Neonatology Flashcards by Claudia Zizzo

what are causes of a prem baby

idiopathic

infections

iugr

congenital abnormalities

preeclampisa

interuterine bleed

cervicle weakness

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what is the management of an at risk prem baby

antenatal corticosteroids (reduces risk of prem ROM)

glucocorticoids (reduce rds risk)

antibiotics

tocolysis (suppress prem labour)

magnesium sulphate (reduce CP risk)

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what are complications of prematurity

RDS

pneumothorax

PDA

necrotising enterocolitis

retinopathy

bronchopulmonary displasia

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how do you staibalise a prem baby

resp breaths

incubator

O2 on high flow nasal cannula/CAPAP

periferal and umbillical lines

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what is gestational diabetes

previous non diabetic developing high blood sugars during pregnancy

due to carbohydrate intolerance and insulin resistant state of pregnancy

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what are the RF for gestational diabetes

PCOS

pre diabtes

increased maternal and paternal age

overweight

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how do you chech for gestational diabetes in pregnancy

glucose tolerence test at 28 weks in high risk women

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describe the glucose tolerence test

nin fasting + 50g glucose load

testes one hour later

2 or more abnormal tests = diabetes

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what is the management of gestational diabetes

insulin = aim to prevent fetal macrosomia

c section if macrosomia

GTT 6 weeks post partum

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what complications does maternal hyperthyroidism pose to baby

prem

iugr

higher risk of perinatal mortality

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what are maternal complications of hyperthyroidism

infertility

miscarrige

cardiac failure

thyroid storm

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how do you manage maternal hyperthyroidism

propythiouracil (better than carbimazole in pregnancy)

regular fetal US to chech tachycardia (thyroid dysfunction) after 32 weeks

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what features of pregestational diabetes would indicate a poor prognosis

uncontrolled diabetes

DKA

Pyleonephritis

vasculopathy

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what is the management of poorly controlled pre diabetes

good control prior to conception

check HBA1C

in labour: IV glucose and 1-2hrly BMs

insulin

metformin

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what fetal complications may arise due to pregestational diabetes

congenital malformations (like CHD)

iugr

macrosomia

birth asphixia

shoulder dystocia

nerve paulseys

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what is the presentation of fetal hypoglycaemia

sweating

irritability (due to abdo pain)

pallor

hunger

lethargy

seizures

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why is fetal hypoglycemia common in first day of life

fetal hyperinsulinism

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what are RF for fetal hypoglycemia

IUGR

prem

T1+2 DM maternal

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why do prem babys have higer risk of becoming hypoglycemic

low / no glycogen stores

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why do babys with DM T1+2 have higher risk of hypoglycemia

due to hyperplasia of islat cells causing hyperinsulinism

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how do you diagnose hypoglycemia

x2 low readings

x1 very low reading

or symptomatic

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how do you treat fetal hypoglycemia

iv glucose + glucagon/hydrocortisone

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how do you treat an a granuloma (umbilical )

silver nitrate topical

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what cab GBS cause

early or late sepsis

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describe the early presentation of sepsis

RDS pneumonia septicemia meningitis

describe the presentationof late onset sepsis

meningitis: irritability, neck stiffess, unlwell

when does late onset sepsis occur

7days-3months post delivery

how does late onset sepsis occur

BS carried on skin or mucosa

what are RF for sepsis

prolonged ROM maternal fever

when do you check for GBS

35-38w

a pregnant lady is positive for GBS at 35w what is her management

proflactic intrapartum abx * penicillin * vancomycin and give same ABx to child within 2-4h of birth

what is RDS

surfactant deficiency causes a decrease in surface tension causing alveolar collapse and inadequate gas exchange

what is surfactant

phospholipids and protein excreted by T2 pneumocytes

what are the RF for RDS

prem \<28weeks male has worse severity maternal diabetes

what is the presentation f RDS

tachyopnea laboured breathing chest wall recession nasal flaring expiratory grunting cyanosis

how do you manage RDS

if suspected premature antenatally give glucocorticoids then: O2/CPAP surfactant therapy via trachyal tube

what is bronchopulmonary displasia

lung damage due to trauma from o2 therapy, infections, artificial ventilation. this lung damage means infants have high o2 requirements past 36 weeks

what is the diagnosis of **bronchopulmonary displasia**

clinical x ray = wide spread opacification and cystic changes

what is tha management of bronchopulmonary displasia

reduce o2 conc on CPAP\>O2 therapy\>nothing over the course of months short corse of corticosteriods

what do long courses of corticosteroids in infants cause (when treating bronchopulmonary displasia )

