Neonates Flashcards
Androgen insensitivity syndrome genotype and phenotype?
46XY
Female genitalia + undescended testes
What is cryptorchidism and what are the risks?
Undescended testes by adulthood
Risk of becoming testicular seminoma
How does the foetus prepare for birth in the 3rd trimester? (6)
- Surfactant production (25 wks)
- Inhibit lung fluid synthesis
- Accumulation of glycogen
- Accumulation of brown fat- thermoregulation
- Accumulation of subcut fat
- Swallowing amniotic fluid
What does the foetus release to induce labour?
Adrenaline and cortisol
What colour is a baby when first born, and why?
Blue
Due to utero being a hypoxic environment (baby sats=60-70%)
How does SVD encourage own breathing?
Squeeze chest
rub if C section
How does crying encourage breathing in newborns?
Creates negative intrathoracic pressure with closed glottis
Pressure pushes down into lungs
–>
ENCOURAGE REABSORPTION OF LUNG FLUID
Features of Transient Tachypnoea of Newborn?
Can’t clear fluid efficiently
Common in C-section- no preparation/cortisol released to stop fluid production
What causes meconium aspiration, and what are the signs?
Hypoxia in utero causing stressed baby to pass meconium
Reflex GASPING causes aspiration and irritates lungs
Where is the ductus venosus?
Liver
Where is the ductus arteriosus?
Between pulmonary artery and aorta
What happens to the foetal circulation to lungs when it is born?
O2 causes vasodilation- lower pulmonary vascular resistance= more blood to lungs!
What happens to the foetal circulation to body when it is born?
Placental cut-off (low resistance organ) and cause increase in systemic vascular resistance
Ducts close due to prostaglandins constricting smooth muscle
What does the ductus arteriosus become?
Ligamentum arteriosus
What does the ductus venosus become?
Ligamentum teres
How does Persistent Pulmonary Hypertension of Newborn occur?
Failure to transition to new circulation- leading to hypoxia
Management of Persistent Pulmonary Hypertension of Newborn? (5)
O2 Sedation Nitric oxide- pulmonary vasodilator Inotropes ECLS- heart-lung bypass
What happens to O2 sats in Persistent Pulmonary Hypertension of Newborn?
10-20% difference in sats from right hand to foot
What is most of the amniotic fluid made of?
Foetal urine
Why are newborns at high risk of heat loss?
Large surface area
Wet when born
No shivering
Do not break down brown fat in first 12 hours
How to prevent hypothermia in newborns?
Dry with towel Skin-to-skin Hat + blanket Heated mattress Incubator
What happens to glucose homeostasis in newborn?
Drop in insulin
Increased glycogen
Gluconeogenesis occurs
Other than glucose, what else can babies use as brain fuel?
Ketones
What is a normal BG for newborns?
> 2.6
How can hypoglycaemia occur in a newborn?
Increased energy demands
Decreased glycogen stores
Maternal diabetes
Labetalol
What is a normal amount of weight loss in the first few days?
10%
How does physiological anaemia occur in newborn?
Switch to adult Hb
Adult Hb produced more slowly that foetal Hb is broken down
How does physiological jaundice occur in newborn, and how long does it last?
Due to breakdown of foetal Hb- immature liver causes high levels of unconjugated bilirubin
24 hours - 2 weeks
When might a liver be visible on X ray of newborn?
In pneumoperitoneum- air surrounding liver that has leaked from a perforated bowel
10 days old baby presents with distension, tenderness and rectal mucous/blood- what’s the diagnosis?
Necrotising enterocolitis (NEC) Bowel bacterial (aerobic) infection producing air- necrotic and abscesses in severe
How is NEC diagnosed?
X ray with contract
Treatment of NEC?
Stop oral feeding
Antibiotics
Surgery
3 general causes of obstruction?
- stuck in lumen (intralumenal)
- Compression from outside
- Something in wall
What is meconium ileus?
Meconium gets stuck (more common in CF)
Symptoms of meconium ileus?
No bowel movements
Vomiting in first 2 days
Distention
Meconium mass
Investigation of meconium ileus?
X ray with contrast
Symptoms of obstruction due to something ‘in the wall’?
Keen to feed
Vomiting after first feed
Distention
Common cause of ‘in the wall’ obstruction?
Jejunal atresia
What sign on X ray suggests obstruction in small bowel?
Dilated bowel will line up like rungs of a ladder
Less rungs= higher obstruction
Common cause of external compression obstruction?
Hernia
What is malrotation?
Twisted mesentery during development of the bowel
Symptoms of malrotation + volvulus?
Vomiting bile
Investigation of malrotation + volvulus?
Upper GI contrast X ray with FOLLOW THROUGH TO BOWEL
Why is surgery for malrotation + volvulus an emergency?
Prevent bowel ischaemia + necrosis
What is a normal birth weight?
2.5-4kg
What is APGAR score a measure of, and what are the components?
Measure of perinatal adaptation
Appearance-colour Pulse- HR Grimace- responsiveness Activity- tone Respiration- RR
When is APGAR measured, and how is it scored?
Measured at 1, 5 + 10 mins
0-2 points for each component
>8= normal
Which screening tests are carried out on newborns? (5)
- Baby checks
- Hearing
- Hip exam
- Guthrie test (day 5)
- Newborn EWS chart
When is a newborn examination carried out and what does it involve?
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
What is erythema toxicum?
‘Baby acne’
What is a mangolian spot?
Benign black spot at sacrum
document!- not bruise!
What should the RR of a newborn be?
40-60 / minute
What should the HR of a newborn be?
120-140 bpm
Features of hypoglycaemia in newborns?
