minutes after birth.A pperanceP ulseG rimaceA ctivityR espiration

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7
Q

What interventions are done immediately after birth for a neonate born at 24 weeks onwards?

A

Cutting the umbilical cord has caused a cut from oxygen and nutrition .:. need to provide oxygen and nutritionincubationventilationInserting a central line through the umbilical cord.

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8
Q

What is surfactant, and why is it given to preterm neonates?

A

Surfactant is a substance (lipoprotein made of proteins and fats)administered via ET(endotracheal) tube to coat the lungs so they do not collapse=breathe easily.It’s a synthetic version of what coats our lungs. Onlystarts being produced at 32 weeks!Also know as protactant alfa–given via aLISA catheter.

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9
Q

What is the role of caffeine in premature neonates?

A

Caffeine is a respiratory stimulant that improves breathing problems and improves neurodevelopmental outcomes in preterm neonates.

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10
Q

Why is morphine given to premature neonates?

A

used to settle the baby and assist with long-term ventilation.

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11
Q

What is the role of antibiotics in preterm neonates?

A

Antibiotics are given to treat early-onset sepsis, as neonates are highly susceptible to infections from bacteria in the birth canal and due to the infection prone environment(hospital).

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12
Q

How does the underdeveloped kidney function in neonates affect drug dosing?

A

Causes poor drug clearance, which requires careful fluid balance and individualised drug dosing.

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13
Q

How is kidney function affected in premature neonates?

A

Since kidneys are undeveloped there’s very little output in first day’s which increases risk of hypernatremia but there may also be large losses of fluid.

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14
Q

How does gastric pH at birth affect drug absorption in neonates?

A

All Neonates have a neutral gastric pH (6-8) at birth due to residual amniotic fluid in babys stomach-affecting absorption of drugs.Acid-labile drugs have higher bioavailability, while weakly acidic drugs have reduced absorption due to existing in ionised form.

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15
Q

What are the changes in gastric emptying rates in neonates?

A

Gastric emptying is prolonged in both premature and term neonates, reaching adult rates by 6-8 months, which can enhance the absorption of certain drugs.

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16
Q

What is gastro-oesophageal reflux (GOR), and how is it treated in neonates?

A

GOR occurs when stomach contents flow back into the esophagus=complications e.g oesophagitis, chronic aspiration, failure to thrive.Treatment options-alginates, H2 antagonists, omeprazole(most common), feed thickening and sometimes surgery.

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17
Q

What gastro condition can occur in premature babies?

A

GOR-Gastro-oesophageal Reflux

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18
Q

Why is TPN critical for neonates, especially premature ones?

A

Total Parenteral Nutrition is vital for neonates because their energy expenditure is very high, and lack of adequate nutrition at this stage can affect long-term development, including bone and brain growth

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19
Q

What is Patent Ductus Arteriosus (PDA), and how is it treated in preterm neonates?

A

PDA is a condition where the ductus arteriosus fails to close after birth.In preterm neonates, it is treated with paracetamol to inhibit prostaglandin synthesis, which causes the ductus to close. Prostin can be used if the baby has congenital heart defects=a struggle to get blood to body without PDA.

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20
Q

what does the ductus arteriosus do? when is it supposed to close?

A

Carries blood away from the lungs and sends it directly to the body.Closes within first few days of life. Increase in oxygen concentrations and fall in prostaglandin levels leads to Vasoconstriction of the PDA.

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21
Q

What are the main side effects of caffeine used as a respiratory stimulant in neonates?

A

tachycardia

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22
Q

How do the changes in liver enzyme activity in neonates affect caffeine metabolism?

A

Neonates mostly excrete caffeine unchanged until about 3 months of age, when liver enzyme activity increases, leading to its metabolism.

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23
Q

What is the importance of line compatibility and access points in neonates?

A

Understanding line compatibility and access points, like the umbilical arterial and venous catheters, is crucial for administering medications and fluids safely in neonates.

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24
Q

What is neonatal respiratory distress syndrome (RDS)? what are the signs? what ?

A

a syndrome caused by a reduction in pulmonary surfactant for development and structural immaturity in the lungsThe appearance of a baby with increased work of breathing, nasal flaring, rib recession, tachypnoea, a require oxygen therapy and/or retention of carbon dioxide on blood gas analysis.

