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Neonatology Flashcards

1
Q

What is neonatology?

A

The medical care of newborn infants, especially the ill or premature

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2
Q

What do neonatologists deal with?

A 
Prematurity
Low birth weight 
IUGR
Congenital malformations 
Infection 
Birth asphyxia
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3
Q

When does the CVS begin to develop?

A

Towards the end of the 3rd week

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4
Q

When does the heart start to beat?

A

Beginning of 4th week

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5
Q

When is the critical period of heart development?

A

Day 20 to day 50 after fertilisation

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6
Q

Foetal body saturations

A

60-70%

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7
Q

What is the biggest organ of the baby when it is born and what is the significance of this?

A

Liver

Gets most of the oxygenated blood

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8
Q

What are the functions of the Ductus Arteriosus?

A

Protects lungs against circulatory overload - safety valve
Allows the right ventricle to strengthen
Carries low oxygen saturated blood

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9
Q

What does the ductus venosus do?

A

Connects the umbilical vein to the IVC

Carries mostly oxygenated blood

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10
Q

What is ductus venosus blood regulated by?

A

Sphincter

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11
Q

What happens with the first breath?

A

Breathe with the fluids
Start moving the fluids out
Normal labour forces cause stress and mechanical squeeze
First breath opens the arteries in the lungs - so instead of blood on bypass, it is getting great oxygenation and circulation
Ductus arteriosus, ductus venosus, umbilical veins and arteries become ligaments
Foramen ovale closes and leaves a depression

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12
Q

Normal BP for a 1 hr old newborn

A

70/44

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13
Q

Normal BP for a 3 day old newborn

A

77 +/- 12 / 49 +/- 10

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14
Q

RR for full term newborn

A

30 - 60 / min

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15
Q

What is a feature of breathing of a full term newborn?

A

Periodical breathing

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16
Q

Normal HR for a full term newborn

A

120 - 160 b / min

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17
Q

Tachycardia value for a newborn

A

> 160 b / min

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18
Q

Bradycardia value for a newborn

A

< 100 b / min

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19
Q

How is thermoregulation done in the foetus?

A

Maternal thermoregulation in the womb
Metabolic production of heat due to lack of shivering
Brown fat well innervated by sympathetic neurones
Cold stress leads to lipolysis and heat production

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20
Q

Loss of heat occurs by….

A

Radiation - heat dissipated to colder objects
Convection - heat loss by moving air
Evaporation
Conduction - heat loss to surface on which the baby lies

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21
Q

How is breathing measured in newborns?

A 
Non invasive
- Blood gas
- Trans cutaneous pCO2 / O2 measurement 
Invasive
- capnography 
- tidal volume 4-6ml / kg 
- minute ventilation TV x RR
- flow volume loop
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22
Q

What is normal values of PaCO2 and PaO2 in newborns?

A 
PaCO2 = 5-6kPa
PaO2 = 8-12 kPa
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23
Q

When does physiological jaundice appear?

A

DOL 2-3

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24
Q

What does DOL stand for?

