Neonatology Flashcards
List 5 features that increase the risk of neonatal birth injury
- Macrosomia
- Cephalo-pelvic dysjunction (CPD)
- Breech position
- Instrumental delivery
- Shoulder dystocia
What are the layers of the scalp - working outside - inside (7 items)
- Skin
- Subcutaneous connective tissue
- Galea aponeurotic layer
- Periosteum
- Bone
- Periosteum
- Dura
What is the galea aponeurotica?
Scalp Anatomy: A layer of fibrous connective tissue that forms the middle (third) layer of the scalp. Deep to this, but above the periosteum, is the sub-galeal space. Blood vessels within the galea aponeurosis communicate with scalp layers above and below.
What is a subgaleal haemorrhage?
Bleeding into the space below the galea apnoenurosis and above the periosteum
Define the margins of the sub-galeal space (3 items)
- Orbital ridge
- Nape of the neck
- Top margin of the ears
How might a sub-galeal haemorrhage be identified on examination of a newborn? (5 items)
- Pallor (anaemia)
- Resting tachycardia (early shock)
- Diffuse swelling not confined by suture lines
- Moves like water beneath the fingers
- Pooling at the nape of the neck
List 4 PREVENTATIVE aspects of routine care for all neonates (in a low resource context)
Source: MSF Neonatal Guidelines
- Cord care - Disinfect
- Eye drops
- Vitamins (Vit K inj/Vitamin D)
- Vaccines (BCG/Polio/Hep B)
Aside from prophylactic treatments - what other support should all mothers and babies receive? (3 items)
- Breastfeeding support
- Thermoregulation (hat/skin-skin/wrap)
- Infant screening examination (top-toe)
What solutions can be used for cord disinfection? (2 items)
Source: MSF Neonatal guidelines
- 7.1% chlorhexidine digluconate gel (4% Chlorhexidine content) - usually comes in a 3g sachet. Apply the full contents to the tip, stump and base of the cord.
For a home birth give 7 day supply of day to the mother - apply once daily
- 10% Povidone solution - applied with a sterile compress
What eye ointment can be used for the prevention of gonococcal eye disease in newborns?
Source: MSF Neonatal guidelines
1% Tetracycline ointment - Single application to both eyes as soon as possible after birth
What is the standard dose of IM Vitamin K for a neonate who is <1500grams?
0.05mL of 2mg/0.2ml vial
Dose of 0.5mg
What is the standard dose of IM Vitamin K for a neonate who is >1500grams?
0.1mL of 2mg/0.2ml vial
Dose of 1mg
Can Vitamin K be given intravenously instead?
Yes, at the same does - for sick neonates who already have an IV cannula for another reason.
How long should infants receive Vitamin D supplementation?
From 0-6 months of age
Prophylactic dosing
Oral supplements (liquid)
What is the dose of Cholecalciferol (Vitamin D3) for infants GA of 37 weeks or above (term)?
400-800IU/day
Check how many IU per drop for your choice/concentration of choice has
What is the dose of cholecalciferol (Vitamin D3) for infants < 37 weeks GA OR living in high-risk areas?
600-1200IU/day
Check how many IU per drop for your choice/concentration of choice has
If you wish to give a mother sufficient Cholecalciferol (Vit D3) to give her infant for 0-6 months, how might you achieve this?
Source: MSF Neonatal Guidelines
Cholecalciferol (Vitamin D3 liquid) 10ML bottle
Concentration 10,000 IU/Ml
2 bottles for 6 months supply
What is the recommended sunlight exposure for a breastfeeding neonate to prevent Vitamin D deficiency?
Approx 30 minutes of afternoon sun per week, with 40% body exposed - can keep nappy on.
How many doses of oral polio vaccine are required?
4 total
Dose 0 occurs at birth
1-3 as part of the Expanded Immunisation Program (EPI) in childhood.
When should the Hep B vaccine be given to a neonate?
Ideally in the delivery room
At least within the first 24 hours
Prevention of mother-child transmission
At least 2 other doses are required to complete the primary series. Some countries give 3 as part of a combined vaccine.
What is a ‘late birth dose’ of Hep B vaccine?
A dose given after the first 24 hours of life - anytime up to the first 6 weeks post partum.
Effectiveness for prevention of horizontal transmission declines over time - but some vaccine has a benefit over none if given within the 6-week window.
Why should the BCG ideally be given 2-3 days prior to discharge?
Source: MSF Neonatal Guidelines
To monitor for apnoea - a rare side effect of this vaccine
What is the dose of the Hep B vaccine for a neonate?
Single-dose
Monovalent vaccine
10micrograms IM
What is the dose of the Oral Polio Vaccine (OPV) for a neonate?
Dose 0
Bivalent vaccine (type 1+3)
0.1ml (2 drops)
What is the dose for the neonatal BCG vaccine?
Single-dose
0.05mL
Intra-dermal injection - deltoid region
What are the contraindications to giving a neonatal BCG vaccine?
- Clinically suspected HIV infection
- Confirmed HIV infection
- Maternal active TB
- Sick neonate - sepsis/congenital infection - delay dose
