Neonates Flashcards
At what gestation is a baby considered pre-term?
Before 37 weeks
When is a baby considered extremely pre-term?
Before 28 weeks
When is a baby considered very pre-term?
28-32 weeks
What are some risk factors for pre-term birth?
Multiple pregnancy, GU infections, placenta praevia, placental abruption, PPROM, cervical incompetence, pre-eclampsia, hypertension, diabetes, cigarette smoking, alcohol abuse
How long should cord clamping be delayed for and why?
At least one minute to allow blood flow to equilibriate between placenta and baby
How should pre-term babies be kept warm when delivered?
Should be placed when still wet into a suitable plastic bag and then later under a radiant heater
What should be the airway positioning of a newborn baby?
Neutral head position, jaw thrust and suction if needed for secretions
If respiratory support is needed in preterm infants how is this done?
Usually start with air and if positive pressure ventilation is needed, start at lower pressures
What is a complication of lung overinflation in preterm infants?
Overinflation leads to volu/baru trauma leading to an inflammatory cascade that predisposes to broncho-pulmonary dysplasia
Why is hypothermia a common problem in the preterm infant?
Low BMR
Minimal muscular activity
Negligable subcut fat
High surface area to body mass
`What should you remember to do when plotting growth charts for pre-term infants?
Gestational correction
How long should gestation correction continue?
If born 32-37 weeks - one year
If born before 32 weeks - 2 years
Why is gestational correction continued for this long?
As this is how long it takes for the infant to catch up with normal growth
What is respiratory distress syndrome?
Deficiency of alveolar surfactant and structural immaturity of alveoli
Why is surfactant important?
It maintains the surface tension which stops the alveoli from collapsing and therefore making breathing more difficult for the baby
How does RDS present?
Tachypnoea (>60/min), grunting, nasal flare, indrawing, cyanosis
When is the onset of RDS?
Onset from minutes to 4 hours after birth. Does NOT resolve in 24 hrs like TTN.
What may be seen on a CXR of an infant with RDS?
Ground glass appearance
Air bronchogram
How is RDS prevented?
Antenatal steroids
2 x 12 mg betamethasone 12 hours apart
How is RDS managed?
Surfactant and ventilation (intubation/CPAP)
What is apnoea of prematurity?
Breathing centres in baby’s brain not fully developed yet resulting in the baby forgetting to breathe
How does apnoea of prematurity present?
Cessation of breathing for >20secs, and/or hypoxia and bradycardia
How is apnoea of prematurity managed?
IV caffeine
Ventilation
What is bronchopulmonary dysplasia?
Long term complication of ventilation of babies due to barotrauma and oxygen toxicity
What signs are seen in bronchopulmonary dysplasia?
CXR shows hyperinflation
Histology shows necrotizing bronchitis and alveolar fibrosis
How does bronchopulmonary dysplasia present?
Hypoxia and difficulty weaning off ventilator
What long term consequences are there of bronchopulmonary dysplasia?
Decreased IQ, cerebral palsy, feeding issues
What is transient tachypnoea of the newborn?
A period of rapid breathing shortly after delivery that resolves within 24-48hrs
What causes TTN?
Amniotic fluid remaining in the fetal lungs meaning it is difficult to breathe
What babies are more likely to get TTN?
C-Section - not had pressure of SVD to push fluid out of lungs
How is TTN managed?
Supportive - oxygen, CPAP, non-oral feeds to prevent aspiration
What is early onset sepsis of the newborn?
Bacteria acquired before and during delivery (within 48hrs)
What is late onset sepsis?
Bacteria acquired after delivery (after 48hrs)
What organisms usually cause neonatal sepsis?
Early - GBS, Ecoli
Late - Listeria, staph A, strep pyogenes
How does neonatal sepsis present?
Fever, poor feeding, tachypnoea, cyanosis, stiff limbs, increased work of breathing
How is neonatal sepsis treated?
Benzylpenicillin and gentamicin
What is meconium aspiration syndrome?
Meconium is passed in utero allowing the baby to swallow it
Why may meconium aspiration syndrome occur?
Fetal distress
Post term baby
How does meconium aspiration present?
Meconium stained amniotic fluid Respiratory distress (hypoxia, increased effort of breathing)
How is meconium aspiration managed?
Suctioning and supportive care
What causes heart failure in newborns?
Infection
Chromosome abnormalities
Rhesus disease
How does heart failure present in newborns?
Cyanosis, respiratory distress, pulmonary oedema, sacral/periorbital/ankle oedema, hepatosplenomegaly
What is persistent pulmonary hypertension?
Failure of fetal circulation to adapt to being outwith the womb, leading to failure of pulmonary pressure to fall. Causes shunting of blood and hypoxia
What is patent ductus arteriosis?
