Neonatology Flashcards
Which cells produce surfactant?
Type 2 alveolar cells
What are the 5 parts of neonatal resus?
- Warm baby
- Calculate APGAR
- Stimulate breathing
- Inflation breaths
- Chest compressions
What is used for inflation breaths?
Term babies - Air
Preterm babies - Air + oxygen
What are the five parts of APGAR?
Appearance = Blue centrally, blue peripheries, pink
Pulse = Absent, <100, >100
Grimace = Absent, little response, good response
Activity = None, flexed arms/legs, active.
Respiration = Absent, weak, good/crying
What is caput succudaneum?
Present at birth
Oedema of the scalp at the presenting part - typically the vertex
No discolouration associated
Lump crosses suture lines
What is cephalohaematoma?
Develops several hours after birth
Collection of blood between the skull and the periosteum
Lump does not cross suture lines
Jaundice may be apparent due to blood breakdown
What is Erb’s palsy?
A result of injury to C5/C6
Internally rotated shoulder
Extended elbow
Pronated wrist
What is the most organism responsible for neonatal sepsis?
GBS
What are features of neonatal sepsis?
Respiratory distress - grunting, nasal flaring, tachypnoea
Apnoeas
Fever
Reduced tone
Jaundice
Seizures
Poor feeding
Vomiting
How is neonatal sepsis managed?
IV Benzylpenicillin + Gentamicin (suspected or confirmed neonatal sepsis)
What are causes of persistent or severe neonatal hypoglycaemia?
Preterm birth
Maternal DM
IUGR
Hypothermia
Neonatal sepsis
Inborn errors of metabolism
Nesidioblastosis
Beckwith-Wiedemann syndrome
How can neonatal hypoglycaemia present?
Irritability
Tachypnoea
Pallor
Poor feedng
Drowsiness
Hypotonia
Seizures
How is neonatal hypoglycaemia treated?
Encourage normal feeding
If severe (less than 1) IV 10% dextrose
What is hypoxic ischaemic encephalopathy? What are the causes?
Damage to brain due to hypoxia during birth
Maternal shock
Intrapartum haemorrhage
Prolapsed cord
Nuchal cord (cord wrapped around neck of baby)
How can the risk of hypoxic ischaemic encephalopathy be reduced?
Therapeutic hypothermia after birth
When is jaundice pathological in neonates?
If it presents in first 24 hours of life
If it is prolonged (more than 14 days in term babies, more than 21 days in preterm babies)
What are causes of neonatal jaundice?
Can be split into causes which cause increased bilirubin production, and causes which cause decreased clearance of bilirubin
Increased production = haemolytic disease, ABO incompatibility, haemorrhage, cephalohaematoma, polycythaemia, G6PD
Decreased clearance = prematurity, breast milk jaundice, neonatal cholestasis, biliary atresia, hypothyroidism, Gilbert syndrome
What is classed as prolonged jaundice?
> 14 days in term neonates
> 21 days in preterm neonates
What is kernicterus? How can it present?
Brain damage due to excessive bilirubin - Bilirubin can cross the BBB
Floppy, drowsy baby
Poor feeding
What are risk factors for necrotising enterocolitis?
VLBW // very preterm
Formula fed
Respiratory distress
Sepsis
PDA
How does necrotising enterocolitis present?
Intolerance to feeds
Green bilious vomiting
Distended, tender abdomen
Absent bowel sounds
Blood in stools
What is seen on Abdominal XR in necrotising enterocolitis?
Dilated loops of bowel
Bowel wall oedema
Pneumatosis intestinalis (gas in bowel wall)
Pneumoperitoneum (free gas in peritoneal cavity)
Football sign = air outlining the falciform ligament
Rigler sign = air both inside and outside of the bowel
How is NEC managed?
NBM
IV Fluids
TPN
Surgery
What are causes of bilious vomiting in neonates?
Necrotising enterocolitis
Duodenal atresia
Meconium ileus
Neonate will double bubble sign on abdominal XR?
Duodenal atresia
Double bubble sign = dilation of both the duodenum and the stomach.
Bilious vomiting in a neonate with CF?
Meconium ileus
Neonate with persistent salivation/drooling?
Oesophageal atresia
What are features of fetal alcohol syndrome?
Microcephaly
Thin upper lip
Smooth, flat philtre
Short palpebral fissure
Learning disability
Behavioural difficulties
Hearing + vision problems
Cerebral palsy
What are features of congenital rubella syndrome?
Congenital cataracts
Congenital heart disease
Learning disability
Hearing loss
What are features of congenital varicella syndrome?
Fetal growth restriction
Microcephaly
Hydrocephalus
Learning difficulty
Limb hypoplasia
Scarring/skin changes in the dematomes
Cataracts
What is Exomphalos/Omphalocele and Gastroschisis?
Exomphalos/Omphacele = abdominal contents protrude through the umbilical ring - covered with a transparent sac
Gastoschisis = abdomianl contents protrude through defect in anterior abdominal wall - no covering sac
What are causes of jaundice presenting within the first 24 hours of life? How should it be investigated?
Investigate with a blood film analysis
Rhesus haemolytic disease (RHD)
ABO incompatibility
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
hereditary spherocytosis
How does malrotation present?
Bilious vomiting
Haemodynamic instability
What is seen on abdominal XR in meconium ileus?
Air-fluid levels
How does meconium ileus present?
Failure to pass meconium within 48hrs
Billous vomiting
Abdominal distension
How does meconium aspiration syndrome present?
Respiratory distress
Patchy infiltrates on CXR
What is transient tachypnoea of the newborn and how does it present?
Most common cause of respiratory distress in the newborn period
Delayed resorption of fluid in the lungs
Low oxygen sats at birth
Resolves within a couple of days
What is seen on CXR in transient tachypnoea of the newborn?
Hyperinflation of the lungs
Fluid in the horizontal fissure
Duodenal atresia vs. Malrotation
Both present with billous vomiting
Duodenal atresia = few hours after birth
Malrotation = 3-7 days after birth + signs of haemodynamical instability
How is malrotation managed?
Ladd’s procedure
How does the abdomen feel in duodenal atresia?
Soft, distended
How does meconium aspiration syndrome present?
Respiratory distress
Patchy infiltrates on CXR
What is transient tachypnoea of the newborn and how does it present?
Most common cause of respiratory distress in the newborn period
Delayed resorption of fluid in the lungs
Low oxygen sats at birth
Resolves within a couple of days
What is seen on CXR in transient tachypnoea of the newborn?
Hyperinflation of the lungs
Fluid in the horizontal fissure
Congenital infection: Sensorineural deafness + congenital cataracts + congenital heart disease (E.g. PDA)?
Rubella
Congenital infection: Cerebral calcification + Chorioretinitis + Hydrocephalus
Toxoplasmosis
Congenital infection: Growth retardation. + Purpuric skin lesions
Cytomegalovirus
What does neonatal resp distress + fluid in the horizontal fissure suggest?
Transient tachypnoea of the newborn
