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Neonates Flashcards

1
Q

What is meconium aspiration syndrome

A

Where baby inhales meconium into the lungs
This blocks the airways and starts an inflammatory process
Gives lungs a streaky appearance on X-ray

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2
Q

What are the 3 shunts in the foetal circulation

A

Ductus venosus
Foramen ovale
Ductus arteriosus

All must shut after birth

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3
Q

How does the foetus prepare itself for birth in the 3rd trimester

A

Surfactant production
Accumulation of glycogen – liver, muscle, heart
Accumulation of brown fat –for warmth
Accumulation of subcutaneous fat
Swallowing amniotic fluid - helps lungs grow and expand

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4
Q

How does labour help prepare the baby’s lungs for life

A

Synthesis of lung fluid stops
Vaginal delivery – squeezes lungs to get rid of some fluid
The first cry is very important for the baby to absorb the extra fluid into their lymphatic

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5
Q

What colour is a baby when it is first born

A

All babies will be blue or pale when born
Gradually turns pink as the circulation transitions from foetal to ‘adult’ – baby is now oxygenating their own blood as they have started breathing

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6
Q

Is delayed cord clamping recommended

A

Yes
Advocate delayed cord clamping in all babies (especially in prem babies) – this allows for final transfer of blood and immunoglobulins

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7
Q

Describe how foetal circulation transitions to adult after birth

A

Pulmonary vascular resistance drops - fluid leaves lungs when breathing starts
Systemic vascular resistance rises - cord clamped
Oxygen tension rises
Circulating prostaglandins drop - this helps close the foetal shunts
Duct constricts
Foramen ovale closes

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8
Q

When do the foetal shunts close

A

Most close physiologically in 24hrs but some can be take a few days to shut completely – some babies will have a murmur on day 1 which will go away

Anatomical closure occurs within 7-10 days

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9
Q

What happens to the 3 foetal shunts after birth

A

Foramen ovale closes
Some may persist as PFO

Ductus arteriosus should become the ligamentum arteriosus
May persist

Ductus venosus becomes the ligamentum teres

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10
Q

What are the complications if there is a failure of cardiorespiratory adaptation

A 
Asphyxia – hypoxia / acidosis
Prematurity 
Sepsis
Hypoxia – meconium aspiration
Cold stress
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11
Q

How does persistent pulmonary hypertension of the newborn present

A

Blue baby
Big difference between pre and post ductal sats
Sick babies

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12
Q

Describe persistent pulmonary hypertension of the newborn

A

The lung vascular resistance doesn’t fall enough and the shunts remain open
Will have patent foramen ovale and ductus arteriosus

Therefore blood cannot be effectively oxygenated

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13
Q

How do you manage persistent pulmonary hypertension of the newborn

A

Ventilation
Oxygen
Nitric oxide - given through ventilator to dilate pulmonary vasculature
Sedation - prevents baby fighting the ventilator and causing a mismatch
Inotropes
ECLS - very invasive and high risk

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14
Q

What is transient tachypnoea in newborns

A

Relatively common condition caused by excess fluid remaining in the lungs for longer than expected
Seen in large babies born by section (don’t have the squeeze to remove some of the fluid)
Diagnosis of exclusion - need to be sure its not an infection
Usually gets better on their own – will clear fluid eventually

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15
Q

Why are babies at high risk of heat loss

A

Large surface area
Lose a lot from their head as it is so big in proportion
Wet when born
They cannot shiver yet
Don’t have a lot of fat stores to use up and breaking this down isn’t effective in first 12 hours

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16
Q

How can you prevent hypothermia in a new-born

A 
Keep them dry 
Put a hat on them 
Skin to skin
Blanket / clothes
Wraps or bags for prems 
Heated Mattress
Incubator
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17
Q

How does a new-born manage their glucose levels

A

They lose their supply of glucose from mum
In the first few days they usually don’t get much milk
Insulin levels drop physiologically to cope with the expected ‘starvation’ stage in first few days
There is mobilisation of hepatic glycogen
Can also use ketones for brain fuel

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18
Q

Which babies are most at risk of hypoglycaemia

A

If they are unwell - sepsis
Hypothermic - use up energy stores to keep warm
Small or premature babies
Maternal diabetes baby will have high insulin
Some medications

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19
Q

Why is colostrum so beneficial

A

Colostrum contains lots of IgA, cellular immunity, growth factors
Great for the baby

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20
Q

Is it normal for a baby to lose weight after birth

A

Yes - lose some fluid before they start growing
Around 10% is normal – don’t want more
Expect them to find a centile and stick to it – be more worried if they start dropping

