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0Finals Revision > Neonatology > Flashcards

Neonatology Flashcards

1
Q

what are the 5 most common organisms in neonatal sepsis?

A
  • GBS
  • E. coli
  • listeria
  • klebsiella
  • staph aureus
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2
Q

what are the risk factors for neonatal sepsis?

A
  • maternal vaginal GBS colonisation
  • GBS sepsis in previous baby
  • maternal sepsis
  • chorioamnionitis
  • maternal fever >38
  • prematurity
  • premature rupture of membranes
  • prolonged rupture of membranes
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3
Q

what are the clinical features of neonatal sepsis?

A
  • fever
  • reduced tone and/or activity
  • poor feeding
  • respiratory distress or apnoea
  • vomiting
  • tachy or bradycardia
  • hypoxia
  • jaundice within 24hrs of birth
  • seizures
  • hypoglycaemia
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4
Q

what are the red flags for neonatal sepsis?

A
  • confirmed or suspected maternal sepsis
  • signs of shock
  • seizures
  • term baby needing mechanical ventilation
  • respiratory distress starting >4hr after birth
  • presumed sepsis in another baby in a multiple pregnancy
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5
Q

what should be done if one risk factor or clinical feature of neonatal sepsis is identified?

A

monitor obs and clinical condition for at least 12hrs

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6
Q

what should be done if more than one risk factor or clinical feature of neonatal sepsis is identified?

A

start antibiotics

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7
Q

what should be done if a red flag for neonatal sepsis is identified?

A

start antibiotics

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8
Q

in what time frame should antibiotics for neonatal sepsis be started?

A

within 1 hr of the decision to prescribe

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9
Q

what bloods should be requested for a baby starting antibiotics for suspected neonatal sepsis?

A
  • blood cultures (before abx given)
  • FBC
  • CRP
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10
Q

in addition to blood tests, what investigation should be requested in a baby with suspected meningitis?

A

lumbar puncture

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11
Q

what does NICE recommend at first line abx for neonatal sepsis?

A

benzylpenicillin and gentamicin

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12
Q

what is the ongoing management of suspected neonatal sepsis?

A
  • further CRP at 24hrs and again at 5 days if still on treatment
  • check blood culture results at 36hrs
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13
Q

when should you consider a lumbar puncture in a neonate?

A
  • suspected sepsis with CRP >10

- features suspicious of meningitis e.g. seizures

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14
Q

what criteria must be met to stop abx for suspected neonatal sepsis at 36hrs?

A
  • baby is clinically well
  • blood culture negative
  • CRP <10
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15
Q

what criteria must be met to stop abx for suspected neonatal sepsis at 5 days?

A
  • baby is clinically well
  • blood culture negative
  • lumbar puncture negative
  • CRP normal
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16
Q

At what gestation do Type II alveolar cells become mature enough to produce surfactant?

A

24-34 weeks

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17
Q

How does surfactant help with physiological ventilation?

A
  • reduces surface tension
  • keeps alveoli inflated and maximises surface area
  • reduces force needed to expand alveoli in inspiration and promotes equal expansion of all alveoli
  • increases compliance of the lungs
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18
Q

How does normal labour help prepare a foetus for extrauterine life?

A
  • foetal thorax is squeezed in the birth canal and fluid is cleared from the lungs
  • temperature change, sounds and physical touch stimulate release of adrenalin and cortisol which promote respiratory effort
  • a strong cry expands the alveoli for the first time, decreasing pulmonary vascular resistance
  • consequently, pressure in the RA falls below that of the LA and there is functional closure of the foramen ovale
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19
Q

What causes closure of the ductus arteriosus?

A

fall in prostaglandins due to increasing blood oxygenation

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20
Q

What maintains the ductus arteriosus?

A

prostaglandins

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21
Q

What does the closed ductus arteriosus become?

A

ligamentum arteriosum

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22
Q

What does the closed foramen ovale become?

A

fossa ovalis

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23
Q

When and why does the ductus venosus stop functioning?

A
  • immediately after birth

- due to cord clamping and a lack of flow in the umbilical veins

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24
Q

What does the closed ductus venosus become?

A

ligamentum venosum

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25
Q

What complications might a baby experience during and after a normal labour and delivery?

A
  • hypoxia
  • hypothermia (due to large SA:weight and being born wet)
  • babies born through meconium may have this in their airway or mouth
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26
Q

What is an APGAR score used for and when is it carried out?

A
  • an indicator of progress over the first few minutes after birth
  • calculated at 1, 5 and 10 minutes as resuscitation continues
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27
Q

What are the components of an APGAR score?

A
  • appearance (skin colour)
  • pulse
  • grimace (response to stimulation)
  • activity (tone)
  • respiration
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28
Q

What is the range of APGAR scores one can achieve?

A

0-10

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29
Q

How is appearance graded for an APGAR score?

A 
0 = blue / pale centrally
1 = blue extremities
2 = pink
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30
Q

How is pulse graded for an APGAR score?

A 
0 = absent
1 = below 100
2 = above 100
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31
Q

How is grimace graded for an APGAR score?

