Neonates Cram Flashcards by Olivia Wells

Layers of the scalp and which bleeds occur between layers?

Skin
Connective tissue
- caput - 
Apneurosis
Loose connective tissue
- cephalohaematoma - 
Periosteum
- subgaleal - 
Bone
- subdural -

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Complications of cephalohaematoma?

Underlying fracture in 10-25%
Calcification of haematoma
Skull deformity
Infection - most commonly E Coli
Hyperbilirubinaemia

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Cause of subgaleal haemorrhage? Complications of subgaleal?

Shearing of emissary veins causing bleeding that crosses suture lines
Blood loss - 20-40% of circulating volume
Coagulopathy
Skull fracture
Hyperbilirubinaemia

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Risk factors and complications of clavicle fracture?

Operative delivery
Shoulder dystocia
Breech

Erb’s palsy - c5-6 nerve roots “waiter’s tip”

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Management of brachial plexus injuries?

Conservative
Physiotherapy
Splinting to reduce contractures
Surgical repair if absent biceps function at 6-12 weeks

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Long term outcome following kernicterus with neurological signs?

75% mortality

Survivors have choreoathertoid CP

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Mechanism of phototherapy?

Photochemical reaction

reversible photo isomerisation converts toxic to non-toxic isomer
formation of lumirubin which can be excreted by the kidneys

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NAS peak onset RF and treatment

Usually onset D3 of life
70% of of infants whose mothers on methadone

Reduce stimuli
Barrier cream
Demand feed
Pharmacological treatment indicated in 3x scores >8 or 2x >12
Morphine NOT naloxone (rapid withdrawal)

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Facial nerve injury risk factors, presentation and management?

Forceps birth
Usually only mandibular branch - lip weakness when crying
Usually spontaneous resolution 2-6 weeks

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Phrenic nerve injury presentation and management?

Resp depression, reduced breath sounds and hemidiaphragm on CXR
Lie on affected side
Spontaneous recovery 1-3 months. May require plication if not resolved.

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Causes of retinal haemorrhages in neonates?

Late onset HMD
Meningococcal meningitis
Moderate head injury in a child w vWD
Pertussis

NOT SIDS

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Findings in retinopathy of prematurity and RFs?

Small intra-retinal haemorrhages in the neo vascular ridge, may extend to vitreous seen from 32-34/40 CGA onwards

Prematurity
Low birth weight/IUGR
Oxygen therapy
Male

Laser for Gr3 and above
Long term risk of retinal detachment , myopia. strabismus, glaucoma

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Causes of cataracts in neonate?

Congenital glaucoma (most common)
HSV/Varicella infection
Birth trauma due to forceps
Dermoid tumour
Mucopolysaccharidoses
Peters anomaly
Sclerocornea

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Cause of congenital glaucoma?

Improper development of aqueous outflow system
Tears in Descement membrane
Leads to raised intraocular pressure and risks loss of vision
Surgical management required

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Key features of neonatal encephalopathy and risk factors?

Reduced level of consciousness
Difficulty initiating and maintaining respiration
Depressed tone & reflexes

IUGR is strongest risk factor
70% associated with events prior to labour
- unemployment, FHx seizures/neurological disease, infertility, thyroid disease, PET, placental conditions

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Neonatal markers of hypoxic ischaemic encephalopathy?

Apgar of <5 at 5min, 10min
Umbi artery acidaemia pH <7.0/base excess >12
Deep nuclear grey matter injury or watershed cortical injury on MRIB
Multi-system organ failure

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Developmental outcomes associated with hypoxic ischaemic encephalopathy?

Spastic quadriplegia
Dyskinetic cerebral palsy
Death

Moderate: 5% mortality, 20% neuro sequalae
Severe: 75% mortality 90-100% neuro sequelae

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Mechanism of therapeutic hypothermia and SEs?

Cooling to 33-35C within 6hrs of birth
Reduces cerebral metabolic rate, reduced apoptosis, lower nitric oxide production and free radicals and is neuroprotective
Improved survival/outcomes at 18mths

SEs:
thrombocytopenia, bradycardia, subcutaneous fat necrosis and hypercalcaemia

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Periventricular injury outcome most associated?

Spastic diplegia

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Neonatal stroke outcome most associated?

Spastic hemiplegia

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Congenital infection CP associated?

Spastic quadriplegia

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Severe perinatal asphyxia CP associated?

Dyskinetic CP

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Grade IV intraventricular haemorrhage outcome?

Cerebral palsy with spastic hemiparesis if unilateral, quadriparesis if bilateral
Intellectual deficit

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Risk factors for IVH and protective factors?

Chorioamnionitis
Very low birthweight or <32/40
Coag abnormalities, hypoxia, neonatal transport, CPR, mechanical ventilation
Intrapartum asphyxia

Protective:
Antenatal steroid therapy, term infant

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Symptoms of IVH?

Usually asymptomatic until neurological sequqale evident in later infancy as spastic motor deficit 25-50% detected on routine CrUSS screening

Necrosis of cerebral white matter surrounding lateral ventricles and involving area adjacent to trigones/frontal horn?

Periventricular leukomalacia | Usually asymptomatic until later infancy - may have lower limb weakness

Area of most arterial ischaemic stroke in neonates?

MCA distribution Arm and face affected > lower limb Most common presentation is focal seizures

Risk factors for TTN

Prematurity Cesarean Infants of diabetic mothers Maternal asthma

Risk factors for meconium aspiration?

