Neonates Flashcards
Three categories of neonatal jaundice
Physiological (1-14 days) Pathological (<24 hours) Prolonged (>14 days)
Cause of physiological jaundice
ABSENCE OF ANAEMIA, MODERATE BILIRUBIN AND shortened RBC lifespan Increased breakdown Low EPO
Pathological jaundice causes (<24 hours)
- METABOLIC + Crigler Najar + Gilbert’s disease - IMMUNE + Haemolytic disease of Newborn - INFECTION + TORCH organisms + Hepatitis B - TRAUMA + Cephalhaematoma
Prolonged jaundice (1-14 days)
- METABOLIC + Galactosaemia + Breast milk jaundice - ENDOCRINE + Hypo/hyperthyroidism
4 causes of conjugated hyperbilirubinaemia
- Neonatal hepatitis - Sepsis - CF - Biliary atresia
Complication of jaundice
Kernicterus - EPSEs, visual problems, cognitive impairment
Risk factors for neonatal jaundice
1) Sibling with phototherapy 2) Breast fed babies 3) Mothers with diabetes
Other signs to look for in jaundice
1) Hepatosplenomegaly 2) Petechiae 3) Microcephaly
Investigations jaundice
1) Bilirubin 2) LFTs 3) Infection screen: TORCH, Swabs, Blood culture, Urine Culture 4) Direct Coombs Test in the infant
Management of jaundice (3)
Phototherapy Exchange transfusion Monitor bilirubin
Risk factors for IVH (2)
Prematurity Low birthweight
Signs of IVH
Bulging fontanelle Eye signs Diminished primitive reflexes
Neonatal sepsis presenting
Symptoms Seizures Sleeping Reduced movements Diarrhoea Poor feeding Signs Abnormal HR Bulging/depressed fontanelle Decreased/increased temp Hypoxia
Neonatal sepsis investigations
UNLESS OBVIOUS BRONCHIOLITIS in Neonate <30 days 1) FBC 2) Blood culture 3) Urinalysis 4) Lumbar puncture 5) Urine culture ALSO CXR
Neonatal sepsis management
1) IV penicillin + gentamicin
Neonatal sepsis causative organisms
1) GBS, e.coli, Haemophilus influenza 2) If late onset (4-90 days) then Staph aureus, e.coli, candida
What is PPROM?
Preterm prelabour rupture of membranes (P-PROM) is the rupture of membranes prior to the onset of labour, in a patient who is at less than 37 weeks of gestation
What are three risks to neonate of PPROM?
Prematurity Sepsis (ascending infection) Pulmonary hypoplasia
How should PPROM be manageD?
1) Steroids 2) Prophylactic antibiotics - Erythromycin or penicillin if GBS identified
Short-term complications of IUGR
1) Jaundice 2) Meconium aspiration 3) Necrotising enterocolitis
Late complications of IUGR
1) Cerebral palsy 2) Poorer scores on cognitive testing 3) Obesity
Definition of prematurity
Born <37 weeks
Problems of prematurity (short-term)
BRAIN - IVH EYES - ROP LUNGS - RDS (O2 leads to ROP) GUT - NEC LIVER - Jaundice & Kernicterus METABOLIC - Hypothermia - Hypoglycaemia
Problems of prematurity (long-term)
- Cognitive difficulties - Obesity
Causes of prematurity
Pre(eclampsia)-M-atU(terine abnormalities)RI(UGR)TY 1) multiple pregnancy 2) Pre-eclampsia 3) IUGR 4) Uterine anomalies
Identify
Stork bite
Not serious
Lesions on eyelids fade in the first year; over 95% will fade by 12 months. Back of the neck may never fade.
Identify
Milia
Sebaceous cysts, very small raised pearly white or yellowish bumps on the skin.
Seen on the nose, cheeks, eyelids, forhead and chest, but can occur anywhere
Affects about half of babies
Retentions of keratin and sebaceous material in sweat glands that are not fully formed
Will clear spontaneously in weeks
Identify
Erythema Toxicum
Small firm yellow or raised bumps filled with pus on top of a red area of skin, contains eosinophils.
Occur on any part of the body except the palms and soles.
Often begins on face and spreads. Appears on day 2-3 and disappears by day 10. HALF of all newborn infants.
Identify
Cradle Cap
Usually occurs on the scalp but can affect face, ears, neck, nappy area or skin folds
Does not cause itch or discomfort – if scratching consider atopic eczema
Recognised by large, greasy yellow or brown scale on cap
Seborrhoeic dermatitis
Large greasy yellow or brown scales on the scalp
Massaging scalp with baby oil will help loosen flakes
Identify
Cavernous Haemangioma
May be present at birth but more commonly develop in the first month. Grow for 3-4 years when they start to regress.
