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J Repro > Neonates > Flashcards

Neonates Flashcards

1
Q

what are the 3 shunts in the cardio system of feotuses that close over after birth

where are each

A

foramen ovale - between the RA and LA, allows blood to travel form RA directly to LA = more oxygenised

ductus arteriosum - between pulmonary artery and arch of aorta

ductus venosus - in the liver

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2
Q

apart from the 3 shunts, why doesn’t much blood go to the lungs

why is this

A

high resistance in pulmonary system

theres no need to go to lungs bc not getting any oxygen there (oxygen comes from placenta)

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3
Q

what happens to the shunts present in fetuses in the 3rd trimester

A

they close over

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4
Q

at what age does a fetus start producing surfactant

clinical significance of this

A

24w, becomes sufficient at 36w

if premature <36w, not enough surfactant = risk of ARDS = need steroids

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5
Q

normal gestation (weeks)

A

37-42w

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6
Q

normal weight

A

2.5-4kg

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7
Q

what is normal weight gain/loss in first 10 days

A

10% weight loss = NORMAL

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8
Q

initial O2 sats of baby

O2 sats of baby after 10 mins

A

60%

>90% by 10 mins

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9
Q

why do babies cry when they first come out

A

causes alveolar expansion and increase intrathoracic pressure = max air into lungs

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10
Q

what is in the lungs when inside mum

how does crying change this

A

fluid inside lungs when inside mum

crying = increased intrathoracic pressure = pushes fluid into interstitial spaces = reabsorbed in lymph

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11
Q

when do you cut the babies cord

A

after it stops pulsating (10 mins)

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12
Q

what causes foramen ovale closure when out the womb

what is the result if this doesn’t happen

A

increased systemic vascular resistance = increased pressure into RA = closes foramen ovale

persistent foramen ovale

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13
Q

what causes ductus arteriosus to close when out of the womb

what is the result if this doesn’t happen

A

decreased pulmonary pressure (compared to inside womb) = persistent ductus arteriosus

patent ductus arteriosus

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14
Q

what causes the ductus venosus in the liver to close

what structure does this result in

A

systemic vascular pressure increase

becomes the ligamentum teres

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15
Q

what happens to prostaglandin when outside womb, what does this do to the circulatory ducts

A 
prostaglandin drops (produced by placenta) 
= closes ducts
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16
Q

why are babies often cold when they come out the womb

by what mechanism do they overcome this

A

large SA
wet
cant shiver (immature hypothalamus and muscles)

overcome this by non shivering thermogenesis

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17
Q

what is non shivering thermogenesis

A

breakdown of brown fat = increase body temp in neonates

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18
Q

which group of babies are even worse at maintaining temp than normal babies (hence need extra help)

A

preterm or SGA babies

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19
Q

why does physiological aneamia occur

A

change from fetal haemoglobin to adult haemoglobin (gamma to beta)

but adult haemoglobin takes longer to be made than fetal haemoglobin takes to be destroyed

= physiological anaemia

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20
Q

what does apgar score stand for

when is it done

A

1, 5, 10 mins after birth
should gradually increase to 10

Appearance
Pulse 
Grimace (reflex) 
Activity (muscle tone) 
Respiration

everything out of 2

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21
Q

definition of preterm (in weeks)

A

24w-36w and 6 days

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22
Q

causes of preterm

A 
multiple births 
infection 
placental abruption 
pre-eclampsia/eclampsia 
mum teenager or >40yo
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23
Q

post delivery care of preterm babies

A

warmth - plastic bag, hat, skin to skin
steroids - to reduce risk of ARDS
delay cord clamping - to increase Hb going into baby

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24
Q

how should preterm babies be delivered

A

c section (emergency or planned)

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25
Q

why is it harder for preterm babies to stay warm

A

less brown fat
less sub cut fat
increased SA

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26
Q

which brain/MSK problem are preterm neonates at risk of

A

cerebral palsy

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27
Q

survival rates of preterm infants <24 weeks

A

<25%

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28
Q

survival rates of preterm infants >26 weeks

A

> 80%!!

