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Neonatology Flashcards

1
Q

When is surfactant produced

A

24-34 weeks gestation

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2
Q

What are the issues with neonatal hypoxia

A

Happens during normal labour and delivery

Can lead to fetal bradycardia

If ongoing, can get hypoxic-ischaemic encephalopathy

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3
Q

What are the main principles in neonatal resuscitation

A

Warm baby

Calculate APGAR score

Stimulate breathing

Inflation breaths

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4
Q

How is the APGAR score calculated

A

Appearance (colour)

Pulse

Grimace (response to stimulation)

Activity (muscle tone)

Respiration

Calculate at 1, 5, and 10 minutes

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5
Q

How is breathing stimulated during neonatal resuscitation

A

Dry vigorously with towel

Place head in neutral position

If gasping, check for obstruction

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6
Q

How are inflation breaths delivered in neonatal resuscitation

A

2 cycles of 5 inflation breaths

30 seconds ventilation breaths

Chest compressions

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7
Q

Why is delayed umbilical cord clamping used

A

Allows time for blood from cord to go into fetal circulation

Improves: Hb levels, iron stores, blood pressure

Reduces: intraventricular haemorrhage, necrotising enterocolitis

Uncompromised neonates: at least 1 minute

Compromised neonates: clamp when needed and start resuscitation

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8
Q

What conditions are screened for in the newborn heel prick test

A

On day 5, results in 6-8 weeks

Sickle cell disease

Cystic fibrosis

Congenital hypothyroidism

Phenylketonuria

MCADD

Maple syrup urine disease

Isovaleric acidaemia

Glutaric aciduria type 1

Homocysteine

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9
Q

When does the newborn examination take place

A

Within 72 hours

At 6-8 weeks (by GP)

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10
Q

What do you need to look for in the general appearance part of the newborn examination

A

Colour

Tone

Cry

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11
Q

What do you need to look for in the head part of the newborn examination

A

General appearance (size, shape, dysmorphology, cephalohaematoma)

Head circumference

Sutures

Ears (low set, asymmetry)

Eyes (epicanthic folds in Down’s, discharge in infection)

Red reflex (absent in congenital cataracts and retinoblastoma)

Mouth (cleft lip, tongue tie)

Sucking reflex and cleft palate

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12
Q

What do you need to look for in the shoulders and arms part of the newborn examination

A

Shoulder asymmetry

Arm movements

Brachial pulses

Radial pulses

Palmar creases

Digits

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13
Q

What do you need to look for in the chest part of the newborn examination

A

Observe breathing (distress, symmetry, stridor)

Heart sounds

Breath sounds

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14
Q

What do you need to look for in the abdomen part of the newborn examination

A

Observe for sex

Palpate testes and scrotum (descent, hernias, hydrocele)

Inspect penis (hypospadias, urination)

Inspect anus (check patency)

Ask about meconium

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15
Q

What do you need to look for in the legs part of the newborn examination

A

Observe legs and hips (equal movements, skin creases, tone, talipes)

Barlow and Ortolani manoeuvres (clunking, clicking, dislocation)

Count toes

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16
Q

What do you need to look for in the back part of the newborn examination

A

Inspect and palpate spine (curvatures, spina bifida, pilonidal sinus)

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17
Q

What do you need to look for in the reflexes part of the newborn examination

A

Mono reflex (arms and legs extend when tipped back quickly)

Suckling reflex (when place finger in mouth)

Rooting reflex (turn towards stimulus when tickling cheek)

Grasp reflex (grab finger if placed in palm)

Stepping reflex (make stepping movements when upright and feet touch a surface)

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18
Q

What do you need to look for in the skin findings part of the newborn examination

A

Haemangiomas

Port wine stains

Mongolian blue spot

Cradle cap

Desquamation

Erythema toxisum

Milia

Nevus simplex

Moles

Transient pustular melanosis

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19
Q

What is caput succedaneum

A

A birth injury

Oedema of scalp (outside periosteum, able to cross suture lines)

Due to pressure on scalp during long/traumatic/instrumental delivery

Will resolve in a few days

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20
Q

What is caphalohaematoma

A

A birth injury

Collection of blood between skull and periosteum (does not cross suture lines)

Due to pressure on scalp during long/traumatic/instrumental delivery

Discolouration of skin

Will resolve in a few months

Risk of anaemia and jaundice

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21
Q

What is Erb’s palsy

A

Injury to C5/C6 in brachial plexus

Associated with: shoulder dystocia, traumatic delivery, high birth weight

Weakness of: shoulder abduction, external rotation, arm flexion, finger extension

Get a waiter’s tip appearance

Function usually returns in a few months

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22
Q

What are clavicle fracture birth injuries

A

Associated with: shoulder dystocia, traumatic delivery, high birth weight

Picked up during newborn examination (lack of movement, asymmetry, pain)

