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Paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What are some causes of hypoxic ischaemic encephalopathy?

A

Asphyxia:
- Maternal shock
- Intrapartum haemorrhage
- Prolapsed cord = cord compression
- Nuchal cord = cord stranguling baby

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2
Q

What are the different grades for HIE?

A

Sarnat staging:
Mild - poor feeding, irritable, hyper alert, resolves w/i 24 hours, normal prognosis
Mod - poor feeding, lethargic, hypotonic, seizures, can take weeks to resolve, ~40% = CP
Severe - reduced conc, apnoea, flaccid, reduced or absent reflexes, ~50% die, 90% CP

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3
Q

What is the management of HIE?

A

Supportive - neonatal resus, ventilation, circ support, nutrition, acid base balance, treat seizures
Therapeutic hypothermia - helps to protect brain from hypoxic injury

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4
Q

What is therapeutic hypothremia?

A

Cooling baby’s core body temp in NICU w cooling blankets and a cooling hat - 33-34 degrees is the target. Measure using rectal probe. Do this for 72 hours and then warm to normal temp over 6 hours.
Reduce inflam and neurone loss after acute hypoxic injury

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5
Q

What are some organisms that cause neonatal sepsis?

A

GBS
E.coli
Listeria
Klebsiella
S.aureus

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6
Q

What are the RF of neonatal sepsis?

A

Vaginal GBS colonisation or GBS sepsis in prev baby
Maternal sepsis, chorioamnionitis or fever >38 degrees
Prematurity <37 weeks
PPROM - preterm rupture mem
PROM - prolonged rupture mem

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7
Q

What are the CF of neonatal sepsis?

A
  • Fever
  • Reduced tone and activity
  • Poor feeding
  • Resp distress or apnoea
  • Vom
  • Tachy or brady
  • Hypoxia
  • Jaundice
  • Seizures
  • Hypoglycaemia
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8
Q

What are the red flags of neonatal sepsis?

A

Confirmed sepsis in mother
Signs of shock
Seizures
Term baby needing invasive ventilation
Resp distress >4 hours after birth
Presumed sepsis in another baby in multiple preg

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9
Q

What are the guidelines for presumed sepsis?

A
  • If there is one RF or CF - monitor for 12 hours
  • 2+ RF or CF - start abx
  • If one red flag - start abx
  • Give abx w/i 1 hour of deciding to start them
  • Take blood cultures before giving abx, check FBC and CRP
  • Perform LP if suspect meningitis
    Abx - benzylpenicillin and gentamycin but check local guidelines
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10
Q

What is the ongoing management of presumed sepsis?

A
  • Check CRP again at 24 hours
  • Check blood culture results again at 36 hours
  • Stop abx if baby clincally well, blood cultures -ve and CRP <10
  • Check CRP again at 5 days if still on treatment
  • Stop abx if baby clinically well, LP and blood cultures -ve and CRP normal by 5 days
  • If CRP >10 do LP
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11
Q

What is neonatal jaundice?

A

Jaundice in preterm or term babies w/i first month of life. Affects ~60% of term babies at birth, is more common in pre term babies.

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12
Q

What are the CF of physiological jaundice?

A
  • Harmless w no underlying cause
  • Breastfed babies more commonly have physiological jaundice
  • RBC have shorter lifespan so higher turnover and slower excretion = more bilirubin
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13
Q

What are some causes of pathological jaundice?

A
  • Haemolysis - newborn haemolytic anaemia, G6PD
  • Errors of metabolism - Gilbert syndrome, Crigler Najjar syndrome = disorder of biliary conjugation
  • Biliary atresia
  • Sepsis, bruising
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14
Q

What is Kernicterus?

A

Unconjugated bilirubin = toxic to neural tissue in newborns and can cross the blood brain barrier. Is yellow staining of the cerebral tissue due to bilirubin deposition - acute or chronic bilirubin encephalopathy but is v rare

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15
Q

What are the features of acute bilirubin encephalopathy?

A
  • Lethargy
  • Irritability
  • Abnormal muscle tone/posture
  • Aponea episodes
  • Convulsions
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16
Q

What are the features of chronic bilirubin encephalopathy?

A
  • CP
  • Sensorineural hearing loss
  • Gaze palsy
  • Dental dysplasia
17
Q

What are the ix into acute neonatal jaundice?

A

Serum bilirubin to confirm jaundice
Blood packed cell vol
Blood group of mother and baby
Direct antiglobulin test - look for ab mediated RBC destruction/direct Coombs test
FBC, blood film, LFTs, G6P levels, cultures, TFTs

18
Q

What are the ix into prolonged jaundice?