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25
What is the cause of RDS?
Lung immaturity due to surfactant insufficiency at the time of birth.
26
what is the pathophysiology of RDS? what are the signs and symptoms in premature babies?
surfactant deficiency, leading to alveolar collapse, impaired gas exchange, hypoxemia, and respiratory distress. Tachypnea.Grunting (to maintain ventilation).Retractions (using accessory muscles to breathe).Cyanosis (bluish discoloration due to hypoxia).Respiratory failure if untreated.Apnoeareduced urine output increased sweating
27
What is the purpose of surfactant administered via an ET tube in neonates?
Surfactant, also known as protactant alfa, is a synthetic version of what coats our lungs, and it begins production in the body at 32 weeks gestation. It is given via a LISA catheter to aid in lung function.
28
Why is Vitamin K administered to neonates?
Vitamin K is given to neonates due to their high risk of intraventricular hemorrhage, which Vitamin K can help prevent.
29
What role do fluids and TPN play in neonatal care?
10% dextrose or startup TPN is administered within the first hours after birth for growth, especially when neonates cannot have milk, as they have a very high energy requirement.
30
How is early-onset sepsis managed in neonates?
Antibiotics are administered, and a calculator is used to predict the risk of early-onset sepsis based on common bacteria found in the birth canal.
31
What are the uses of a UAC (Umbilical Arterial Catheter) in neonates?
A UAC is used for monitoring arterial blood pressure, performing frequent blood gas analysis, and regular blood sampling.
32
What is the purpose of a UVC (Umbilical Venous Catheter) in neonates?
A UVC, typically a double lumen catheter, provides central access for up to 10 days and can be used to run fluids to maintain catheter patency.
33
What does the abbreviation "TTO" stand for, and what is its purpose?
TTO stands for "to take out" and refers to a discharge form for patients that includes a summary of their hospital stay and prescriptions for medications to take home.
34
What considerations are important when preparing a TTO for neonates?
It’s ideal to send neonates home on as few medications as possible, often stopping all supplements except Abidec(vitamins). If discharged on Joulies phosphate or calcium syrup, endorse 4 bottles as they expire after 7 days once opened and need to be ordered from the hospital.
35
What instructions should be followed when preparing HIV prophylactic medications for discharge?
HIV prophylactic medications are stored in the D10 fridge. The bottle in use should be relabeled for discharge, and the ward must order a replacement bottle to ensure continuity of medication.
36
What is gestational age?
Gestational age is the time from conception to birth and directly affects the immediate and long-term health and prognosis of newborns.
37
What is the normal gestational timeframe, and what does it signify?
The normal gestational timeframe is 37-42 weeks, known as full term. Babies born at full term usually have fully developed organ systems, are at a healthy weight, and typically have the best prognosis with low risk of complications.
38
How does being born late preterm (34-36 weeks) affect a newborn?
Late preterm babies may look healthy but can have issues with feeding, maintaining body temperature, and underdeveloped lungs, which may lead to respiratory distress syndrome (RDS). They may need a short time in NICU for support with oxygen, nutrition, and development.
39
What are the long-term health risks for extremely premature babies (<28 weeks)?
Extremely premature babies have a high risk of chronic health issues such as lung disease, motor and cognitive impairments, learning difficulties, and developmental delays. They also have higher rates of hospital admissions later in life.
40
How does gestational age impact a baby's prognosis?
Babies born full term have the best prognosis with normal growth and low complication risks. Late preterm babies may experience some complications but usually recover with NICU support. Extremely premature babies face significant long-term health risks and developmental delays.
41
What is meconium, and when is it usually passed?
Meconium is the first stool that builds up inside a baby and is typically passed shortly after birth
42
What risk is associated with a baby breathing in meconium?
If meconium is inhaled into the lungs, it can cause respiratory distress and other health issues.
43
How does weight loss after birth differ between full-term and premature babies?
Full-term babies may lose a little weight after birth as their bodily functions are developed and working properly, while premature babies may experience a greater weight loss due to underdeveloped bodily functions and fluid imbalances.
44