Commonest tumour in infancy affecting 5-10% of Caucasian babies. More common with low birthweight, prematurity and multiple gestations
Increases in size until 3-15 months and then regresses
No treatment unless interferes with vision or the airway
Can be external, internal (liver, heart, brain) or both
Identify
A vascular malformation of developmental origin with ectasia of superficial dermal capillaries
Face, nape of neck and upper trunk
Pink to deep red or purple patches; often unilateral with distinct cut-off
Lesions tend to persist, darken and thicken with age
Disfiguring lesions can be improved with laser therapy
Occasionally associated with congenital glaucoma, sturge
weber syndrome (Portwine + hemiparesis + epilepsy + vascular headache) and klippel-trenauny-weber syndrome (portwine + giant limb)
Identify
Blue/black discolouration at the base of the spine or on the buttocks
Occasionally occurs on the legs or any other part of the body
Usually, although not invariably, on afro-carribean or Asian babies
Fade slowly over the years
Identify
Satellite lesions are common
Fungal infection manifest by widespread vivid sharply bordered erythema with satellite pauples or vesicles.
Frequently found in anterior perineum, perianal and folds
Systemic antibiotic treatment is a common trigger
Antifungal agents like nystatin or miconazole can be used in association with gentle cleansing of the perineum. May need oral nystatin.
Identify
‘W’ shape of lesion – affecting convex areas and sparing folds
Worsening of lesions with baby wipes and cloth diapers also suggest diagnosis, because that kind of diaper has diminished power of absorption. Baby wipes make worse so advise against.
Other causative are increasing skin h, local humidity, coverage and friction
Treated with zinc oxide
Meconium aspiration syndrome definition
AS is defined as a respiratory distress that develops shortly after birth, with radiographic evidence of aspiration pneumonitis and presence of meconium-stained amniotic fluid.
Risk factors for Meconium Aspiration Syndrome
Pre-eclampsia
Oligohydramnios
Smoking
Meconium Aspiration Syndrome Investigations
FBC
CXR
Brain imaging
ECG
Meconium Aspiration Syndrome Management
Suction
Oxygen
Ventilatory support
Surfactant replacemetn
Respiratory Distress Risk Factors
Prematurity
C-section
Maternal diabetes
Respiratory distress presentation
Tachypnoea
Grunting
Flaring of nostrils
Subcostal recession
Respiratory Distress Management
Surfactant Replacement Therapy
Oxygen therapy
Gentle management
Respiratory Distress Chronic Complications
Bronchopulmonary dysplasia
Retionpathy of prematurity
Neurological impairment
Determining level of gestation
Dubowitz/Ballard Examination
Investigation for IVH
Cranial Ultrasound Scan
Investigations for premature infants
Blood gas
FBC
U&E
Blood culture
CRP
Blood group & direct coombs test
What should obstetricians offer women likely to give birth to premature babies? (2)
Antenatal steroids
Magnesium sulphate
NEC Symptoms
Bloating
Off feeds
Altered stool pattern
Bloody mucoid stool
Billious vomiting
NEC investigations
Abdominal x-ray
FBC, U&E, Blood gas
NEC Management
Nil by mouth
IV fluids, TPN, IV antibiotics (Ampicillin & Gentamicin)
NEC Prevention
Feed with human milk
Slow-feeds
What is this?
Ground glass shadowing indicated respiratory distress
What is this?
NEC
What does condition does a meconium ileus indicate?
Cystic Fibrosis
When should meconium be passed by?
24 hours
Bilious vomiting: five causes
1) Meconium ileus
2) hirschprung’s disease
3) Duodenal atresia
4) Imperforate anus
5) Necrotizing entercolitis
Cephalhaematoma vs Caput Succenadeum
Cephalhaematoma - between periosteum and skull, limited by suture lines
Caput Succenadeum - Between scalp and periosteum , spreads over suture lines
Subgaleal - scalp galea aponeurosis and periosteum. Lots of associated head trauma.
Name three overarching newborn screening tests
1) Newborn and 6-8 week physical examination
2) Newborn hearing screen
3) Newborn blood spot test
Give five conditions tested for by newborn bloodspot test
1) PKU
2) Congenital hypothyroidism
3) Sickle cell disease
4) Cystic fibrosis
5) Maple syrup urine disease
6) MCAD
7) Homocysteinuria
Give four conditions picked up by newborn physical examinations
1) Cataracts
2) Congenital heart disease
3) Undescended testes
4) Developmental dysplasia of the hip
Two bits of newborn hearing test
1) Automated otoacoustic emission
2) Autmated auditory brainstem response
Neonatal sepsis red flags (5)
1) Seizures
2) Shock
3) Resp distress >4 hours after birth
4) Suspected or confirmed infection in twin
5) Systemic abx given to mother intrapartum
When to stop ABx in babies with neonatal sepsis?
the blood culture is negative, and
the initial clinical suspicion of infection was not strong, and
the baby’s clinical condition is reassuring with no clinical indicators of possible infection, and
the levels and trends of C-reactive protein concentration are reassuring.
