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Paeds > Neonates > Flashcards

Neonates Flashcards

1
Q

Who gets neonatal jaundice?

A

50% of term babies, 80% of preterm babies

Usually 2-4days after birth

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2
Q

Explain physiological jaundice of the neonate

A

Normal transition of fetal to adult haemaglobin-> increased haemolysis-> increased bilirubin
Reduced hepatic excretion due to immature liver
Less conjugation due to less UDPGT (uridine diphosphate glucuronlytransferase) enzyme. Unconjugated bilirubin is fat soluble-> skin, eyes, brain
Neonatal gut motility is slow, increased enterohepatic circulation of bili-> less is excreted

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3
Q

What is the risk of hyperbilirubinaemia?

A

Neurotoxic

Death via kerniterus

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4
Q

Name 11 causes of pathological neonatal jaundice (6 categories)

A
  • Haemolytic (haemolytic anaemia, blood group incompatibilities, G6DP deficiency)
  • Polycythaemia (delayed cord clamping)
  • Congenital infection (cytomegalovirus, toxoplasmosis)
  • Obstruction (cholestasis, biliary obstruction, congenital abnormality of bile duct/pancreas)
  • Drugs bind and compete for albumin, more free bilirubin
  • Gilbert’s syndrome
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5
Q

In biliary atresia, what needs to be given?

A

Fat soluble vitamins

A, D, E, K

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6
Q

Treatment of neonatal jaundice

A 
Phototherapy (isomerisation, isomers are less neurotoxic)
IV immunoglobulins (blood group incompatibilities)
Exchange transfusion (3rd line)
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7
Q

What does a neonate’s fluid requirement depend on?

A

Gestation, day of life, weight, blood glucose and electrolytes

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8
Q

What fluid are neonates usually given?

A

0.9% saline with 10% glucose
Electrolytes given according to levels
Na 2-6mmol/kg/day
K 1-3mmol/kg/day

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9
Q

In a term, well, neonate on 1st day of life, how much fluid would you give?

A

50-60ml/kg over 24hrs

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10
Q

Days 5-28 of life, term well neonate, how much fluid?

A

120-150ml/kg/day

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11
Q

What does APGAR stand for?

A 
Appearance
Pulse
Grimace
Activity
Respiration
(assessment at delivery, 1 min, 5 mins and 10 mins)
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12
Q

What scores can be given in an APGAR for appearance?

A

0=blue all over
1= blue at extremities
2= No blue colouration

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13
Q

What scores can be given in an APGAR for pulse?

A

0=no pulse
1=<100bpm
2=>100bpm

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14
Q

What scores can be given in an APGAR for grimace?

A 
0= no response to stimulation
1= grimace of feeble cry when stimulated
2= sneezing, coughing or pulling away when stimulated
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15
Q

What scores can be given in an APGAR for activity?

A 
0= no movement
1= some movement
2= active movement
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16
Q

What scores can be given in an APGAR for respiration?

A 
0= no breathing
1= weak, slow or irregular breathing
2= strong cry
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17
Q

Why is an APGAR score relevant?

A

A score of 0-3 at 1 min indicated immediate resuscitation is needed

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18
Q

What is done is a NIPE shows clunking hips?

A

Referred to a specialist
USS at 6 weeks
Treatment is usually multiple nappies

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19
Q

What is the Guthrie/blood spot test?

A

Heel prick test onto filter paper
Done on day 5-8
Screening

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20
Q

What is screened for in the heel prick test of the newborn? 9 things

A
  • Congenital hypothyroidism (TSH tested)
  • Sickle cell disorders (SCD)
  • Cystic fibrosis (CF)
  • Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
  • Phenylketonuria (PKU)
  • Maple syrup urine disease (MSUD)
  • Isovaleric acidaemia (IVA)
  • Glutaric aciduria type 1 (GA1)
  • Homocystinuria (HCU)
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21
Q

What makes a baby more mucusy as a neonate?

A 
C section (mucus not squeezed out, natural steroids not initiated by stress)
Water birth
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22
Q

Name 8 common neonatal abnormalities

A 
Mucusy baby
Problems latching/feeding
Heart murmurs
Dislocated hips
Delayed passage of meconium
Neonatal jaundice
Strawberry naevus
Umbilical cord stump infection
23
Q

What is IUGR?

A

When a fetus is unable to reach its genetically determined potential size

24
Q

Name 3 categories of causes of IUGR?

