neonatology Flashcards
what is an inguinal hernia
weakness in the muscle around the groin, resulting in a loop of bowel bulging through
in babies, is an inguinal hernia congenital or acquired
congenital
how does an inguinal hernia present in babies
bulging of the testes
complications of inguinal hernias
bowel obstruction and perforation
what is a meconium ileus
neonatal bowel obstruction of the distal ileum due to abnormally thick and impacted meconium
what does meconium ileus usually indicate
cystic fibrosis
investigation of a meconium ileus
x-ray with contrast
what must be ruled out in a baby with bilious (green) vomiting
malrotation
investigation for malrotation
upper GI contrast and follow through
what is jejunal atresia
congenital abnormality characterised by obliteration of the lumen of the jejunum
what is associated with duodenal atresia
down syndrome
clinical presentation of jejunal atresia
abdominal distension and bilious vomiting within the first 24 hrs after birth
investigation of jejunal atresia
x-ray
what is intraventricular haemorrhage
bleeding into the ventricles inside the brain
who is at most risk of intraventricular haemorrhage in neonates
premature infants
what is the most common type of intraventricular haemorrhage in neonates
germinal matrix
at what point in gestation does the risk of interventricular haemorrhage significantly decrease
35-36 weeks as the germinal matrix baso disappears at this point
what is necrotising enterocolitis
where part of the bowel becomes necrotic
who is at risk of necrotising enterocolitis
premature neonates
what can cause necrotising enterocolitis
premature baby being fed too early
pathophysiology of necrotising enterocolitis
serious intestinal injury to a relatively immature gut resulting in perforation
clinical presentation of necrotising enterocolitis
intolerance to feeds
vomiting
distended, tender abdo
absent bowel sounds, blood in stools
what is used to investigate suspected necrotising enterocolitis
abdo x-ray
clinical signs of necrotising enterocolitis
(on abdo x-ray)
dilated loops of bowel
bowel wall oedema, gas
what can gas in the peritoneal cavity indicate
bowel perforation
management of necrotising enterocolitis
nil by mouth, clindamycin, cefotaxime
IMMEDIATE referral to surgical team
what is hydrocephalus
CSF buildup within the brain and spinal chord
what causes hydrocephalus
over production of CSF or problem with drainage
clinical presentation of hydrocephalus
enlarged or rapidly increasing head circumference
bulging anterior fontanelle
poor feeding and vomiting
management of hydrocephalus
ventriculoperitoneal shunt
what is neonatal hypoglycaemia
BGL < 2.6
name some factors that may contribute to neonatal hypoglycaemia
preterm, small for gestational age, low birth weight
infant of diabetic mother
hypothermia
infection/sepsis
neonatal abstinence syndrome
clinical presentation of neonatal hypoglycaemia
lethargy
jitteriness
seizure activity
management of neonatal hypoglycaemia
early feed and keeping baby warm to prevent
feeding: enterally if safe, IV glucose if not
who does neonatal respiratory distress affect
75% of infants born before 29 weeks
pathophysiology of respiratory distress of the newborn
not enough surfactant so high surface tension in the alveoli
lung collapse -> inadequate gas exchange
clinical presentation of respiratory distress of the newborn
tachypnoea, grunting, intercostal recession, nasal flaring, cyanosis
investigation for respiratory distress of the newborn
CXR
clinical finding of investigation of respiratory distress of the newborn
ground glass appearance and air bronchograms
how to prevent respiratory distress in potentially preterm babies
steroids
management of neonatal respiratory distress
surfactant replacement, ventilation
name 2 metabolic causes of neonatal respiratory distress
acidosis
hypoglycaemia
name 2 haematological causes of neonatal respiratory distress
polycythaemia, blood loss/anaemia
name 3 neurological causes of neonatal respiratory distress
seizures
intracranial bleed
withdrawal
name a congenital cause of neonatal respiratory distress
congenital lung malformations
define preterm
a birth that occurs before 37 weeks of gestation
define a term birth
between 37-42 weeks of gestation
define post-term birth
occurs after 42 weeks of gestation
what is defined as a normal birth weight
2.5kg - 4kg
when, during gestation, does most weight gain occur
3rd trimester
at what part during labour is the baby in a hypoxic environment
during contractions
what is used to measure perinatal adaptation
APGAR score
why is vitamin K offered in the newborn period
prevents haemorrhagic disease of the newborn
what is haemorrhagic disease of the newborn
vitamin K dependent clotting disorder
what is the preferred route of administration of vitamin K during the new born period
IM
name some risk factors for having a preterm birth