Hypothermia Jittery/seizure activity Poor feeding Floppy Lethargy Apnoea
Most common antenatal infection of baby?
CMV
Most common perinatal infection of baby?
Group B strep
When is Hep B vaccine given to a newborn?
If going home to high risk environment e.g. PWIDs around
What is hypoxic ischaemic encephalopathy?
Multi-organ damage due to tissue hypoxia
Management of hypoxic ischaemic encephalopathy?
Cooling mat may reduce adverse neurological outcomes
What is hydrops foetalis?
Accumulation of fluid in lungs, heart, or abdomen, or under the skin
(ascites, pleural effusion, pericardial effusion)
What is Tetralogy of Fallot?
Pulmonary Stenosis
Ventricular Septal Defect
RV hypertrophy
Overriding aorta
What is Potter’s Syndrome?
Kidneys can’t produce amniotic fluid (therefore no lung fluid)
No movement in-utero–> ALL IUD
Feature of myotonic dystrophy?
Breathing difficulties
Improves with time
What does the Guthrie Test screen for?
CF
Sickle cell disorders
Congenital hypothyroidism
Inherited metabolic conditions (PKU, MCADD, maple syrup urine disease etc.)
Why is a IM vitamin K infection given to all newborns?
To prevent haemorrhagic disease of newborn (due to lack of vit K as newborn)
Symptoms associated with jaundice?
Yellow skin Sleepiness Poor feeding Weight loss Pale stool Dark urine
What increased the risk of physiological jaundice?
Forceps delivery–> bruising broken down into bilirubin
Features of early jaundice?
<24 hours
Usually due to haemolysis
(also polycythaemia, infection)
Causes of haemolysis in newborns?
ABO incompatibility Rhesus disease Sepsis Poor feeding Intestinal obstruction (e.g. pyloric stenosis)
Investigation of early jaundice in newborns?
Total + conjugated serum bilirubin
Blood group + antibodies
Coombs test (direct)
Urine/stool culture
What is breast feeding jaundice?
Insufficient milk supply causing jaundice
What is persistent jaundice and how is classified?
Term >14 days
Preterm >21 days
Can be mostly conjugated or unconjugated
Causes of persistent unconjugated jaundice?
Breast milk jaundice
Haemolysis
Infection
Hypothyroidism
Causes of persistent conjugated jaundice?
ALWAYS ABNORMAL Hepatitis Biliry atresia CF Down's Syndrome etc.
Treatments of jaundice?
Phototherapy- blue light box (add O2 + bilirubin- water soluble= out in bile + urine)
Treat cause
Hydrate
Exchange transfusion (IV immunoglobulins)
What can unconjugated bilirubin lead to?
Kernicterus (bilirubin encephalopathy)
unconjugated toxic to brain
Symptoms of kernictus?
High pitched cry Spasticity Muscle spasms Seizures Hypotonia- floppy Temperature instability Lethargy Irritability Poor feeding
What can kernictus lead to?
Cerebral palsy Learning disability Hearing loss Twitching Eye movement disorders Poor teeth development
What is NAS?
Neonatal Abstinence Syndrome
- exposure to drugs in-utero
Management of NAS?
Hydrate + feed (NG tube)
Decrease loud noises + lights
ORAMORPH 40mg/kg every 4 hours
Causes of preterm birth?
Spontaneous Multiple pregnancy Premature ROM Hypertension Antepartum haemorrhage
What is normal temperature for neonates?
36.5-37.4
Why is preterm baby more at risk of hypothermia?
Lack of muscle activity
Lack of subcut/brown fat
Why is preterm baby more at risk of nutritional compromise?
Lack of nutrient reserves
Gut immaturity
Increased demands
How is nutritional compromise managed in preterm babies?
100-140kcal/kg
Breastfeeding, formula or IV vitamin therapy (yellow infusion)
What is early onset neonatal sepsis and typical pathogens?
Acquired before/during delivery e.g. premature ROM
Group B strep/ gram -ves
What is late onset neonatal sepsis and typical pathogens?
Community sources
Gram -ves, staph aureus, coagulase negative staph
Risk factors for neonatal sepsis?
Group B strep colonisation
Premature ROM
Maternal temp >38
Chorioamnionitis
Symptoms of neonatal sepsis?
Respiratory distress (grunting, cyanosis) Pallor (hypotension, hypoxia) Lethargy Poor feeding Tachycardia
Treatment of neonatal sepsis?
Early- benzylpenicillin + gentamicin
Late- vancomycin/flucloxacillin
What is respiratory distress syndrome (RDS) due to?
Surfactant deficiency (<25 weeks) or structural immaturity
Other causes of breathlessness in preterm babies?
TTN Infection/sepsis Pneumothorax Pneumonia Polycythaemia Cardiac cause
How does RDS appear on CXR?
Hazy throughout
Treatment of RDS?
Suction
Surfactant
Steroids
Ventilation
Preterm baby with cyanosis, tired, sweating, heavy breathing etc.?
Patent ductus arteriosus
How does intraventricular haemorrhage occur in preterms, and how is it diagnosed?
Due to limited control of BP between body and brain
Diagnosed on USS
Treatment of intraventricular haemorrhage?
Magnesium sulphate to mother for neuroprotection
How can the eyes be affected by preterm delivery?
Retinopathy- neovascularisation
What is SUDI and what increases high?
Sudden Unexpected Death in Infancy (cot death)
Increased in prematurity, multiple babies, babies with chronic conditions, parents of previous SUDI etc.
How to identify a dilated bowel on X ray?
If bowel diameter is more than diameter of vertebral bodies
