Neonatology Flashcards
What does extended hypoxia lead to?
hypoxic-ischaemic encephalopathy(HIE)
What is the APGAR score?
Scores heart rate, resp effort, muscle tone, response to stimulation and skin colour in a newborn
What can you do if there is still significant volume of blood in the placenta?
Delayed umbilical cord clamping to give more time for Hb, iron stores and blood pressure to increase
What is respiratory distress syndrome?
Inadequate surfactant commonly in babies under 32 weeks leads to lung collapse and inadequate gas exchange
What is the presentation of RDS?
Cyanosis, tachypnoea, chest in drawing, grunting
What is the main investigation for RDS?
CXR - bilateral, diffuse ground glass lungs
What is the management of RDS?
Antenatal dexamethasone to mothers of suspected preterm labour to increase surfactant
Intubation and ventilation
Endotracheal surfactant
What is bronchopulmonary dysplasia?
Impaired alveolar development in pre-term infants and require mechanical ventilation damaging their fragile lungs
What are the symptoms of bronchopulmonary dysplasia?
Breathing quickly
Nostril flaring
Grunting
Pulling at the chest
What is the treatment for bronchopulmonary dysplasia?
None specifically
Oxygen
Diuretics
Corticosteroids
What is meconium aspiration?
Meconium enters the respiratory tract and can cause mechanical obstruction and chemical pneumonitis
What is meconium composed of?
Skin, intestinal cells, hair, vernix and amniotic fluid
What are the features of meconium aspiration?
Respiratory distress, pneumonitis, pneumothorax, bacterial pneumonia
What are the investigations for meconium aspiration?
Pre and post ductal saturations to assess respiratory involvement and detect congenital cardiac lesions
Capillary gas
FBC
CRP
CXR
What is the management of meconium aspiration?
Endotracheal suction for prevention
Oxygen therapy
Antibiotics
Surfactant
What is HIE?
Hypoxia during birth
What can HIE lead to?
Permanent brain damage causing cerebral palsy
What are some causes of HIE?
Maternal shock
Asphyxia
Intrapartum haemorrhage
Prolapse cord
Nuchal cord
What is the staging for HIE?
Sarnat Staging (mild, moderate and severe)
What is the management of HIE?
Neonatal resuscitation
Circulatory support
Nutrition
Acid base balance treatment
Therapeutic hypothermia
What does TORCH stand for?
Toxoplasmosis
Rubella
CMV
HSV
HIV
Zika
What are TORCH infections?
An infection of the developing foetus or newborn that can occur in utero, delivery or after birth
How are TORCH infections transmitted?
Placenta, passing through the birth canal or through breastmilk
What are some shared symptoms of TORCH infections?
Fever, lethargy, cataracts, jaundice, hepatosplenomegaly, low birth weight, hearing loss
What rash is often seen in TORCH infections?
Blueberry muffin rash
What is toxoplasmosis?
Protozoan parasite transmitted via undercooked meats and cat faeces
How do you treat toxoplasmosis?
Pyrimethamine and sulfadiazine
What can Zika cause in pregnancy?
Microcephaly
Foetal growth restriction
Cerebellar atrophy
What are some investigations for TORCH infections?
Prenatal USS
PCR
Viral culture
CT scans
What are some causes of increased bilirubin production?
Haemorrhage
ABO incompatibility
Haemolytic disease of the newborn
Polycythaemia
Sepsis and DIC
What are some causes of decreased bilirubin clearance?
Prematurity - immature liver
Breast milk jaundice
Neonatal cholestasis
Gilbert syndrome
What are some investigations for neonatal jaundice?
FBC and blood film
Conjugated bilirubin
Blood type testing
Thyroid function
What is a treatment for neonatal jaundice?
Phototherapy - blue light breaks down bilirubin
Exchange transfusions
What is kernicterus?
Bilirubin crossing the blood-brain barrier causing CNS damage
What is necrotising entercolitis?
Part of the bowel becomes necrotic and can lead to perforation, peritonitis and shock
What are some risk factors for necrotising enterocolitis?
Very low birth weight or premature
Formula feeds
Respiratory distress
Assisted ventilation
Sepsis
PDA
What is the presentation of necrotising entercolitis?
