Neonatology 2 Flashcards

1
Q

What are the dates for a term baby?

A

37-42 weeks

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2
Q

What are the symptoms of sepsis in a newborn?

A
  • Baby pyrexia or hypothermia
  • Poor feeding
  • Lethargy or irritable
  • Early jaundice
  • Tachypnoea (RR>60)
  • Hypo or hyperglycaemia
  • Floppy
  • Asymptomatic
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3
Q

What are the risk factors for a term baby developing sepsis?

A
  • PROM (prolonged ruptured membrane: >18 hours of labour)
  • Maternal pyrexia
  • Maternal GBS (group B strep) carriage
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4
Q

How is presumed sepsis managed in newborns?

A
  • 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 cardiovascular systems as required
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5
Q

What are the commonest causes of neonatal sepsis?

A
- *Group B strep*
□ Early onset: birth to 1 week
□ Late onset or recurrence: up to 3 months
□ Symptoms: may be non-specific
□ May have no risk factors
□ Complications
® Meningitis, DIC, pneumonia and respiratory collapse, hypotension and shock 
□ Prognosis – 4 to 30% mortality
- *E. Coli*
- Listeria
- Coagulase-negative staph.
- Haemophilus Influenzae
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6
Q

What are the congenital infections in newborns?

A
- ToRCH
□ Toxoplasmosis (and other including syphilis) 
□ Rubella
□ CMV
□ Herpes
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7
Q

What might congenital infections in newborns result in?

A
□ IUGR (intrauterine growth restriction) 
□ Brain calcifications
□ Neurodevelopmental delay
□ Visual impairment
□ Recurrent infections
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8
Q

What are the causes of respiratory distress syndrome?

A
  • Sepsis
  • TTN – transient tachypnoea of the new-born
  • Meconium aspiration
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9
Q

Talk about transient tachypnoea of the new-born

A
  • Self-limiting and common
  • Presents within 1st few hours of life
  • Clinically
    □ Grunting, tachypnoea, oxygen requirement, normal gases
  • Pathophysiology
    □ Delay in clearance of foetal lung fluids
  • Management
    □ Supportive, antibiotics, fluids, O2, airway support
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10
Q

What are the risk factors of meconium aspiration?

A

□ Postdates (aged placenta)
□ Maternal diabetes
□ Maternal hypertension
□ Difficult labour

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11
Q

What are the symptoms of meuconium aspiration?

A
□ Cyanosis
□ Increased work of breathing
□ Grunting
□ Apnoea
□ Floppiness
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12
Q

What investigations are done for meuconium aspiration?

A

□ Blood gas
□ Septic screen
□ CXR

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13
Q

What is the treatment for meuconium aspiration?

A
□ Suction below cords
□ Airway support- intubation and ventilation
□ Fluids and antibiotics
□ Surfactant 
□ NO or ECMO
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14
Q

What is the prognosis of meuconium aspiration?

A

□ Most do well
□ Some develop Persistent pulmonary hypertension of the new-born
□ There is an associated mortality

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15
Q

What investigations are done on the “blue baby”?

A
  • Examination and history
  • Sepsis screen
  • Blood gas and blood glucose
  • CXR
  • Pulse oximetry
  • ECG
  • Echo
  • (Hypoxia test)
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16
Q

What aree the diferentials for the “blue baby”?

A
  • (1) truncus arteriosus
  • (2) TGA
  • (3) tricuspid atria
  • (4) tetralogy of Fallot’s
  • (5) TAPVD
  • Hypoplastic left heart syndrome
  • Pulmonary atresia
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17
Q

Talk about hypoglycaemia and the new-born

A

○ If requires admission to NNU may still manage with enteral feeds
○ Monitor blood glucose
○ Start iv 10% glucose
○ Increase fluids
○ Increase glucose concentration (central iv access)
○ Glucagon
○ Hydrocortisone

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18
Q

Talk about hypothermia and the newborn

A

○ If unable to maintain temperature on PNW admit and place in incubator
○ Sepsis screen and antibiotics
○ Consider checking thyroid function
○ Monitor blood glucose

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19
Q

Talk about jaundice and the newborn

A

○ In severe jaundice may require admission for intensive phototherapy and/or exchange transfusion
○ Incubator and IV fluids may be required

20
Q

What are the causes of birth asphyxia?

