Neonatology Flashcards
What is surfactant produced by
Type 2 alveolar cells
How does surfactant effect lung surface tension
Reduces it
Why is high surface tension an issue in lungs
Water in lungs
Water attracts each other
On either side of sacs
Closes alveoli sacs
How does surfactant effect compliance
Increases compliance
Less force needed to expand alveoli
When is surfactant produces and fully equipped
24 - 34 weeks gestation
What does hypoxia in birth lead to
Hypoxic-ischaemia encephalopathy
THEN CP
Why do babies get cold when born
Large surface to weight ratio when born
And wet
1st thing to do when a baby is born and not breathing
vigerious rubbing/ drying
BEFORE A-E/ 5 RESCUE BREATHS
When should a Apgar score be calculated
1, 5 and 10 minutes
What should be done after drying if baby is not breathing
5 breaths
Reassess
5 breaths
3:1 CPR
Then chest compressions
Acceptable pre ductal sats at 2 mins and when should they be 100%
65%
10 mins (or sooner!!)
In a newborn what bpm would indicate need for CPR
Less than 60
5 components of APGAR
Appearance (colour) Pulse Grimmace Activity Respiration
One possible negative of delayed cord clamping
May be associated with higher rates of neonatal jaundice
How soon should the newborn exam be after birth
72 hours
When is the newborn heel prick test taken
Day 5
Can be upto 8
How long does it take for newborn heel screening test to come back
6-8 weeks
What should babies o2 sats be on newborn exam
Pre and post ductal
Above 96% with no less than 2 % difference
What is affected in Erbs palsy
Injury to the upper trunk - C5 and C6
Paralysis or loss of sensation
How do port wine stains change with time
Get darker
What is Sturge Weber syndrome
Associated with port wine stains
Visual impairment, learning difficulties, headaches, epilepsy, glaucoma
How long does a cephalohaematoma take to resolve
Months
Does a cephalohaematoma cross suture lines
No
Blood and fluid below the periosteum
Does a caput succedaneum cross suture lines
Yes
CAP = CAPUT (crosses lines just like a cap)
What is more dangerous caput or cephalohaematoma
cephalohaematoma as blood collection can cause anaemia and jaundice
5% associated with scull fracture
What nerves are injured in Erbs palsy
C5 C6 in the brachial plexus
How does Erbs palsy present
Waiters tip
Internal rotation of shoulder, extended elbow and pronated wrists
Does Erbs palsy ever resolve?
Normally resolves within a few months
Other than the scull, what bone is most commonly fractured in birth
Clavicle
Most common organism in neonatal sepsis (and 4 other less common)
GBS
E coli, listeria, klebsiella, staph aureus
Which babies may receive therapeutic hypothermia
HIE at term or near term
When is neonatal jaundice always pathological
First 24 hours!
Main complication of neonatal jaundice
Kernicterus
Prolonged jaundice cut off periods
2 weeks for term
3 weeks for pre term
Grades of prematurity
Under 28 - extreme
28-32 - very preterm
32-37 - moderate to late pre term
Definition and management of apnoea of prematurity
Breathing stops for 20 seconds or more with bradycardia/ low sats
Apnoea monitors and IV caffeine
4 key interventions to improve outcomes in preterm labour
Tocolysis (nifidipine)
Maternal steroids
IV MGSO4
Delayed cord clamping/ milking
Cervical suture/ vaginal progesterone before labour
What condition can affect retina of pre term newborns
Retinopathy of prematurity
Retinal blood vessel development finishes at 37-40 weeks
Retinopathy of prematurity key risk
Scar causes retinal detachement
Retinopathy of prematurity pathophysiology
Hypoxia drives new vessel growth
If vessels not already developed, giving baby O2 reduces hypoxia so less hypoxic vessel growth
What babies are screened for Retinopathy of prematurity
Under 32 weeks or under 1.5kg
Every 2 weeks screening test until vessels grow to outskirts of eye
Treatment for Retinopathy of prematurity
Transpupilary laser photocoagulation to stop new blood vessels forming
Xray appearance of RDS
Ground glass
Key risk factors for NEC
Low birth weight/ premature
Formula fed
Sepsis
PDA or congenital heart defect
Imaging of choice for NEC
Abdominal X ray
NEC abdo xray key findings
GAS IN BOWEL WALL (pneumatosis intestinalis)
Dilated loops of bowel
Bowel wall oedema
Pneumoperiternium (if perforated)
NEC management
Nil by mouth
IV fluid, TPN
Antibiotics
Surgical removal