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29
Q

definition of small for gestational age (SGA)

A

<10th centile

<2.5kg full term

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30
Q

aetiology of SGA

A 
maternal malnutrition
smoking 
alcohol 
drugs 
fetal infection 
chromosome abnormalities
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31
Q

why does smoking cause SGA

A

smoking = vasoconstriction = less blood getting to placenta = less nutrients getting to baby to grow

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32
Q

what size is the head and abdo in symmetrical intrauterine growth restriction (IUGR)

A

head small

abdo small

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33
Q

what size is the head and abdo in asymmetrical intrauterine growth restriction (IUGR)

A

head normal

abdo small

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34
Q

investigations if SGA (3)

A

CTG - to check fetal distress
US
umbilical arterial doppler US - measures flow into placenta

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35
Q

definition of LGA (large for gestational age)

A

> 95th centile

>4kg full term

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36
Q

aetiology for LGA (4)

A

‘big baby’ - familial obesity, maternal/gestational diabetes
polyhydramnios - caused by diabetes, infection
wrong dates - concealed pregnancy, vulnerable women
multiple pregnancy

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37
Q

what is polyhydramnios

A

excess amniotic fluid

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38
Q

how does polyhydramnios present externally

A

tense shiny abdomen, inability to feel baby

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39
Q

investigations for polyhydramnios (4)

A

US
OGTT - for diabetes
serology - for infectious cause
antibody screen

40
Q

complications of LGA

A

hypoglycaemia - if maternal diabetes

41
Q

does assisted conception increase or decrease you risk of multiple pregnancies

A

increases it!

42
Q

does older age increase or decrease you risk of multiple pregnancies

A

increases it

43
Q

how many eggs are involved in identical twins

A

1

spitting of a single fertilized egg

44
Q

how many eggs are involved in non identical twins

A

2

fertilization of 2 ova by 2 sperm

45
Q

which type of twins, with how many placenta, are highest risk (get fortnightly assessment)

A

monozygous monochorionic

46
Q

when is c section indicated for multiple pregnancy

A

> 2

non cephalic presentation (breech)

47
Q

what does gestational diabetes increase risk of long term

A

type 2 diabetes in mum

48
Q

treatment of gestational diabetes/maternal diabetes in pregnancy

A

insulin (non teratogenic)

49
Q

absent femoral pulses in neonate

A

coarctation of aorta

50
Q

what is oesophageal atresia

when does the problem occur

A

when the oesophagus ends in a blind pouch (doesn’t reach stomach)

problem in embryology

51
Q

where might an oesophageal atresia attach to (instead of stomach)

A

trachea

52
Q

how does oesophageal atresia present

A

doesn’t feed
frothy secretions
CXR with air in stomach

53
Q

‘gut in lungs’ seen on CXR

A

diaphragmatic hernia

54
Q

presentation of hypoglycaemia in neonates

A

seizures

jittery limbs

55
Q

what causes hypoglycaemia in neonates

A

poorly controlled gestation/maternal diabetes

preterm

56
Q

management of hypoglycaemia in neonates

A

glucose

57
Q

what causes haemorrhagic disease of new born

A

vit K deficiency

58
Q

preventative measure for haemorrhagic disease of newbown

A

vit K IM at birth

59
Q

presentation of haemorrhagic disease of new born if not given vit K

A

easy bruising/bleeding

60
Q

what is transient tachypnoea of the new born

A

excess fluid in lungs after birth

resolves after 24h

61
Q

what causes transient tachypnoea of the new born

A

c section - bc no trauma (like in vaginal delivery) = aren’t mentally prepared for outside world

