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neonatology Flashcards

1
Q

what is preterm, term and post term?

A

preterm = before 37 wks
term = 37-42 wks
post term = after 42 wks

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2
Q

what is normal weight, small & large at birth?

A

normal weight = 2.5kg-4kg (5.5lb-8.8lbs)
small = under 2.5kg (5.5 lbs)
large = over 4kg (9lbs)

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3
Q

what transplacental transfers happen in 3rd trimester?

A
  • iron
  • vitamins
  • calcium
  • phosphate
  • antibodies
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4
Q

what is challenge for baby during contractions?

A

during contractions = baby in hypoxic environment - foetal Hb helps release oxygen but prolonged labour challenges this

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5
Q

what can be result of placental insufficiency?

A

not enough nutrients & support so tricky for baby to cope in hypoxia

(placental insufficiency can be due to maternal smoking, drug use, pre eclampsia)

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6
Q

why can too small or too big baby be bad in labour?

A

too small = not enough reserves
too big = tricky to get out

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7
Q

what is role of cortisol & adrenaline in birth?

A

they’re released as stress response in labour = this enhances perinatal adaptation (surviving out of womb)

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8
Q

what does 1st breath/cry cause? (like in lungs)

A

it causes alveolar expansion prompting change from foetal to newborn circulation (decreased pulmonary arterial pressure)

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9
Q

what score measures perinatal adaptation?

A

apgar score = quick examination done at 1 min and 5 min

A = appearance (colour of baby)

P = pulse (150 bpm)

G = grimace (reflex, is face screwed up, responding properly)

A = activity (floppy or flexed)

R = respiration

get 0,1,2 for each thing (score of 10 is quite rare tho)

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10
Q

what are main helps needed for baby immediately after birth?

A
  • need to be warm
  • need skin to skin contact
  • don’t need much calorific intake in 1st 24hrs
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11
Q

why is vitamin K given in newborn period?

A

usually given IM vit K to prevent haemorrhagic disease of newborn

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12
Q

what infections are screened for in new born, what vaccinations needed?

A

screen for = hep B, hep C, HIV, syphilis, TB, group B strep (neonatal sepsis)

vaccinate = maternal pertussis & influenza vaccine, hepB at birth, BCG in 1st month

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13
Q

what are screening tests done in newborns?

A
  • newborn examination
  • universal hearing screening
  • hip screening
  • cystic fibrosis
  • hypothyroid
  • haemoglobinopathies
  • metabolic disease (maple syrup urine disease, MSUD, & phenylketonuria, PKU)
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14
Q

what are some risk factors for preterm baby?

A
  • previous preterm deliveries
  • abnormal shaped uterus
  • multiple pregnancies
  • conceiving through IVF
  • smoking, drugs, poor nutrition, miscarraiges
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15
Q

what is management of preterm infant?

A
  • delay cord clamping which gives more time for blood & nutrients from placenta to baby
  • keep baby warm with plastic bag & radiant heater/hat
  • gentle lung inflation, PEEP important (keeping alveoli open, as they have more fragile lungs)
  • use of saturation monitor like oxygen etc ( as have fewer reserves & don’t breathe effectively)
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16
Q

what are some common problems for preterm infants? (just super big list)

A
  • hypothermia (due to low basal metabolic rate)
  • growth & nutrition impairment due to limited reserves, gut immaturity, immature metabolic pathways
  • resp immaturity & issues (resp distress, apnoea, bronchopulmonary dysplasia, patent ductus arteriosus)
  • neonatal sepsis
  • retinopathy of prematurity
  • hypoglycaemia/hyponatraemia
  • osteopenia
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17
Q

what is neonatal hypotonia? causes? manage?

A

= floppy baby

  • loads of causes that don’t need to know = main few examples = spinomascular atrophy, myotonic dystrophy (shake hand, can’t let go), spinal muscular dystrophy, prader will syndrome (babies tricky to feed, obese when older)

*different management depending on cause = resp or feeding support may be needed some might be fine etc

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18
Q

what is presentation of floppy baby? (neonatal hypotonia)

A
  • rag doll
  • slips out hands
  • lack head control
  • frog legged (legs naturally abduct when sit in cot)
  • might have difficulty breathing/feeding
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19
Q

what investigations can be done for neonatal hypotonia?

A
  • bloods = genetic, metabolic, congenital, CK
  • imaging = cranial USS, MRI (looking for cause)
  • full examination, testing strength
20
Q

what is usually the cause of early & late onset neonatal sepsis?

A

early = usually due to bacteria acquired before or after delivery e.g. group B strep, gram negatives

late = usually acquired after delivery (in hospital or community) from coag -ve staph, staph aureus

21
Q

what are risk factors for neonatal sepsis?

A

immature immune system, intensive care environment, indwelling tubes & lines

22
Q

how does baby with neonatal sepsis present?

A
  • fever
  • reduced tone & activity
  • poor feeding
  • vomiting
  • resp distress
  • tachycardia
  • hypoxia
  • jaundice within 24hrs
  • seizures
  • hypoglycaemia
23
Q

how common is neonatal jaundice? why can be normal?

