neonatology Flashcards
APGAR GRADINE
out of 10
7-10 - excellent
4-6- moderately depressed
<4 - severely depressed
describe HIE grade 2
tendon reflexes can be overactive reudcued by not absent spontanous movement seizures later on can have some form of delay mild hypotonia parsympathetic predominate primitve refelxes weak or absent
HIE 3
no seizures hypotonia apnea flaccidity HR variables associated with epilepsy later on and CP (quadriplegic type)
meconium aspiration and diagnosis and when does it occur
in the womb the bay struggles for oxygen this triggers parasympathetic system which relaxes the anal sphincter and meconium is released and baby swallows it. meconium is irritating to the lungs so a lot of babies are born with surfactant deficiency. it typically occurs during birth when the fetus is stressed during labour especially when baby is passed due date
dx
- looking at vocal chords for staining
- greenish amniotic fluid
- x ray - streakiness of lungs difficulty breathing
- bradycardia
physiological weight loss of the newborn RF
breastfed babies loose more
less than 8% body weight and most prominent on 3/4th day, should be compnesated around 8/14 days after birth
what can be a cause of fever in neonates
infection
overheating
dehydration
how can you measure dehydration
dry diaper for >6 hours or less than 6 wet nappies
omphalitis
infection of umbilical stump
treatment of thirsty fever
oral rehydration with h20 or 5% if less than 10%
if >10% then IV 5%
risk factor of C-Section
intracranial hemorrhage
more breathing problems as more fluid in the lugs as it hasnt been squeezed out by natural birth
hypoglactia of the mother
causes of a big baby
diabetics
post term
multiparity
adaptation syndrome def
observed in healthy neonates in the first week after birth. They reflect the physiologic adaptation for extrauterine life but may easily evolve — to pathology. |
normal values of neonatal jaundice (uncojugated)
normal -<200
pretetm - <240
diagnosis of thirsty fever
hypernatremia
which adaptation syndromes are more common in premies
sclerodema neonatorum
sclerema neonatorum- only in premies and more severe
post term baby defiton
> 42 weeks
signs of post term
hands of long nails lots of hair visible creases on palms and soles meconium staining on skin no lanugo more alert+ wide eyed dry peeling skin minimal sc fat
diabeic mother babies
big babies >4000 can be at risk for hypoglycemia red skin, plethoric face and visceromegaly polyglobulia - viscosity hyperbilirubinemia- excessive breakdown RDS- impaired surfactant synthesis
retained sweat glands and oil glands
miium - oil glands
miliara crystallina- retained sweat glands small vesicles with clear fluid and can become infected alba/rubra needs treatment
bonn nodules
retained salivary glands yellowish in colour don’t need treatment
naevi flammei
capillary hemangiomas on the glabelle
and the neck disappearing first year
when should jaundice appear
after the first day, pathological if appears 24 h within birth
what type of jaundice is the physiological jaundice
flavin rubin( these babies are more redder)
rubin vs icter
rubin - don’t have anemia
icter- have anemia so pale
what is the link between hypothyroidism and jaundice
affects the conjugation process
rbc span in baby
70 days
what % should conjugated br be
no more than 20% of the total br
deposition of br in BG can lead to
dystonic cp? its in my book
adr of phototherapy
bronze baby syndrome- benign
corneal damage
loose stools
erythroblastosis fetalis
‘hemolytic disease of newborn’ mothers ab’s attacking baby
what are the features of hemolytic disease of newborn (exam question)
- what can lead to hemoltic disease of newborn
- hepat/splenomegaly - RES working overime, liver trying to make more rbc etc
- increased LDH (increased in liver diseases and most notably liver diseases due to hemolysis)
- elevated reticulocyte count(needs time so you won’t see on the first day )
- hydrops fetalis - more severe form
any time the 2 bloods mix-so even abortions,miscarriages, proceudres like CVS and amniocentiesis