A
  • Placental problem
  • Long, difficult delivery
  • Umbilical cord prolapse
  • Infection
  • Neonatal airway problems
  • Neonatal anaemia
21
Q

What are the stages of birth asphyxia?

A
- First
□ Within minutes without O2
□ Cell damage occurs with lack of blood flow and O2
- Second
□ Reperfusion injury 
□ Can last days or weeks
□ Toxins are released from damaged cells
22
Q

What is the management of birth asphyxia?

A
  • Supportive
  • Therapeutic hypothermia (cooling) – improves outcome especially in moderate group
  • Fluid restriction (avoid cerebral oedema)
  • Monitor for renal and liver failure
  • Respiratory support
  • Cardiac support
  • Treat seizures
23
Q

List some surgical problems newborns might have

A
  • Oesophageal atresia/ fistula
  • Duodenal atresia and other GI atresia
  • Causes of failure to pass stool
    □ Constipation
    □ Large bowel atresia
    □ Imperforate anus
    ® +/- fistula
    □ Hirschsprung’s disease
    ® When you don’t have the normal amount of nerves that are at the end of the bowel
    ® It means that the normal motility is not there
    □ Meconium ileus
    ® think cystic fibrosis
  • Abdominal wall defects
    □ Exomphalos
    □ Gastroschisis
  • Diaphragmatic hernia
24
Q

Talk about diagphragmatic hernias in newborns

A
□ 1 in 2500 births
□ 90% on left
□ Male > female
□ Can be syndromic
□ Usually pulmonary hypoplasia
□ Intubation at birth
□ Respiratory support
□ Surgery 
□ (ECMO)
25
Q

What is neonatal abstinance syndrome?

A

○ Withdrawal from physically addictive substances taken by the mother in pregnancy

  • Opioids (methadone, heroin)
  • Benzodiazepines
  • Cocaine
  • Amphetamines
26
Q

How is neonatal asbstinance syndrome diagnosed?

A
  • Finnegan Scores

- Urine toxicology

27
Q

How is neonatal abstinance syndrome managed?

A

○ Maternal co-morbidity (smoking, alcohol, blood born viruses, ill health)
○ Social & discharge planning
○ Treatment:
- Comfort (e.g. swaddling)
- Morphine
- Phenobarbitone
○ Main aim of the treatment is to comfort the baby, enable them to grow and feed and to prevent seizures which is on the extreme end

28
Q

What type of rashes might a postnatal infant get?

A
  • Benign
  • Milia
  • Malaria
  • Erythema toxicum neonatorum
    • maculo-papular rash
    □ Red background with small red papules
    □ 30 – 70% of normal term neonates.
    □ very rare in the pre-term.
    □ rash fades by end of 1st week
    □ no Rx is required.
  • Infections
  • Sebaceous nevus
29
Q

What birthmarks might a postnatal baby get?

A
  • Capillary haemangiomas (Strawberry naevus)
  • Mongolian blue spots
  • Port wine stains (Capillary vascular malformations)
  • Stork marks (Capillary vascular malformations)
  • Giant melanocytic naevi
  • Café au lait spots
30
Q

What is a capillary haemangioma?

A

□ A cluster of dilated capillaries which appears within the first month after birth.
□ Raised and bright red, with discrete edges, occurring in any part of the body.
□ Usually regresses after one year of age

31
Q

What is a mongolian blue spot?

A
□ Blue-grey pigmentations
□ Often : lower back + buttocks
□ Accumulation of melanocytes
□ Very common : races with pigmented skin
□ Less obvious as skin darkens
32
Q

What is a port wine stain?

A

□ Naevus flammeus
□ Present at birth, flat or slightly raised.
□ Caused by dilated, mature capillaries in the superficial dermis.
□ These do not regress.
□ Associations:
® Sturge Weber
® Klippel-Trenaunay

33
Q

What are stork marks?

A
□ Nevus simplex
□ light colour capillary dilatation
□ commonly at back of neck. 
□ Maybe along midline of face. 
□ Gradually fades 
□ within the 1st 2 years
34
Q

What is the energy triangle?