A

Day of life

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25
When does physiological jaundice disappear?
7-10 DOL | up to 21 DOL in premature infants
26
What % of babies develop visible jaundice?
60% terms | 80% premature
27
How much bilirubin comes from haemoglobin?
75%
28
What does bilirubin cause at high concentrations?
Irreversible changes in the brain - kernicterus
29
What does blue light do to jaundice?
Converts bilirubin to water soluble form and increases oxidation of bilirubin
30
Loss of fluid in the full term newborn is due to what?
Shift of interstitial fluid to intravascular | Diuresis
31
Loss of fluid in the premature infant is due to what?
``` Less fat in body composition Increased loss through kidney - slower GFR - reduced Na reabsorption - decreased ability to concentrate or dilute urine Increased insensible water loss (IWL) - immature skin - breathing ```
32
How much insensible water loss is normal to lose?
20 - 40 ml / kg / day
33
Anaemia of prematurity
Reduced erythropoiesis Infection Blood letting
34
Most important cause of anaemia of prematurity
Blood letting
35
Types of small babies
Small for gestational age (SGA) IUGR Hypotrophy - symmetric / asymmetric
36
What centile is IUGR?
< 10th centile
37
What centile is severe IUGR?
< 0.4th centile
38
Causes of small for dates babies
``` Maternal - smoking - alcohol - PET Foetal chromosomal e.g. Edwards syndrome Infection e.g. CMV, syphilis Placental - insuffiency - abruption Twins - TTN Normal Mixed ```
39
Common problems in small for dates babies
``` Perinatal hypoxia Hypoglycaemia Hypothermia Polycythaemia Thrombocytopenia Hypoglycaemia GI problems (feeds, NEC) RDS (less surfactant) Infection ```
40
Long term problems for small for dates babies
``` HTN Reduced growth - first 2 - 3 yrs remain small Obesity Ischaemic Heart disease ```
41
What gestational age is a baby preterm?
< 37 weeks
42
What gestational age is a baby extremely preterm?
< 28 weeks
43
What is considered a low birth weight?
< 2500g
44
What is considered an extremely low birth weight?
< 1000g
45
Incidence of prematurity
5 - 12%
46
What is RDS?
Respiratory distress syndrome
47
What is IVH?
Intraventricular haemorrhage
48
What is PVL?
Peri-ventricular leuomalacia
49
What is NEC?
Necrotising entero-colitis
50
What is PDA?
Patent ductus arteriosus
51
What is BPD?
Broncho-pulmonary dysplasia
52
What is ROP?
Retinopathy of prematurity
53
What is PHH?
Post haemorrhagic hydrocephalus
54
What is NAS?
Neonatal abstinence syndrome
55
What is HIE?
Hypoxic - ischaemic encephalopathy
56
Pathology of RDS
Alveoli collapse Become hypercapnic even though have good perfusion Less surfactant
57
Prevention of RDS
Antenatal steroids
58
Treatment of RDS
Early - surfactant Early extubating Non invasive support (N-CPAP) Minimal ventilation (low tidal volume and good inflation)
59
Pathology of BPD
``` Overstretch by volubaro trauma Atelectasis infection via ETT O2 toxicity Inflammatory changes tissue repair - scarring ```
60
Treatment of BPD
Patience NUTRITION AND GROWTH steroids
61
Minor respiratory problems include
Apnoea Irregular breathing Desaturations Sometimes forget to breathe
62
Treatment of minor resp problems
Caffeine | N-CPAP
63
Prevention of IVH
Antenatal steriods
64
Treatment of IVH
NO TREATMENT | Drainage
65
Pathology of PVL
white matter surrounding ventricles deprived of O2 and blood leading to malacia (softening) - leading to holes in the brain and abscess
66
What % of PVL have adverse outcomes?
95%
67
Pathology of PDA
Over perfusion of lungs - Lung odema Lung oedema steals from systemic circulation leading to Systemic ischaemia
68
Consequences of PDA
Worsening of resp symptoms Retention of fluids (low renal perfusion) GI problems (GI ischaemia)
69
What does NEC involve?
Ischaemic and inflammatory changes | Necrosis of bowel
70
Treatment of NEC
Surgical often required Antibiotics Parental nutrition
71
Prognosis of prematurity
1 / 3 die 1 / 3 normal life or mild disability 1 / 3 have moderate or severe disability for lifetime 1 in 6 entirely normal at 6 y/o
72
Treatment of PVL
No treatment
73
What can IVH lead to?
PHH
74
What is a risk factor for NEC?
Formula feeding
75
What is protective of NEC?
Breastfeeding
76
What is the first step in neonatal resuscitation?
Dry the neonate
77
Neonatal resus guidelines
1. Dry the neonate, remove any wet towels and start the clock / note the time 2. within 30 seconds; assess tone, breathing and HR 3. within 60 seconds; if gasping or not breathing; open airway and give 5 inflation breaths 4. Re-asses; if no increase in HR, look for chest movement 5. if chest not moving; recheck head position, consider 2 person airway control and other airway manouvres, repeat inflation breaths and look for a response 6. If no increase in HR, look for chest movement 7. When the chest is moving, if the HR is not detectable or slow (<60bpm) start chest compressions 3 compressions to each breath 8. Reassess HR every 30 seconds. If HR not detectable or slow consider venous access and drugs
78
What is used to assess the health of a newborn baby?
APGAR score
79
What is looked at in the APGAR score?
``` Pulse Resp effort Colour Muscle tone Reflex irritability ```
80
What parts of the APGAR score get a score of 2?
``` Pulse > 100 Resp effort - strong, crying Pink in colour Muscle tone - active movement Reflex irritability - Cries on stimulation/sneezes, coughs ```
81
What parts of the APGAR score get a score of 1?
``` Pulse < 100 Resp effort is weak and irregular Body pink but extremities blue Muscle tone - limb flexion Reflex irritability - grimace ```
82
What parts of the APGAR score gets a score of 0?
``` Pulse absent Resp effort nil Blue all over Muscle tone - flaccid No reflex irritability ```
83
Interpretation of APGAR scores
0 - 3 very low score 4 - 6 moderate low 7 - 10 baby in good state
84
When is a childs hearing first assessed and how?
Newborn | Otoacoustic emissions test
85
In the first 10 mins of life, what can be expected of O2 sats of neonates?
They may be suboptimal
86
What are the greater risks associated with neonatal meningitis?
``` LBW Prematurity Traumatic delivery Foetal hypoxia Maternal peripartum infection ```
87
If a baby has a heel prick test done, and it is found to have raised immunoreactive trypsinogen (IRT), what is the next most appropriate test for the baby? What are they looking for?
Sweat test | Tests for CF
88
Presentation of NEC
``` Feeding intolerance Abdominal distension Bloody stools Can quickly progress to - abdominal discolouration - perforation - peritonitis ```
89
What is the investigation for NEC and what does it show?
AXR - Dilated bowel loops (often asymmetrical in distribution) - Bowel wall oedema - Pneumatosis intesinosis (intestinal gas) - portal venous gas - pneumoperitoneum resulting from perforation - Air both inside and outside of the bowel (rigler sign) - air outlining the falciform ligament (football sign)
90
If a baby has an abnormal hearing test at birth, what test are they offered?
Auditory brainstem response test
91
What is the compression to ventilation ratio in neonates?
3:1
92
All breech babies at or after 36 weeks gestation require what?
USS for DDH at 6 weeks regardless of mode of delivery
93
Risk factors for surfactant deficient lung disease of the newborn
``` Decreasing gestation Male Maternal DM C section Second born of prem twins ```
94
Presentation of surfactant deficient lung disease of the newborn
``` Resp distress of the newborn - tachypnoea - intercostal recession - expiratory grunting - cyanosis CXR - 'Ground glass' appearance with an indistinct heart border ```

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