A

pretty common, 60% of term and 80% of preterm

  • can be normal since increased RBC breakdown & immature liver not being able to process high bilirubin concentration (this exaggerated in preterm since even more immature liver)

*immature liver can’t keep up

24
Q

what are some causes of neonatal unconjugated jaundice?

A

*unconjugated = before liver/at liver

  • normal (immature liver can’t keep up)
  • breast milk jaundice (just happens but resolves in 1.5-4 months)
  • haemolysis
  • infection (neonatal sepsis most common cause if within 24hrs)
  • inherited cause
  • intestinal obstruction
25
what are causes of conjugated neonatal jaundice?
*conjugated = after liver/gallbladder issues - biliary atresia - TPN (total parental nutrition) - hypothyroidism - genetic conditions
26
when is jaundice prolonged? (when you start to get more concerned?)
prolonged jaundice = over 14 days if term or over 21 days in preterm *so worrying if jaundice lasts too long or also if jaundice within first 24 hrs (think sepsis)
27
what are investigations to do if neonatal jaundice and think maybe concerning?
if within 1st 24 hrs = FBC, serum bilirubin, direct coombs if prolonged jaundice = FBC, LFTs, serum bilirubin, TFTs
28
what is treatment of early jaundice (first 24 hrs)?
- phototherapy - adequate hydration - resolve underlying cause
29
what is respiratory distress in newborn?
common in before 29 weeks preterm infants as at 29 wks is when start making surfactant *inadequate surfactant = high surface tension within alveoli = atelectasis (lung collapse) = hypoxia & hypercapnia (poor exchange)
30
what is presentation and management of respiratory distress in newborns?
PRESENT - tachypnoea - grunting - intercostal recessions - nasal flaring - cyanosis MANAGE - maternal steroid - surfactant replacement - ventilation
31
what is neonatal abstinence syndrome? presents? manage?
when mum takes drugs during pregnancy so baby gets withdrawal symptoms PRESENTS = irritability, tremors, seizures, sweating, unstable temp, tachypnoea, poor feeding, vomiting, hypoglycaemia MANAGE = try & know in advance so in hospital with monitoring via NAS chart (dim, quiet environment w gentle care)
32
what blood glucose level is neonatal hypoglycaemia?
<2.6 mmol/L
33
what are risk factors for neonatal hypoglycaemia?
- preterm - small for gestational age/low birth weight - diabetic mother - hypothermia - poor feeding - infection/sepsis - neonatal abstinence syndrome (mum took substances in pregnancy)
34
what is management of neonatal hypoglycaemia? how does baby present?
PRESENT - lethargy, jittery, seizure activity MANAGE = early feed & keep baby warm to prevent. feed either enterally or IV glucose if needed (if recurrent then hypoglycaemia screen)
35
what is birth asphyxia? causes?
when baby not enough oxygen, before, after or during birth CAUSES = maternal shock, intrapartum haemorrhage, prolapsed cord (compression of cord in birth), nuchal cord (cord wrapped around babies neck)
36
what is hypoxic ischaemic encephalopathy?
big complication of birth asphyxia - when multi organ damage due to tissue hypoxia can treat with therapeutic hypothermia = reduced risk of cerebral palsy, developmental delay, blindness & death
37
what is hydrocephalus? presentation? management?
CSF builds up within brain & spinal cord (either body makes too much or doesn't drain properly) PRESENTS = enlarged/rapidly increasing head circumference, bulging anterior fontanelle, poor feeding & vomiting, poor tone, sleepy MANAGE = ventriculoperitoneal shunt
38
what is necrotising enterocolitis?
disorder of premature neonates when part of bowel becomes necrotic (inflammation & gut dies) = it's serious injury due to immature gut (premature baby being fed too early) making perforation of bowel
39
what is presentation of necrotising enterocolitis?
- intolerance to feeds - vomiting (green bile) - generally unwell - distended & tender abdomen - absent bowel sounds - blood in stool
40
what is investigation of necrotising enterocolitis?
- abdo x-ray (dilated loops of bowel, bowel wall oedema, gas in bowel wall, gas in peritoneal cavity)
41
what is management of necrotising enterocolitis?
clindamycin & cefotaxime, immediate referral to neonatal surgical team
42
what is intraventricular haemorrhage? cause?
bleeding into ventricles in brain (mostly premature infants) CAUSE = germinal matrix (it's a highly vascular temporary structure in brain), by 35 wks germinal matrix disappeared (makes sense why more common if premature)
43
what is jejunal atresia?
congenital issue when destruction of jejunum lumen - baby gets abdominal distension & bilious vomiting within 24hrs of birth = needs surgery
44
what is meconium ileus?
meconium = newborns 1st stool - this is when neonate gets bowel obstruction due to abnormally thick & impacted meconium *usually manifests cystic fibrosis
45
what is inguinal hernia?
weakness in muscle around groin resulting in loop of bowel bulging through & causing limp
46
what is best 1st line antibiotic for neonate?
benzylpenicillin 1st line (since good for group B strep which is most severe cause of neonatal sepsis)
47
what can cause jaundice within first 24 hrs of life?
haemolytic disease of newborn & neonatal sepsis

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