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Y3- TO LEARN > Neonates > Flashcards

Neonates Flashcards

1
Q

Androgen insensitivity syndrome genotype and phenotype?

A

46XY

Female genitalia + undescended testes

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2
Q

What is cryptorchidism and what are the risks?

A

Undescended testes by adulthood

Risk of becoming testicular seminoma

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3
Q

How does the foetus prepare for birth in the 3rd trimester? (6)

A
  1. Surfactant production (25 wks)
  2. Inhibit lung fluid synthesis
  3. Accumulation of glycogen
  4. Accumulation of brown fat- thermoregulation
  5. Accumulation of subcut fat
  6. Swallowing amniotic fluid
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4
Q

What does the foetus release to induce labour?

A

Adrenaline and cortisol

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5
Q

What colour is a baby when first born, and why?

A

Blue

Due to utero being a hypoxic environment (baby sats=60-70%)

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6
Q

How does SVD encourage own breathing?

A

Squeeze chest

rub if C section

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7
Q

How does crying encourage breathing in newborns?

A

Creates negative intrathoracic pressure with closed glottis
Pressure pushes down into lungs
–>
ENCOURAGE REABSORPTION OF LUNG FLUID

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8
Q

Features of Transient Tachypnoea of Newborn?

A

Can’t clear fluid efficiently

Common in C-section- no preparation/cortisol released to stop fluid production

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9
Q

What causes meconium aspiration, and what are the signs?

A

Hypoxia in utero causing stressed baby to pass meconium

Reflex GASPING causes aspiration and irritates lungs

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10
Q

Where is the ductus venosus?

A

Liver

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11
Q

Where is the ductus arteriosus?

A

Between pulmonary artery and aorta

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12
Q

What happens to the foetal circulation to lungs when it is born?

A

O2 causes vasodilation- lower pulmonary vascular resistance= more blood to lungs!

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13
Q

What happens to the foetal circulation to body when it is born?

A

Placental cut-off (low resistance organ) and cause increase in systemic vascular resistance

Ducts close due to prostaglandins constricting smooth muscle

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14
Q

What does the ductus arteriosus become?

A

Ligamentum arteriosus

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15
Q

What does the ductus venosus become?

A

Ligamentum teres

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16
Q

How does Persistent Pulmonary Hypertension of Newborn occur?

A

Failure to transition to new circulation- leading to hypoxia

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17
Q

Management of Persistent Pulmonary Hypertension of Newborn? (5)

A 
O2
Sedation
Nitric oxide- pulmonary vasodilator
Inotropes
ECLS- heart-lung bypass
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18
Q

What happens to O2 sats in Persistent Pulmonary Hypertension of Newborn?

A

10-20% difference in sats from right hand to foot

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19
Q

What is most of the amniotic fluid made of?

A

Foetal urine

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20
Q

Why are newborns at high risk of heat loss?

A

Large surface area
Wet when born
No shivering
Do not break down brown fat in first 12 hours

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21
Q

How to prevent hypothermia in newborns?

A 
Dry with towel
Skin-to-skin
Hat + blanket
Heated mattress
Incubator
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22
Q

What happens to glucose homeostasis in newborn?

A

Drop in insulin
Increased glycogen
Gluconeogenesis occurs

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23
Q

Other than glucose, what else can babies use as brain fuel?

A

Ketones

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24
Q

What is a normal BG for newborns?

A

> 2.6

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25
Q

How can hypoglycaemia occur in a newborn?

A

Increased energy demands
Decreased glycogen stores
Maternal diabetes
Labetalol

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26
Q

What is a normal amount of weight loss in the first few days?

A

10%

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27
Q

How does physiological anaemia occur in newborn?

A

Switch to adult Hb

Adult Hb produced more slowly that foetal Hb is broken down

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28
Q

How does physiological jaundice occur in newborn, and how long does it last?

A

Due to breakdown of foetal Hb- immature liver causes high levels of unconjugated bilirubin

24 hours - 2 weeks

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29
Q

When might a liver be visible on X ray of newborn?

A

In pneumoperitoneum- air surrounding liver that has leaked from a perforated bowel

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30
Q

10 days old baby presents with distension, tenderness and rectal mucous/blood- what’s the diagnosis?

A 
Necrotising enterocolitis (NEC)
Bowel bacterial (aerobic) infection producing air- necrotic and abscesses in severe
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31
Q

How is NEC diagnosed?

A

X ray with contract

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32
Q

Treatment of NEC?

A

Stop oral feeding
Antibiotics
Surgery

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33
Q

3 general causes of obstruction?

