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CH > Neonatology > Flashcards

Neonatology Flashcards

1
Q

Definition of preterm, v.preterm and extremely preterm

A

Preterm: 23-37wks
V.preterm: 23-32wks
Extremely preterm: 23-27wks

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2
Q

What are the risk factors for preterm?

A 
>1baby
Problems with uterus or cervix
Maternal htn, diabetes, clotting disorders
Infections
Smoking, alcohol
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3
Q

Normal HR and RR for babies <1yr

A

HR: 120-160
RR: 30-60

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4
Q

What is the use of cord clamping in premature baby management?

A

Cord clamping ok if baby is ok and can be kept warm.

Pause for at least 1 min to allow placental transfusion and use this time to assess baby.

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5
Q

What is the difference in resuscitation between term and preterm infants?

A

Term: should commence in air.

Preterm: a low conc of O2 (21-30%) should be used initially for resuscitation at birth. If in spite of effective ventilation oxygenation remains unacceptable higher O2 can be considered.

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6
Q

What is the sequence of actions in neonatal resuscitation?

A
  1. Keep baby warm and assess
  2. Airway
  3. Breathing
  4. Chest compressions
  5. Drugs
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7
Q

Action in neonatal resuscitation: Keep baby warm and assess?

A 
Delay in cord clamping if uncompromised
Maintain temp 36.5-37.5
APGAR
Reassess breathing and HR every 30s
HR key observation: if there is an improvement in baby, there will be an increase in HR
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8
Q

Action in neonatal resuscitation: Airway

A

Head in neutral position

Assess for obstruction with mucus, blood, meconium, vernix

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9
Q

Action in neonatal resuscitation: Breathing

A

Most babies have good HR after birth and establish breathing by 90s
If baby not breathing adequately, 5 inflation breaths
If HR increases, assume lungs aerated

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10
Q

Action in neonatal resuscitation: when should chest compressions commence?

A

If HR <60 or absent after 5 effective breaths or 30s of effective ventilation

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11
Q

Action in neonatal resuscitation: Chest compressions

A

Two thumbs on lower end of sternum

Compression: inflation, 3:1

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12
Q

Which is low admission temp significant?

A

Independent risk factor for neonatal death

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13
Q

Why is thermal regulation ineffective in the preterm baby?

A

Low BMR
Minimal muscular activity
Subcut fat insulation negligible
High ratio of S.A to body mass

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14
Q

Which 3 factors influence temp control in the neonate?

A

Hypothermia
Hypoxia
Hypoglycaemia

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15
Q

What is gestational correction?

A

The age that the child would have been if the pregnancy was at term:

40weeks- no weeks gestation

e.g:
40-28wks=12wks-3months
Today aged 6months
corrected age: 6months-3months=

3 months corrected age

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16
Q

How long is corrected age used?

A

1year for infants born 32-36wks

2years for infants <32wks

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17
Q

What is the time of onset in neonatal sepsis?

A

Early onset: due to bacterial spread acquired before and during delivery.

Late onset: acquired after delivery

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18
Q

What are some of the causative organisms in neonatal sepsis?

A

GBS
Gram -ve (Ecoli, Klebsiella)
Gram +ve (Staph Aureus, Strep Pneumoniae)

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19
Q

How does early onset neonatal sepsis arise?

A
  • <48hrs after birth
  • Bacteria ascends birth canal + invades amniotic fluid
  • Baby secondarily infected as lungs are in direct contact with infected amniotic fluid
  • These babies have pneumonia/sepsis
  • Risk increased if PPROM, mother fever
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20
Q

How does early onset neonatal sepsis present clinically?

A

Respiratory distress
Aponea
Temperature instability

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21
Q

What are the investigations and management of early onset neonatal sepsis?

A
  • CXR and septic screen
  • Abx started prior to culture results
  • IV Abx to cover: GBS, listeria, gram -ve, gram +ve
  • If cultures and CRP -ve and baby clinically well, stop Abx after 48hrs.
  • If culture +ve or any neurological signs–> CSF exam and culture
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22
Q

How does late onset neonatal infection arise?

A
  • > 48hrs after birth, baby’s environmental source
  • Nosocomial or NICU due to CVC
  • CoNS most common pathogen
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23
Q

What is the tx of late onset neonatal infection?

A
  • Initial Abx to cover Staph and gram-ve bacilli.

- Use of prolonged or broad spectrum Abx predisposes to invasive fungal infections in premature babies.

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24
Q

How does neonatal meningitis present?

A
  • Uncommon, high mortality
  • Bulging fontanelle
  • Hyperextension of head and back
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25
Q

What are the risk factors of GBS infection?

A
  • Prematurity
  • PPROM
  • Previous sibling with GBS infection
  • Maternal pyrexia (2ndry to chorioamnionitis)
26
Q

What are the screening recommendations of GBS?

A
  • Universal screening is NOT offered to all women.
  • Maternal request is NOT an indication.
  • Women who’ve had GBS in previous pregnancy have a 50% risk of GBS carriage in this pregnancy.
27
Q

Who should be given Abx for GBS?

A
  • Women with a previous GBS pregnancy should be offered maternal IV Abx prophylaxis OR late testing and if +ve Abx.
  • Maternal IV Abx prophylaxis given to all women in preterm labour regardless of GBS status.
  • Given to women with pyrexia in labour.
28
Q

What is the Abx for GBS?

A

Benzylpenicillin

29
Q

Is sticky eyes at 3-4 days normal?