Why might a premature baby have more noticeable weight loss after passing their first bowel movement?
Premature babies may have underdeveloped immune systems, kidneys, and other functions. This can lead to fluid imbalances and adjustments, causing a greater weight loss as the body rebalances its levels.
45
How long does weight loss in newborns typically last, and when is normal weight expected to return?
Weight loss in newborns usually lasts around 3 to 4 days, with weight returning to normal after a couple of weeks
46
How does neonatal sepsis differ from adult sepsis?
Neonates have a much less developed immune system compared to adults, making them more vulnerable to sepsis.
47
What are the signs and symptoms of sepsis in neonates?
a weak, high-pitched, or continuous crytemperature of 38°C in those under 3 monthspallor of skin, lips, or tongue,breathing difficulties,and poor feeding.
48
What are the red-flag temperature thresholds for sepsis in neonates and young children?
Red-flag temperatures are 38°C for those under 3 months, 39°C for those aged 3–6 months, and less than 36°C for any age
49
What are common symptoms of sepsis in adults?
new-onset confusion, slurred speech,temperatures below 36°C,leg pain,and new onset arrhythmia.
50
What is the first step in managing suspected neonatal sepsis?
A doctor or nurse will insert a cannula into the baby's vein to take a blood sample and start antibiotics immediately.
51
What is the NICE recommended antibiotic regimen for suspected early-onset neonatal sepsis?
NICE recommends intravenous benzylpenicillin with gentamicin as the first-choice empirical treatment.
52
What are examples of empiric treatment regimens for adult sepsis of unknown origin in the UK?
co-amoxiclav + gentamicinceftriaxone + metronidazole + gentamicin (for mild penicillin allergy)and levofloxacin + metronidazole + gentamicin (for severe penicillin allergy).
53
Why is caffeine citrate used in premature infants? whats the MOA?
Caffeine citrate is used for short-term treatment of breathing problems (apnea) in premature infants. Helps to reduce frequency of apnea by blocking adenosine receptors .:. improves breathing.
54
What is FiO2 and why is it important in neonatal care?
FiO2 is the fraction of inspired oxygen, representing the amount of oxygen pumped into the baby's lungs via a ventilator. It helps to maintain adequate oxygen levels, which caffeine citrate supports in cases of apnea.
55
What does skin turgor indicate in a patient? how is it done?
Skin turgor refers to the elasticity of the patient’s skin and is used to assess hydration statusBy pinching the skin on the arm or abdomen to form a tent and then releasing it to see how quickly it returns to its normal position.
56
What does it mean if skin with poor turgor takes time to return to normal? whats a normal turgot time?
Poor skin turgor, where skin takes longer to return to normal, indicates moderate to severe fluid loss.A turgor time of 1.5 seconds or less suggests a less than 50 mL/kg deficit or a normal infant.
57
What deficit range does a turgor time of 1.5 to 3.0 seconds indicate?  What does a turgor time of more than 3 seconds suggest?
A turgor time of 1.5 to 3.0 seconds indicates a deficit between 50 and 100 mL/kg. while more than 3 seconds suggests a deficit of more than 100 mL/kg
58
Why might skin turgor be less accurate in people over 65?
Skin turgor is not very effective for detecting dehydration in people over 65 due to reduced skin elasticity.
59
What health conditions can affect skin turgor?
Conditions such as diarrhea, diabetes, dehydration, extreme weight loss, and vomiting can affect skin turgor
60
How do maternal infections affect preterm labor?
Maternal infections, such as urinary tract infections and chorioamnionitis, significantly contribute to premature labor. Studies show a correlation between infection and increased inflammatory markers that can trigger early delivery.
61
What chronic health issues in mothers are linked to preterm birth?
Chronic health issues like hypertension, diabetes, and thyroid disorders can complicate pregnancy and lead to preterm birth. Effective management of these conditions is crucial to reducing risk.
62
How does substance use influence the risk of preterm birth?
Substance use, including smoking, drug use, and excessive alcohol consumption, is consistently linked to higher rates of preterm births. These factors negatively impact fetal development and increase the likelihood of early labor.
63
Why do multiple pregnancies raise the risk of preterm birth?
Carrying twins or more significantly increases the risk of preterm birth due to the added physical demand on the mother’s body and the higher chance of complications.
64
What is cervical insufficiency, and how does it affect pregnancy?
Cervical insufficiency, or a weakened cervix, can lead to premature dilation and early labor. This condition often requires close monitoring and sometimes intervention.