A
  1. stuck in lumen (intralumenal)
  2. Compression from outside
  3. Something in wall
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34
Q

What is meconium ileus?

A

Meconium gets stuck (more common in CF)

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35
Q

Symptoms of meconium ileus?

A

No bowel movements
Vomiting in first 2 days
Distention
Meconium mass

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36
Q

Investigation of meconium ileus?

A

X ray with contrast

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37
Q

Symptoms of obstruction due to something ‘in the wall’?

A

Keen to feed
Vomiting after first feed
Distention

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38
Q

Common cause of ‘in the wall’ obstruction?

A

Jejunal atresia

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39
Q

What sign on X ray suggests obstruction in small bowel?

A

Dilated bowel will line up like rungs of a ladder

Less rungs= higher obstruction

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40
Q

Common cause of external compression obstruction?

A

Hernia

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41
Q

What is malrotation?

A

Twisted mesentery during development of the bowel

42
Q

Symptoms of malrotation + volvulus?

A

Vomiting bile

43
Q

Investigation of malrotation + volvulus?

A

Upper GI contrast X ray with FOLLOW THROUGH TO BOWEL

44
Q

Why is surgery for malrotation + volvulus an emergency?

A

Prevent bowel ischaemia + necrosis

45
Q

What is a normal birth weight?

A

2.5-4kg

46
Q

What is APGAR score a measure of, and what are the components?

A

Measure of perinatal adaptation

Appearance-colour
Pulse- HR
Grimace- responsiveness
Activity- tone
Respiration- RR
47
Q

When is APGAR measured, and how is it scored?

A

Measured at 1, 5 + 10 mins

0-2 points for each component
>8= normal

48
Q

Which screening tests are carried out on newborns? (5)

A
  1. Baby checks
  2. Hearing
  3. Hip exam
  4. Guthrie test (day 5)
  5. Newborn EWS chart
49
Q

When is a newborn examination carried out and what does it involve?

A

24 hours of age

Measure head + inspect
Red reflex
Ear inspection
Mouth inspection + tongue tie + palate
Reflexes
Respiration assessment
Pulses + precordial exam
Abdo inspection
Examine genitalia
Hip exam
Tone
50
Q

What is erythema toxicum?

A

‘Baby acne’

51
Q

What is a mangolian spot?

A

Benign black spot at sacrum

document!- not bruise!

52
Q

What should the RR of a newborn be?

A

40-60 / minute

53
Q

What should the HR of a newborn be?

A

120-140 bpm

54
Q

Features of hypoglycaemia in newborns?

A 
Hypothermia
Jittery/seizure activity
Poor feeding
Floppy
Lethargy 
Apnoea
55
Q

Most common antenatal infection of baby?

A

CMV

56
Q

Most common perinatal infection of baby?

A

Group B strep

57
Q

When is Hep B vaccine given to a newborn?

A

If going home to high risk environment e.g. PWIDs around

58
Q

What is hypoxic ischaemic encephalopathy?

A

Multi-organ damage due to tissue hypoxia

59
Q

Management of hypoxic ischaemic encephalopathy?

A

Cooling mat may reduce adverse neurological outcomes

60
Q

What is hydrops foetalis?

A

Accumulation of fluid in lungs, heart, or abdomen, or under the skin

(ascites, pleural effusion, pericardial effusion)

61
Q

What is Tetralogy of Fallot?

A

Pulmonary Stenosis
Ventricular Septal Defect
RV hypertrophy
Overriding aorta

62
Q

What is Potter’s Syndrome?

A

Kidneys can’t produce amniotic fluid (therefore no lung fluid)

No movement in-utero–> ALL IUD

63
Q

Feature of myotonic dystrophy?

A

Breathing difficulties

Improves with time

64
Q

What does the Guthrie Test screen for?

A

CF
Sickle cell disorders
Congenital hypothyroidism
Inherited metabolic conditions (PKU, MCADD, maple syrup urine disease etc.)

65
Q

Why is a IM vitamin K infection given to all newborns?

A

To prevent haemorrhagic disease of newborn (due to lack of vit K as newborn)

66
Q

Symptoms associated with jaundice?

A 
Yellow skin
Sleepiness
Poor feeding
Weight loss
Pale stool
Dark urine
67
Q

What increased the risk of physiological jaundice?

A

Forceps delivery–> bruising broken down into bilirubin

68
Q

Features of early jaundice?

A

<24 hours
Usually due to haemolysis
(also polycythaemia, infection)

69
Q

Causes of haemolysis in newborns?

