Neonates Flashcards
Causes of neonatal jaundice (overview)
<24 hrs ABO incompatibility Rhesus G6PD Hereditary spherocytosis Infection
24hrs - 2 weeks Infection Physiological BREAST FEEDING Dehydration
>2 weeks CF Congenital hypothyroidism Biliary atresia Hepatitis Pyloric stenosis Infection
Causes of physiological jaundice
Dehydration - decreased
Immature hepatocytes
Gut immaturity
RBC life span low –> increased RBC turnover
TORCH infections and what they can result in (brief)
Toxoplasmosis - cerebral calcification/ hydrocephalus
Other - syphilis (still birth) VZV - limb defects, intellectual defects, skin defects
Rubella - cataracts/ hearing/ heart
CMV - eyes, hearing, intellectual disability
HSV - encephalitis
GBS complications
meningitis
pneumonia
give ben pen in labour so maybe this is the abx of choice?
Listeria
CHEESE MILK POULTRY
meningitis
pneumonia
Organisms causing neonatal conjunctivitis
Strep/ staph - neomycin
Gonococcal - cef
Chlamydia - erythromycin
Bronchopulmonary dysplasia
What is it
O2 requirement >36 weeks
Aetiology
- High flow O2 eg from RDS
Presentation
Crackles
Wheeze
Investigations
CXR - round radiolucent areas
Management
- Dex
- O2
- Palivizumab
Complications
- Cerebral palsy
- P HTN
- Bronchiolitis
RDS
what is it Aetiology pres inv management prevention complications
low surfactant in the preterm –> resp distress
Aetiology
- prem
- C section
- 2nd born of twins
Presentation
Resp distress
Investigations
CXR - ground glass appearance
Management
O2
CPAP
Surfactant down ET tube
Prevention
- Dex!
- Delayed cord clamping
Complications - Bronchopulmonary dysplasia - Pneumonthorax - retinopathy of prematurity all from high flow O2
HIE
What is it Aetiology Pres Investigations Management Complications
hypoxia in the neonate
Aetiology - Maternal Cord compression Prolonged uterine contractions Bleed - Foetal - anaemia
Presentation
Seizure
Tone abnormality
Investigations
MRI
∆ thalami/ BG/ internal capsule
Management
- O2
- Anticonvulsants
Complications
Cerebral palsy
Encephalopathy
Seizures
NEC
What is it Aetiology Presentation Investigations Management Complications
Bowel ischaemia/ bacterial infection in the neonatal gut wall
Aetiology
- Cows milk is a RF
Presentation Red tense shiny abdomen Bilious vomiting Red stools Abdo distension Shock if peritonitis
Investigations AXR Intramural gas (rigler and football sign) distended loops of bowel pneumoperitoneum
Bloods
- Thrombocytopaenia
- Neutropaenia
- Acidosis
Management ABC NBM NG tube - decompression Abx - cef + vanc and gent Surgery - immediate resection
Complications
Short bowel syndrome
Peritonitis/perforation
Retinopathy of prematurity
due to high flow O2
Can –> blindness and retinal detachment
Complication of RDS Rx
Screen at 36w or birth weight <1500g
Laser therapy if severe
Hypoglycaemia
Aetiology
- Prem
- Sepsis
- IUGR
- Hypothermia
Rx
1) Enteral feed
2) buccal dextrose
3) IV dextrose 10/15/20%
Resus in neonates
Start clock + DRY THAT BABY
Assess
- HR
- Breathing
- Tone
Not breathing
Airway open
5 inflation breaths
SpO2 monitor
No HR or <60 -> compression 3:1
Drugs
Epinephrine for HR
Sodium bicarb 4.5% for acidosis
Dextrose for hypoglycaemia
APGAR score
HR - none, <100, >100
Breathing effort none, gasp/irregular - strong cry
Muscle tone flaccid, some flexion, well flexed
Irritability - none, grimace, cry/cough
Colour blue/pale - central pink, periphery pale/blue - all pink
Gastroschisis vs omphalocoele
Gastroschisis
part of the bowel has protruded through a defect in the abdominal wall (usually to the left of the umbilicus)
There is NO membrane covering
Management
- Clingfilm
- Fluids
- IV dextrose
- NG tube
- Immediate surgery
Omphalocoele
Associated with other conditions (imperforate anus + spinal defects)
There IS a membrane covering (peritoneum and amniotic sac)
There is protrusion of bowel contents through the umbilical ring
Management
- Surgery over 6+ 9 months