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21
Q

How does foetal haemoglobin change after birth

A

Blood produced in liver in foetus which then shift to the bone marrow when they are born
Need to change Hb as O2 pressure increases massively
Adult Hb takes longer to produce so may be a drop

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22
Q

Describe physiological anaemia of the new-born

A

Baby needs to start using adult Hb instead of foetal

Adult Hb takes longer to produce but foetal Hb breaks down quickly
Therefore Hb will be slightly lowered while this changeover occurs

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23
Q

What causes physiological jaundice in new-borns

A

Breakdown of foetal haemoglobin
However the conjugating pathway is immature so there is a rise in circulating unconjugated bilirubin
Usually not harmful

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24
Q

When should you worry about jaundice in a newborn

A

Early or prolonged jaundice may be pathological

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25
Q

How would you treat pathological jaundice in a new born

A

If mild you use phototherapy = light breaks down the bilirubin
If very high levels they need exchange transfusion – change the circulating blood

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26
Q

What are the risk factors for problems with neonatal adaptation

A 
Hypoxia / asphyxia during delivery
Particularly small or large babies
Premature babies 
Some maternal illnesses and medications
Ill babies – sepsis, congenital anomalies
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27
Q

What is considered a normal birth weight

A

2.5-4kg

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28
Q

What birth weight is considered large for gestational age

A

Over 4kg

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29
Q

What birth weight is considered small for gestational age

A

Under 2.5kg

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30
Q

What happens to O2 levels during contractions

A

Every time there is a contraction the blood flow to the baby is reduced or even stopped – hypoxia
This is why prolonged labour is dangerous

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31
Q

What score is used to monitor new-born babies

A

APGAR score
Scores them based on HR, RR, responsiveness, tone and colour
Score 0,1 or 2 on each
Over 8 is normal

32
Q

What is the risk of haemorrhagic disease of the new-born

A

Risk of GI bleed, epistaxis and worse case – brain haemorrhage

33
Q

Why are babies given vitamin K after birth

A

To prevent haemorrhagic disease of the new-born – clotting problem

34
Q

Which vaccines can be offered to new-borns

A

If mum has had Hep B then baby could get early vaccination

Offer BCG to babies at risk of TB contact - within first month

35
Q

Which screening tests are offered to new-borns

A 
New-born examination
Universal hearing screening
Hip screening -  clinical and USS
Cystic fibrosis - heel prick
Haemoglobinopathies - heel prick
Metabolic disease - heel prick
36
Q

When are newborn screening tests carried out

A

Day 5

Includes the heel prick

37
Q

What do you look for on the head during the new-born examination

A

Measure the circumference of the head
Overlapping sutures - seen if there has been moulding
Fontanelles
Ventouse/forceps marks
Head is often bruised or swollen due to delivery

38
Q

What do you look for in the eyes during the new-born examination

A

Red reflex is one of the most important things to check
Most likely to have a cataract if absent – baby will have reduced vision for life if not caught and treated early
Conjunctival haemorrhage - common due to birth but must be documented so it’s not confused with abuse
Squints
Iris abnormality

39
Q

What do you look for in the ears during the new-born examination

A

Position - sign of genetic syndromes
External auditory canal
Tags/pits - may be a sign of another condition
Folding

40
Q

What do you look for in the mouth during the new-born examination

A 
Shape
Philtrum - is smooth it could be FAH 
Tongue tie
Palate
Neonatal teeth - removed as aspiration risk 
Ebsteins pearls
Sucking/rooting reflex
41
Q

What respiratory signs should you look for on new-born examination

A 
Chest shape 
Nasal flaring
Grunting
Tachypnoea
In-drawing
Breath sounds
42
Q

What cardiovascular signs should you look for on new-born examination

A 
Colour/Saturation (SaO2)
Pulses: femoral
Apex
Thrills/heaves
Heart sounds
43
Q

What abdominal signs should you look for on new-born examination

A 
Distension
Hernia
Umbilicus - look for infection 
Bile stained vomiting
Passage of meconuim
Anus
44
Q

What genitourinary signs should you look for on new-born examination

A

Normal passage of urine
Normal genitalia
Undescended testes - check scrotum
Hypospadias

45
Q

At what point is a baby boy referred for undescended testes

A

If testes are still undescended by 6 months then it will need surgical repair

46
Q

How is DDH diagnosed and treated

A

Clinical examination and targeted US (if high risk)

Put baby in the Pavlik harness to fix the hips – wear for 2-4 weeks

47
Q

What are the primitive reflexes that should be checked for

A 
Suck
Rooting
Moro - spread arms when dropped 
ATNR - fencing 
Stepping
Grasp
48
Q