Confirm via ultrasound or X-ray

Conservative management

Can get brachial plexus nerve palsies

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23
Q

What are the common organisms that cause neonatal sepsis

A

Group B strep

E coli

Listeria

Klebsiella

Staph aureus

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24
Q

What are the risk factors for neonatal sepsis

A

Maternal vaginal GBS

GBS in previous baby

Maternal sepsis, chorioamnionitis, or fever > 38

Prematurity

Premature rupture of membranes

Prolonged rupture of membranes

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25
What are the clinical features of neonatal sepsis
Fever Reduced tone and activity Poor feeding Respiratory distress Vomiting Tachycardia or bradycardia Hypoxia Jaundice within 24 hours Seizures Hypoglycaemia
26
What are the red flags for neonatal sepsis
Confirmed or suspected sepsis in mother Signs of shock Seizures Term baby needed mechanical ventilation Respiratory distress starting >4 hours after birth Presumed sepsis in another baby in multiple pregnancy
27
What is the management for presumed neonatal sepsis
1 risk factor or clinical feature: close monitoring for 12 hours 2+ risk factors or clinical signs: start antibiotics Any red flags: start antibiotics Antibiotics: within 1 hour, benzylpenicillin Consider lumbar puncture
28
What is the ongoing management for neonatal sepsis
Check CRP at 24 hours Check blood culture results at 36 hours Consider stopping antibiotics when: baby clinically well, blood cultures negative, CRP low
29
What is hypoxic-ischaemic encephalopathy
Occurs in neonates due to hypoxia during birth Can lead to permanent damage (cerebral palsy) Causes: maternal shock, intrapartum haemorrhage, prolapsed cord, nuchal cord (cord around neck)
30
What are the signs of mild hypoxic-ischaemic encephalopathy
Poor feeding Generally irritable Hyper-alert Resolves within 24 hours
31
What are the signs of moderate hypoxic-ischaemic encephalopathy
Poor feeding Lethargy Hypotonia Seizures Can take weeks to resolve 40% develop cerebral palsy
32
What are the signs of severe hypoxic-ischaemic encephalopathy
Reduced consciousness Apnoea Flaccid, absent, or reduced reflexes Up to 50% mortality 90% develop cerebral palsy
33
What is the management for hypoxic-ischaemic encephalopathy
Supportive care Therapeutic hypothermia (protects brain from hypoxic injury, cool to 33-36 degrees for 72 hours, warm over 6 hours)
34
What is neonatal jaundice
Jaundice in babies as they have high concentration of fragile red blood cells and less developed livers Normal at 2-7 days Pathological if within 24 hours Prolonged if > 14 days in term babies (> 21 days in preterm babies)
35
What are the causes of neonatal jaundice related to increased production of bilirubin
Haemolytic disease of newborn ABO incompatibility Haemorrhage Intraventricular haemorrhage Cephalo-haematoma Polycythaemia Sepsis DIC G6PD deficiency
36
What are the causes of neonatal jaundice related to decreased clearance of bilirubin
Prematurity Breast milk jaundice Neonatal cholestasis Extrahepatic biliary atresia Endocrine disorders Gilbert syndrome
37
What are the investigations for neonatal jaundice
FBC Blood film Conjugated bilirubin Blood type testing Direct Coombs test (for haemolysis) Thyroid function tests Blood culture Urine culture G6PD
38
What is the management for neonatal jaundice
Plot bilirubin levels on treatment threshold chart (specific to gestational age of baby at birth) Phototherapy (converts unconjugated bilirubin to isomers which can be excreted) Exchange transfusion
39
What factors are associated with prematurity
Social deprivation Smoking Alcohol Drugs Over/underweight mother Twins Personal or family history
40
What is the management for prematurity before/at birth
Tocolysis (nifedipine, suppresses labour) Maternal corticosteroids (if < 35 weeks) IV magnesium sulphate (protect baby's brain, if < 34 weeks) Delayed cord clamping and cord milking
41
What are the issues of prematurity in early life
Respiratory distress syndrome Hypothermia Hypoglycaemia Poor feeding Apnoea Bradycardia Neonatal jaundice Intraventricular haemorrhage Retinopathy of prematurity Necrotising enterocolitis Immature immune system
42
What are the long term effects of prematurity
Chronic lung disease of prematurity Learning disability Susceptibility to infection Hearing and visual impairment Cerebral palsy
43
What is apnoea of prematurity
Breathing stops spontaneously for more than 20 seconds Often with bradycardia Very common in neonates born at < 28 weeks Incidence decreases with increasing gestational age
44
What are the causes of apnoea of prematurity
Due to immaturity of autonomic nervous system Often a sign of developing illness (infection, anaemia, airway obstruction, CNS pathology, GOR, neonatal abstinence syndrome)
45
What is the management for apnoea of prematurity
Attach apnoea monitors Tactile stimulation (prompt baby to restart breathing) IV caffeine (stimulate respiratory drive) Episodes settle as baby grows and develops
