Neonatology Flashcards
what are causes of a prem baby
idiopathic
infections
iugr
congenital abnormalities
preeclampisa
interuterine bleed
cervicle weakness
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)
what are complications of prematurity
RDS
pneumothorax
PDA
necrotising enterocolitis
retinopathy
bronchopulmonary displasia
how do you staibalise a prem baby
resp breaths
incubator
O2 on high flow nasal cannula/CAPAP
periferal and umbillical lines
what is gestational diabetes
previous non diabetic developing high blood sugars during pregnancy
due to carbohydrate intolerance and insulin resistant state of pregnancy
what are the RF for gestational diabetes
PCOS
pre diabtes
increased maternal and paternal age
overweight
how do you chech for gestational diabetes in pregnancy
glucose tolerence test at 28 weks in high risk women
describe the glucose tolerence test
nin fasting + 50g glucose load
testes one hour later
2 or more abnormal tests = diabetes
what is the management of gestational diabetes
insulin = aim to prevent fetal macrosomia
c section if macrosomia
GTT 6 weeks post partum
what complications does maternal hyperthyroidism pose to baby
prem
iugr
higher risk of perinatal mortality
what are maternal complications of hyperthyroidism
infertility
miscarrige
cardiac failure
thyroid storm
how do you manage maternal hyperthyroidism
propythiouracil (better than carbimazole in pregnancy)
regular fetal US to chech tachycardia (thyroid dysfunction) after 32 weeks
what features of pregestational diabetes would indicate a poor prognosis
uncontrolled diabetes
DKA
Pyleonephritis
vasculopathy
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
what fetal complications may arise due to pregestational diabetes
congenital malformations (like CHD)
iugr
macrosomia
birth asphixia
shoulder dystocia
nerve paulseys
what is the presentation of fetal hypoglycaemia
sweating
irritability (due to abdo pain)
pallor
hunger
lethargy
seizures
why is fetal hypoglycemia common in first day of life
fetal hyperinsulinism
what are RF for fetal hypoglycemia
IUGR
prem
T1+2 DM maternal
why do prem babys have higer risk of becoming hypoglycemic
low / no glycogen stores
why do babys with DM T1+2 have higher risk of hypoglycemia
due to hyperplasia of islat cells causing hyperinsulinism
how do you diagnose hypoglycemia
x2 low readings
or
x1 very low reading
or symptomatic
how do you treat fetal hypoglycemia
iv glucose + glucagon/hydrocortisone
how do you treat an a granuloma (umbilical )
silver nitrate topical
what cab GBS cause
early or late sepsis
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