65
How does a history of preterm birth influence future pregnancies?
Women who have previously delivered prematurely are at an increased risk for future preterm births. This history strongly predicts recurrent preterm labor.
66
What age-related factors increase the risk of preterm birth?
Young mothers (under 20) and older mothers (over 35) face increased risks of preterm birth, possibly due to age-related factors affecting physiological resilience and pregnancy complications.
67
How does ethnicity relate to preterm birth rates?
Certain ethnic groups, particularly Black women, experience higher rates of preterm births, likely due to a combination of genetic, environmental, and socioeconomic factors.
68
How does socioeconomic status affect the risk of premature birth?
Limited access to healthcare and prenatal services is often correlated with higher rates of premature birth, indicating that social determinants of health play a critical role in maternal and infant outcomes.
69
How is Streptococcus pneumoniae transmitted?
This gram-positive bacteria is spread through direct contact with respiratory secretions, such as sneezing and coughing from an infected person.
70
What are the common signs and symptoms of a Streptococcus pneumoniae infection?
Pain in the chest, cough, fever, dyspnoea (shortness of breath), and sputum production.
71
What types of infections can Streptococcus pneumoniae cause?
It can cause a variety of illnesses, including both invasive and non-invasive infections.
72
What are the clinical features of pneumonia caused by Streptococcus pneumoniae?
Invasive infection characterized by pain in the chest, cough, fever, dyspnoea, and sputum production.
73
What are the clinical features of meningitis caused by Streptococcus pneumoniae?
Confusion, stiff neck, fever, and light sensitivity.
74
What are the symptoms of otitis media caused by Streptococcus pneumoniae?
Ear ache, hearing loss, nausea, fluid coming out of the ear, and difficulty sleeping.
75
What are the signs and symptoms of bronchitis caused by Streptococcus pneumoniae?
Sore throat, shortness of breath (SOB), productive cough, high temperature, and runny nose
76
What is parenteral nutrition? who receives it?
Parenteral nutrition is the intravenous administration of nutrients to patients who cannot take food orally or through a tube, bypassing the gut to supply essential nutrients.It is given to patients who are malnourished or at risk of malnutrition, those with gut motility issues, inflammation, or when the gut cannot absorb necessary nutrients.
77
Why might preterm neonates require parenteral nutrition? How many kcal/kg/day are required when parenteral nutrition is given within the first 4 days after birth?
Preterm neonates may need it if they are unlikely to establish sufficient enteral feeding or haven't made enough progress with enteral feeding within 72 hours.The baby would need 40-60 kcal/kg/day, gradually increasing to a maintenance range of 75-120 kcal/kg/day.
78
What type of parenteral nutrition solutions do hospitals usually provide?
Hospitals typically use standardized parenteral nutrition bags with pre-formulated aqueous and lipid solutions that meet the needs of specific groups of babies
79
Can additional infusions be administered with parenteral nutrition?
Yes, additional IV infusions can be given to meet individual electrolyte or fluid requirements.
80
What is the age range for a pre-term neonate and the key stages of development?
Age: 23 to 37 weeks gestation. Key stages: Rapid growth, fully formed, but most systems are not fully developed.
81
What is the age range for a neonate and the key stages of development?
Age: Birth to one month. Key stages: Normal initial period of human development and growth.
82
What is the age range for an infant and the key stages of development?
Age: One month to one year. Key stages: High growth rates and rapid changes.
83
What is the age range for a child and the key stages of development?
Age: 1 to 12 years. Key stages: Slower growth and development.
84
What is the age range for an adolescent and the key stages of development?
Age: 12 to 18 years. Key stages: Final period of growth and puberty, transitioning into adulthood.
85
What is the gestational age range for moderate-to-late preterm neonates?
32 to 37 weeks.
86
What is the gestational age range for very preterm neonates?
28 to 32 weeks.
87
What is the gestational age range for extremely preterm neonates?
Less than 28 weeks.
88
What is the definition of low birth weight (LBW)?
Birth weight less than 2500 grams.
89
What is the definition of very low birth weight (VLBW)?
Birth weight less than 1500 grams.
90
What is the definition of extremely low birth weight (ELBW)?
Birth weight less than 1000 grams.

4th year (2 decks)

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