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Paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

Define Birth asphixia - Hypoxic-ischaemic encaphalopathy

A

When a babies organs do not get enough O2 before, During or directly after birth. May lead to HIE which is a neonatal Brain injury secondary to prenatal, perinatal or postnatal asphixiation

0.1-0.2% of pregnancy

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2
Q

Aetiology

A 
Mother inadequate O2 levels
   Cardiac/Resp issues
Poor placental function
Placental Abruption
Low BP in mum 
Umbilical cord compression
Drugs used in pregnancy
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3
Q

What is the APGAR score

A

used to assess the health of a new born baby

                                 0                        1                        2                          A - Activity               Absent          Flexed arms         Active 
                                                      and legs P -Pulses                 Absent            <100bpm          >100bpm G - Grimace            Floppy              Minimal              Prompt A - Appearance     Blue/pale         Blue Limbs           Pink R - Reflexes            Absent                Slow             Vigorous

0-3 poor 4 - 6 is moderate and 7 - 10 means baby is doing well

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4
Q

Clinical Presentation of HIE

A 
Suggestive criteria
Normal CTG
Hypoxic event present
Poor APGAR
Metabolic Acidosis in pH (<7)
Multisystem dysfunction within 72hrs

Symptoms and Signs
BLUE BABY AND DEC PULSE
MILD: irritable, increase tone and reflexes, staring eyes, poor feeding
MOD: Lethargy, Reduced tone and reflexes, seizures
SEVERE: Coma, reduced tone, Absent reflexes, prolonged seizure, multi-organs failure

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5
Q

Ix for HIE

A

APGAR score - taken at 1, 5 and 10 minutes - <3 after 10 minutes indicates poor outcome

Cerebral Function Monitor - (CFM)

MRI Brain

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6
Q

Rx of HIE

A

Resp and circulatory Support
Fluid Balance - avoidance of cerebral oedema
management of seizures - Anticonvulsants
whole body cooling for up to 72 hours to 33 or 34 degrees

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7
Q

Complications of HIE

A

CP
Learning difficulties
epilepsy
Hearing and Visual impairment

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8
Q

Prognosis of HIE

A

Mild - Majority have no sequelae
Mod - 40% serious long term complications; 15% minor disability
Severe - 30% mortality, 50% severe disability, 10% moderate disability

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9
Q

Small for Date causes

A

PET
Chromosomal - Edwards syndrome
Infection (e.g. CMV)
Twin Pregnancy

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10
Q

Common Problems of a small for date baby

A 
Perinatal Hypoxia
Hypoglycaemia
Hypothermia
Polycythaemia
Thrombocytopaenia
GI problems (Feeds/NEC)
RDS and Infection
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11
Q

Long Term Problems:

A

Hypertension
Reduced Growth
Obesity
Ischaemic heart disease

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12
Q

Categories of preterm births

A

Preterm = <37wks
Extremely Pre-term = <28wks

Low B/W = <2500g
Very LowB/W = <1500g
Extremely Low B/W = <1000g

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13
Q

Common Problems in preterm babies

A 
AN SYSTEM CAN BE HIT
Resp
Circulatory 
Metabolic/nutrition
Immune/Infection
Brain 
GI
Haematology
Renal 
Skin

(All this has Done is remind me of the systems I don’t have time to study)

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14
Q 
3 letters Quiz
RDS
IVH
PVL
NEC
PDA
BPD
ROP
PHH

NAS
HIE`

A 
Respiratory Distress syndrome
Intraventricular Haemorrhage
periventricular leucomalacia
Necrotising enetro-colitis
Persistent Ductus Arteriosus
Broncho-pulmonary displasia
Retinopathy of Prematurity
Post-Haemorrhage Hydrocephalus
Neonatal Abstience syndrom
Hypoxic-ischaemic encephlopathy
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15
Q

RDS

A

Prevention
Antenatal Steroids

Early Treatment
Neonatal Surfactant -and then as little as possible

Early extubation
non-invasive support (N-CPAP)
minimal ventilation

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16
Q

BPD

A 
Overstretched by volu-baro-trauma
Atelectasis
Infection via ETT
O2 toxicity
Inflammatory changes
Tissue repair --> Scarring
Treatment 
   Patience
   Nutrition 
   Steroids (!)
17
Q

IVH

A

Most common limiting factor for good long term prognosis
Grades I - IV (IV having a 75% adverse outcome)

Prevention
AN Steroids

Treatment
Symptomatic
Drainage???

