Neonates: Flashcards
Why is vitamin K given at birth?
To prevent Haemorrhagic disease of newborn (low vitamin K dependent clotting factors at birth)
What is neonate?
A baby up to 28 days of age
What is a term baby?
Born between 37 and 42 weeks gestation
What is a preterm baby?
Born between 23 weeks and 36 +6 weeks gestation
List 6 causes of high-risk deliveries:
- Preterm (<6 weeks)
- Multiple births
- ‘Crash’ or emergency c-sections - fetal distress, undiagnosed breech
- Meconium stained liquor
- Instrumental deliveries - forceps, ventouse
- Expected problems - anomaly scans
What syndrome is associated with neurological and skin disorder?
Sturge-Weber Syndrome/neurocutaneous syndrome
What is Sturg-weber syndrome characterised by?
Proliferation of arteries of the brain -> multiple angiomas occur on same side as physical signs
What is Sturge-weber syndrome associated with?
- Port-wine stains
- Glaucoma
- Seizures
- Mental retardation
How is club foot treated?
Physio/surgery:
- Serial plaster casting
In congenital displasia of the hip, what signs can be elicited during examination?
Barlows - displacement downwards
Ortolani - to relocate hip (tests for posterior dislocation)
What can be given to help treat ‘Strawberry Naevus’?
Propanolol
What is associated with an unilateral absent red reflex?
Retinoblastoma (more commonly picked up 9-22months)
What is associated with a bilateral absent red reflex?
Congenital cataracts
What can failure of treatment of congenital cataracts cause?
Amblyopia - lazy eye
What is performed on all babies within the first 48hrs of birth?
New born baby screen
Outline the components of the newborn examination:
Head-to-toe:
- Head - measure, feel fontanelles, any asymmetry
- Face - dysmorphic, red reflex, jaundice sclera, palate, look at ears
- Moro reflex
- Heart - listen for murmurs
- Arms/hands - count digits, palmar creases, posture, movements
- Abdo - distention, masses, organomegaly, ‘flare’
- Spine - scoliosis, dimples, hairy tufts
- Groin and genitallia - femoral pulses, male/female genetalia, hypospadias
- Bottom - anus present and correctly positioned
- Hips/legs/feet - check for clicky/clunky hips, talipes (club foot), accessory digits
What should a doctor do if they find a unilateral undescended testis?
Recheck at 6 weeks
What can be the cause of bilateral undescended testis?
Idiopathic usually or hormonal disorders
List 3 risk factors for infection in neonates:
- PROM
- Group B strep. (GBS)
- Inadequate labour prophylactic Abx
What can sepsis cause?
metabolic acidosis
What causes should be considered in an unwell term baby?
- Sepsis - GBS, E. coli, Listeria
- Hypoglycaemia
- Congenital cardiac abnormality
- Metabolic problems
When are antibiotics given to reduced GBS sepsis?
During labour - 90% risk reduction
What antibiotics are used in the management of sepsis in the newborn?
Initially - Benzylpenicillin and gentamicin until microbiology results
Benzylpenicillin -> GBS, staphs, streps
Gentamycin -> Gram -ve, E. Coli
Amoxicillin -> Listeria
What is the Coombs Test (direct antiglobulin test) used for?
To diagnose Autoimmune haemolytic anaemia
Give 2 features found in biliary atresia:
- Conjugated bilirubin (serum)
- Dark urine, pale stools
Due to no allowing conjugated bilirubin to enter the bowels = pale stools.
What do most jaundiced babies have?
Physiological jaundice - liver enzymes not mature enough yet.
Onset is first 2-5 days off life
What type of jaundice does physiological jaundice cause?
Unconjugated. This is due to the liver not having a high enough conjugation rate.
How can breast milk cause jaundice and what type of jaundice does it produce?
Delayed establishemnt of gut flora results in increased bilirubin reabsorption. Substances in breast milk inhibit conjugation and excretion of bilirubin.
