Neonatology Flashcards
What are the 5 components to the APGAR score?
There are 5 components to the APGAR score: Appearance, Pulse, Grimace, Activity, Respiration.
APGAR score: what does it score?
The APGAR score uses 5 components to quickly assess the state of a newborn baby. The APGAR score is a method of assessing the state of a neonate quickly after birth. The score is intended as a quick assessment of current status, and is not a long-term prognostic indicator, although long periods of low APGAR scores are correlated with reduced neurological function.
‘A’ in APGAR?
Appearance relates to the colour of the child.
2 is for a pink baby
1 if the baby is blue peripherally but pink centrally
0 if the baby is blue all ove
‘P’ in APGAR?
Pulse:
2 for >100 beats per minute
1 for <100 beats per minute
0 for a non-detectable heart rate
‘G’ in APGAR?
Grimace:
relates to the response to stimulation
2 for crying on stimulation scores
1 for a grimace
0 for no response
‘A (2nd)’ in APGAR?
Activity:
2 for flexed limbs that resists extension
1 for some flexion
0 for a floppy baby
‘R’ in APGAR?
Respiration:
2 for a strong cry
1 for a weak cry
0 for no respiratory effort
When is APGAR assessed? (3)
Newborns are assessed at 1, 5 and 10 minutes.
A baby boy is born by emergency C-section at 29 weeks gestation. The baby weighs 1050 grams.
The APGAR scores are 3, 4 and 5 at 1, 3 and 10 minutes of life respectively. The baby is intubated and transferred to the neonatal intensive care unit, where they are given an intra-tracheal instillation of synthetic surfactant. For the next 2 weeks, high FiO2 levels are required via the endo-tracheal tube to maintain the baby’s oxygen saturations. The baby is screened every 2 weeks by an ophthalmologist.
What is the mechanism of the condition that the ophthalmologist is screening for?
This premature baby with a very low birthweight that requires high levels of FiO2 is at very high risk for retinopathy of prematurity (ROP). Retinopathy of prematurity (ROP) is characterized by abnormal and uncontrolled development of blood vessels in the retina in premature infants as a result of free radical damage from high oxygen levels
A double hit of the retinoblastoma (Rb) tumor suppressor gene causes the retinal tumor retinoblastoma. This presents as a …
A double hit of the retinoblastoma (Rb) tumor suppressor gene causes the retinal tumor retinoblastoma. This presents as a white-eye reflex and is screened for during neonatal checks
Visual Impairment in Children - Causes
Genetic (albinism, retinoblastoma, Oculocutaneous albinism)
Ante/perinatal (congenital infections causing cataracts, retinopathy of prematurity, cerebral damage)
Postnatal (juvenile idiopathic arthritis, infection, trauma)
Oculocutaneous albinism
What is this disease?
Oculocutaneous albinism is a genetic disease which causes a defect in the production of melanin. Oculocutaneous albinism demonstrates autosomal recessive inheritance.
Children with oculocutaneous albinism have no skin pigmentation, white hair and no pigment in the iris (appears red from light reflecting off retinal blood vessels).
There are several factors that contribute to visual impairment in oculocutaneous albinism, but the most important is poor development of the fovea.
Care should be taken to protect the eyes and skin from sunlight to prevent further damage and skin cancer.
Retinoblastoma - how to spot it?
Retinoblastoma is a tumour of the retina that occurs in infancy or childhood. This is caused by an inherited mutation in the Rb (retinoblastoma) tumour suppressor gene, which then randomly receives a ‘double hit’ to the non-mutated copy of the gene, which triggers proliferation.
Children with retinoblastoma present with a white eye reflex (loss of the normal red reflex) which parents might note on flash photography.
What is Retinopathy of prematurity?
Retinopathy of prematurity is a cause of visual impairment in premature babies.
The mechanism of retinopathy of prematurity is thought to involve free radicals. Supplemental oxygen therapy creates free radicals which damage the retina and trigger proliferation of blood vessels on the retina. This can lead to retinal fibrosis, retinal detachment and ultimately blindness.
Indications for referral: Babies born at less than 32 weeks gestation or less than 1.5kg birth weight should be screened for retinopathy of prematurity with fortnightly fundoscopy by an ophthalmologist
Prevention: Cautious administration of supplemental oxygen
Treatment: laser therapy
Cataracts in children
Cataracts are a relatively rare cause of visual loss in children
In babies, cataracts can be caused by congenital infections and metabolic defects (e.g., galactosaemia)
Cataracts are a cause of an absent red reflex