List some common birth marks that need to be recorded on new-born examination

A

Haemangiomas – can be raised and get irritated but usually go away on their own
Port wine stain - vessel abnormality which wont go away
Blue spots – common but need documented as can look like bruises

49
Q

What are the risk factors for neonatal death

A 
Pre-term delivery 
Low birth weight 
Twins etc 
Maternal age 
Smoking 
Disadvantaged circumstances
50
Q

What are the risk factors for pre-term delivery

A 
> 2 preterm deliveries 
Abnormally shaped uterus
Multiple pregnancy 
Interval of < 6 months between pregnancies 
IVF 
Smoking, drinking alcohol and using illicit drugs
Poor nutrition
Multiple miscarriages or abortions
51
Q

What are some common problems of prematurity

A

Temperature control
Feeding/nutrition
Sepsis
System immaturity / dysfunction - respiratory distress, PDA etc

52
Q

Why are premature babies at increased risk of nutritional compromise

A

Limited nutrient reserves
Gut immaturity
Immature metabolic pathways
Increased nutrient demands

53
Q

What is the difference between early and late onset neonatal sepsis

A

early onset (EOS) is mainly due to bacteria acquired before and during delivery

Late onset (LOS) is acquired after delivery

54
Q

Which organisms are usually responsible for early onset neonatal sepsis

A

Group B Streptococcus

Gram negatives

55
Q

Which organisms are usually responsible for late onset neonatal sepsis

A

Coagulase negative staphylococci
Gram negatives
Staph Aureus

56
Q

What causes respiratory distress syndrome in premature babies

A

Usually due to surfactant deficiency or structural immaturity
Occasionally due to secondary pathology

57
Q

How does respiratory distress syndrome present in premature babies

A 
Respiratory distress
Tachypnoea
Grunting
Intercostal recessions
Nasal flaring
Cyanosis

Gradually gets worse

58
Q

How do you manage respiratory distress syndrome in premature babies

A

Maternal steroid before birth
Surfactant
Ventilation - Invasive / non invasive

59
Q

What are the outcomes of intraventricular haemorrhage

A

Neurodevelopmental delay

Death

60
Q

What is considered a neonatal death

A

All deaths up to 28 days old

61
Q

What is a normal heart rate in a term baby

A

100-140bpm

62
Q

What is a normal respiratory rate for a term baby

A

40-60 breaths per minute

63
Q

How may a seizure present in a neonate

A

They are subtle in neonates – cycling movements, lip smacking, eyes rolling, apnoea

64
Q

What are some signs of breathing difficulties in neonates

A

Grunting
Nasal flaring
Subcostal or intercostal recession
Some can have apnoea’s when unwell

65
Q

Why might you deliberately lower a neonates temperature

A

Gives hypothermia in a controlled way for 72hrs – protective if baby is at risk of neurological damage

66
Q

What is hydrops foetalis

A

Congenital abnormality causes HF a few days after birth

Baby will be very oedematous and lungs will fill with fluid

67
Q

How is next generation sequencing used

A

Can sequence the whole genome or just all known exons

Finds lots of polymorphisms

68
Q

What are the symptoms of patent ductus arteriosus

A 
Constant machine-like systolic murmur 
Cyanosis 
Low O2 sats 
Heavy, fast breathing 
Fatigue 
Failure to thrive and feed
69
Q

When is it normal for neonates to develop jaundice

A

It is common 2-3 days after birth

70
Q

What is kernicterus

A

It is a rare but serious complication of untreated jaundice in babies
Caused by excess bilirubin damaging the brain or central nervous system.
Risk of cerebral palsy

71
Q

Is HIV a contraindication to breastfeeding

A

Yes and No

Only a risk if they have a high viral load

72
Q

Is Hep C a contraindication to breastfeeding

A

No

73
Q

What are the signs of hypoglycaemia in a neonate

A 
Temperature is low or dropping 
Sleepiness 
Not feeding 
Irritability 
High pitched cry 
Apnoea 
Hypotonia 
Cyanosis 
Seizures
74
Q

How do you manage neonatal abstinence syndrome (withdrawal)

A

Calm and secure environment
Lots of cuddles from mum and rocking them
Monitor them and score them every 4 hours
Oral morphine solution for those withdrawing from opioids

75
Q

What is tested for in the heel prick

A

PKU, congenital hypothyroidism, maple syrup urine disease, cystic fibrosis, MCADD, homocystinuria, sickle cell disease and another metabolic disorder

Reproduction (16 decks)

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