Outline the management of jaundice in neonates:
- Adequate hydration through continued feeding
- Phototherapy breaks down bilirubin into easily excreted isomers.
- Very high levels - Exchange blood transfusion
- Extreme hyperbilirubinaemia - kenicterus may occur = form of dystonic cerebral palsy
List 4 complications of preterm delivery:
Respiratory: respiratory distress syndrome
Cardiovascular: Patent ductus arteriosus
Gastroenterological: Necrotizing enterocolitis
Neurological: Intraventricular haemorrhage (due to capillary bed immaturity)
Why is respiratory distress more likely in preterm delivery?
Usually as a result of surfactant deficiency. Production typically begins between 24-28 weeks and is adequate by 35 weeks
What intervention is performed to reduce the chances of respiratory distress in preterm babies?
Antenatal steroids help promote production in threatened pre-term labour
What CXR findings are present in a baby with respiratory distress syndrome?
- Ground- glass shadowing
- Air bronchograms
What respiratory support can be given in those with RDS?
- CPAP - (continuous positive airway pressure) prevents alveolar collapse during expiration
- Surfactant (‘curosurf’) via endotracheal tube
What is necrotizing enterocolitis (NEC)?
Bowel ischaemia, inflammation, necrosis and even performation.
List 3 symptoms of NEC:
- Poor feed tolerance
- Abdominal distension
- Bloody stools
What can be seen on AXR in a child with NEC?
- Distended bowel loops
- Wall thickening
- Riglers sign (double walled sign)
When does NEC typically present?
2nd-3rd week of life.
What is a good measure of the severity of NEC?
Platelets <100x10^9 = severe
What is the management of NEC?
- Bowel rest (NBM)
- Total parenteral nutrition (TPN)
- Antibiotics
- Surgery to remove perforated or necrotic bowel
What is a stillbirth?
Baby delivered with no sign of life after 24 weeks
What is early neonatal death?
Baby dies within 7 days of delivery
What is late neonatal death?
Baby dies within 7-28 days of delivery
Outline what low birth weight (LBW), VeryLBW and ExtremelyLBW are:
LBW = <2000g VLBW = <1500g ELBW = <1000g
Outline newborn resuscitation in terms of when to give breaths and chest compressions:
If no respiratory effort and HR <100bpm, give 5 inflation breaths.
If HR does not increase after inflation breaths, check position and try again.
If not success, start chest compressions at 3:1 ratio.
What is produced as part of haemolysis?
Unconjugated bilirubin
What can excessive haemolysis cause?
Unconjugated jaundice
What can cause excessive haemolyis in newborns?
- Sepsis
- Immune destruction: blood group ABO incompatibility, rhesus incompatibility
- Congenital RBC defects - hereditary spherocytosis, G6PD deficiency
What two features suggest haemolytic jaundice?
- Positive Coombs test (direct antiglobulin test)
- Unconjugated hyperbilirubinaemia
If severe what does haemolytic jaundice necessitate?
Exchange transfusion.
What are the common serious congenital infections?
(TORCH) T - toxoplasmosis O - other (HIV, measles, parvovirus, hepatitis) R - Rubella C - Cytomegalovirus (CMV) H - Herpes simplex
What is biliary atresia?
Congenital abnormality of the bile ducts (blockage/absence). Untreated it can result is progressive liver failure.
List 4 signs in biliary atresia:
- Jaundice
- Pale stools
- Dark urine
- Abdominal distention 2ndry to hepatomegaly
What is done to diagnose biliary atresia?
- USS
- LFTs
What is the surgical management of biliary atresia?
- Kasai hepatoportoenterostomy (if only external bile duct involved)
- Liver transplant (if intra-hepatic duct involved)
What medical management can be used in those with biliary atresia?
- Abx - prevent choleangitis
- Ursodeoxycholic acid (to encourage bile flow)
- ADEK fat soluble vitamins
