Neonates Flashcards
What are causes of jaundice in the 1st 24hrs?
Haemolytic
TORCH - congenital infection
What are causes of jaundice from the 2nd day-3rd wk?
Physiological (gone after 1st wk) Breast milk Sepsis Polycythemia Cephalhaematoma Crigler-Najjar syndrome Haemolytic disorders
What are causes of jaundice after the 3rd wk?
Breast milk
Hypothyroidism
Pyloric stenosis
Cholestasis
What is the treatment for jaundice?
Treat underlying cause Hydrate Phototherapy Exchange transfusion Immunoglobin
What % of normal term neonates get erythema toxicum?
30-70%
What is erythema toxicum is?
Maculo-papular rash
What happens usually to erythema toxicum?
Fade by end 1st wk
What are Mongolian blue spots?
Blue-grey pigmentations
Accumulation of melanocytes
When do Mongolian blue spots usually present?
Lower back and buttocks
What happens to Mongolian blue spots?
Normally disappears three to five years after birth
What are stork marks?
Naevus simplex
Light colour capillary dilatation
Where are stork marks normally found?
Back of neck
Midline of face
What happens to stork marks?
Disappear within 1st 2yrs
What are examples of capillary vascular malformations?
Stork marks
Port wine stain
What is port wine stain?
Naevus flammeus
Present at birth, flat or slightly raised
Caused by dilated, mature capillaries in the superficial dermis
Do port wine stains go away?
Do not regress
What is an example of a capillary haemangioma?
Strawberry naevus
What is strawberry naevus?
Cluster of dilated capillaries which appears within first month after birth
Raised and bright red, with discrete edges, any part of body
What happens to strawberry naevus?
Usually regresss after one yr
What babies are at risk of limited glucose supply?
Premature babies
Perinatal stress
What babies are at risk of hyperinsulinism?
Infants of diabetic mothers
What babies are at risk of increased glucose use?
Hypothermia
Sepsis
What is the definition of hypoglycaemia in babies?
<2.0mmol/l blood sugar
When can bedside testing for hypoglycaemia be inaccurate?
At low/high levels
When poor perfusion
When polycythaemia
What are symptoms of hypoglycaemia in babies?
Jitteriness Temperature instability Lethargy Hypotonia Apnoea, irregular respirations Poor suck/feeding Vomiting High pitched or weak cry Seizures Asymptomatic
What ways can babies become hypothermic?
Evaporation (wet skin)
Conduction (cold towels)
Convection (open windows)
Radiation (cold objects nearby)
What is the management of babies with hypothermia?
Dry quickly Remove wet linens Use warm blankets Provide radiant warmer heat Use heated/humidified oxygen
What is tongue ties?
Short +/- thickened frenulum
Attached anteriorly -> base of tongue
When should you do a frenotomy for tongue tied ness?
Restriction of tongue protrusion beyond alveolar margins AND feeding affected
What types of GI problems can babies have?
Vomiting Posseting Mucous vomits Gastro-oesphageal reflux Cows milk protein intolerance Bilious vomiting Failure to pass meconium Bloody stools Bloody vomit
How can you assess respiratory function in babies?
RR
Increased effort: grunting, retractions, nasal flaring
Colour
O2 sats
What areas should you assess for retractions?
Substernal
Subcostal
Intercostal
Suprasternal
What % of cleft lip also have cleft palate?
70%
What are the types of cleft lip?
Complete - small gap in lip
Incomplete - continue into nose
Why does cleft lip occur embryonically?
Maxillary and medial nasal processes fail to merge
Usually 5wks gestation
What can cleft lip/palate issues be?
Feedings issues
Airway problems
Associated anomalies: hearing/heart/trisomies
What ophthalmological defects should you check for in babies?
Red reflexes
Cataracts
Retinoblastoma
What can spinal dimples suggest?
Spina bifida +/- tethered cord
What is a cephalohaematoma?
Localised swelling over one or both sides of head, becomes maximal in size by 3rd/4th day of life
Soft, non translucent swelling
What is the treatment for cephalohaematomas?
