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Neonates Flashcards

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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
How would you treat pathological jaundice in a new born
If mild you use phototherapy = light breaks down the bilirubin If very high levels they need exchange transfusion – change the circulating blood
26
What are the risk factors for problems with neonatal adaptation
``` Hypoxia / asphyxia during delivery Particularly small or large babies Premature babies Some maternal illnesses and medications Ill babies – sepsis, congenital anomalies ```
27
What is considered a normal birth weight
2.5-4kg
28
What birth weight is considered large for gestational age
Over 4kg
29
What birth weight is considered small for gestational age
Under 2.5kg
30
What happens to O2 levels during contractions
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
31
What score is used to monitor new-born babies
APGAR score Scores them based on HR, RR, responsiveness, tone and colour Score 0,1 or 2 on each Over 8 is normal
32
What is the risk of haemorrhagic disease of the new-born
Risk of GI bleed, epistaxis and worse case – brain haemorrhage
33
Why are babies given vitamin K after birth
To prevent haemorrhagic disease of the new-born – clotting problem
34
Which vaccines can be offered to new-borns
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
Which screening tests are offered to new-borns
``` New-born examination Universal hearing screening Hip screening - clinical and USS Cystic fibrosis - heel prick Haemoglobinopathies - heel prick Metabolic disease - heel prick ```
36
When are newborn screening tests carried out
Day 5 | Includes the heel prick
37
What do you look for on the head during the new-born examination
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
What do you look for in the eyes during the new-born examination
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
What do you look for in the ears during the new-born examination
Position - sign of genetic syndromes External auditory canal Tags/pits - may be a sign of another condition Folding
40
What do you look for in the mouth during the new-born examination
``` Shape Philtrum - is smooth it could be FAH Tongue tie Palate Neonatal teeth - removed as aspiration risk Ebsteins pearls Sucking/rooting reflex ```
41
What respiratory signs should you look for on new-born examination
``` Chest shape Nasal flaring Grunting Tachypnoea In-drawing Breath sounds ```
42
What cardiovascular signs should you look for on new-born examination
``` Colour/Saturation (SaO2) Pulses: femoral Apex Thrills/heaves Heart sounds ```
43
What abdominal signs should you look for on new-born examination
``` Distension Hernia Umbilicus - look for infection Bile stained vomiting Passage of meconuim Anus ```
44
What genitourinary signs should you look for on new-born examination
Normal passage of urine Normal genitalia Undescended testes - check scrotum Hypospadias
45
At what point is a baby boy referred for undescended testes
If testes are still undescended by 6 months then it will need surgical repair
46
How is DDH diagnosed and treated
Clinical examination and targeted US (if high risk) | Put baby in the Pavlik harness to fix the hips – wear for 2-4 weeks
47
What are the primitive reflexes that should be checked for
``` Suck Rooting Moro - spread arms when dropped ATNR - fencing Stepping Grasp ```
48
List some common birth marks that need to be recorded on new-born examination
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
What are the risk factors for neonatal death
``` Pre-term delivery Low birth weight Twins etc Maternal age Smoking Disadvantaged circumstances ```
50
What are the risk factors for pre-term delivery
``` > 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
What are some common problems of prematurity
Temperature control Feeding/nutrition Sepsis System immaturity / dysfunction - respiratory distress, PDA etc
52
Why are premature babies at increased risk of nutritional compromise
Limited nutrient reserves Gut immaturity Immature metabolic pathways Increased nutrient demands
53
What is the difference between early and late onset neonatal sepsis
early onset (EOS) is mainly due to bacteria acquired before and during delivery Late onset (LOS) is acquired after delivery
54
Which organisms are usually responsible for early onset neonatal sepsis
Group B Streptococcus | Gram negatives
55
Which organisms are usually responsible for late onset neonatal sepsis
Coagulase negative staphylococci Gram negatives Staph Aureus
56
What causes respiratory distress syndrome in premature babies
Usually due to surfactant deficiency or structural immaturity Occasionally due to secondary pathology
57
How does respiratory distress syndrome present in premature babies
``` Respiratory distress Tachypnoea Grunting Intercostal recessions Nasal flaring Cyanosis ``` Gradually gets worse
58
How do you manage respiratory distress syndrome in premature babies
Maternal steroid before birth Surfactant Ventilation - Invasive / non invasive
59
What are the outcomes of intraventricular haemorrhage
Neurodevelopmental delay | Death
60
What is considered a neonatal death
All deaths up to 28 days old
61
What is a normal heart rate in a term baby
100-140bpm
62
What is a normal respiratory rate for a term baby
40-60 breaths per minute
63
How may a seizure present in a neonate
They are subtle in neonates – cycling movements, lip smacking, eyes rolling, apnoea
64
What are some signs of breathing difficulties in neonates
Grunting Nasal flaring Subcostal or intercostal recession Some can have apnoea's when unwell
65
Why might you deliberately lower a neonates temperature
Gives hypothermia in a controlled way for 72hrs – protective if baby is at risk of neurological damage
66
What is hydrops foetalis
Congenital abnormality causes HF a few days after birth | Baby will be very oedematous and lungs will fill with fluid
67
How is next generation sequencing used
Can sequence the whole genome or just all known exons | Finds lots of polymorphisms
68
What are the symptoms of patent ductus arteriosus
``` Constant machine-like systolic murmur Cyanosis Low O2 sats Heavy, fast breathing Fatigue Failure to thrive and feed ```
69
When is it normal for neonates to develop jaundice
It is common 2-3 days after birth
70
What is kernicterus
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
Is HIV a contraindication to breastfeeding
Yes and No | Only a risk if they have a high viral load
72
Is Hep C a contraindication to breastfeeding
No
73
What are the signs of hypoglycaemia in a neonate
``` Temperature is low or dropping Sleepiness Not feeding Irritability High pitched cry Apnoea Hypotonia Cyanosis Seizures ```
74
How do you manage neonatal abstinence syndrome (withdrawal)
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
What is tested for in the heel prick
PKU, congenital hypothyroidism, maple syrup urine disease, cystic fibrosis, MCADD, homocystinuria, sickle cell disease and another metabolic disorder

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