Neonates Flashcards
Define term? Preterm? Neonate?
T- birth at 37-42 weeks gestation
P- birth before 37 weeks
Neonatal period - first month of life
Diabetes mellitus effect on fetus?
Congenital malformations - 3x more esp cardiac
Macrosomia- fetal insulin response to hyperglycaemia promotes excessive growth
Maternal Diabetes mellitus effect on neonate
Hypoglycaemia - transient due to increased insulin (avoid with early feeding)
Respiratory distress syndrome
Polycythaemia (haematocrit >0.65)
Which antiepileptic have effect on fetus? What is the effect ?
carbamazepine, valproate, phenytoin.
Mid facial hypoplasia; CNS, limb & cardiac malformations
Which drug used in blood has an effect on fetus and what does it do?
Warfarin
Interferes with cartilage formation; cerebral haemorrhages & microcephaly
What are the effects of amiodarone on the fetus
Hypothyroidism
Use of iodines/ propylthiouracil in pregnancy on fetus?
Goitre / hypothyroidism
Effect of lithium in pregnancy
Congenital heart disease
Use of tetracyclines in pregnancy
Enamel hypoplasia of the teeth
ACEi in pregnancy
Host of things including renal agenesis, CHD…..
Effect of alcohol on fetus
Growth restriction, characteristic face, cardiac defects, developmental delay
What are the characteristic facial features of fetal alcohol syndrome
Low nasal bridge, epicanthal folds, short palperbral fissure, flat mid face, short nose, indistinct philtrum, micrognathia
Smoking risks to fetus
Miscarriage & stillbirth, low birth weight, IUGR
Opiates effect on fetus
Prematurity, neonatal withdrawal, IUGR
Cocaine effect on fetus
Small placenta, prematurity, cerebral infarction, spontaneous abortion
Egs of congential infections causing issues
Rubella, cytomegalovirus, toxoplasmosis, varicella zoster, HIV
Effects of maternal rubella infection at different stages of pregancy
Before 8/40 - deafness, cardiac malformations, cataracts
13-16/40 - hearing impairment
>18/40 - minimal
Usual effect of CMV in pregancy
90% born normal
What are the clinical features if baby is affected by maternal CMV infection during pregnancy
Hepatosplenomegaly & petichae at birth
Neurodevelopmental problems - sensorineural deafness, CP, epilepsy, cognitive impairment
What type of organism causes toxoplasmosis? What are the effects on fetus ? Where is it found?
Protozoan (toxoplasma gandis)
Hydrocephalus; intracranial calcification; clorioretinitis; neurological damage.
Raw/undercooked meat, infected cat feaces
Usual effect on fetus with varicella zoster?
Unaffected
What can happen to fetus with maternal varicella zoster infection? What is the treatment ?
Congenital varicella syndrome - skin lesions, malformed digits, cataracts, CNS damage, chlorioretinitis
Varicella zoster immune globulin (VZIG) in susceptible women
What is the risk of transmission of HIV from mother to fetus? How is this minimised ?
1%
Zidovudine to mother in pregancy & labour & neonate for first 6/52 of life
Egs of drugs and fluids used in labour and effects on fetus
IV fluids - hyponatraemia in neonate
Analgesia (opioids) - respiratory suppression at birth
Sedatives (eg diazepam) - sedation, hypothermia, hypotension
What is the scoring system used at birth to make sure fetus is ok? What are the parts?
Apgar score
Heart rate, respiratory effort, muscle tone, reflex response to stimulation (crying), colour (blue/just- extremities, pink)
All score 0,1 or 2 (2 is best )
What do you do if baby is not breathing / there is a poor respiratory effort? What if there is no improvement?
Stimulate, open and clear airway - bag and mask
No improvement + HR
Egs of benign lesions in newborn
Neonatal urticaria (erytherma toxicum)
Miliaria
Mangolian blue spots
Positional talipes
What is neonatal urticaria
Common rash at 2-3/7
white, pin point papules at centre of erythermatous base
(Fluid contains eosinophils; lesions concentrated on trunk but can come and go all over)
What are miliaria
White pimples on the nose and cheeks from retention of keratin and sebaceous material
What are Mongolian blue spots ? Who are they found in usually?
Blue / black macular discolouration at lower spine / buttocks
Asian / Afro Caribbean
What are positional talipes
Unlike true talipes equinovarus, the foot can be fully dorsiflexed to touch shin (just due to positioning in womb)
What are the two categories (and egs) for causes of IUGR
Intrinsic fetal problem - chromosomal disorders, congenital infections, small normal fetus
Placental insufficiency (asymmetrical small growth - brain sparring effect) - pre eclampsia, multiple pregancy, sickle cell disease
Where can a fetus bleed / Bruise due to birth injuries ? What are they called ? How to differentiate ?