A 
ABO incompatibility
Rhesus disease
Sepsis
Poor feeding
Intestinal obstruction (e.g. pyloric stenosis)
70
Q

Investigation of early jaundice in newborns?

A

Total + conjugated serum bilirubin
Blood group + antibodies
Coombs test (direct)
Urine/stool culture

71
Q

What is breast feeding jaundice?

A

Insufficient milk supply causing jaundice

72
Q

What is persistent jaundice and how is classified?

A

Term >14 days
Preterm >21 days
Can be mostly conjugated or unconjugated

73
Q

Causes of persistent unconjugated jaundice?

A

Breast milk jaundice
Haemolysis
Infection
Hypothyroidism

74
Q

Causes of persistent conjugated jaundice?

A 
ALWAYS ABNORMAL
Hepatitis
Biliry atresia
CF
Down's Syndrome etc.
75
Q

Treatments of jaundice?

A

Phototherapy- blue light box (add O2 + bilirubin- water soluble= out in bile + urine)
Treat cause
Hydrate
Exchange transfusion (IV immunoglobulins)

76
Q

What can unconjugated bilirubin lead to?

A

Kernicterus (bilirubin encephalopathy)

unconjugated toxic to brain

77
Q

Symptoms of kernictus?

A 
High pitched cry
Spasticity
Muscle spasms
Seizures
Hypotonia- floppy
Temperature instability
Lethargy
Irritability
Poor feeding
78
Q

What can kernictus lead to?

A 
Cerebral palsy
Learning disability
Hearing loss
Twitching
Eye movement disorders
Poor teeth development
79
Q

What is NAS?

A

Neonatal Abstinence Syndrome

- exposure to drugs in-utero

80
Q

Management of NAS?

A

Hydrate + feed (NG tube)
Decrease loud noises + lights
ORAMORPH 40mg/kg every 4 hours

81
Q

Causes of preterm birth?

A 
Spontaneous
Multiple pregnancy
Premature ROM
Hypertension
Antepartum haemorrhage
82
Q

What is normal temperature for neonates?

A

36.5-37.4

83
Q

Why is preterm baby more at risk of hypothermia?

A

Lack of muscle activity

Lack of subcut/brown fat

84
Q

Why is preterm baby more at risk of nutritional compromise?

A

Lack of nutrient reserves
Gut immaturity
Increased demands

85
Q

How is nutritional compromise managed in preterm babies?

A

100-140kcal/kg

Breastfeeding, formula or IV vitamin therapy (yellow infusion)

86
Q

What is early onset neonatal sepsis and typical pathogens?

A

Acquired before/during delivery e.g. premature ROM

Group B strep/ gram -ves

87
Q

What is late onset neonatal sepsis and typical pathogens?

A

Community sources

Gram -ves, staph aureus, coagulase negative staph

88
Q

Risk factors for neonatal sepsis?

A

Group B strep colonisation
Premature ROM
Maternal temp >38
Chorioamnionitis

89
Q

Symptoms of neonatal sepsis?

A 
Respiratory distress (grunting, cyanosis)
Pallor (hypotension, hypoxia)
Lethargy
Poor feeding
Tachycardia
90
Q

Treatment of neonatal sepsis?

A

Early- benzylpenicillin + gentamicin

Late- vancomycin/flucloxacillin

91
Q

What is respiratory distress syndrome (RDS) due to?

A

Surfactant deficiency (<25 weeks) or structural immaturity

92
Q

Other causes of breathlessness in preterm babies?

A 
TTN
Infection/sepsis
Pneumothorax
Pneumonia
Polycythaemia
Cardiac cause
93
Q

How does RDS appear on CXR?

A

Hazy throughout

94
Q

Treatment of RDS?

A

Suction
Surfactant
Steroids
Ventilation

95
Q

Preterm baby with cyanosis, tired, sweating, heavy breathing etc.?

A

Patent ductus arteriosus

96
Q

How does intraventricular haemorrhage occur in preterms, and how is it diagnosed?

A

Due to limited control of BP between body and brain

Diagnosed on USS

97
Q

Treatment of intraventricular haemorrhage?

A

Magnesium sulphate to mother for neuroprotection

98
Q

How can the eyes be affected by preterm delivery?

A

Retinopathy- neovascularisation

99
Q

What is SUDI and what increases high?

A

Sudden Unexpected Death in Infancy (cot death)

Increased in prematurity, multiple babies, babies with chronic conditions, parents of previous SUDI etc.

100
Q

How to identify a dilated bowel on X ray?

A

If bowel diameter is more than diameter of vertebral bodies

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