CP neurodevelopmental delay

why is pertusis + RSV dangerous for kids with bronchopulmonary displasia

severe disease causing: pulmonary HTN and resp failure often requiring ICU

what type of conjunctivtis is normal in infants

sticky eyes but clear discharge with no redness washing with saline is all requried

what is abnormal conjunctivitis

red eyes with purulent discharge

what pathogen usually causes conjuntivitis in neonates

staph or strep

what is the treatement for staph or step conjunctivitis

neomycin eye drops

what are signs of a ghonnococcal eye infection

within 48 hrs of birth red eyes and purlulent discharge

what must you do if you suspect a ? ghonnococcal conjunctivitis

gram stain and swab blood cultures

what is the management of gonnococcal conjunctivitis

cefalexin penicinnin IV

what is the presentation of chlamydia conjuntivitis

eye swelling! purulent discharge can present upto 2 w post birth

what is the treatement for chlamydia conjunctivitis

erythromycin x2 weeks

how is listeria transmitted

listeria myogenes i stransmitted via foods like unpasteurised chese or undercooked paultry

what is maternal presentation of listeria

flu like

what are consequenses of listeria infections to baby

spontaneous abortion prem baby fetal / neonatal sepsis

what is the just born presentation of listeria

meconium stained liquor rash septicemia + meningitis (although this can have late onset)

how do you treat listeria

ampicillin + gentaycin

what is a PDA

a left to right shunt in prem babies as ductus rteriosis hasnt closed yet

what is the presentation of a PDA

mainly asymptomatic but: apnoea bradycardia cynosis HF if severe

what are the cardiac signs of a PDA

Bounding pulse systolic murmur

what is used to investigate a PDA

an echo

how would you manage a PDA

prostaglandin synthase inhibitors = indomatacin or ibruprofen surgery

what causes HIE to occur

compramised cardiac function or decreased perfusion to brain causing barin injury

what can trigger the events leading to HIE

prolonged contractions placental abruption umbillical cord compression shoulder dystocia maternal hypotension/hypertension IUGR failure to breathe at birth

what is the presentation of HIE

must be within 48hrs of birth!! mild= irritable, hyperventilative, staring of eyes mod = fluctuating hyper + hypotonia. May have seizures severe = no response to pain, fluctuating tone, multiorgan failure, seizures

what is the management of HIE

resp sopport +/- anticinvulstants EEG fluid restriction inotrope (digoxin) hypoglycaemia support hypocalcaemia support manage hypothermia

what is retinopathyof immaturity

vasular proloferation causinf retinal detachement

what are Rf for retinopathy of prematurity

high o2 therapy low birth weight (1500g) prem (\<32) and if under 28 weeks theres risk of bilaterap retinopathy of prematurity

what is the management of at risk patients of retinopathy of prematurity

weekly fundoscopy lazer surgery

what is necrotising enterocolitis

bacterial invasion of ischemic bowel wall upon bowel death

how does necrotising enterocolitis present

feeding intolerence abdo pain and distension shiny skin on abdomen bloody stools bile stained vomit shock

what investigations are used in necrotising enterocolitis

x ray transillumination of abdomen

what findings on Xray would there be for necrotising enterocolitis

distended bowel loops thickened bowel walls intermural gas gas under duaphragm and in billary tree

how do you manage necrotising enterocolitis

stop feeds parenteral nutrition abx ventilation surgery

is an infant has necrotising enterocolitis what are they at risk of getting in later ife

strictures and malabsorbtion

what are the types of cleft lip and pallette

unilateral]bilateral

what is the pathophysiology of cleft lip/pallette

failure of fusion of frontonasal + maxillary process as well as failure to fuse palatine process and nasal septum

what causes cleft lip/pallette

folic acid deficiency chromosomal maternal anticonvulstant therpay

what is the management of cleft lip/pallette

surgery erly in life

describe caput succedaneum

bruising of presenting part of baby

describe cephalohaematoma

bleeding below periosteum usually on parietal bone

when can a chingon ocur

ventrose delivery

what can scalp electrodes do to baby

cause abrasions

why would a brachial paulsey occur

breech shoulder dystocia

what nerve does erbs paulsey affect

C5+6 'waiters arm'

why wuld a facial nerve pasley occur

compression during birth

what may you need to help manage facial nerve palsey

hydrating eye drops mathylcellulose

when do palseys usually reverse by

2-3 months