Neonatology Flashcards
When is a baby considered to be ‘severely’ preterm?
<28 weeks
When is a baby considered to be ‘very’ preterm?
28-32 weeks
When is a baby considered to be ‘moderate/late’ preterm?
32-37 weeks
Give 5 risk factors for prematurity
Previous preterm delivery
Multiple pregnancy
Smoking and illicit drug use in pregnancy
Under/overweight
Chronic condition- diabetes, hypertension
Physical injury/trauma
Pregnancy problems eg. infection
Give 4 causal categories of preterm delivery
Elective due to pregnancy complications (25%)
Emergency delivery (25%)
P-PROM (30%)
No identifiable cause (40%)
What is a Dubowitz/Ballard Examination?
Assessment tool to estimate fetal maturity- gives 2 week window of gestation
Based off skin, lanugo, eyes, ears and genital formation + posture and arm recoil
What investigations are done in a preterm neonate?
Blood gas FBC U+Es Blood culture CRP Blood group and Direct Coombs test Chest and abdo x-ray Cranial USS- look for hemorrhage
How is a preterm neonate initially managed?
Antenatal steroids (in labour)
Magnesium sulfate (neuroprotective)
Parents counselled by senior neonatologist
Thermoregulation help
Explain the resuscitation guidance for babies born at <23 weeks, 23-23+6, 24-24+6 and >25 weeks
<23 weeks = no resuscitation
23-23+6 = decision between doctor and parents
24-24+6 = resuscitation commenced unless compromised
>25 weeks = resuscitate and start intensive care
What respiratory problems may a premature neonate experience and how are they treated?
Respiratory distress syndrome
Recurrent apnoea
Exogenous surfactant
ET tube
Oxygen
Caffeine
What cardiovascular problems may a premature neonate experience and how are they treated?
Hypotension
PDA
Inotrope infusion (adrenaline, dopamine) Fluid management
What neurological problems may a premature neonate experience and how are they treated?
Intraventricular haemorrhage
Seizures
Cerebral palsy
Surveillance with Cranial USS
Antiepileptics
What gastrointestinal problems may a premature neonate experience and how are they treated?
Feed intolerance
Necrotising enterocolitis
TPN
Abx and surgical review- for NEC
What renal problems may a premature neonate experience and how are they treated?
Immature renal function
Monitor electrolytes and correct as needed
What metabolic problems may a premature neonate experience and how are they treated?
Jaundice
Hyperglycaemia
Hypoglycaemia
Phototherapy
Insulin/IV glucose
What ocular problems may a premature neonate experience and how are they treated?
Retinopathy of prematurity
Laser treatment
Avoid excess oxygen
When is the Guthrie heel prick test performed?
Between day 5 and 8
What does the Guthrie heel prick test screen for?
PKU, MCADD, MSUD, IVA, GA1, homocystinuria
Cystic fibrosis
Sickle cell
Congenital hypothyroidism
Give 4 predisposing factors for neonatal jaundice
Prematurity SGA Low birth weight Exclusively breastfed Previous siblings needing phototherapy Diabetic mother
Describe physiological neonatal jaundice
Immature liver, increased RBC breakdown
Starts at day 2 and peaks at day 5, resolved by day 10. Baby remains well and needs no extra care
Give 5 causes of pathological neonatal jaundice
Haemolytic disease of the newborn ABO incompatibility G6PD deficiency Spherocytosis Dehydration Bruising/cephalohematoma Neonatal infection Hypothyroid Hypopituitary Galactosaemia Biliary atresia
How is neonatal jaundice investigated?
Transcutaneous bilirubinometer Serum bilirubin Blood group Direct Coombs test (looks for autoimmune haemolytic anaemia) FBC U+Es TFT Infection screen
How is neonatal jaundice managed?
Phototherapy (use treatment threshold graph)
[will need eye protection + breaks for breastfeeding and nappy changes]
Monitor fluid intake
Exchange transfusion- exchange baby’s blood with donor blood
IV Immunoglobulin- in rhesus and ABO incompatibility
