Neonatology 2 Flashcards
A 3 day old neonate is brought into the paediatric assessment unit due to purulent discharge from his eyes + swollen eyelids.
How would you assess + manage this patient?
- Urgent swab of discharge to microbiology.
- Give single dose IM/IV CEFOTAXIME for possible gonococcal infection whilst awaiting swab results
- If results suggest chlamydia give:
- PO/IV ERYTHROMYCIN 14 days
- PO AZITHROMYCIN 3 days (2nd line)
You review a neonate who was born 12hrs previously and notice a swelling on his head. What is your differential for neonatal head lumps and how would you distinguish?
- CAPUT SUCCEDANEUM
- oedema of presenting part
- skin swelling not limited by suture lines (crosses midline)
- presents right after delivery and resolves over days - CEPHALOHAEMATOMA
- bleeding between bone + periosteum
- fluctuant swelling limited by suture lines
- presents right after delivery and resolves over weeks - SUBAPONEUROTIC HAEMATOMA
- bleeding between aponeurosis + periosteum
- fluctuant swelling not limited by suture lines that may shift with movement
- develops 12-72hrs after delivery
- can cause rapid loss of intravascular volume (tachycardia, pallor) and may require fluid resuscitation and surgical evacuation
A male baby was delivered at 36/40 by C-section due to IUGR. Within minutes of delivery, respiratory distress + grunting were noted. What is your differential diagnosis?
- Transient tachypnoea of the newborn
- Respiratory distress syndrome
- Congenital heart defects e.g. TOF, TGA
- Congenital resp. defects e.g. diaphragmatic hernia, choanal atresia
A male baby was delivered at 36/40 by C-section due to IUGR. Within minutes of delivery, respiratory distress + grunting were noted. TTN is diagnosed. How would you manage him?
Assess requirement for respiratory support and consider:
- supplement O2 or CPAP
- witholding feeds during episodes of tachypnoea
A male baby was delivered at 36/40 by C-section due to IUGR. Within minutes of delivery, respiratory distress + grunting were noted. You suspect RDS. How would you diagnose and manage him?
Diagnosis:
- CXR: bilateral ground glass appearance + air bronchograms
- SpO2 + blood gas monitoring
Management:
- delivery room resuscitation as required
- respiratory support e.g. high-flow nasal cannulae, CPAP, intubation + ventilation
- surfactant therapy via catheter or ETT