A

> 14 days in term, >21 days in preterm
- Assess for features of obstructive jaundice - pale stools, dark urine
- Conjugated bilirubin levels
- LFTs, FBC
- Urine culture
- Metabolic screen

19
Q

What is the management of neonatal jaundice?

A

Plot total bilirubin levels on treatment threshold charts that are age specific.
- Phototherapy - converts unconjugated bilirubin into water soluble molecules that can be excreted
- Emergency exchange transfusion if vvv high bilirubin - remove blood from neonate and replace w donor blood

20
Q

What are the CF of neonatal resp distress?

A
  • Cyanosis
  • Stridor, grunting
  • Head bob, flared nostrils
  • Recessions
  • <32 weeks gestation when lungs don’t have enough surfactant to keep alveoli open
  • CXR = ground glass appearance
21
Q

What is the management of neonatal resp distress?

A
  • Dex to mothers w preterm labour to increase surfactant production
  • Severe resp distress = intubation and ventilation
  • Can give endotracheal surfactant via endotracheal tube
  • CPAP via nasal mask w supplementary O2 - 91-95% is the aim in preterm neonates
22
Q

What are the short term complications of neonatal resp distress?

A

Pneumothorax
Infection
Apnoea
IV haemorrhage
Pulm haemorrhage
Necrotising enterocolitis

23
Q

What are the long term complications of resp distress?

A
  • CLD of prematurity - ARDS >28 days
  • Retinopathy of prematurity
  • Neuro, hearing and visual impairment
24
Q

What are the principles of neonatal resus?

A

Warm the baby - vigorous drying, heat lamp, <28 weeks = plastic bag while wet and heat lamp
APGAR score to indicate progress, done at 1, 5 and 10 mins
Stim breathing - dry vigorously, neutral position, check for meconium in airway

25
Q

What to do if baby gasping or not breathing?

A
  • x2 cycles x5 inflation breaths for 3 secs each
  • No response = 30 secs ventilation breaths
  • No response = chest compressions w ventilation breaths
  • Chest compressions if HR <60 BPM despite resus and inflation breaths
26
Q

What is delayed umbilical cord clamping?

A

More time for fetal blood to enter baby’s circ = placental transfusion.
Healthy babies = improved Hb, iron stores and BP and reduces IV haemorrhage and necrotising enterocolitis. May increase neonatal jaundice = more phototherapy. Should delay at least 1 min.

27
Q

What are the RFs of SIDS?

A

Prematurity
Low birth weight
Smoking during pregnancy
Male baby

28
Q

What can be done to reduce risk of SIDS?

A

Baby on back when not supervised
Uncovered head
Feet at the foot of the bed
Clear cot - not many toys or blankets
Comfortably room temp
Avoid smoking and handling baby after smoking
Avoid co sleeping, esp on sofa or chair
If co sleeping = avoid alc, drugs, smoke, sleeping tablets or deep sleepers

29
Q

What is SIDS?

A

Sudden infant death syndrome - no cause, happens in first 6 months

30
Q

What are the weeks of prematurity?

A

<28 w - extreme preterm
28-32 w - v preterm
32-37 - mod to late preterm

31
Q

What are some associations w prematurity?

A
  • Social deprivation
  • Smoking
  • Alc and drugs
  • Overweight or underweight mother
  • Maternal co morbidities
  • Twins
  • Personal or FH of prematurity
32
Q

What can be done to prevent preterm labour or improve outcomes in prematurity?

A

Prophylactic vaginal progesterone or cervical cerclage
Tocolysis w nifedipine
Maternal corticosteroids
IV Mg sulphate
Delayed cord clamping or cord milking

33
Q

What are some early issues associated w prematurity?

A

ARDS
Hypothermia
Hypoglycaemia
Poor feeding
Apnoea and brady
Neonatal jaundice
IV haemorrhage
Retinopathy of prematurity
Necrotising enterocolitis
Immature immune system and infection

34
Q

What are some longer term effects of being premature?

A
  • CLD of prematurity
  • ID and behavioural probs
  • Susceptible to infection
  • Hearing and visual impairment
  • CP
35
Q

What is retinopathy of prematurity?

A

Hypoxia = neovascularisation = scarring, retinal detachment and blindness.
Screen in all babies born before 32 weeks

36
Q

How do you treat retinopathy of prematurity?

A

1st line - transpupillary laser photocoag to stop neovascularisation

37
Q

What is corrected age?

A

Chronological age of baby and minus the weeks of how early they are

38
Q

What are the features of congenital diaphragmatic hernia?

A
  • Resp distress soon after birth
  • Bowel sounds in lung fields - tinkling?
    Unwell baby !!

Paediatrics (15 decks)

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