Look at image for help / card 136
Caput succadaneum - brusing/ odema over presenting part (Extends OVER skull margins)
Cephal haematoma - subperiosteal haematoma (Doenst cross skull margins)
Subaponeurotic haemorrhage - diffuse swelling of scalp with ++ blood loss (rare)
Egs of nerve palsy coming from brachial plexus ? What causes these palsys
Erb’s, Klumpke’s
Damage due to traction of nerve roots from breech presentation / shoulder dystocia
Which nerve roots affected in Erb’s palsy? Features?
Upper never roots C5/6
Straight arm with hand pronated and fingers flexed (“waiters tip”)
Which nerve roots are affected in Klumpke’s palsy ? Features?
Lower nerve root damage c8/t1
Supinated forearm with wrists and fingers flexed “claw hand”
What causes facial nerve palsy? What are the features
Foceps or pressing against ischial spine of mother
Unilateral facial weakness
Prognosis of nerve palsys
90% resolve in 2 years
Causes of respiratory distress syndrome
SURFACTANT DEFICIENCY, hyaline membrane disease
What does surfactant do
Lowers alveolar surface tension & prevents collapse on expiration
Who commonly gets RDS
Infants born before 28 weeks
Features of RDS
Tachypnea (
What investigation can be done in RDS? What does it shoe?
Chest X-ray - defuse granular “ground glass” appearance
Management of lack of surfactant -> RDS
Before birth - glucocorticoids -> stimulate surfactant production
After birth - surfactant therapy, oxygen (+/- CPAP intubation)
What does CPAP intubation stand for
Continuous positive airway pressure
Complications of intubation for RDS
Pneumothorax - increased WOB, decreased breath sounds & movement on affected side, transilluminates
Treatment of pneumothorax
Chest drain and try to avoid by ventilating with lowest pressures possible
Who commonly gets apnoea attacks ? How long do they last? What is the cause ? Predisposing factors?
Very low birthweight (
Treatment for apnea attacks ? If they are frequent?
Breathing usually restarts with *physical stimulation *
Freq with no underlying cause - oral caffine (+CPAP if severe)
How does caffeine work ?
Phosphodiesterase inhibitor
Who commonly gets PDA? Features? Treatment?
Preterm esp. With RDS
Bounding pulse, hyper dynamic precordium + systolic murmur
Usually closes spontaneously but prostaglandin inhibitors (eg ibuprofen ) if it doesn’t
What is necrotising enterocolitis (NEC) ? Risk factors?
Necrosis of bowel secondary to infection & ischemia.
Rapid oral feeding with cows milk formula; prematurity; asphyxia; PDA
What are the features of NEC
Distended abdomen, vomiting (can be bilious), bloody stools
What’s seen on abdo X-ray of NEC ?
Distended loops of bowel with mural thickening and intramural gas
Initial Treatment for NEC ? What can be done for necrosed segment?
Stop oral feeds, gastric aspiration & parenteral nutrition (TPN)
Broad spectrum Abx - penicillin, gentamicin & metronidazole
Ventilation & circulatory support often required
Surgical resection
When does the suck reflex develop?
32-34/40
Where does intracranial haemorrhage usually occur ? What is the effect?
Germinal matrix / ventricles
Small - no sequale
Large - risk of cerebral palsy
What can happen with a large ventricular haemorrhage
Decrease CSF absorption -> hydrocephalus
What are the causes of periventricular white matter injury ? How can it be seen?
Follow ischemia / inflammation (with/out haemorrhage)
Appear as ‘flare’ of echo density in brain parenchyma on cranial USS
What is it called if there is multiple bilateral cysts on the periventricular white matter? What is this a risk for?
periventricular leukomalacia
80% risk of spastic diplegia
Risk factors for intracranial haemorrhage / periventricular White matter injury? What is important here?
Pneumothorax, asphyxia, hypotension, hypoxia
They are all complications of RDS
What is retinopathy of prematurity also called? What is it? What can it lead to? What are the risk factors?
Retrolentral fibroplasia - disease of blood vessels at junction of vascular & non-vascular retina -> vascular proliferation -> retinal detachment, fibrosis & blindness.
hyperoxia (PaO2 > 12kPa); ver low birth weight;
What is chronic lung disease of prematurity also called? What is it?