18
Q

PDA

A

Pressure Ao >PA –> L to R shunt
Additional Blood to pulmonary Ventilation –> over perfusion of lungs –> Lung Oedema

+

Steal form systemic circulation -> systemic ischaemia

19
Q

Consequences of PDA

A

Worsenig of respiratory system + retention of fluids (low renal perfusion)

GI ischaemia

20
Q

NEC

A 
Ischamic and inflammatory Bowel Changes
Necrosis of the Bowel 
Surgical Intervention is often required
Conservative management is sometimes possible
   Antibiotics and Parenternal Nutrition
21
Q

Preterm Nutrition

A

Enormous part of neonatal medicine

Some Pts will triple weight during time in hospital

Aids in building new functional tissues from compunds provided artificially

22
Q

Purpose of the Ductus arteriosus

A

Protects the Lungs from Circulatory overload
Allows Right Ventricle to Strengthen
Carries low O2 saturated blood

23
Q

Purpose of Ductus Venosus

A

Foetal Blood vessel connecting umbilical vein to IVC
Blood Flow regulated via a sphincter
Carries mostly Oxygenated blood

24
Q

Normal HR of a full term new Born

A

HR - 12-160

Tachy at >160
Brady at <100

25
Q

BP at 1 hour old

A

70/44mmHg

26
Q

BP at 1 day old

A

70 (+/-9)/42 (+/-12) mmHg

27
Q

BP at 3 days

A

77 (+/- 12) / 49 (+/- 10)

28
Q

Respiratory rate of a new borm

A

30 - 60 BPM - Periodical Breathing

29
Q

Thermoregulation

A

Maternal Thermoregulation in the Womb
New born babies lack shiver response tus need metabolic production of heat
Brown fat well innervated by sympathetic neurons
Cold stress leads to lipolysis and therefore thermoregulation

30
Q

Loss of heat

A 
Radiation
   Heat dissipated to colder objects
Convection
   Heat loss by moving air
Evaporation
   We are born in water
Conduction
   Heat loss to surface when baby lies on it
31
Q

Non-invasive assessment of newborn breathing

A

Blood gas determination
PaCO2 5-6 kPa, PaO2 8-12 kPa
Transcutaneous pCO2/O2 measurements

32
Q

Invasive Assessment of newborn breathing

A 
Capnography
Tidal Volume 4-6ml/kg
Minute ventilation
   Tidal Volume x Resp Rate
Flow-volume loop
33
Q

Physiological Jaundice

A

Appears on DOL 2-3
Disappears within 7-10 DOL in term infants and up to 21 in premature
Very common; 60% term and 80% preterm
0% breast fed jaundice at 30 DOL

34
Q

More on physiological Jaundice

A

7-% biliruben comes from Hb
Metabolised and conjugated in the liver
Biliruben is lipid soluble and so hemato-encephalic barrier
At high concentrations it causes changes in the brain - KERNICTERUS
Blue light cenverts Biliruben to water soluble and so increases oxidisation of biliruben

35
Q

Fluid Balance in Premature babies

A 
Less fat in body composition
increased loss via kidneys
   Slower GFR
   Reduced Na absorption
   Decreased ability to concentrate or dilute urine 
Increased insensible water loos (IWL)
   Premature skin and breathing 
   physiologcial IWL is 20-40ml/kg/day but could be up to 80ml/kg/day in 750 - 1000g
36
Q

Physiological anaemia in newborns

A 
RBC production is 10% of in utero DOL 7
born with 15-20g/l Hb
week 10 11.4 g/l hb
Increased production of EPO
Week 20 12g/l Hb
Anaemia in prematurity
   Reduced erythropoesis
   Infection
   Blood letting - Most important cause

Paediatrics (19 decks)

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