rf for intracranial hemorrhage
premature babies
babies head too big to fit
precipitate birth
treatMent for brachial plexus injury
premature baby care
vasodilators, anticholinesterases (nivalin), splinting whilst asleep
Physiotherapy
Massage
25- 27 degrees but if baby <1500 32 in incubator
feed with 120 cal per kg
may need NG tube if <1500 because poor suck reflex
using too much force whilst delivering is risk for
clavicular fracture
Brachial plexus trauma
Spinach cord injury - very rare but life threatening (clinical picture is similar to SMA, absolutely floppy baby, breathing problems
SCM injury
Nurses for clavicular fracture
prophylactic pre term baby stuff
does not need treatment
vit k injection from birth
vit d - 2000 units day 7 or day 10 (book)
iron supplementation after 2/3 months
clavicular fracture
reflexes preserved
asymmetric moro reflex
neonatal sepsis age
<4 weeks
classification of neonatal sepsis and common causes
early onset: up to 1 week group b strep and gram - species
late onset:>1 week most likely staphy
risk factor for early sepsis
maternal infection UTI
chorioamnionitis
premature
meconium staining
risk factot for late spesis
being large for gestational age risks
prolonged stay in hospital with catheters, nasal cannulas, GI tract pathology
birth injuries as bigger, fracture, SCM, also deleyaed development, malformations of heart and brain
diagnosis of sepsis
take samples from everywhere
bloods- cbc, thrombocytopenia + anemia , inflammatory markers
x ray - pneumonia
common agents of neonatal meningitis
e. coli, group b. listeria monocytogenes
crieteria for neonatal meningitis LP
> 30 leukocytes
CSF <50% serum glucose
protein >1.2 (i think not very clear)
age for NEC
1-2 weeks of life
key feature of NEC and complications and causes + rf
almost always premies, translocation of gut bacteria to blood stream
don’t know the exact cause but can be associated with blood transfusions. RF hypoxia at birth, premies, formula fed babies
strictures, perforation, short bowel syndrome
presentation of NEC
Like sepsis Abdominal distention + redness of abdomen Increased residual gastric content Biliary vomiting (can be bloodstained ) Bloody diarrhoea
DIAGNOSIS OF NEC + treatment
x ray to see air loops (pneumoperitoneum, dilated bowel loops) + bloods
AB’S
noenteral feeding
abdominal decompression (gastric tube + enema)
Giving supplemental oxygen (if abdomen is so swollen it interferes with breathing )
parrots pseudoparlaysis
congenital syphilis
as a result of osteochondriits and loss of movements of affected limb
signs of phrenic nerve palsy
difficulty breathing
baby also has brachial plexus pathology
respiratory distress signs - tachypnea
premies features
- absent sc fat (like post term)
- abundant lanugo
- deformed ears (stuck)
- short nails
- prominent labia minora
- boys - cryptorchidism
- absent vernix caseosa
- limbs less felxed than a term baby
Vernix caseosa
Vernix caseosa is a white, creamy, naturally occurring biofilm covering the skin of the fetus during the last trimester of pregnancy. Vernix coating protects the newborn skin and facilitates extra-uterine adaptation of skin in the first postnatal week if not washed away after birth.
symmetrical retardation vs asymmetrical retardation
symmetrical: happens early on (congenital) all 3 parameters affected
asymmetrical: main problem is the weight then length etc and happens later on in pregnancy e.g preclampsia, preterm labour and undernutriton
rules for premature baby values
by 38 week every baby should be 2,500, for every 2 weeks behind subtract 250g
normal bw range
2, 500- 4000
or 3-500
physiological decline of hb
at 3 motnhs 105-120
ballard score
The Ballard score is based on the neonate’s physical and neuromuscular maturity and can be used up to 4 days after birth (in practice, the Ballard score is usually used in the first 24 hours). The neuromuscular components are more consistent over time because the physical components mature quickly after birt