A 
0 = no response to stimulation
1 = little response to stimulation
2 = good response to stimulation
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32
Q

How is activity graded for an APGAR score?

A 
0 = floppy
1 = flexed arms and legs 
2 = active
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33
Q

How is respiration graded for an APGAR score?

A 
0 = absent
1 = slow / irregular
2 = strong / crying
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34
Q

How should baby be cared for immediately after birth (assuming no complications)?

A
  • skin to skin
  • delayed cord clamping
  • dry baby
  • keep warm with hat and blankets
  • Vitamin K IM
  • label baby
  • measure weight and length
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35
Q

When should feeding be initiated after birth?

A

as soon as baby is alert enough

36
Q

When should baby have it’s first bath?

A
  • whenever it is warm and stable

- it can be delayed for days without consequence

37
Q

What screening does baby need in the first few days of life?

A
  • NIPE
  • blood spot test
  • newborn hearing test
38
Q

What is the newborn blood spot test?

A
  • aka heel prick test

- screening for 9 congenital conditions using 4 samples of blood taken by pricking baby’s heel

39
Q

What conditions does the newborn blood spot test screen for?

A

(9 congenital conditions)

  • sickle cell disease
  • cystic fibrosis
  • congenital hypothyroidism
  • PKU
  • MCADD
  • MSUD
  • IVA
  • GA1
  • homocystinuria
40
Q

What is the NIPE? When is it carried out?

A

newborn and infant physical examination

  • first performed within 72 hours of birth by a trained midwife or a paediatric doctor
  • repeated at 6-8 weeks in GP
41
Q

Can jaundice in a newborn be normal? Why?

A

Yes - there is a normal rise in bilirubin after birth which can cause a mild jaundice from 2-7 days of life where the baby is otherwise well

42
Q

Why do neonates gets jaundiced?

A
  • high concentration of fragile RBCs
  • immature liver function
  • unable to use the placenta to excrete bilirubin as they did in utero
43
Q

What are the causes of neonatal jaundice?

A 
Increased production:
- haemolytic disease of the newborn
- ABO incompatibility
- haemorrhage
- cephalo-haematoma
- polycythaemia
- sepsis +/- DIC
- G6PD deficiency
Decreased clearance:
- prematurity
- breast milk jaundice
- neonatal cholestasis
- extrahepatic biliary atresia
- endocrine disorders
- gilbert syndrome
44
Q

Jaundice is the first 24 hours of life is normal. True or false?

A

False

  • jaundice in the first 24 hours is always pathological
  • often indicates neonatal sepsis
45
Q

Why might premature babies appear more jaundiced than their term peers?

A
  • immature liver
46
Q

What is kernicterus? How does it present? What can it cause?

A
  • brain damage due to high bilirubin levels
  • presents as less responsive, floppy, drowsy baby with poor feeding
  • can cause cerebral palsy, learning disability and deafness
47
Q

Breast fed babies are more likely to have neonatal jaundice. True or false? Why?

A

True

  • components of breast milk inhibit liver processing of bilirubin
  • breast-fed babies are more likely to be dehydrated and have sluggish bowels so more bilirubin is absorbed in the intestine
48
Q

When is jaundice considered “prolonged” in a newborn?

A
  • more than 14 days in term babies

- more then 21 days in premature babies

49
Q

What should be done if a baby has prolonged neonatal jaundice?

A

investigate for an underlying cause e.g. biliary atresia, hypothyroidism, G6PD deficiency:

  • FBC and blood film
  • conjugated bilirubin levels
  • blood typing
  • direct Coombs test
  • TFTs
  • blood and urine cultures
  • G6PD levels
50
Q

How is neonatal jaundice managed?

A
  • plot total bilirubin levels against age of baby (
    in hours) on treatment threshold chart
  • if a pt’s measurements cross the threshold on the chart they will need treatment
  • phototherapy is usually adequate but exchange transfusion may be required in extreme cases
51
Q

How does phototherapy treat neonatal jaundice?

A

converts unconjugated bilirubin into isomers than can be excreted in urine and bile without requiring processing in the liver

52
Q

What is SIDS?

A
  • sudden infant death syndrome

- an unexplained death, usually in the first 6 months of life

53
Q

What are the risk factors for SIDS?

A
  • prematurity
  • smoking during pregnancy
  • low birth weight
  • male baby (only slight increased risk)
54
Q

How can the risk of SIDS be minimised?

A
  • put baby on their back unless supervised
  • keep baby’s head uncovered
  • put baby at the foot end of their bed to prevent them sliding down and under the blanket
  • keep baby’s bed clear of blankets and toys
  • maintain room temp 16-20 degrees
  • share a room with baby if possible
  • avoid smoking, and don’t handle baby after smoking
  • avoid co-sleeping, particularly in chairs / sofa
  • avoid alcohol / drugs / smoking / sleeping tablets / deep sleepers if co-sleeping necessary
55
Q

What is the CONI team?

A
  • care of next infant team

- provide support to a family with their next infant, following on infant death

56
Q

What is the prevalence of SIDS in the UK?

