Neonatology Flashcards
When is the neonatal period?
First 28 days of life
What is measured in the Apgar score?
Appearance - Pale, blue, pink
Pulse - Absent, 100
Grimace - No response, grimace, sneeze/cough/pulls away
Activity (tone) - Absent i.e. floppy, arms and legs flexed, arms and legs actively moving
Respiration - Absent, slow/irregular, good and crying
What is the process of resuscitation for a newborn?
- Dry baby, remove wet clothes, start the clock
- Initial assessment, call for help
- Maintain airway by keeping head neutral
- Breathing - Inflation breaths if no effort, may need face mask or even intubation
- Circulation - Compressions are done 3:1 in neonates
What is therapeutic hypothermia and when is it used?
Used in babies with hypoxic-ischaemic encephalopathy to reduce the risk of secondary brain damage after ischaemic insult. Baby is cooled to 35.5 degrees within 6 hours of birth and maintained at this temperature for 72 hours before slow rewarming happens (0.5 degrees every 2 hours)
List 5 important problems which are commonly faced by premature infants
Respiratory Distress Syndrome Intraventricular Haemorrhage Patent Ductus Arteriosus Necrotising Enterocolitis Retinopathy of Prematurity
What are the appearances on a chest x-ray of respiratory distress syndrome in a preterm infant?
Ground glass appearance
Bronchograms
Increased lung opacity
May be reduced lung volume
Why does respiratory distress syndrome happen?
Affects preterm infants due to lack of surfactant production.
What is the treatment for respiratory distress syndrome in a preterm infant?
Surfactant administration via nasotracheal tube
Oxygen via CPAP or mechanical ventilation
Which site of the brain is usually affected by intraventricular haemorrhage?
The germinal matrix above the caudate nucleus
What is the management of intraventricular haemorrhage?
Therapeutic lumbar puncture to relieve pressure
Shunt if LP fails
What diagnostic tool is used to investigate and intraventricular haemorrhage in neonates?
Cranial ultrasound
What is the grading system for intraventricular haemorrhage?
I = Isolated germinal matrix haemorrhage II = Intraventricular haemorrhage without ventricular dilatation III = Intraventricular haemorrhage with ventricular dilatation IV = Intraventricular haemorrhage with associated parenchymal haemorrhage
When should jaundice in a neonate be investigated?
- If occurs within first 24 hours of life
- If lasts for more than 2 weeks in term babies or more than 21 days in preterms
- If levels are rapidly rising (>100Umol/L/24hrs)
- > 250umol/L by 48hrs or >200umol/L by 96hrs
- Conjugated hyperbilirubinaemia
What are the causes of physiological jaundice?
Breast feeding Haemolysis Increased enterohepatic circulation Immature hepatic enzymes Increased RBC turnover
What are the causes of non-physiological jaundice?
Haemolysis: Rhesus disease, ABO incompatibility, G6PD deficiency, hereditory spherocytosis, pyruvate kinase deficiency, alpha-thalassemia
Polycythemia
Extravasated blood
Liver enzyme deficiencies
What is the most likely cause of jaundice occurring in the first 24 hours of life?
Haemolysis
What are the treatment options for managing neonatal jaundice?
- Optimise hydration
- Phototherapy
- Exchange transfusion
Why is it important to keep neonatal bilirubin levels at acceptable levels?
Risk of kernicterus if bilirubin levels are too high
Which conditions are tested for in the neonatal screening ‘Guthri’ test?
Congenital hypothyroidism
Cystic fibrosis
Haemoglobinopathies (Sickle cell, thalassaemia)
Phenylketonuria (PKU)
MCADD (Medium-chain acyl-coA dehydrogenase deficiency)
What is the probably cause of necrotising enterocolitis?
Ischaemia of the bowel wall and infection from organisms colonising the bowel
What is the presentation of necrotising enterocolitis?
Stops feeding Distended abdomen Milk aspiration Vomiting - may be bile stained Blood stained stool Shock Apnoea
What is the characteristic appearance of necrotising enterocolitis on abdominal x-ray?
Distended bowel loops
Intramural thickening due to gas in the bowel wall
Air in portal tract
Bowel perforation
What is the treatment for necrotising enterocolitis?
Stop oral feeds and start enteral feeding
Cardiopulmonary support
Broad spectrum antibiotics to cover a range of organisms e.g. penicillin, gentamicin, metronidazole
Surgery to repair perforation
True / False: It is standard practice to resuscitate a baby at 22+3 weeks gestation
False - It is standard practise NOT to resuscitate a baby under 23 weeks gestation
What is measured in a neonatal ‘septic screen’?
Full blood count
Blood cultures
CRP
What is the most common congenital infection?
Cytomegalovirus
List some causes of conjugated hyberbilirubinaemia in the neonate
Bile duct obstruction Neonatal hepatitis Biliary atresia Bacterial sepsis Cystic fibrosis
Prolonged neonatal jaundice can be divided into what two categories?
Unconjugated
Conjugated
List some causes of UNconjugated prolonged neonatal jaundice
Infection, particularly UTIs
Hypothyroidism
Haemolysis e.g. G6PD deficiency
Galactosaemia
High GI obstruction e.g. pyloric stenosis
Liver enzyme deficiency e.g. Crigler-Najjar syndrome
What is a Kasai procedure?
Performed in the management of biliary atresia in the neonate to allow bile to drain
