Neonatology Flashcards
What is small normal and large for gestation age weight limits?
<2.5kg - SGA
2.5-4kg- Normal
>4kg- LGA
what are the 3 shunts in fatal circulation?
Ductus venosus
Foramen vale
Ductus arteriosus
What happens to a baby in the third trimester to prepare it for birth?
Surfactant production
Accumulation of glycogen-liver, muscle, heart
Accumulation of brown fat- between scapulae and around internal organs
Accumulation of subcut fat
Swallowing amniotic fluid
What does the ductus arterioles become in an adult?
Ligamentum arteriosus
What does the ductus venous become in an adult?
Ligamentum teres
What is transient tachypnoea caused by?
Retained lung fluid due to impacted clearance mechnaisms
What is the main source of heat production in newly born babies?
Non shivering thermogenesis
heat produced by breakdown of stored brown adipose tissue in response to catecholamines
Non shivering thermogenesis starts as soon as the baby is out of the vagina TRUE/FALSE
FALSE
It is not efficient in the 1st 12h of life
TRUE/FALSE
In the first few hours post birth there is mobilisation of hepatic stores for gluconeogenesis
TRUE
Physiological anaemia is lowest at 8-10wks. Why?
Adult Hb synthesised more slowly than Fetal Hb broken down
On what day is the neonatal heel prick done?
Day 5
What does the BM ahem to be below for it to be counted as hypoglycaemia?
<2.6
Name 4 risk factors for neonatal jaundice?
SGA
Maternal antibodies
Maternal illness/medication
Potential congenital abnormalities
What are the symptoms of jaundice?
Yellowing of skin/sclera of the eyes
Yellowing of the palms of the hands and soles of the feet
Dark, yellow urine (newborn babies should be colourless)
Pale coloured stools (instead of yellow or orange coloured stools)
How long does it take for the adult concentration of haemoglobin to be attained?
6-8 months
Causes of pathological unconjugated jaundice
Breast milk Haemolysis Infection Inherited causes Intestinal obstruction
Causes of pathological conjugated jaundice
Biliary atresia TPN Hypothyroidism a1 antitrypsin galactosaemia CF Trisomy 21 Dubin johnson Alagille syndrome
Treatment for pathological jaundice
Phototherapy (blue light 420-470nm wavelength)
Adequate hydration
Ix and Rx underlying cause
How does phototherapy for jaundice work?
Photo-isomerisation of bilirubin
(convert trans bilirubin to the more water soluble cis-form which it excretes in the bile without conjugation)
How many days is classed as prolonger jaundice?
> 14 days in a term baby
>21 days in a preterm baby
What is kernicterus?
A rare but serious complication of untreated jaundice in babies caused by excess bilirubin damaging the brain or CNS
Unconjugated liver is carried by —- to the liver
Albumin
What are the causes of tachypnoea in the newborn?
Sepsis Withdrawl Meconium aspiration TTN PDA
How is NRDS reduced?
Use of steroids to mothers during premature labour
What are the red flag risk factors for infection?
Mother received IV antibiotics in past 24h
Resp distress starting 4+ hours after birth
Multiple birth- other baby has suspected or confirmed infection
Name 4 causes of neonatal abstinence syndrome
Illicit drugs
Alcohol
Prescribed medication
Caffeine
What is the management for neonatal abstinence syndrome and when is it indicated?
Indicated if three consecutive scores averaging >8
Management: Oromorph, methadone, phenobarbitone
What are the 3 reasons for bowel obstruction?
Intra-lumen
External compression
Something in the wall
What is necrotising enterocolitis?
Inflammatory bowel necrosis when food is started too early and moved to a weakened area of intestinal tract
What is meconium ileus?
Bowel obstruction that occurs when the meconium in the intestine is even thicker/sticker than normal creating a blockage in the ileus
Most people with meconium ileus have which condition?
CF (this will be 1/3rd of patients 1st presentation)
What do you get soap sign in?
Meconium ileus
What is jejunal atresia?
A birth defect, partial/complete absence of the mesentery
The jejunum twists around the marginal artery resulting in intestinal blockage
What is ladder bowel a sign of?
Small bowel obstruction
What colour is the vomiting in malrotation?
Green vomiting
Volvulus is a complication of malrotation TRUE/FALSE
true
Treatment of hypoxic ischaemia encephalopathy
Cool them for 3 days on cooling mat, low temperature at 33 degrees, muscles become stiff
Haemorrhage disease of the newborn is caused by a deficiency of what vitamin?
Vitamin K
Symptoms of fetal alcohol syndrome
Epicanthal folds Small eye openings Flat midface Dysplastic kidneys Ventricular septal defect Micrognathia (undersized jaw) Upturned nose Smooth philtre Thin upper lip Microcephaly
What is gastroschisis?
Birth defect of the abdominal wall
The baby’s intestines are found outside of the baby’s body, exiting through a hole beside the belly button
How is gastroschesis treated?
Exposed intestines wrapped in “cling film” to reduce amount of fluids and heat loss, protects intestines from further damage
What percentage of pregnancies deliver before 37wks?
6-7% of pregnancies
Why is the number of preterm babies globally rising?
increasing maternal age
increasing rate of prig-related complications
greater use of infertility treatment
more c-sections than term
Causes of preterm
Infection Vascular Over distension --> Multiple, polyamnios Cervical incompetence Intercurrent illness --> UTI/Pyelonephritis, appendicitis and Pneumonia Idiopathic
If you are going to have an early pregnancy to induce you need what?
Steroids
OR
Magnesium sulphate
Death of babies before which age are not officially registered?
24wks
RF for infant death
Higher risk for twins Complications during delivery Preterm Black/asian Tennage mothers and mothers >40 Mothers living in poverty
Why are there so many more problems with premature babies?
Need more help to stay warm
more fragile lungs
Fewer reserves
Don’t breathe effectively
TRUE/FALSE
Low admission temperature is an independent risk factor for neonatal death
true
What bacterial are implicated in early onset sepsis?
Gp B Streptococcus
Gram negatives
What bacteria are implicated in lat onset sepsis?
Coagulase negative staphylococci
Gram negatives
Steph aureas
What is the primary pathology of respiratory distress syndrome?
Surfactant deficiency, structural immaturity
Respiratory distress syndrome occurs in what percentage of infants <29 weeks?
75%
Signs of respiratory distress syndrome
Tachypnoea
GruntingIntercostal recession
Nasal flaring
Cyanosis
PDA is more common in male neonates TRUE/FALSE
FALSE
More common in female neonates
When is retinopathy of prematurity most common?
6-8wks after delivery