46
What is retinopathy of prematurity
Abnormal development of blood vessels in retina, leading to scarring, retinal detachment, blindness Retinal blood vessels start developing at 16 weeks (finish at 37 weeks), form under hypoxic conditions If have hypoxic episode after birth, get production of excessive blood vessels (neovascularisation) When hypoxic episode ends, blood vessels can regress, causing retinal detachment
47
When is retinopathy of prematurity screened for
For babies born at < 32 weeks or < 1.5 kg At 30-31 weeks gestational age for babies born before 27 weeks At 4-5 weeks of age for babies born after 27 weeks Monitor every 2 weeks
48
What is the management for retinopathy of prematurity
Transpupillary laser photocoagulation (halt and reverse neovascularisation) Cryotherapy Inject intravitreal VEGF inhibitors Surgery (for retinal detachment)
49
What is respiratory distress syndrome
Common in babies born before 32 weeks Get ground glass appearance on chest X-ray
50
What is the management for respiratory distress syndrome
Antenatal steroids for mother Intubation and ventilation Endotracheal surfactant CPAP Oxygen
51
What are the short term complications of respiratory distress syndrome
Pneumothorax Infection Apnoea Intraventricular haemorrhage Pulmonary haemorrhage Necrotising enterocolitis
52
What are the long term complications of respiratory distress syndrome
Chronic lung disease of prematurity Retinopathy of prematurity Neurological impairment Hearing impairment Visual impairment
53
What is necrotising enterocolitis
Part of bowel becomes necrotic in premature neonates Life threatening emergency Can get bowel perforation
54
What are the risk factors for necrotising enterocolitis
Very low birth weight Very premature Formula feeding Respiratory distress or assisted ventilation Sepsis Patent ductus arteriosus
55
How might a patient with necrotising enterocolitis present
Intolerant to feeds Vomiting with green bile Generally unwell Distended, tender abdomen Absent bowel sounds Blood in stool
56
What are the investigations for necrotising enterocolitis
Bloods Capillary blood gas Blood cultures Abdominal X-ray (dilated bowel loops, bowel wall oedema, pneumatosis intestinalis, pneumoperitoneum)
57
What is the management for necrotising enterocolitis
Nil by mouth IV fluids Total parenteral nutrition Antibiotics A surgical emergency
58
What are the complications of necrotising enterocolitis
Perforation and peritonitis Sepsis Death Strictures Abscess formation Recurrence Long term stoma Short bowel syndrome
59
What is neonatal abstinence syndrome
Withdrawal symptoms in neonates of mothers using substances during pregnancy
60
What are the common substances that cause neonatal abstinence syndrome
Opiates Methadone Benzodiazepines Cocaine Amphetamine Nicotine Cannabis Alcohol SSRIs
61
How might a patient with neonatal abstinence syndrome present
Usually between 3 and 72 hours CNS signs: irritability, increased tone, high pitched cry, not settling, tremors Vasomotor and respiratory signs: yawning, sweating, unstable temperature, tachypnoea Metabolic and gastrointestinal signs: poor feeding, regurgitation, vomiting, hypoglycaemia, loose stools
62
What is the management for neonatal abstinence syndrome
Monitor in hospital for at least 3 days Urine test for substances Neonate in quiet, dim room Oral morphine for opiate withdrawal Oral phenobarbitone for non-opiate withdrawal Test for Hep B, Hep C, HIV Safeguarding Support mother to stop using Check suitability for breast feeding
63
What are the effects of fetal alcohol syndrome on the baby
Microcephaly Thin upper lip Smooth, flat philtrum Short palpebral fissure (horizontal distance from one eye to the other) Learning disability Hearing and vision problems Cerebral palsy
64
What are the effects of congenital rubella syndrome on the baby
Congenital cataracts Congenital heart disease Learning disability Hearing loss Ensure mothers have had MMR vaccine
65
What are the effects of congenital varicella syndrome on the baby
If within first 28 weeks of gestation Fetal growth restriction Microcephaly Hydrocephaly Learning disabilities Scars and significant skin changes Limb hypoplasia Cataracts Chorioretinitis
66
What are the effects of congenital cytomegalovirus on the baby
Fetal growth restriction Microcephaly Hearing loss Vision loss Learning disability Seizures
67
What are the effects of congenital toxoplasmosis on the baby
Intracranial calcification Hydrocephalus Chorioretinitis
68
What is sudden infant death syndrome
Cot death Usually within first 6 months
69
What are the risk factors for sudden infant death syndrome
Prematurity Low birth weight Smoking during pregnancy Male
70
How can the risk of sudden infant death syndrome be minimised
Put baby on back when not directly supervised Keep head uncovered Place feet at end of bed Keep toys and blankets out of cot Maintain comfortable temperature Avoid smoking Avoid co-sleeping

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