Failure of ductus arteriosis to close after birth
What is the ductus arteriosis?
A communication between the left pulmonary artery and descending aorta that allows blood to bypass the fluid filled fetal lungs
How does PDA present?
Failure to thrive, CCF, bounding pulse, continuous machine like murmur
How is PDA treated?
Indomethacin
Surgical management
How does intraventricular haemorrhage start?
Bleeding in the germinal matrix due to lack of structural integrity
What is intraventricular haemorrhage associated with?
Difficult/fast labour
Instrumental delivery
Breech
Prematurity
How does intraventricular haemorrhage present?
Can be clinically silent, or with intermittant or catastrophic deteriorations
How is IVH prevented?
Antenatal Steroids
2 x 12 mg betamethasone 12 hours apart
What is necrotizing enterocolitis?
Inflammatory widespread necrosis of small and large bowel
What is the biggest risk factor for NEC?
Prematurity
How does NEC present?
Poor feeding, lethargy, abdominal distention, bloody stool, shock & DIC if perforation
What may be seen on AXR in NEC?
Asymmetrical dilated loops of bowel Pneumatosis intestinalis (gas on gut wall)
How is NEC managed?
Stop oral feeding, supportive care and antibiotics.
Surgery to resect dead bowel and prevent perforation
What is neonatal hypoglycaemia defined as?
<2.6 mmol
Why may neonatal hypoglycaemia occur?
Maternal diabetes
Low birth weight/pre term
Complex metabolic disorder
What is haemorrhagic disease of the newborn?
Vitamin K deficiency related bleeding
When does haemorrhagic disease of the newborn occur?
2-7 days post partum with bleeding and bruising
How is haemorrhagic disease of the newborn managed?
Vitamin K injection (given by midwife at birth to prevent)
When does physiological jaundice occur?
> 24 hours after birth
What causes physiological jaundice?
Accumulation of bilirubin due to increased RBC breakdown and reduced ability of liver to conjugate bile and gut to excrete it
What is pathological jaundice?
Jaundice occuring <24 hours after birth
What are some causes of pathological jaundice?
Sepsis
Haemorrhagic disease of the newborn
Red cell incompatibility
Inherited conditions (e.g. G6PD, spherocytosis)
What is prolonged jaundice?
Any jaundice lasting longer than 14 days
What are some causes of prolonged jaundice?
Hypothyroidism
Infection (UTI, TORCH)
Biliary atresia
CF
How is jaundice management decided?
Babies age and bilirubin levels plotted on a graph to help them choose between management options
What are the two management options for jaundice?
Phototherapy
Exchange transfusion
How does phototherapy work in jaundice?
UV light source breaks down bilirubin to products that don’t require conjugation for release
Which babies get an exchange transfusion for jaundice?
Those with higher bilirubin levels
What is kernicterus?
Bilirubin induced encephalopathy
How does kernicterus present?
Jaundice, poor feeding, shrill cry, hypertonicity
How is kernicterus managed?
Exchange transfusion and phototherapy
What are some long term outcomes of kernicterus?
Deafness, reduced IQ
What is gastroschisis?
Extrusion of abdominal viscera
What is Hirschsprungs disease?
Lack of colonic ganglion and autonomic innervation meaning it cannot function
How does Hirschsprungs disease present?
Constipation, faeces felt on palpation, explosive discharge of stool, wind on PR
What is oesophageal atresia (+/- trachea-oesophageal fistula)?
Spectrum of disease - narrowing of oeseophagus and formation of fistula with the trachea
How does trache-oesophageal fistula present and what is it associated with?
Frothy secretions, drooling and difficulty passing catheter into the stomach
Polyhydramnios
What is jejunal atresia?
Congenital anomaly of small bowel where jejunum does not form a continuous tube but instead two blind ended sacks
How does jejunal atresia present?
Vomiting and failure to pass meconium
What is perinatal mortality?
24 weeks to 1 week post partum
What is neonatal mortality?
Birth - 4 weeks post partum
What is postnatal mortality?
4 weeks - 1 year
What is infant mortality?
Birth - 1 year
What is extremely low birth weight?
<1000g
What is very low birth weight?
<1500g
What is low birth weight?
<2500g
What is normal birth weight?
2500-4000g
What is large birth weight?
> 4000g
What is erythema toxicum?
Harmless rash occurring in babies aged 2-5 days. Erythematous maculopapular discrete lesions with white centre, becomes widespread and confluent
What is mongolian blue spot?
Bluish/black macule on lumbar/sacral area - important NAI differential
What is a salmon patch/stork mark?
Erythematous vascular marks on eyelids, face and nape of neck
What is a strawberry naevi?
Haemagioma - rapid proliferation between 4 and 9 months then involutes
What is a port wine stain?
Naevus flammus - capillary vascular malformation. Can be treated with lasers
