neonates Flashcards
newborn screening
PKU Homocystinuria MSUD Congenital toxo Congenital hypothyroidism GALACTOSAEMIA
caput succedaneum
brusing and odeam of the presenting part
Resolves within few days
EXTENDS BEYOND SKULL MARGIN
Caphalhaematoma
heamatoma from bleeding bellow the periosteum
invovles parital bone
CONFINED TO SKULL MARGINS
Cignon
from vacum deliveries - odeam and brusing of head
what is the risk of getting NEC if you dont breast feed
6X
what is the risk of getting Gastroenteritis if you dont breast feed
5X
what is the risk of getting Resp distress, otitis media, ecema and wheeze if you dont breast feed
2 times increase
number one cause of prematurity
spontaneous - 45%
delivery / maternal infection - 30%
PROM - 25%
RDS RF
Males , 2nd born and materneral DM
RDS Dx
Ground glass apperance and AIR BRONCHOGRAM
TTP Dx
fluid in the horizontal fissure
Conenital pneumonia Dx
Non specific patchy infiltrates
Neutropenia
Trachal aspiration and
Gram stain for Dx
when does RDS present
48-72 hours after birth in resp distress
Treatment RDS
CPAP
Artifical surfactant
3. pretreat mom at risk w. corticosteroids
complications of RDS
RIPBBN
Retinopathy of prematurity
Intracentricular Heamorrage e
BPD
Barotrauma - from postive pressure ventillation
NEC
apnea of prematurity
20sec no breath
normal in preterms
Adnormal if term / worsening / no hx
Cause
- poor resp drive or airway problem or BOTH
STIMULATE
O2 / CAP
CAFFINE
BPD
infants with low birth weight and those who receive prolonged mechanical ventilation to treat respiratory distress syndrome (RDS).
Dx BPD on X-ray
Streaky intersitial marking
Atelectasis
Cyst
hyperinfilated
Diganosed at age 28 weeks old
NEC CLINICAL EARLY THEN LATE
Early - feeding difficulties - delayed gastric emptying Distension - bloody stools
Lateral
- interestinal perforation
- peritonitis
- abdo erythema
- shock
RF NEC
PReterm
Dx
pneumoatosis intestinalis - hten take US every 60 minutes to see if it become walled off or bowl necrosis
treatment
IV metranidazole and surgery
complication NEC
strictures and short bowl syndrome
what age do you get nec
w/i days - weeks of birht
BABIES BORN EARLIER GET NEC AT LATER AGES
retinopathy of prematuritis
retinal vessels develop at 32 weeks - therefore preterm are at risk
IVH
germinal matric and neurons mirgrate during last few weeks of utero
DDX Mekles
technitium 999 pertechnetate
Treatment of intussuception
Air contrast barium edema
cause of constipation in newborn
HHHA Hypothyroidism HYPERcalemia Hirshprund Anal stenosis
Sepsis clinical and treatment
EARLY 4 days
- fuminating multisystem pneumonia
- 15-50%
- Benzylpenicillin and gentamycin
Lat >4
- focal progressive meningitis
- 10-20%
Treat w/ fluoxacillin and gentamycin
chlamydia vs. gonorrhea infection in baby
Chlamydia - 5-14 days
Gonorrhea 2-5 days
5 things cafe au lait spots are ass. w.
NF1 MArphans Tuberous sclerosis McCune Albright Fanconi anemia
kassabach Meritt syndrome
Telangetasia and haemaginoma
Klippel Trenaunay Syndrome
Capillary malofrmation and overgorwth
bone and limb defect
who get umbilicated hernia
Downs
Hypothyrpidism
PRETERM
REFER FOR TREATMENT IF it does not resolve by age 3
Sandifers syndrome
GERD ass. w/ lateral head til and back arching resulting in osephagitis
cause of GERD
- Decrease LES
- inappropiate LES relaxation
- Large histus hernia
- dealyed gastric emptying
treatment of GERD
Sit up right
Thicker formulas
H2 antagonist - CIMETIDINE - to help reduce the reflux
Resolves w/i 9-18 months and if it does
NISSEN FUNDOPLICATION
SE of phototheraphy
interupt maternal bonding Dehydrating Hyperthermia rentinal deamge Decrease intestinal transiet
Se of exchange transfusion
death infection thrombocytopenia port vein thrombosis NEX Electrolyte imblance Gvs, Host
when to do exhcnage transfusion vs. phototherphy
UCB >20
physiological jaudice of a newborn why?