A

Yes

30
Q

Neonate with purulent discharge with conjunctival infection + swelling of eyelids within first 48hrs of life?

A

Gonococcal infection

31
Q

What is the tx for gonococcal neonatal conjunctivitis?

A

Gram stain and culture discharge
Permanent loss of vision can occur
Penicillin resistance is a problem

32
Q

Neonate with purulent discharge and swelling or eyelids at 1-2weks?

A

Chlamydia Trachomatis

33
Q

What is the tx for Chlamydia Neonatal conjunctivitis?

A

Identify organism with immunofluorescent staining
Tx with oral Erythromycin for 2wks
Also check and tx mother and partner

34
Q

Who should be offered screening for Hep B?

A

All mothers

35
Q

What is the management for a baby who’s mother is HBsAG +ve?

A

Should receive HepB vaccination shortly after birth

36
Q

What is the management for a baby who’s mother is ‘e’ antigen positive?

A

Should be given passive immunisation with HepB immunoglobulin within 24hrs birth

37
Q

What are the clinical features of neonatal sepsis?

A
  • Fever, temp instability or hypothermia
  • Poor feeding
  • Vomiting
  • Resp distress
  • Jaundice
  • Shock
  • Irritability
  • Lethargy
38
Q

When is jaundice physiological and pathological in the newborn?

A

Pathological: <24hrs
Physiological: 2-14days

39
Q

In which babies is neonatal jaundice more common in?

A

Breast fed babies

40
Q

If signs of jaundice after 14days, a jaundice screen should be performed. What is this?

A 
Conjugated and unconjugated bilirubin
Direct Coombs test
TFTs
FBC and blood film
Urine for MC&amp;S and decreased sugars
U&amp;Es and LFTs
41
Q

What would a raised conjugated bilirubin indicate in a neonate >14days and what is the tx?

A

Biliary atresia

Surgical intervention required

42
Q

What are some of the signs/symptoms in neonatal jaundice?

A

Yellow pigmentation
Sleep and lethargic
Poor feeding/weight gain (dehydration worsens jaundice)
Pale stool + dark urine in conjugated

43
Q

What is the tx for physiological jaundice?

A

Observe and reassurance

44
Q

What is the tx of acute bilirubin encephalopathy?

A

Medical emergency

Immediate exchange transfusion

45
Q

What are the signs of acute bilirubin encephalopathy?

A 
Hypertonia
Arching 
Retrocollis (backwards neck dystonia)
Opisthotobos (muscle spasm, backwards arching)
Fever
High pitched cry
46
Q

What is the process of an exchange transfusion in acute bilirubin encephalopathy?

A

Removes the unconjugated bilirubin by doing a double volume exchange transfusion to allow bilirubin to move out of the brain tissue and decrease the risk of neurological toxicities.

+phototherapy, +hydration

47
Q

How does phototherapy work for neonatal jaundice?

A

By blue band of light spectrum converting unconjugated bilirubin into water soluble pigment therefore more readily excreted and does not require coagulation

48
Q

What is the tx of: pathological unconjugated and conjugated neonatal jaundice?

A

Unconjugated: phototherapy or exchange transfusion

Conjugated: tx of underlying cause

49
Q

What is the tx of breast milk jaundice?

A

1st line: temporary cessation of breast-feeding for 24-24hrs
2nd line: phototherapy + hydration
3rd line: exchange transfusion

50
Q

What is Kernicterus?

A

Complication of jaundice

Due to accumulation of unconjugated bilirubin in basal ganglia

51
Q

What does Kernicterus lead to?

A 
Choreoathetoid CP (dyskinetic)
Sensorineural hearing loss
52
Q

What are some of the causes of neonatal jaundice <24hrs?

A

Haemolytic disorders:

  • Rh incompatibility
  • ABO incompatibility
  • G6PD deficiency
53
Q

What are some of the causes of neonatal jaundice 24hrs-2weeks?

A
  • Physiological
  • Breast milk jaundice
  • Infection (UTI)
  • Haemolysis
  • Polycythaemia
  • Crigler-Najjar Syndrome
54
Q

What are some of the causes of unconjugated neonatal jaundice >2weeks?

A
  • Physiological or breast milk
  • Infection (UTI)
  • Hypothyroidism
  • Haemolytic anaemia
  • High obstruction: pyloric stenosis
55
Q

What are some of the causes of conjugated neonatal jaundice >2weeks?

A

Bile duct obstruction

Neonatal hepatitis

56
Q

If jaundice is present >2weks, what is it important to diagnose?

A

Biliary atresia

57
Q

How does neonatal hypoglycaemia present?

A 
<24hrs life
In babies with IUGR who are preterm, born to mothers: 
-T2DM
-Large for dates pregnancy 
-Hypothermia
-Polycythaemia
58
Q

What glucose level is desirable for optimal neurodevelopment outcome in neonates?

A

> 2.6mmol/l

59
Q

How can neonatal hypoglycaemia be prevented an treated?

A

Prevented: early and frequent milk feeding
Tx: IV Glucose

60
Q

What needs to be ruled out when neonatal seizures are observed?

A
  • Hypoglycaemia and meningitis

- Cerebral US to identify haemorrhage

61
Q

What are some of the causes of neonatal seizures?

A 
HIE
Cerebral infarction
Metabolic (hypoglycaemia)
Intracranial haemorrhage 
Cerebral malformations 
Dx withdrawal (maternal opiates)
Congenital infection 
Kernicterus

CH (7 decks)

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