Neonatology Flashcards
what is the normal BP, RR and HR of a full term newborn?
BP:
- 1hr old: 70/44
- 1 day old: 70(+/-9)/42(+/-12)
- 3 days old: 77(+/-12)/49(+/-10)
RR: 30-60/min
HR:
- normal: 120-160bpm
- tachycardia: > 160bpm
- bradycardia: < 100bpm
how do newborn babies thermoregulate?
- Maternal thermoregulation in the womb.
- Newborn babies lack shivering thermo genesis thus need a metabolic production of the heat.
- Brown fat well innervated by sympathetic neurons.
- Cold stress leads to lipolysis and heat production.
what are some causes of a baby being born small for dates?
- maternal: smoking, maternal pre-eclamptic toxemia (PET)
- foetal: chromosomal (e.g. Edward’s syndrome), infection (e.g. CMV)
- placental e.g. abruption
- twin pregnancy
what are some common problems that can happen to a baby born small for dates?
- perinatal hypoxia
- hypoglycaemia
- hypothermia
- polycythaemia
- thrombocytopenia
- hypoglycaemia
- GI problems
- RDS, infection
What are some long-term problems associated with being born small for dates?
- hypertension
- reduced growth
- obesity
- ischaemic heart disease
what is considered pre-term and extremely pre-term?
- pre-term < 37w
- extremely preterm < 28w
what is considered a low, very low and extremely low birth weight?
- low: < 2500g
- very low: < 1500g
- extremely low: < 1000g
how can respiratory distress syndrome be prevented and treated?
- prevention: antenatal steroids
- early treatment: surfactant
- early extubation: non-invasive life support (N-CPAP), minimal ventilation (low tidal volume and good inflation)
hopw are minor respiratory problems such as apnoea/irregular breathing and desaturations in a pre-term infant treated?
- caffeine
- N-CPAP
jaundice treatment
- treat underlying cause
- hydrate
- phototherapy
- exchange transfusion
- immunoglobulin
how is cold stress treated?
- dry quickly
- remove wet linens
- use warm towels/blankets
- provide radiant warmer heat
- use heated/humidified oxygen
what is considered hypoglycaemia in a neonate?
blood sugar < 2.0mmol/l
what are symptoms/signs of hypoglycaemia in a neonate?
- jitteriness
- temperature instability
- lethargy
- hypotonia
- apnoea, irregular respiration
- poor sucking/feeding
- vomiting
- high pitched or weak cry
- seizures
- asymptomatic
why is it very important that the femoral pulses are palpated during the newborn examination?
- absent/weak femoral pulses can indicate coarctation of the aorta
what could the presence of spinal dimples indicate?
- can reveal a more serious abnormality involving the spine and/or spinal cord, such as spina bifida occulta which is the least serious form of spina bifida +/- tethered cord
- if the dimple is large, or midline, high, or with other cutaneous markers (e.g. hairy tuft) > spinal imaging
developmental dysplasia of the hip (DDH) tests
- Barlow
- Ortolani
DDH treatment
- goal: relocate head of femur to acetabulum so hip develops normally
- Pavlik harness
- surgical reduction
neonatal sepsis treatment
- admit NNU
- partial septic screen (FBC, CRP, blood cultures) and blood gas
- consider CXR, LP
- IV penicillin and gentamicin 1st line
- 2nd line IV vancomycin and gentamicin
- add metronidazole if surgical/abdominal concerns
- fluid management and treat acidosis
- monitor vital signs and support respiratory and CV systems as required
what are the 5 most common causative organsims in neonatal sepsis?
- group B streptococcus
- e.coli
- listeria
- coag-neg staphylococcus (if lines in situ)
- haemophilus influenzae
what is considered early and late onset GBS sepsis?
- early: birth to 1 week
- late: up to 3 months
GBS sepsis complications
- meningitis
- DIC
- pneumonia and respiratory collapse
- hypotension
- shock
what are some causes of RDS?
- sepsis
- TTN: transient tachypnoea of the newborn
- meconium aspiration
Meconium aspiration risk factors
- post dates
- maternal diabetes
- maternal hypertension
- difficult labour
meconium aspiration investigations
- blood gas
- septic screen
- CXR
differential cardiac diagnoses for the ‘blue baby’
5 Ts:
- truncus arteriosus
- TGA
- tricuspid atresia
- ToF
- TAPVD
how is neonatal hypoglycaemia treated?
- admission to NNU
- monitor blood glucose
- start IV 10% glucose
- increase fluids
- increase glucose concentration
- glucagon
- hydrocortisone
what are some causes of birth asphyxia?
- placental problem
- long, difficult delivery
- umbilical cord prolapse
- infection
- neonatal airway problem
- neonatal anaemia
describe the stages of birth asphyxia
1st:
- within minutes
- cell damage occurs with lack of blood flow and O2.
2nd:
- reperfusion injury
- can last days or weeks
- toxins are released from damaged cells
what are some causes of failure to pass stool in a neonate?
- large bowel atresia
- imperforate anus +/- fistula
- Hirchsprungs disease
- meconium plug
- meconium ileus, think cystic fibrosis
describe neonatal abstinence syndrome (NAS)
- withdrawal from physically addicitve substances taken by the mother in pregnancy such as opioids, benzos, cocaine, amphetamines
neonatal abstinence syndrome treatment
- comfort e.g. swaddling
- morphine
- phenobarbitone
hypoxic ischaemia encephalopathy treatment
- early supportive manahement
- cooling of baby
- treat seizures
- fluid restriction
