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Reproduction > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What is hypoglycaemia defined as in neonates?

A

BM <2.6

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2
Q

What puts a newborn at risk for hypoglycaemia and hypothermia?

A

preterm; SGA; LBW; infants of diabetic mothers; intraprtum asphyxia or needed resus at birth; maternal beta-blocker use

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3
Q

What is the main cause of neonatal jaundice?

A

physiological

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4
Q

What does dark urine indicate?

A

increased conjugated bilirubin

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5
Q

What do pale stools indicate?

A

cholestasis- need to rule out obstruction

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6
Q

What effect does TPN have on jaudnice?

A

can cause direct hyperbilirubinaemia after >2weeks

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7
Q

What are the causes of neonatal aundice?

A

physiological; blood group incompatibility; other haemolytic disorders; sepsis; liver disease; metabolic disorders

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8
Q

Why does physiological jaundice happen?

A

increased production; decreased uptake and binding by hepatocytes; decreased conjugation; decreased excretion; increased enteroheptic circulation of bilirubin

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9
Q

Under what time from birth is jaundice always pathological?

A

<24 hours

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10
Q

What is jaundice <24 hours from birth usually caused by?

A

haemolysis with excessive production of bilirubin

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11
Q

What are the causes of haemolysis <24 hours of age?

A

ABO incompatibility; Rh immunisation; sepsis; other blood group incompatibilities; red cell defects

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12
Q

What should be considered as a cause of jaundice in a baby <24 hours old if there is >15% conjugated bilirubin?

A

hepatits

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13
Q

What investigations should be done for early pathological jaundice?

A

total and conjugated serum bilirubin conc.; maternal blood group and antibody titres; babys blood group ; direct antigolbulin test; FBC and blood film; CRP; TFTs: LFTs

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14
Q

What is the function of the direct antiglobulin test?

A

detects antibodies on the baby’s red cells

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15
Q

What are the causes of too high serum bilirubin jaundice?

A

mild dehydration/insufficient milk supply; haemolysis; breakdown of extravasated blood; polycythaemia; infection; increased enterohepatic circulation

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16
Q

When is physiological jaundice too long?

A

> 10 days; esp. >2 weeks (>21 days for preterm)

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17
Q

What is the cause of persistent unconjugated hyperbilirubinaemia?

A

breast milk jaundice; continued poor milk intake; haemolysis; infection; hypothyroidism

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18
Q

What is the usual cause if jaundice suddenly reappears after the infant has gone home?

A

haemolyssi

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19
Q

What type of hypobilirubinaemia is always abnormal?

A

conjugated hyperbilirubinaemia

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20
Q

What causes persistnet conjugated hyperbilirubinaemia?

A

hepatitis; biliary atresia

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21
Q

What can cause hepatitis ina neonate?

A

infection or metabolic disorder

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22
Q

What is the cause of kernicterus?

A

unconjugated bilirubin crosses the BBB which is toxic to the brain

23
Q

What is kernicterus characterised by?

A

death of brain cells and yellow staining esp. in the grey matter of the brain

24
Q

What are the signs of acute bilirubin encephalopathy?

A

lethargy; poor feeding; temperature instabilit;y hypotonia; opisthotonos; spasticity and seziures

25
Q

What is opisthotonos?

A

arching of the head, neck and back

26
Q

What level of unconjugated bilirubin is at risk of leading to kernicterus?

A

> 340micromol/L

27
Q

What increases the risk of developing kernicterus?

A

preterm; asphyxia; acidosis; hypoxia; hypothermia; meningitis; sepsis; decreased albumin binding

28
Q

What is the treatment for jaundice

A

adequate hydration; phototherpay; exchange transfusion

29
Q

How often should a baby with jaundice be breastfed for the first few days?

A

8-12 times per day

30
Q

When does physiological jaundice tend to set in?

A

day 2

31
Q

When does physiological jaundice tend to resolve?

A

day 10-14

32
Q

What is the function of phototherapy in jaundice?

A

converts trans-bilirubin to the more water soluble cis-form which is excreted in bile without conjugation

33
Q

What are the SEs of phototherapy?

A

dehydration; skin rash; eye damage

34
Q

What can cause conugated jaundice?

A

biliary atresia; TPN; hypothyroidism; a1 antitrypsin; galactosaemia; CF; Down;s syndrome

35
Q

What should be suspected in an asymptomatic infant in which jaundice occurs after 8 days of age?

A

UTI

36
Q

How does the appearance of jaundice differe between conjugated and unconjugated hyperbilirubinaemia?

A

unconjugated- more yellow compared with conjugated- more green

37
Q

How is gestational age related to hyperbilirubinaemia?

A

risk of unconjugated hyperbilirubinaemia is inversely proportional to GA

38
Q

What 3 factors contribute to the development of TTN?

A

delayed resoprtion of fetal lung fluid; pulmonary immaturity and milk surfactant deficiency

39
Q

What are the risk factors for developing TTN?

A

elective C/S; male sex; macrosomia; excessive maternal sedation; prolonged labour; birth asphyxia; fluid overload to mother; maternal asthma; delayed clamping of umbilical cord; breech; polycythaemia; diabetes; prematurity; maternal substance abuse; LBW

40
Q

What is tachypnoea defined as in infants?

A

> 60 breaths/min

41
Q

What is the differential diagnosis of TTN?

A

pneumonia/sepsis; heart disease; RDS; cerebral hyperventialtion; metabolic disorders; polycythaemia

42
Q

What can cause cerebral hyperventilation?

A

meningitis or hypoxis-ischeamic insult (CNS lesion cause over stimulation of th resp centre)

43
Q

What metabolic disorders can cause tachypneoa?

A

hypothermia; hyperthermia; hypoglycaemia

44
Q

Why may materal dibaetes cause polycythaemia?

A

poor control during pregnnacy leads to chornic fetal hypoxia which may result in increased neonatal erythroepoeisis

45
Q

What are the risk factors for developing polycythaemia?

A

high altitude; delayed cord clamping; high-risk delivery; enhanced fetal erythropoeisis- fetal hypoxia–placental inusfficiency and endocrine disorders; genetic trisomies

46
Q

What can cause placental insufficiency?

A

materanl hypertensive disease; abruptio placentae; postmatiruty; cyanotic congenital heart disease; IUGR; maternal smoking

47
Q

Why do endocrine disorders cause fetal hypoxia and increased erythropoiesis?

A

increased metabolism–increased oxygen consumption

48
Q

Which endocrine disorders are implicated in polycythaemia?

A

maternal diabetes; congential thyrotoxicosis; congenital adrenal hyperplasia; secondary hyperinsulinism

49
Q

What are the perinatal RF for neonatal sepsis?

A

Group B strep colonisation; PROM (>18hours); signif GBS bacteuria; maternal temp >38 degrees during labour; chorioamnionitis; sustainined intraprtum fetal tachy; prior delivery of infant with GBS disease

50
Q

What investigations should be doen for neonatal sepsis?

A

blood cultures; LP; urine culture; BM; FBC; CRP

51
Q

What are the most common causes of neonatal sepsis?

A

GBS; e.coli; s. aureus; enterococcus; staph. epi; klebsiella

52
Q

What is the treatment for new delivered baby with sepsis?

A

benzylpenicillin and gent

53
Q

What is given to babies with central catheters for sepsis in the NICU?

A

vanc and fluclox

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