- pathway of bilirbunin excretion is not mature
- extrahepatic circulation
- 70-90 days in term
- 40 days in preterm
INCREASE HCT than adults
CEPHALOHEAMATOA
kernicturis
complication of UCB > 25 when it deposits in the basal ganglion pons and cerebellu
>25- 30 mg/dl Risk factor ; - PRETERm - Aphyxia - Sepsis
PENTAD
- MOTOR - OCULOMOTOR _ CHOcLEAR - ID
causes of polycythemia
Vennous hct is ?65% or more Increase hct = increase viscosity Causes chronic IUGR Excessive transfusion (delayed cord clamping infant of diabetic mom
CLinical BRAIN - jitteriness, headache HEART - HTN , PFC REnal GI - NEX HYpoglycemia and Jaudice
when does heamolytic disease of newborn present
2-4 days
causes of RAISED alpha fetal protein
NOT CO TPN
Normal
Omphalocele
Twins
Congenital nephorisis
Oligohydramniosis
Turners
Pateau
NTD
Clinical hydrocephalus
The syptoms of INCREASE Intacranial pressure vomitting and decrease LOC anterior fontanelle open and buldging scalp weins are dilated space suture EYES DEVIATED DOWN ( SUN SETTING)
treatment of hydrocephalus
Acetazolamide plus/minus furosemide
Serial lumbar puncture
VP shunt
Dx hydrocehalus
antenatal US
cranial US
CT or MRI
head circumferance
treatment of cleft lip
refer to specialist unit
3 moths - lip repair
Palate repair at 9-12 months
Wide forehead with a small triangle-shaped face and small, narrow chin
Russell-Silver syndrome
high arch palate , micrognathia and prominant tongue
Pierre Robin Syndrome
0 feeding problem and airway obstruction
MEC aspiration Complication
Mechanical obstruction
Chemical pneumonitis
obstruction
pneumothorax
overinflated lung with patches of consolidation and collapse
Meconium Aspiration
treatment of penumonia in neonates
benzylpenicillin and gentamycin
pneumothorax caues
secondary to
- MEc aspiration
- RDS
- mechanical respiration
Pneumothorax treatment
small - O2 and 2ICS aspirate
Larger - 5ICS chest drainage
PPHT of Newborn causes
birth aphyxia
MEC
SEPticaemia
Resp Distress
treatment of PPHN
Mechanical ventilation and cirulatory report
inhaled NO - causes pulm arteries to vasodilate and therefore reduce pressures
high frequence oscillatory ventilation (HPOV) and ECMO
what can BPD result in
Cor pulmonale
venous hum
benign murmur age >2 infraclavicular area louder on right Muscial hum ASCENTUATED with diastolic inspiration
Resloves the murmus
- placing child supine
- turning child’s neck and
Compressing jugular vein
Stil murmur
AGE 3-5
vibratory low frequency
increased in HIGH states
Positional change
symptoms of Systolic murmur
Systolic Short Soft/ low pitch Left Sternal edge Positional changes
hypoxia (nitrogen washout test
R - L shunt
determines presence of disae
100% O2 for 10 minutes
if right radial aterial
complications of dibaetes in pregnancy
- Calvical fracture
- RDS
- Hypoglycemia
- give early feeds or IV glucose if they cant feed
- Congenital
- anencepahly, holoprosencaphaly, meningomylocele, sacral agenesis
- small left colon syndrome
- CHF (TGV , HOCM)
- Polycythemia
- Renal vein thrombosis
- Jaucine - hyperbilinrunemia
- Hypocalemia - hyper phosphate/ hypo Mg
- IU fetal dealth
- TTP
how is congenital diapharamic hernia normally dx
anternatal US
Right - more difficult to dx b/c liver and collapse lung have similar apperance
Left - fluid filled stomach
OR BY POLYHYDRAMNIOS
ddx CDH
CAM - cyst adenmatoid malformation pulm sequestration
neurenteric and dublicated cyst
Cystic teratoma
Post natal presentation CDH
first few hours - resp distress - if they have pulm hypoplasia
Pulmonary HTN
intermediate or early presentation CDH
minutes or few hours of birth with
0 resp distress, tachypnea , cyanosis, sternal recession and marked hypotonia
SCAPHOID ABDOMEN
Cxray of CDH
fluid dilled loops in chest
nasogastric tube
Lack of intestinal gas shawdoe
If normal you think CAM
late presentation of CDH
LESS DRAMATIC w/ better prognosis
alveolar development
less pulm HTN
FLuid filled loops in chest
Clinical - vomitting and requesnt chest infection
treatmnet of CDH
- IV access
- O2
- Urinary catherter
- fluids and pressor
- restricted fluids
good prognosis for CDH / normal prognosis
- present later 2 years of life
- stomach is NOT in chest
- less pulm HTN
- Better prognosis
Normal prognosis - 50% mortality
CDH is ass. w/
PENTAD CANTRELL sternal exophalus Pericardia Coarctation Pericardia Ventircular Arterial septal defect
treatment of meconium ileus
corrected by doing hydrophilic contrast enema (Gastrograffin) –> softens and inspissated meconium to faciliate package
NOTE: IVE ACCESS FLUID CAUSE GASTROGASTRIN CAN CUASE DEHYDRATION
Reactal distal ileum -
Ladd’s band
malrotation
treatment of fastroschis
CLING FILM WRAP
NGT - antibiotics
IV FLUIDS 10-20mls/kg
Colon washout with gastrograffin
If successful closeure - TPN 2-3 weeks
