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
How might NEC present?
feeding intolerance
vomiting - bile or blood stained
abdominal distention
haematochezia
progression - abdominal tenderness, abdominal oedema, erythema and palpable bowel loop
systemic sx!!
What are some complications of NEC?
peritonitis
shock
long term - intestinal stricture, short bowel syndrome, neuro-developmental disorder and recurrence
How do you investigate NEC?
*bell scoring system used
FBC, CRP, U&E, CBG (metabolic acidosis), cultures
AXR - dilated bowel loops, bowel oedema, pneumoperitoneum
How do you manage NEC?
*NBM, IVF, Abx
total parenteral nutrition - 10 to 14 days
NGT
Systemic support - ventilatory support, fluid resuscitation, inotropic support, correction of acid-base balance coagulopathy
surgery!! -> intestinal resection, stoma, clip and drop
What are some differentials for jaundice in a neonate within 24h?
- sepsis - impaired organ function
- rhesus incompatibility
- ABO incompatibility
- red cell abnormalities - spherocytosis, elliptocytosis
- haemolytic disease of the newborn
What are some differentials for prolonged jaundice?
- Biliary atresia
- hyperthyroidism
- increased production of bilirubin in G6PD
- ABO incompatibility
- infection
What are some RF for developing jaundice?
delayed cord clamping
assisted delivery
prematurity
bruising after instrumental delivery
siblings hx
What is kernicterus?
permanent neurological sequelae of high BLB and BLB encephalopathy caused by free flow through blood brain barrier due to it being poorly developed