Intolerance to feeds
Vomiting - green bile
Generally unwell
Distended tender abdomen
Absent bowel sounds
Blood in stools
What are some investigations for necrotising entercolitis and what is the gold standard?
Gold - X-ray showing dilated loops of bowel
CRP
DBC
U&E
What is the management of necrotising entercolitis?
NBM with IV fluids
NG tube to drain fluid and gas
Surgical emergency - remove dead bowel tissue
What is gastroschisis?
Foetal abdominal organs protrude outside the abdomen with no protective membrane coating
What are some risk factors for gastroschisis?
Maternal smoking
Maternal age under 20
Environmental exposures
Aspirin and ibuprofen
What is the presentation of gastroschisis?
Visible at birth or on USS at 20 weeks
Omphalocele
What is the management of gastroschisis?
Sterile clear covering over the herniated contents such as cling film
Surgery to reduce organs and close abdominal wall defect
NG tube to decompress bowel
What is oesophageal atresia?
Congenital birth defect with incomplete formation of the oesophagus
Upper and lower oesophagus and stomach do not connect
What does oesophageal atresia cause?
A pouch so food doesn’t reach the stomach
What does oesophageal atresia occur alongside?
Tracheo-oesophageal fistula - connection between lower oesophagus and trachea
What are the causes of oesophageal atresia?
Polyhydraminos
VACTERL conditions
What are the symptoms of oesophageal atresia?
Aspiration pneumonia at any feeding attempt
Excessive secretions
Coughing
Cyanosis
Failure to thrive
White frothy bubbles in the mouth
What are the investigations for oesophageal atresia?
USS
Feeding tube to see if it reaches the stomach
X-ray
What is the treatment for oesophageal atresia?
Surgical repair
IV nutrition and suction tube
Antibiotics
When are most cases of gestational diabetes diagnosed?
Routine testing at 24-28 weeks
What are some complications of gestational diabetes?
Marcosomia (large baby)
Increased risk of shoulder dystocia
Neonatal hypoglycaemia
Hyperbilirubininaemia
What is shoulder dystocia?
Shoulder stuck at pubic bone during delivery
What are some risk factors for gestational diabetes?
Previous GDM
Over 35 years
Obesity
PCOS
Smoking
Family history of T2DM
What are the investigations for gestational diabetes?
Oral glucose tolerance test at 24-28 weeks
HbA1c
Foetal USS every 4 weeks from 36-38 weeks
What is the management of gestational diabetes?
Glucose monitoring
Diet
Exercise
Metformin and insulin if exercise and diet cannot control
What is hypoglycaemia?
A blood glucose of less than 2.6 mmol/L
What are the risk factors for hypoglycaemia?
Gestation/ prematurity under 37 weeks
Maternal beta blocker use
Infant of a diabetic mother
Hypothermia
Cord pH of less than 7.1
Inborn errors of metabolism
What is the presentation of hypoglycaemia?
Hypotonia
Lethargy
Poor feeding
Hypothermia
Apnoea
Irritability
Pallor
What is the treatment for hypoglycaemia?
IV dextrose infusion as a bolus then continuous infusion
IM glucagon
Keep them ‘warm, pink, sweet and calm’
What is group B strep?
Lives in rectum or vagina and normally harmless but it can cause meningitis and sepsis
What are some risk factors for group B strep infection?
Premature baby, previous GBS infection, fever during labour, waters broken more than 24 hours before birth
What is cleft lip/ palate?
Congenital condition with split or open section of the upper lip
Palate - defect in the hard or soft palate at the roof of the mouth
What are some complications of cleft lip/ palate?
Feeding, swallowing and speech problems
Psycho-social implications
Hearing problems
Ear infections
Glue ear
What is the management of cleft lip and palate?
plastic, maxillofacial and ENT surgeons
Dentists
SLT
Surgery - lip at 3 months and palate at 6-12 months
When are the effects of alcohol in pregnancy the greatest?
First 3 months - can lead to miscarriage, small for dates and premature delivery
What are some features of foetal alcohol syndrome?
Microcephaly
Thin upper lib
Small flat philtrum
Short palpebral fissure
Learning disability
Cerebral palsy
What is pathognomic of NEC?
Pneumatosis intestinalis/ gas in the gut wall