No treatment required, usually resolution in 3-4wks
What happens if cephalohaematoma very large?
Increased haemolysis can occur = increased/prolonged neonatal jaundice
What are talipes?
Medial (varus) or lateral (valgus) deviation of foot
What is the treatment for Medial (varus) or lateral (valgus) deviation of foot?
Often positional, so just physio
What is the treatment for fixed talipes?
Strapping, casting or possibly surgery
What is a complication of talipes?
Developmental dysplasia of the hips
What are the tests for developmental dysplasia of the hip (DDH)?
Barlow test
Ortolani test
What are the treatment options for DDH?
Pavlik harness
Surgical reduction
What are the features of trisomy 21/DS?
Dysmorphism - low set ears, downward slanting palpebral tissues, epicanthic folds, single palmar creases, wide sandal gap Hypotonia Cardiac defects Learning problems Haematological problems Thyroid problems
What are the symptoms of sepsis in neonates?
Baby pyrexia/hypothermia Poor feeding Lethargy or irritable Early jaundice Tachypnoea Hypo or hyperglycaemia Floppy
What are risk factors for sepsis in neonates?
PROM (premature rupture of membranes)
Maternal pyrexia
Maternal Group B Strep carriage
What is the management of presumed sepsis in neonates?
Admit NNU Partial septic screen Consider CXR, LP IV penicillin and gentamicin - 1st line IV vancomycin and gentamicin - 2nd line Add metronidazole if surgical concerns Fluid management Treat acidosis Monitor vital signs Support resp/CVS systems
What are the commonest causes of neonatal sepsis?
Group B strep E.coli Listeria Coag-neg staph Haemophilus influenzae
What are the complications of GBS sepsis?
Meningitis DIC Pneumonia Resp collapse Hypotension and shock
What are the TORCH infections in neonates?
Toxoplasmosis
Rubella
CMV
Herpes
What are causes of respiratory distress in neonates?
Sepsis
TTN - transient tachypnoea of the newborn
Meconium aspiration
What are the symptoms of TTN (transient tachypnoea of the newborn)?
Grunting, tachypnoea, O2 requirement, normal gases
What causes TTN (transient tachypnoea of the newborn)?
Delay in clearance of foetal lung fluids
When does TTN present?
First few hours of life
What are the risk factors for meconium aspiration?
Post dates
Maternal diabetes
Hypertension
Difficult labour
What are the symptoms of meconium aspiration?
Cyanosis Increased work of breathing Grunting Apnoea Floppiness
What investigations should be done for meconium aspiration?
Blood gas
Septic screen
CXR
What is the treatment for meconium aspiration?
Suction below cords Airway support Fluids Antibiotics IV Surfactant NO or ECMO
What are investigations for a ‘blue baby’?
Exam and history Sepsis screen Blood gas and glucose CXR Pulse oximetry ECG ECHO Hyperoxia test
What are differentials a ‘blue baby’?
TGA ToF TAPVD Hypoplastic left heart syndrome Tricuspid atresia Truncus arteriosus Pulmonary atresia
What is the treatment for hypoglycaemia?
Monitor blood glucose IV 10% glucose Increase fluids Increase glucose conc Glucagon Hydrocortisone
What is birth asphyxia?
Lack of O2 at or around birth leading to multi organ dysfunction
What are causes of birth asphyxia?
Placental problems Long, difficult delivery Umbilical cord prolapse Infection Neonatal airway problem Neonatal anaemia
What are the 2 stages of birth asphyxia?
- Within minutes without O2, cell damage occurs with lack of blood flow and O2
- Reperfusion injury, can last days/wks, toxins released from damaged cells
What are causes of failure to pass stool?
Constipation Large bowel atresia Imperforate anus +/- fistula Hirshsprungs disease Meconium ileum (think CF)
What are abdominal wall defects?
Diaphragmatic hernia
Which side does a diaphragmatic hernia usually affect?
Left
