Neonatology Flashcards
Grade 1-4 IVh
I: germinal matrix 35%
II: extension into lat ventricles <50% space
III: haemorrhage occupying at least 50%
IV: parenchyma involvement
(50% withinin 24h most by 3 days)
Indomethacin action
Cyclooxygenase 1 and 2 inhibitor - decreases prostaglandin synthesis from arachidonic acid
Ibuprofen action
Cyclooxygenase 2 inhibitor
Less profound s/e
Spontaneous closure what percent PDA
30-65%
Which zero type GBS more common in meningitis/late onset
Type 3
Colonisation rate GBS
5-40%
RBC lifespan prem and term
35-50 days
60-70
Bw under 1500g or <28w behaviour outcome
> 11x increase depression, 2.6x increase ADHD
Same quality of life
Do preterm babies have increased insulin resistance later in life
Yes
Late preterm risk CP
> 3x more cf term
Anomalies percent in gastroschisis and omphalocoele
10% gastroschisis and 60% omohalocoele
Survival in 23/40, 24, 25, 27, >30
23: 15%
24: 66%
25: 80%
27: 90-95%
30: 97-99%
Severe neurological disability ELBW
10-20%
Infant of diabetics mother at risk for
An infant of a diabetic mother is at risk for hypoglycemia, hypocalcemia,
polycythemia, and neonatal small left colon syndrome.
Soy formula term and preterm
Indications (2)
Term is as good as cows milk formula for growth
Not for preterm
The most appropriate indications for soy formula are in infants with
galactosemia and congenital lactase deficiency (extremely rare)
Me onion aspiration cxr finding
Coarse opacities and hyperexpansion
Corkscrew on axr diagnostic for
Midgut volvulus
Infantile spasms treatment
Vigabatrin
HIE in term cooling temperature
33 degrees
Sats target <28w
90-95%
After 32w need higher sats for better eyes
What percent of CP from birth asphyxia
10%
Severe disability and dev delay in 22-27w what percent
3.7%
Normal volume ventilation baby per breath
4-5ml/kg/breath
HFOV under ventilated and under oxygenated change what settings
To improve ventilation (increase amplitude and then decrease Hz) AF
To improve oxygenation (increase MAP)
IVH 3 and 4 outcome severe impairment
3: 40-50%
4: 60-90%
CAP trial showed
Decreased disability and CP and death
Improved PDA and CLD
NEC likely to present when
Week 2-3
Triad of bloody stool, distension, bile aspirate
Stages of ROP
1-5
4: some retinal detachment
5: complete retinal detachment
Post natal steroids given and why
> 7 days because improves CLD but increased risk ROP (but not blindness)
Very high risks if given sooner
Delayed cord clamping other effects (apart from less blood transfusions)
Less IVH and NEC
Difference in QOL prem vs term
Very little difference in quality of life preterm/VLBW vs term control
IVF IUGR baby with high glucose and low insulin presenting in first 6 months
Neonatal diabetes Genetic links Transient 50% (comes back in adolescence) Permanent (Insulin and oral sulphonuria)
Bifid uvula genetic cause
Loews-Dietz syndrome
Congenital scoliosis also assoc with two other organ abnormalities
Heart and GU
Prem calories required
120kCal/kg/day
Apt Test for maternal blood pink test goes what colour if adult Hb denatured?
Yellow indicating presence of maternal blood not fetal
Kleihauer test is looking for
Quantitating fetal-maternal haemorrhage (differential resistance of fetal hb to acid)
Fergus with flat nasal bridge, wide spaces eyes, digital hypoplasia and CV abnormalities associated with
Phenytoin exposure
Fetal hydatoin syndrome
Most common type oesophageal atresia
Blind pouch with distal TOF
What immunoglobulin in breast milk most protective
IgA
Phenobarbitone is commonly used as the first line anticonvulsant in the treatment of neonatal
seizures. In what percentage of cases would you expect to achieve clinical control of seizures after a
loading dose of 20 mg/kg phenobarbitone?
40%
A six-month-old infant drinks 1000 ml of a standard cow milk formula daily. Approximately how much energy does the child get per day from his milk intake? A. 200 kcal (840 kJ) B. 500 kcal (2100 kJ) C. 670 kcal (2820 kJ) D. 810 kcal (3400 kJ) E. 1000 kcal (4200 kJ)
C
An infant is born at 26 weeks gestational with a birth weight of 750g. What are the expected insensible water losses (mls/kg/hour) on day one of life? A. 0.5 – 1.0. B. 2.0 – 3.0. C. 4.0 – 5.0. D. 8.0 –10.0. E. 12.0 – 15.0.
B
Mother first episode herpes risk to child if vaginal birth?
35-50%
If mother recurrent herpes then risk percent and plan?
3-5%
Cultures at 24-48h and then treat if symptoms or positive swab
Weight gain per week 1-3m 3-6m 61-12m
0 to 3 months
150 -200g/week
3 to 6 months
100 - 150g/week
6 to 12 months
Newborn serum creatinine reflects maternal in first ? Hours
48
What is essential for growth
Sodium
Hearing screen NZ and Aus uses
Automated auditory brainstem response (aABR)
Used to use automated otoacoustic emission (AOAE)
Difference between bochdalek and morgagni hernias
Morgagni on right side cf bochdalek left
Form of SCID with no hair and skin rash like eczema
Omenn syndrome
Risk factor for group b strep
Prematurity (young mum)
Antigen in neonatal alloimmune thrombocytopenia
Human platelet antigens (HPA-1a)
Guthrie TSH cf plasma is
Half
30% pier-robin sequence associated with what syndrome
Stickler
CF males percent infertility
99% azoospermia
Fetal Hb drops below 2% when
12m
Only trace 6-12m (10% at 6m)
What happens to SVR at birth
Due to loss of tremendous blood flow through the placenta, the systemic vascular resistance at birth doubles.
Which one of the following is the major cause of physiologic neonatal jaundice?
A. Decreased bilirubin uptake by the hepatocyte.
B. Decreased hepatic bilirubin conjugation.
C. Decreased hepatic excretion of bilirubin.
D. Increased de novo bilirubin synthesis.
E. Increased enterohepatic circulation
D
Kleihaur and apt test described
HbF is resistant to alkali (Apt) and acids (Kleihauer) and so the HbA containing RBCs (maternal) will be hemolyzed but not the fetal RBCs as they contain the HbF.
Calories in 100ml breast milk?
70
Fetal haematopoeisis
Yolk sac from 2weeks – 2 months; liver 2-7 months; bone marrow starts at 3 months and
predominates from 7th month
Indomethicin mode of action
Inhibits PG synthase
Exposure to what causes broad low nasal bridge epicanthal folds, wide spaced eyes and CVD with digital hypoplasia
Fetal hydantoin syndrome from phenytoin
ALPACA related to what brain abnormality
Holoprosencephaly
Porencephalic cyst vs arachnoid cyst
Arachnoid on outside and surrounded by grey matter
Porencephalic is by ventricle inside
Balanced Robertsonian translocation (carrier with normal phenotype) number of chromosomes total
45
Kidney size per gestational week
Mm per week and complete by about 32-24 weeks
Ear tags associated with?
Nager syndrome
Oculoauriculovertebral
Townes Brockw
4- and 5- deletion and 11q duplication
Ear pits with?
Brachotorenal
BWS