62
Q

CXR of transient tachypnoea of the new born

A

bilateral haziness - fluid in lungs

63
Q

risk factor for respiratory distress syndrome

A

prematurity = decreased lung surfactant production

64
Q

presentation of respiratory distress syndrome

A

tachypnoea
grunting
nasal flaring
intercostal recession

65
Q

CXR of respiratory distress syndrome

A

ground glass appearance

haziness - cant see heart border

66
Q

prevention of respiratory distress syndrome

A

steroids during pregnancy

67
Q

what are the 4 viral infections common in the antenatal period

A

TORCH

toxoplasmosis
rubella
CMV
hepatitis

68
Q

what decreases risk of infection in babies

A

breast feeding - increases neonatal immunity

69
Q

what happens in persistent pulmonary hypertension of the newborn

A

fetal circulation remains (still have patent foramen ovale and patent ductus arteriosus)
failure to adapt to post natal life

70
Q

machine like murmur

A

persistent pulmonary hypertension of new born

71
Q

investigations for persistent pulmonary hypertension of new born

A

preductal and postductal O2 sats (one on R hand, one on L foot)

72
Q

what is a risk factor for persistent pulmonary hypertension of the newborn

A

induction of labour - bc of iatrogenic prostaglandins = prostaglandins increase

need prostaglandins to decrease to close duct

73
Q

treatment of persistent pulmonary hypertension

A

ventilation, O2, nitric oxide, indomethacin (prostaglandin)

74
Q

brown liquor on vaginal examination during labour

A

meconium

75
Q

what happens if meconium in liquor is aspirated

A

hypoxia

76
Q

aetiology of jaundice <24h after birth

is it physiological or pathological

A

haemolytic disease of newborn - when mother has antibodies against the childs Rh

pathological

77
Q

aetiology of jaundice 24h-2 weeks after birth

is it physiological or pathological

A

unconjugated hyperbilirubinaemia
unconjugated = hasn’t been through liver yet, but liver isn’t mature enough to cope = normal

physiological - normal so dw

78
Q

aetiology of jaundice >2 weeks after birth

is it physiological or pathological

A

obstructive jaundice (conjugated hyperilirubinaemia) eg hypothyroidism, breast feeding, biliary atresia

pathological

79
Q

what test do you do if jaundice <24h after birth

what for

A

coombs test

for haemolytic disease of newborn

80
Q

treatment of jaundice in neonate

A

phototherapy - incubator with UV light, cover eyes, if mild SBR
exchange transfusion - if high SBR

81
Q

how does phototherapy work to treat jaundice

A

converts transbilirubin to something that doenst need to be conjugated to be excreted

82
Q

which chronic condition presents with meconium ileus in neonates

A

cystic fibrosis

83
Q

how does meconium ileus present

A

no faeces >2days after birth
vomiting
large abdo

84
Q

pathophysiology of meconium ileus

A

meconium is too poor quality = gets stuck in bowel lumen

85
Q

big loops of air filled bowel on abdo xray (width of distention > with of vertebrae)
in neonate

A

distended bowels = from jejunal atresia

86
Q

risk factors for NEC (necrotizing enterocolitis)

A

premature

formula feeding

87
Q

pathophysiology of necrotizing enterocolitis

A

bowel doest form properly = infection = necrosis

bowel wall gets leaky = air leaks out = pneumoperitoneum

88
Q

abdo x-ray of NEC (necrotizing enterocolitis)

A

pneumoperitoneum (air in abdo cavity, under diaphragm)

89
Q

how does NEC (necrotizing enterocolitis) present

think about pathophysiology

A

abdo distention - from air in abdo cavity

90
Q

treatment of NEC (necrotizing enterocolitis)

A

surgery

91
Q

neonate vomiting green bile

A

malrotation of gut

green bc foodstuffs has mixed with bile in the bowel

92
Q

neonate >6w

vomiting foodstuffs

A

pyloric stenosis

food stuffs bc hasn’t gotten past stomach

93
Q

treatment of malrotation of gut

A

emergency surgery!!!!

94
Q

complications of untreated malrotation of gut

A

bowel ischaemia

95
Q

what is the name of the first faeces that babies pass

what does it look like

A

meconium

is black

J Repro (28 decks)

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