Neonatology Flashcards
Where is surfactant produced?
From type 2 alveolar cells
What is the function of surfactant?
Reduces the surface tension of fluid in the lungs, this keeps the alveoli inflated and maximises the surface area of the alveoli.
This reduces the force needed to expand the alveoli during inspiration and promotes equal expansion of all alveoli in inspiration
When is surfactant produced?
Between weeks 24 and 34 of gestation
What are some physiological issues in neonatal resuscitation?
Babies have a large surface area to weight ratio so lose heat quickly
They are born wet so lose heat quickly
Can be born through meconium and may have this in their mouth or airway
What are the principles of neonatal resuscitation?
Warm the baby
Calculate the APGAR score
Stimulate breathing
Inflation breaths
Chest compression
What position do you put a neonates head in during resuscitation?
A neutral position, a towel can be placed under the shoulders to keep it neutral
What is the APGAR score measured out of?
0-10
What are the different scores relating to appearance in the APGAR score?
0- blue/pale centrally
1- blue extremities
2- pink
What are the different scores relating to pulse in the APGAR score?
0- absent
1- <100
2- >100
What are the different scores relating to grimmace (response to stimulation) in the APGAR score?
0- no response
1- little response
2- good response
What are the different scores relating to activity (muscle tone) in the APGAR score?
0- floppy
1- flexed arms and legs
2- active
What are the different scores relating to respiration in the APGAR score?
0- absent
1- slow/irregular breathing
2- strong/crying
What are some benefits of delayed umbilical cord clamping, allowing fetal blood from the placenta to enter the baby’s circulation?
Improved haemoglobin, iron stores, blood pressure and a reduction in intraventricular haemorrhage and necrotising enterocolitis
What injection will babies have shortly after to birth to prevent bleeding?
Vitamin K, as babies are born vitamin K deficient
What conditions are screened for on the day five heel prick?
Sickle cell, CF, hypothyroidism, phenylketonuria, MCADD, maple syrup urine disease, isovaleric acidaemia, glutaric aciduria type 1, homocystin
What is the moro relfex?
When rapidly tipped backwards the arms and legs will extend
What is the suckling reflex?
Placing a finger in the mouth will prompt the baby to suck
What is the rooting reflex?
Tickling the cheek will cause them to turn towards the stimulus
What is the grasp reflex?
Placing a finger in the palm will cause the baby to grasp
What is the stepping reflex?
When held upright and the feet touch a surface they will make a stepping motion
What are some features that would make you suspect hypoxic ischaemic encephalopathy?
An event occurs that could lead to hypoxia, acidosis pH<7 on umbilical artery blood gas, poor APGAR scores
What are some causes of HIE?
Maternal shock, intrapartum haemorrhage, prolapsed cord, nuchal cord (cord wrapped around baby’s neck)
What are features of mild hypoxic ischaemic encephalopathy?
Mild: poor feeding, General irritability, responds excessively to stimulation, may have staring of the eyes and hyperventilation
What can be used to help protect the brain from hypoxic injury?
Therapeutic hypothermia
What is therapeutic hypothermia in regard to neonatal care?
Active cooling of baby using cooling blankets and hats with a target temperature of between 33-34 degrees. This is continued for 72 hours then they are carefully warmed over 6 hours
What does therapeutic hypothermia reduce the risk of?
Cerebral palsy, neurodevelopmental delay, blindness and death
What are features of moderate hypoxic ischaemic encephalopathy?
Marked abnormalities of movement, hypotonia, poor feeding as cannot suck, may have seizures
What are features of severe hypoxic ischaemic encephalopathy?
No normal spontaneous movements or response to pain, hypotonia, prolonged seizures, apnoeas, signs of multi-organ failure
What is necrotising enterocolitis?
When part of the bowel becomes necrotic in neonates, it is a life threatening emergency that can lead to bowel perforation, peritonitis and shock
What are some risk factors for developing necrotising enterocolitis?
Very low birth weight or early prematurity, formula feeds, RDS, sepsis, congenital heart disease
How will a neonate with necrotising enterocolitis present?
Intolerance to feeds, bilious vomiting, distended tender abdomen, absent bowel sound, blood in stools, unwell child
What blood results would we want to do in a child with necrotising enterocolitis?
FBC
CRP- raised with inflammation
Metabolic acidosis on capillary blood gas
Blood culture for sepsis
What would be seen on AXR with necrotising enterocolitis?
Dilated loops of bowel and bowel wall oedema
Pneumatosis intenstinalis- air in the bowel wall which is sign of NEC
Pneumoperitoneum
Gas in the portal veins
How is necrotising enterocolitis managed?
Keep nil by mouth, IV fluids, parenteral nutrition and antibiotics. NG tube can be inserted to drain fluid and gas from stomach and intestines
Surgical removal of dead bowel
What are some features of neonatal hypoglycaemia?
Autonomic: jittery, irritable, tachypnoeic
Neuroglyopenic: poor feeding, hypotonia, drowsiness, seizures,
Apnoea, hypothermia
What is the management for a neonate with hypoglycaemia who is asymptomatic?
Encourage normal feeding and monitor blood glucose
What is the management for a neonate with hypoglycaemia who is symptomatic or has a very low blood glucose?
Admit to NNU and give 10% dextrose IV infusion
What are some causes of hypoglycaemia in neonates?
Prematurity, maternal diabetes mellitus, hypothermia, IUGR, sepsis, errors of metabolism, nesidioblastosis, beckwith-weidemann syndrome
what are features of foetal alcohol syndrome?
microcephaly, thin upper lip, small eye openings, absent philtrum, low IQ, cardiac abnormalities