A

~230 babies die from SIDS each year in the UK (0.3 per 1000 live births)

57
Q

How do we categorise prematurity?

A 
<28w = extreme preterm
28-32w = very preterm
32-37w = moderate to late preterm
58
Q

What factors and circumstances are associated with premature delivery?

A
  • social deprivation
  • smoking, alcohol and drug use
  • overweight and underweight mums
  • maternal co-morbidities
  • multiple pregnancy
  • personal or FH of prematurity
59
Q

Who would be offered prophylactic interventions aiming to delay birth?

A
  • people with history of preterm birth

- anyone with a cervical length of <25mm on USS

60
Q

What options are there to delay birth in a person who has a high risk of preterm birth, but is not in labour?

A
  • prophylactic vaginal progesterone

- prophylactic cervical cerclage

61
Q

What options are there to delay birth in a person who is suspected to be in preterm labour?

A

tocolysis with nifedipine

62
Q

What interventions might be recommended for someone in suspected preterm labour?

A
  • tocolysis with nifedipine to suppress labour
  • maternal corticosteroids (if 35w +)
  • IV magnesium sulphate (if 34w +)
  • delayed cord clamping or cord milking
63
Q

What neonatal issues are linked to prematurity?

A
  • respiratory distress syndrome
  • hypothermia
  • hypoglycaemia
  • poor feeding
  • apnoea and bradycardia
  • neonatal jaundice
  • intraventricular haemorrhage
  • retinopathy of prematurity
  • necrotising enterocolitis
  • immature immune system increases risk of infection
64
Q

What long term issues are linked to prematurity?

A
  • chronic lung disease of prematurity
  • susceptibility to infections - particularly respiratory
  • learning and behavioural difficulties
  • hearing and visual impairment
  • cerebral palsy
65
Q

What is apnoea of prematurity? Who is affected?

A
  • periods where breathing stops for more than 20 seconds (or shorter periods with desats) which are often accompanied by bradycardia
  • very common in premature neonates
  • occur in almost all babies born <28w
66
Q

Why does apnoea of prematurity occur?

A
  • immature autonomic nervous system in premature neonates
  • apnoeas often signal a developing illness
  • episodes will settle as baby grows
67
Q

What is retinopathy of prematurity?

A
  • abnormal development of blood vessels in the retina which can lead to scarring, retinal detachment and blindness
68
Q

How is retinopathy of prematurity detected?

A

all babies born before 32w or under 1.5kg will be screened every two weeks from around 30-31w gestational age until normal vessel development is observed

69
Q

What is respiratory distress syndrome?

A
  • atelectasis (ground glass appearance on XR)
  • causing inadequate gas exchange
  • resulting in Type 2 Respiratory failure
70
Q

How can respiratory distress syndrome in neonates be managed?

A
  • antenatal steroids are preventative
  • highest level support is intubation and ventilation
  • endotracheal surfactant is a useful adjunct to invasive ventilation
  • NIV e.g. CPAP is a halfway house
  • supplementary oxygen to achieve sats 91-95% is the least invasive intervention before babies maintain their own breathing on RA
71
Q

What is necrotising enterocolitis?

A

bowel necrosis in neonates which can lead to perforation and peritionitis

72
Q

What are the risk factors for developing NEC?

A
  • very low birth weight
  • very premature
  • formula feeding
  • respiratory distress and assisted ventilation
  • sepsis
  • PDA or other congenital heart disease
73
Q

How does NEC present?

A
  • intolerance to feeds
  • vomiting, bilious
  • generally unwell
  • distended, tender abdomen
  • absent bowel sounds
  • blood in stools
74
Q

How is NEC diagnosed?

A
  • supine AXR (+/- additional views)
  • XR shows dilated loops of bowel, bowel wall oedema, pneumatosis intestinalis, pneumoperitoneum, gas in the portal veins
75
Q

How are infants with NEC managed?

A
  • NBM
  • IV fluids
  • TPN
  • Abx
  • surgery may be required
76
Q

NEC is a medical emergency. True or false?

A

False - NEC is a surgical emergency

77
Q

What are the complications of NEC?

A
  • perforation and peritonitis
  • sepsis
  • strictures
  • abscess
  • recurrence
  • long term stoma
  • short bowel syndrome
  • death
78
Q

What does the WHO recommend babies are fed on?

A

breast milk exclusively until 6 months

79
Q

How much milk should babies drink each day?

A

150ml/kg

less in first days of life and gradually increasing to 150ml/kg over the first week

80
Q

How often do babies feed?

A
  • every 2-3 hours initially
  • lengthening time between feeds as the baby ages
  • eventually feeding on demand
81
Q

How much weight loss is expected in the first week of babies life?

A
  • breastfed babies can lose up to 10%

- bottle fed can lose up to 5%

82
Q

At what age should babies be back at their birth weight?

A

10 days

83
Q

What is the most reliable sign of dehydration in babies?

A

weight loss

84
Q

What is the most common reason that babies lose weigh or struggle to regain weight?

A

dehydration due to underfeeding

85
Q

At what age do babies start weaning?

A

6 months

0Finals Revision (21 decks)

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