Neonatology Flashcards
What is a neonate?
a child under 28 days of age, high risk of dying
*term = > 37weeks
What is important to consider when taking a neonatal history?
- age and gestational age
- birth weight
- pregnancy complications
- delivery mode, complications
- antenatal screening
- previous pregnancies
- feeding hx
- social screening: smoke, alcohol
- mothers mood
- twins?
- mothers concerns
What is the earliest accepted gestation in the UK?
22-24 w
When is surfactant produced?
liquid produced by type 2 alveolar cells to reduce surface tension
*24-34 weeks
When is a baby considered premature?
any baby under 37w
What are some RF for prematurity?
- Social deprivation
- Smoking, Alcohol, Drugs
- Overweight or underweight mother
- Maternal co-morbidities
- Twins - multiple pregnancy
- Personal or family history of prematurity
- early pregnancy - within 6m of previous
- infection, diabetes, hypertension
- trauma
What are some early complications of prematurity?
ARDS, hypothermia, hypoglycaemia, poor feeding
neonatal jaundice
retinopathy of prematurity
NEC
What are some long term complications of prematurity?
chronic lung disease of prematurity
learning and behavioural difficulties
susceptibility to infectons
hearing and visual impairment
cerebral palsy
What is hypoxic-iscaemic encephalopathy?
occurs in neonates as a result of hypoxia leading to ischaemic brain damage –> CP or death
*neuronal damage from ischaemia or reperfusion injury
When can HIE occur?
placental abruption
ruptured uterus
cord compression
nuchal cord wrapped around neck
maternal hypotension or hypertension
compromised foetus
intra-partum haemorrhage
how might HIE be picked up on examination?
mild - poor feeding, irritable, hyper alert *24h resolve
moderate - poor feed, lethargic, hypotonic, seizures *40% CP
severe - reduced consciousness, apnoeas, flaccid, reduced or absent reflexes *90% CP, 50% mortality
How do you investigate HIE?
umbilical artery ABG
APGAR
amplitude-integrated EEG - abnormal brain activity
How do you manage HIE?
resus + ventilation
therapeutic hypothermia
- using cooling blanket and hat
- 33-34c target, for 72h, warmed to normal over 6h
What is the aim of therapeutic hypothermia?
reduces inflammation and neurone loss after acute hypoxic injury, risk of cerebral palsy, developmental delay, learning disability, blindness and death
What is necrotising enterocolitis?
disorder in premature neonates where part of bowel becomes necrotic –> risk of perforation, peritonitis, shock and death
What are some RF for NEC?
low birth weight
formula feeds
ARDS + assisted ventilation
sepsis
PDA