Neonatology Flashcards
What is the significance of jaundice in the first 24 hours of life
it is always pathological
What are the causes of jaundice in the first 24 hours of life?
- rhesus haemolytic disease
- ABO haemolytic disease
- hereditary spherocytosis
- glucose-6-phosphodehydrogenase deficiency
When is jaundice considered physiological in the neonatal period
2 - 14 days
Explain the pathophysiology of physiological neonatal jaundice
- high [RBC] in fetus that are more fragile
- fetal RBCs break down more rapidly than normal RBCs
- less developed liver function means at birth, bilirubin can’t be excreted fast enough
In which type of infants is physiological jaundice more commonly observed?
more commonly seen in breastfed babies
What is prolonged jaundice in the neonate
jaundice after 14 days in term infants and 21 days in preterm
Give 5 causes of prolonged jaundice
- biliary atresia
- hypothyroidism
- breast milk jaundice
- prematurity
- UTI/ congenital infections
How is neonatal jaundice investigated
- FBC and blood film
- conjugated and unconjugated bilirubin
- Direct Coombs test - direct antiglobulin test
- thyroid function tests
- U&Es and LFTs
How is neonatal jaundice managed
- bilirubin monitored and plotted on treatment threshold charts for specific gestation
- phototherapy if above threshold
- closely monitor bilirubin during phototherapy
- Recheck bilirubin 12-18 hours after stopping
- exchange transfusion if bilirubin is extremely high
What is a complication of neonatal jaundice
Kernicterus
What is kernicterus
bilirubin induced encephalopathy and irreversible neurological damage
What is necrotising enterocolitis
acute inflammatory disease affecting premature neonates, where part of the bowel becomes necrotic
Give 3 RFs of necrotising enterocolitis
- very low birth weight/ prematurity
- antibiotic therapy >10 days
- formula feeds
How does necrotising enterocolitis present
- new feed intolerance
- Vomiting, particularly with green bile
- Generally unwell/ sepsis
- Distended, tender abdomen
- Absent bowel sounds
- fresh blood in stools
What blood tests are conducted for necrotising enterocolitis ?
- FBC - check for thrombocytopenia and neutropenia
- CRP to assess inflammation
- blood gas to check for metabolic acidosis
- Blood culture for sepsis
What is the imaging investigation of choice for diagnosing necrotising enterocolitis?
abdominal X-ray, performed in the supine position (lying face up).
What X-ray findings are indicative of necrotising enterocolitis?
- Dilated bowel loops
- Bowel wall oedema (thickened bowel walls)
- Pneumatosis intestinalis - gas in the bowel wall
- Pneumoperitoneum is free gas in the peritoneal cavity and indicates perforation
- Gas in the portal veins
- Rigler sign - air both inside and outside of the bowel wall
How is necrotising enterocolitis managed
- nil by mouth with parenteral nutrition
- IV fluids
- bowel decompression by NG tube
- broad spec IV antibiotics
- perforations -> laparotomy
What are the serious complications associated with necrotising enterocolitis?
- Death of bowel tissue, which can lead to bowel perforation
- Bowel perforation leading to peritonitis and shock
- sepsis
- death
What is the pathophysiology of respiratory distress syndrome
- Inadequate surfactant leads to high surface tension within alveoli, resulting in lung collapse
- This hinders lung expansion, causing inadequate gaseous exchange and leading to hypoxia, hypercapnia and respiratory distress
Which maternal condition is linked to higher rates of neonatal respiratory distress syndrome?
more common in infants born to mothers with diabetes mellitus
What causes increased risk of neonatal respiratory distress syndrome in infants of diabetic mothers?
increased insulin inhibits surfactant production and maturation of the fetal lungs.
What is the role of antenatal steroids in managing respiratory distress syndrome
Antenatal steroids (e.g., dexamethasone) given to mothers with suspected or confirmed preterm labour increases surfactant production, reducing the incidence and severity of RDS in the baby
What management options are available for premature neonates with respiratory distress syndrome
- Intubation and ventilation for severe respiratory distress
- artificial surfactant delivered via an endotracheal tube
- Continuous positive airway pressure (CPAP) via a nasal mask
- Supplementary oxygen to maintain saturations between 91-95%
- Gradual reduction of support as the baby develops
What are the short-term complications of respiratory distress syndrome
- Pneumothorax
- Infection
- Apnea
- Intraventricular haemorrhage
- Pulmonary haemorrhage
- Necrotising enterocolitis
What are the long-term complications of respiratory distress syndrome
- Chronic lung disease of prematurity
- Retinopathy of prematurity
- Neurological, hearing, and visual impairment
When is neonatal blood spot screening performed?
5-9 days of life.
Give 4 conditions that are screened for in neonatal blood spot screening?
- Congenital hypothyroidism
- Cystic fibrosis
- sickle cell disease
- Phenylketonuria
