Neonatology Flashcards
What are the main steps in neonatal resuscitation
Warm the baby
Calculate APGAR 1,5,10 mins
Stimulate breathing - dry vigorously with a towel- seep head neutral, check for obstruction
Give inflation breaths when baby is gasping or not breathing
2 cycles of 5 inflation breaths (3 secs each)
-If no response 30 secs of ventilation breaths
-No response then chest compressions - if HR below 60 despite resus - 3:1 ratio of compressions
What are the features in the APGAR score
Appearance- 0 if blue/ pale, 1 if blue extremities, 2 if pink
Pulse- 0 if absent, 1 if <100, 2 if >100
Grimmace- 0 if no response, 1 if little response, 2 if good response
Activity (muscle tone)- 0 if floppy, 1 if flexed arms and legs, 2 if active
Respiration - 0 if absent, 1 if slow and irregular, 2 if strong and crying
What 9 congenital conditions are looked at in the blood spot screening
Taken on day 5-8
Heel prick
-Sickle cell disease
-Cystic fibrosis
-Congenital hypothyroidism
-Phenylketonuria
-Medium chain acyl coA dehydrogenase deficiency
-Maple syrup urine disease
-Isovaleric acidaemia
-Glutaric acuduria
-Homocystin
How are preductal and post ductal oxygen sats measured
Pre ductal sats are from the right hand- right hand receives blood from arteries from the aorta before the ductus arteriosus
Post ductal sats - measured in either foot- they receive blood from the descending aorta after the ductus arteriosus
What are the features of talipes (club foot)
Positional- muscles are tight around the ankle- no bones affected - Physio
Structural - Bones of foot and ankle need surgery
What is a haemangioma and how is it treated
Blood vessels under the skin form a lump
Monitor and resolve with time
If affected eyes, mouth or airway can give propranolol
What is a port wine stain
Pink patches of skin on face
Don’t fade with time and turn darker red or purple
Can be related to storage-weber syndrome
What is a caput succedaneum and how is it managed
-Fluid collection on scalp outside the periosteum
-Pressure during a prolonged/ instrumental delivery
-Able to cross suture lines
-Will resolve in a few days
What is a cephalohaematoma
-Traumatic subperiosteal haematoma
-Blood collection between skull and periosteum
-Prolonged/ instrumental delivery
-Lump does not cross suture lines
-Discolouration of skin
-Will resolve in a few months
-Risk of anaemia and jaundice as blood collection breaks down
What are the features of Erb’s palsy
Injury to C5/C6
Associated with shoulder dystocia, traumatic/ instrumental delivery
Waiters tip appearance
Internally rotated shoulder, extended elbow, pronated wrist and no movement in arm
Spontaneously resolves in a few months
What are the most common bacteria responsible for neonatal sepsis
Group B strep
E colii
Listeria
Klebsiella
Staph aureus
What are the risk factors for neonatal sepsis
Vaginal GBS colonisation
GBS sepsis in previous baby
Maternal sepsis, choiroamnionitis or fever >38
Premature <37
Early rupture of membranes
Prolonged rupture of membranes
What are the symptoms of neonatal sepsis
Fever, reduced tone, poor feeding, apnoea/ resp distress, vomiting, tachycardia/ brady, hypoxia, jaundice, seizures, hypoglycaemia
What is the management for presumed neonatal sepsis
-1 risk factor or clinical feature- monitor obstruction for 12 hrs
-2 risk factors/ features- start abx
Abx started if there is a single red flag symptoms - within 1 hour of decision being made
-Cultures taken before abx
-Do lumbar puncture if infection strongly susuepcted/ there are features of meningitis
Benzylpenicillin and gentamicin are first line abx
Cefotaxime can be an alternative
Continue to check CRP and Cultures after 36 hours
What are the causes and features of hypoxic ischaemic encephalopathy
Hypoxia during birth - ischaemic brain damage can cause cerebral palsy
Causes
Maternal shock
Intrapartum haemorrhage
Prolapse cord (compression during birth)
Nuchal cord- wrapped around neck of baby
Babies near/ at term can get therapeutic hypothermia to 33-34 decrees for 72 hrs- reduce inflam and neurone loss
What is the staging of hypoxic ischaemic encephalopathy
Mild- poor feeding, generally irritable, hyper alert, resolves in 24 hrs, normal prognosis
Moderate- Poor feeding, lethargy, seizures, can take weeks to resolve- 40% cerebral palsy
Severe- LOC, apnoea, flaccid, no reflexes, 50% morality, 90% cerebral palsy
What are the causes of neonatal jaundice
Increased bilirubin production (RBC broken down)
-Haemolytic disease of newborn
-ABO incompatibility
-Haemorrhage
-Intraventricular haemorrhage
-Cephalohaematoma
-Polycythaemia
-Sepsis and DIC
-G6PD deficiency
Decreased bilirubin clearance
-Premature
-Breast milk jaundice
-Neonatal cholestasis
-Extrahepatic biliary atresia
-Endocrine disorders
-Gilbert syndrome
When is jaundice considered prolonged
More than 14 days in full term babies
More than 21 days in premature babies
Prompt investigations- biliary atresia, hypothyroid or G6PD deficiency
How is neonatal jaundice managed
Phototherapy- blue light
Measure rebound bilirubin 12-18 hrs after
What is kernicterus
Brain damage caused by excessive bilirubin levels
Bil can cross the BBB - damage the CNS
Floppy drowsy baby with poor feeding
Can cause cerebral palsy, learning disability and deafness
What is the management of prematurity before birth
Women with history of preterm birth/ ceramic length of 25mm before 24 weeks give
-Prophylactic vaginal progesterone
-Propylactic cervical cerclage
When preterm labour is confirmed
-Tocolysis with nifendipine- surprise labour
-Maternal corticosteroids- before 35 weeks
-IV magnesium sulphate before 34 weeks
-Delayed cord clamping
What are the features of apnoea of prematurity
Periods when baby stops breathing for more than 20 secs (shorter with oxygen desaturation/ bradycardia)
Causes
-Immaturity of the autonomic system
-Sign of developing illness- infection, anaemia, airway obstruction, CNS pathology (seizures/ haemorrhage), GORD, neonatal abstinence syndrome
Management
Apnoea monitors on premature babies
Tactile stimulation
IV caffeine
What are the features of retinopathy of prematurity
Babies born before 32 weeks
Abnormal retinal blood vessel development - normally occurs due to hypoxia in utero which is disrupted if born prematurely - scarring, retinal detachment, blindness
Assessment of the retina in 3 zones
Disease described stage 1 (slight abnormal vessel growth) to stage 5 (completed retinal detachment)
Screening
Babies born before 32 weeks or under 1.5kg are screened
At 30-31 weeks if born before 27 weeks
4-5 weeks after birth if after 27 weeks
Treatment
Transpupillary laser photocoagulation
Cryotherapy
Injections of VEGF inhibitors
Surgery if retinal detachment
What are the features and management of respiratory distress syndrome
Below 32 weeks and ground glass appearance on CXR
Inadequate surfactant- high surface tension in alveoli- lung collapse (atelectasis) - lack of gas exchange
Management
Antenatal steroids (dex) given to mothers in preterm labour
-Intubation and ventilation
-Endotracheal surfactant
-CPAP
-Supplemental 02- keep sats at 91-95%