Bronchiopulmonary dysplasia - oxygen requirement beyond 36/40 (or 28 days old if that occurs first)
What causes BPD
Pressure and volume trauma from artificial ventilation, oxygen toxicity & infection
Treatment of BPD ? Risk of with this?
Continued respiratory support + corticosteroids (dexamethasone) to try and wean off
Neurodevelopmental problems
What’s seen on chest X-ray of BPD
Widespread opaque often with cystic changes
What concentration of serum bilirubin to appear jaundiced ?
Over 80-120umol/L
If there is jaundice in first 24 hours of life what type of bilirubin is it? Due to? Egs?
Always pathological - unconjugated usually due to haemolysis
1 - haemolytic disease of the newborn - Rh / ABO incompatibility
2- intrinsic RBC defects: sphereocytosis, G6PD deficiency
When do you get Rh incompatibility
Rh -ve mother with Rh +ve baby
When do you get ABO incompatibility with baby? What does this cause ?
Group O mother with group A (sometimes B) baby
Competitively weak anti-A (or B) haemolysins -> mild anaemia, no organomegally, weakly +ve Coombs test
Jaundice at 2days - 3 weeks causes? Type of bilirubin ?
Infection (esp UTI)
‘Breast milk’ jaundice
Physiological - diagnosis of exclusion
Unconjugated
When does the term ‘persistent neonatal jaundice’ get used? What is the usual type of bilirubin?
Over 3 weeks
Unconjugated
Can tell conjugated as dark urine & pale stools, hepatomegally & poor weight gain may be present
Causes of conjugated bilirubaemia at over 3 weeks ?
Neonatal hepatitis syndrome
biliary atresia
Which bilirubin can cross the brain and cause kernicterus ?
Unconjugated
Management of neonatal jaundice ? Indications for more aggressive option?
Phototherapy - light in blue/green band breaks down unconjugated bilirubin
Exchange transfusion - indicated if bilirubin +++, associated anaemia or if serum albumin is low
What wavelength of blue/green light
450nm
What are the long term risk of neonatal jaundice
dyskinetic CP, sensorineural deafness, learning difficulties
Egs of respiratory distress / causes in term infants
Transient tachypnea of newborn
Meconium aspiration
Diaphragmatic hernia
Persistent pulmonary hypertension of the newborn
What causes transient tachypnea of the newborn? What’s seen on chest X-ray? Treatment and prognosis?
Delay in reabsorbtion of the fetal lung fluid (more common in c-section)
Prominent pulmonary vasculature with fluid in horizontal fissure
Additional oxygen if required - can take several days to resolve
When do you get meconium aspiration ? What happens ?
Fetal distress -> meconium being passed into amniotic fluid and inhaled by infant.
Lungs are overinflated with patches of collapse and consolidation
What happens in a diaphragmatic hernia? When is it usually diagnosed? What’s seen on X-ray ? Treatment?
Abdo contents enter through hole in diaphragm (usually on left side)
Antenatal USS
Mediastinum shifted to right
Surgery
What is persistent pulmonary hypertension of newborn? What is it also called?
Persistent fetal circulation
Failure of fetal circulation to switch to normal (less to lungs)
What often occurs with persistent fetal circulation?
Birth asphyxia, RDS, meconium aspiration, septicaemia
What happens in persistent fetal circulation
Increased pulmonary vascular resistance leads to R->L shunting and sever cyanosis
What’s seen on chest X-ray of persistency fetal circulation ?
Heart normal size, pulmonary oligaemia (decreased blood flow)
Why is an echo done in persistent fetal circulation
To exclude CHD
Treatment of persistent fetal circulation
Assisted ventilation
Inhaled nitric oxide (vasodilation)
Sidenafil (viagra)
2 craniofacial abnormalities needing surgery?
Cleft lip/palate
Pierre-robin sequence
What happens in Pierre robin sequence?
Micrognathia (small jaw); posterior displacement of tongue; midline cleft/soft palate
What often occurs with oesophageal atresia ? What are the features if not diagnosed at birth
TOF & polyhydroaminos
Persistent salivation & drooling with coughing / choking & cyanotic episodes (esp after feeding)
What’s common with oesophageal atresia ?
50% have other malformations VACTERL association
Vertebral, Anorectal, Cardiac, TracheoEsophageal, Renal & Limb
What is exomphalos
Abdo contents protude through umbilicus covered in transparent sac formed by amniotic membrane and peritoneum
What is gastroschisis
Bowel protrudes through anterior abdo wall adjacent to umbilicus with no covering sac
Treatment for exomphalos / gastroschisis?
Wrap in cling film to decrease fluid and head loss
Supportive therapy and surgery may be needed