A
○ Pink
- Hypoxia/ anoxia
○ Warm
- Hypothermia
○ Sweet 
- Hypoglycaemia
○ If you have a baby with any one of these you need to monitor the others
35
Q

What babies are at risk of hypoglycaemia?

A
- Limited glucose supply
□ Premature babies
□ Perinatal stress
- Hyperinsulinism
□ Infants of diabetic mothers
- Increased glucose use
□ Hypothermia
□ Sepsis
36
Q

How is hypoglycaemia diagnosed in postnatal babies?

A
  • Hypoglycaemia= blood sugar<2.0mmol/l
  • Bedside testing can be inaccurate
    □ At low or high levels
    □ When there is poor prefusion
    □ When there is polycythaemia
    -Check a lab sample if there are any concerns
37
Q

What are the symptoms of hypoglycaemia in postnatal babies?

A
  • Jitteriness
  • Temperature instability
  • Lethargy
  • Hypotonia
  • Apnoea, irregular respirations
  • Poor suck / feeding
  • Vomiting
  • High pitched or weak cry
  • Seizures
  • Asymptomatic
38
Q

What should be done in resusitation and cold stress?

A
  • Dry quickly
  • Remove wet linens
  • Use warm towels/blankets
  • Provide radiant warmer heat
  • Use heated/humidified oxygen
39
Q

What are the advantages of breast feeding?

A
  • Reduces risk of allergic and inflammatory disorders
  • Protects against infection
  • Reduces risk of SIDS
  • Promotes mother and baby bonding
  • Reduces babies risk of obesity, cardiovascular disease and leukaemia
40
Q

What should be done for tonfue ties?

A
  • Short +/- thickened frenulum
  • Attached anteriorly
     base of the tongue
  • Mostly: no treatment necessary
  • Restriction of tongue protrusion beyond the alveolar margins AND feeding is affected
     frenotomy
41
Q

What GI problems can present in the postnatal period?

A
○ Vomiting
○ Posseting
○ Mucous vomits
○ Gastro-oesophageal reflux
○ Cow's milk protein intolerance 
○ Bilious vomiting
○ Failure to pass meconium
○ Bloody stools
○ Blood in vomit
42
Q

Talk about cleft lip in infants

A

○ 70% of cases also have cleft palate.
○ Can be incomplete (small gap in lip) or complete (continue into the nose)
○ Can be unilateral (left sided unilateral is most common) or bilateral (85% have palatal involvement)
○ Maxillary and medial nasal processes fail to merge, usually around 5 weeks gestation

43
Q

What issues are infants with cleft lip faced with?

A
- Feeding issues
□ Special bottles and teats
□ Can still attempt breast feeding 
- Airway problems
- Associated anomalies
□ Need hearing screen
□ Need cardiac echo
□ Remember trisomies
44
Q

What opthamology problems can present in the postnatal period?

A

○ Always check red reflexes
○ Cataracts
- lens opacification
- If undetected early could lead to blindness
- May require no treatment
- May require lens removal and artificial lens
○ Retinoblastoma
- Rare eye cancer which can be successfully treated if picked up early
- Laser therapy, chemo, surgical removal of eye

45
Q

What are spinal dimples?

A

○ 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, off midline, high or with other cutaneous maker (e.g. hairy tuft) → spinal imaging

46
Q

Talk about cephalohaematomas in the postnatal period

A

○ Localised swelling over one or both sides of the head
○ Becomes maximal in size by the 3rd to 4th day of life
○ Soft, non-translucent swelling
○ Limits are those of one of the cranial bones – usually parietal bone
○ Haemorrhage is beneath the pericranium
○ No treatment is required and resolution occurs in 3-4 weeks
○ Occasionally, if the haematoma is very large, the increased haemolysis results in increased or prolonged neonatal jaundice
○ No association with intracranial bleeding

47
Q

What is talipes?

A

○ Medial (varus) or lateral (valgus) deviation of the foot is often positional and requires no treatment other than physiotherapy
○ Fixed talipes requires more vigorous manipulation, strapping, casting or possibly surgery
○ Babies with significant talipes may also have developmental dysplasia of the hips