past history of preterm births
abnormally shaped uterus
multiple pregnancy
IVF
smoking, alcohol, drugs
interval <6 months between pregnancies
name some ways we can manage neonatal hypothermia
wraps/bags
skin-skin care
transwarmer mattress
incubators
why are neonates at an increased risk of nutritional compromise (4)
limited reserves
gut immaturity
immature metabolic pathways
increased demands
when does retinopathy of prematurity usually occur
6-8 weeks after delivery
define the neonatal period
the first 28 days of life
scoring system of APGAR
total score of 1-10
what does APGAR stand for
appearance
pulse
grimace
activity (muscle tone)
respiration
name 3 respiratory problems of a term infant
transient tachypnoea of the newborn
pneumothorax
congenital respiratory disease
give 2 examples of congenital respiratory diseases
tracheo-oesophageal fistula
diaphragmatic hernia
who is TTN most common in
term infants delivered by caesarean
what is TTN
transient tachypnoea of the newborn
management of TTN
nothing - resolves over the first 24 hours of life
what causes TTN
fluid in the lungs doesnt clear away after birth
CXR of TTN
shows fluid in the horizontal fissure
what causes early onset neonatal sepsis
bacteria acquired before and during delivery
organisms associated with early onset neonatal sepsis
group B strep
gram negatives
what causes late onset neonatal sepsis
bacteria acquired after delivery
organisms associated with late onset neonatal sepsis
coagulase negative staph
gram negatives
staph aureus
name 3 risk factors of neonatal sepsis associated with premature infants
immature immune enviro
intensive care enviro
indwelling tubes and lines
name some symptoms of neonatal sepsis
temperature instability
reduced tone and activity
poor feeding
vomiting
what is the most common cause of jaundice within the first 24 hours of life
neonatal sepsis
management of neonatal sepsis
benzylpenicillin and gentamicin
what causes neonatal jaundice
hyperbilirubinemia
name some risk factors for developing significant hyperbilirubinaemia
lower gestational age, jaundice within first 24 hrs, haemolysis, G6PD deficiency, diabetic mothers
pathophysiology of neonatal jaundice
reticuloendothelial cells maintain normal RBCs by destroying old and abnormal cells
name 5 causes of unconjugated neonatal jaundice
physiological
breast milk jaundice
haemolysis
hypothyroidism
infection/sepsis
what may be the earliest sign of hypothyroidism in neonates
persistent jaundice
clinical presentation of breast milk jaundice
persistent jaundice in an otherwise healthy, breast-fed baby
management of breast milk jaundice
reassurance
what causes physiological jaundice to be exaggerated in preterm babies
immature liver
how long does physiological jaundice usually lasy
around 2 weeks
name 4 causes of conjugated neonatal jaundice
biliary atresia
hepatitis
TPN
genetic conditions
name 2 genetic conditions that may cause neonatal jaundice
CF, down syndrome
define prolonged jaundice in a term baby
lasting longer than 14 days
define prolonged jaundice in a preterm baby
lasting longer than 21 days
what neonatal jaundice is always pathological
jaundice in the first 24 hours
investigations for early neonatal jaundice (3)
FBC, SBR, DCT
investigations of prolonged neonatal jaundice (4)
FBC, LFTs, SBR, TFTs
management of early neonatal jaundice
phototherapy
adequate hydration
how does phototherapy help treat neonatal jaundice
lowers serum bilirubin level by transforming it into water soluble without conjugation in the liver
name 2 rare complications of prolonged neonatal jaundice
encephalopathy
hearing impairment
name 3 possible complications of using phototherapy to treat neonatal jaundice
increased water loss
circadian rhythm disorder
bronze baby syndrome
clinical presentation of biliary atresia
pale, clay-coloured stools and dark urine
management of biliary atresia
portoenterostomy before 3 months of age
what is neonatal abstinence syndrome
withdrawal symptoms that happens in neonates of mothers that used substances in pregnancy
name some substances that can cause neonatal abstinence syndrome
opiates
methadone
benzos
alcohol
SSRIs
clinical presentation of neonatal abstinence syndrome
irritability, tremors, seizures
sweating, unstable temp, tachypnoea
poor feeding, hypoglycaemia
how is neonatal abstinence syndrome measured
modified finnegan score
management of neonatal abstinence syndrome
mums breastmilk for weaning
oral morphine
what is birth asphyxia
when a baby doesn’t receive enough oxygen before, during or just after birth
name some causes of birth asphyxia
maternal shock
intrapartum haemorrhage
prolapsed chord
nuchal chord
what is a nuchal chord
where the chord is wrapped around the neck of the baby
name a complication of birth asphyxia
hypoxic ischaemic encephalopathy
what is another name for neonatal hypotonia
floppy baby
what is neonatal hypotonia
baby with low muscle tone
