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