A

Maternal causes
Placental causes
Umbilical cord causes

25
Q

Name 8 maternal causes of IUGR

A 
Hypertension
Cyanotic heart disease
Diabetes
Haemoglobinopathies/thrombophilias
Autoimmune disease
Malnutrition
Smoking/substance abuse
Uterine malformations
26
Q

Name 5 placental causes of IUGR

A 
Multiple pregnancy
Twin to twin transfusion syndrome
Chronic abruption
Placenta praevia
Abnormal cord insertion
27
Q

Is the whole body affected by IUGR?

A

Usually relative head sparing (nutrients directed to brain)

If no head sparing, may be congenital infection or underlying genetic condition

28
Q

What is an ‘intrinsically small’ baby?

A

Secondary to chromosomal or environmental aetiology

eg trisomy 18, CMV infection, fetal alcohol syndrome

29
Q

How do you take blood in a neonate?

A

Much less blood is needed (0.5ml for blood culture)
Drip blood into tubes (not sterile)
VBG collected in a capillary tube

30
Q

When does the suck reflex develop?

A

35 weeks

31
Q

How are preterm neonates fed?

A

Before 35 weeks no suck reflex

NG feeding common with maltodextrin hourly

32
Q

What are preterm neonates fed (after 35 weeks)?

A
  • Expressed breast milk
  • High calorie infantrini
  • Hydrolysed nutramigen
  • Amino acid feed neocate
33
Q

What can be added to feeds to reduce bradycardias

A

Caffeine is often added to feeds as a stimulant

34
Q

How much should a day 1 neonate be fed?

A

60ml/kg/day

35
Q

How much should a day 4 neonate be fed?

A

rises by 30ml/kg/day until day 5

so day 4 is 150ml/kg/day

36
Q

What is the usual volume of feed for an infant?

A

150ml/kg/day

Or breastfeeding every 2 hrs

37
Q

What counts as hypoglycaemia in neonates?

Risk factors

A

Less than 2.6
Common in preterms due to decreased reserve fat
High haematocrit (more cells looking for energy)

38
Q

What is dangerous about polycythaemia?

A

Causes hypoglycaemia

Blood coagulability is increased-> stroke, multi organ failure

39
Q

Treatment of polycythaemia?

A

Dilutional exchange

Replace 80ml/kg blood with saline

40
Q

Causes/risk factors of neonatal sepsis

A
  • Group B strep in mums (urine/swab)
  • Other ascending infection
  • Inhalation of meconium (meconium aspiration syndrome)
  • Premature rupture of membranes (PROM)
  • Prematurity
  • Fever in mother during pregnancy/neonatal period
41
Q

Treatment of GBS (group B strep)

A

Gentamycin + Benzylpenicillin

42
Q

What’s an ABC in neonates?

A

Apnea
Bradycardia
Circulation

43
Q

Classifications of ABCs?

A
  • 1= self limiting
  • 2= feet stimulation
  • 3= chest stimulation
  • 4= suction/oxygen
  • 5= needed ventilation/bagging
44
Q

Whats TTN?

A

Transient tachypnoea of the newborn
Slightly wet lungs
Commoner after C section
Most common cause of resp distress in a term infant

45
Q

If a baby is jaundice in 1st day of life, what investigations would you do?

A 
Bilirubin level
FBC &amp; film 
Blood group
Determine mother's blood group
Direct antiglobulin test (coombs)
46
Q

What counts as a low birth weight?

A

Less than 2.5kg

Irrespective of gestation

47
Q

T or F:

Birth asphyxia causes the majority of cerebral palsy

A

F

Causes 10-15%

48
Q

What is seen on an Xray of RDS?

A 
Ground glass appearance of lung fields
Air bronchogram (air filled bronchi against poor air entry in lung)
49
Q

Why would a newborn’s PaO2 differ in right arm versus left arm

A

Patent ductus arteriosus

50
Q

If a mother develops chickenpox 10 days after delivery, is the infant at risk?

A

Yes
5 days pre-delivery to 22 days post delivery
There is insufficient time for protective antibodies to develop and be transferred to infant
25% infected

51
Q

What causes the foramen ovale to close?

A

Increased pressure in L atrium

52
Q

Why are neonates given vitamin K at birth?

A

Newborns have low levels of vitamin K

Puts them at risk of haemorrhagic disease of the newborn

53
Q

Who is at increased risk of haemorrhagic disease of newborn sue to low vitamin K levels?

A

Preterm infants
Exclusively breastfed infants
Infants with liver disease
Infants with mothers on anticonvulsants

54
Q

What is talipes equinovarus?

A

Newborn’s foot is inverted and can be partially returned to neutral position

Paeds (14 decks)

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