Post-dates | SGA

Signs of severe mechanism asp syndrome?

Pneumothorax/pneumomediastinum PPHN Pre-post ductal SpO2 difference due to R->L shunting

Severe hypoxia in 100% FiO2 R -> L shunt. Normal heart structure on TTE Single loud S2 +/- gallop rhythm of systolic regard murmur

Persistent Pulmonary Hypertension | PPHN

Reversible causes of PPHN?

``` Alveolar hypoxia (eg mec asp) Sepsis Birth asphyxia LV dysfunction/CHD Polycythemia Hypoglycaemia/hypocalcaemia ```

Difficult/irreversible causes of PPHN?

Intrauterine asphyxia Maternal prostaglandin use, SSRI use resulting in early duct closure Congenital diaphragmatic hernia Primary pulmonary hypoplasia

Management of PPHN?

Lower pulmonary vascular resistance by O2, respiratory alkalosis, pulmonary vasodilators Nitric oxide - reduces PPHN by 40%

Incidence of unilateral pneumothorax in all newborns?

1-2%

Subcutaneous emphysema in neonate?

Pneumomediastinum

Ventilated VLBW infant with hyperaemia and hypercarbia within first 4 days of life? May progress to reduced cardiac output

Pulmonary interstitial emphysema | Decrease MAP - consider HFOV - position with affected side down

Risk factors for prev delivery?

``` Maternal age - young/old Cervical incompetence Uterine malformation Substance use (cocaine) Maternal medical illness Multiple pregnancy Polyhydramnios Fetal anomaly Antepartum haemorrhage Chorio HTN/PET ```

Benefit of Magnesium sulphate in premature delivery?

Decreases risk of cerebral palsy

PDA incidence in prev infants?

30% of very low birth weight

Complications of NEC?

Growth delay Neurodev disability Increased mortality

Organisms most commonly associated with late onset sepsis in prems?

70% gram-positive organisms | 50% coagulase negative staph (S epidermis, S haemolytic, S Capitis)

Most important indicator f severity in retinopathy of prematurity?

Presence of plus disease - vessel tortuosity - vessel engorgement - pupil rigidity - vitreous haze

Retinal vascularisation occurs when in gestation?

15-18 weeks Vessels extend from optic disc and grow peripherally VEGF contributes to abnormal development

Physiology contributing to osteopenia of prematurity?

1. Passage of Ca/Phos via placenta >24/40 peaks 32-36 2. GIT absorption is poor 3. Renal loss

Risk factors for metabolic bone disease?

``` Prematurity Inactivity Delay in establishment of enteral feeding >4/52 Short gut/NEC CLD - steroid/diuretic treatment ```

Best biochem marker for bone turnover?

ALP >750 osteopenia >1000 rickets

Risk factors for bronchopulmonary dysplasia?

``` Infants < 1250g (97%) Prematurity Male sex PDA Increased pulmonary artery pressure ```

Prevention of BPD?

``` Prevention of prev birth Antenatal steroids CPAP rather than mechanical ventilation Early caffeine therapy Supplemental vit A ```

Complications of BPD?

``` Pulmonary artery hypertension Systemic hypertension Asthma like symptoms Sleep disordered breathing/sleep hypoxia Resp infections ```

Ear shape for gestation?

24 – 33 weeks: Flat, shapeless. No cartilage 34 – 35 weeks: Minor superior incurving. Minimal cartilage 36 – 38 weeks: Upper 2/3 incurving. Thin cartilage >39 weeks: Full incurving. Cartilage.

Sole creases for gestation?

``` 24 – 31 weeks: No anterior creases 32 – 33 weeks: 1 or 2 anterior creases 34 – 35 weeks: 3 or 4 anterior creases 36 – 37 weeks: Creases covering 2/3 of anterior sole >38 weeks: Heel creases ```

Lanugo for gestation?

22 - 32 weeks: entire body and face 32 - 37 weeks: body only >38 weeks: shoulders only >42 weeks: none

34 week infant renal function vs term infant?

Reduced glomerular filtration rate

Sugars in breastmilk?

Glucose | Galactose

Ex-prem infant with resp distress and CXR shows reticular, bubbly appearance?

Interstitial pulmonary fibrosis

Resp distress and scaphoid abdomen?

Congenital diaphragmatic hernia

Benefits of volume guarantee ventilation?

Consistent tidal volume delivered | Prevents frequent desaturation

Disadvantages of volume guarantee ventilation?

Volutrauma (if volume is too high) Barotrauma if excess PIP is required to reach the volume target Can’t be auto-weaned

Benefits of pressure control ventilation?

``` Limits PIP - reduces barotrauma Adjustable IT Reduces WOB Improves V/Q mismatch as the pressure is achieved throughout the inspiratory cycle Allows for spont resp ```

Disadvantages of pressure control ventilation?

Higher variation in volume delivered | Increased WOB with spont resps

Factors influencing oxygenation?

PEEP | FiO2

Factors influencing ventilation (removal of CO2)?

``` MAP - increase PIP - increase PEEP (makes the most difference) - increase inspiratory time Resp rate ```

Maternal smoking increases risk of which long term outcomes?

``` SIDS T2DM Obesity HTN Nicotine dependance Asthma, LRTI, reduced lung function Impaired academic performance ADHD, behavioural problems Psychiatric illness ```

Jaundice Poor tone Large anterior fontanelle Umbi hernia

Hypothyroidism

What GA can infants co-ordinate suck and swallow?

From 33-34 CGA