neonates Flashcards
what does an apgar score predict?
how much medical attention a baby is going to need
why do babys not usually score 10
their hands and feet are pale, but will pinked up as circulation established
a score of what is normal?
7
what does APGAR stand for
appearance pulse grimace activity respiratory effort
in a child less than 1, what should blood pressure, RR, and heart rate be?
HR 110-160
RR 30-40
blood pressure 70-90 (systolic)
what test is taken from the heel at day 5 to check for things like CF?
guthrie skin prick
what else does the guthrie skin test check for
♣ PKU phenylketonuria. ♣ IVA isovaleric acidaemia. ♣ HCU homocysteinuria. ♣ MSUD Maple syrup urine disease. MCADD medium chain acyl-CoA dehydrogenase deficiency
who does hearing checks in hospital ? in community >
in hospital before discharge by midwife
in community within 4 weeks by health visitor
when are the post natal baby checks carried out
6-8 weeks by the GP
when are pre terms examined ?
6 weeks after expected date of delivery and not at six weeks gestation, at this point they should be at same developmental level
who needs to be at the delivery of a pre term?
neonatologist
why is cord cutting delayed in pre term?
can be delayed for up to 3 minutes to encourage maternal metal transfusion
what does delayed cord cutting reduce the risk of?
need for transfusion and reduce risk of RDS, hypoxia and associated complications
hypothermia management: deliver baby in a room of what temperature?
26 degrees
what do you wrap baby in ?
plastic bag or towel
you would place hypothermic baby in incubator. an incubator is an independent risk of?
infection
what do you give to mothers before delivery to prevent RSD?
steroids (x2 doses, 12 hours apart)
presentation of RDS?
tachypnoea
increased work of breathing
onset of symptoms from minutes - hours after birth
symptoms do not resolve after 24 hours like TTN
investigations for RDS?
02 is low
x ray shows ground glass appearance
management of RDS
surfactant and ventilation
how can you ventilate in RDS?
intubate
CPAP
broncho pulmonary dyplasia - what is it?
long term comp associated with ventilation of babies largely in the context of RDS due to a combination of barotrauma and oxygen toxicity
how would bronchopulmonary dysplasia present?
hypoxia and difficulty weaning off ventilator
is the damage that accord from BPD reversible?
no
what is apnoea of pre maturity?
gaps between breaths of over 20 seconds
may require ventilation due to risk of hypoxia
pathophysiology of apnea of pre maturity?
breathing centres in brain not fully developed , baby “forgets” to breath
inflammatory necrosis of the intestine thought to be associated with gut immaturity.
necrotizing enterocolitis
how would necrotising enterocolitis present?
poor feeding
mucous and blood stained diarrhoea
abdominal distension and tenderness
what do you see in the bowel wall?
pneumostasis intestinalis (air cysts(
management of NE?
stop feeding, supportive care and abx
or surgical removal of part of the bowel
in peri ventricular haemorrhage, where does intra cranial haemorrhage start ?
germinal matrix
when does per ventricular haemorrhage usually startt?
usually within first day of life
outcome of peri ventricular haemorrhage?
variable mortality but most associated with long term neurological problems
what causes birth asphyxia?
reduction of oxygen supply and accumulation of co2 due to cessation of blood supply to the foetus at time of delivery
how does asphyxia present ?
bradycardia and low apgar score
management of asphyxia?
recitation with oxygen
what is CNS complication of birth asphyxia?
hypoxic ischaemic encephalopathy
early and late sepsis defined as?
early = within 48 hours late = after 48 hours
causitive organisms of early and late sepsis?
early is coli and group B strep
late is listeria and staph
management of sepsis in a a newborn?
benxylpenicillin and gentamycin
treatment of pneumonia in newborn?
amoxicillin
what is Opthalmia neonatorum caused by?
passage of chlamydia from mother to baby
what STI do symptoms develop more quickly in? gonorrhoea or chlamydia?
gonorrhoea (gone up tubes faster)
whats the main risk factor for developing TTN?
c section (don’t get the squeeze of vaginal delivery to get rid of fluid in the lungs)
how does TTN present?
a rr of over 60
most cases of TTN resolve within?
24 hours
meconium stained amniotic fluid then respiratory distress following delivery
meconium aspiration syndrome
when does baby usually pass meconium
within 24 hours
management of MAS?
suctioning and supportive care
o yanosis, respiratory distress pulmonary odemea.
o Oedema: sacral, ankle, peri orbital.
o Hepatosplenomegaly.
in newborn?
heart failure
persistent pulmoary hypertension caused by?
a failure of fetal circulation. get right to left shunting of blood and get cyanosis and loud S2
care for pulmonary hypertension ?
inotropes to increase systemic pressure while fetal circulation naturally adapts
when are inborn errors of metabolism screened for?
day 5
what is haemorrhagic disease of the newborn caused by?
vitamin K deficiency
prevention of haemorrhagic disease of the newborn/
vitamin K injection at birth (given by midwife)
what is kernicterus ?
rare type of brain damage that occurs with jaundice
most common cause of seizures in newborn?
hypoxic ischaemic encephalopathy
management of seizures in neonates?
phenobarbitol and phenytoin
pshysiological jaundice occurs after?
24 hours
bilirubin level in physiological jaundice?
under 200
why do you get accumulation of bilirubin in the blood?
RBC have a shorter lifespan
reduced ability of the liver to conjugate bile and for gut to eliminate it
what is pathological jaundice defined as?
jaundice that occurs within 24 hours
causes of pathological jaundice?
sepsis
haemorrhagic disease of the newborn
red cell incompatibility
inherited (G6PD, spherocytosis)
what is prolonged jaundice defined as?
jaundice that lasts more than 14 days
what is plotted to help choose between two potential management options?
babies age and bilirubin levels
what are the two management options?
phototherapy and exchange transfusion
how does phototherapy work?
baby placed in incubator with UV light source
this helps to break down to products that don’t require conjugation for release
what does exchange transfusion involve
removing blood with high bilirubin levels and replacing it with normal blood
in prolonged jaundice, need to investigate for inherited conditions such as?
G6PD
galactoseamia
hypothyroidism
what is kernicterus
bilirubin iduced encephalopthy
management of kernicterus
exchange transfusion and phototherapy
long term outcomes ?
deafness and reduced IQ
