Neonatology Flashcards
Define an extremely, very and moderatly preterm birth
extreme: before 28 weeks
very: 28-32 weeks
moderate: 32-37 weeks
Give 4 risk factors for preterm birth
- previous prem deliveries
- multiple pregnancy
- cervical incompetence
- placental insufficiency
- smoking and drug use in pregnancy
- being underweight or overweight in pregnancy
- early pregnancy (within 6 months of previous pregnancy)
- cervix, uterus or placental problems inc infection
- certain chronic conditions such as diabetes or HTN
- physical injury/ trauma
What imaging may be needed to be carried out on a prem baby?
- CXR- check no infection or ards and position of ET tube
- AXR- risk of necrotising enterocolitis and check position of umbelical artery lines
- cranial US- check for intraventricular haemorrhage or ischaemic periventricular white matter damage
Generally, how should prem births be managed?
- if extreme, need to go to tertiary level neonatal unit
- antenatal steroids to reduce risk of ARDS of newborn
- magnesium sulphate- neuroprotective to baby
- resus for almost all over 24 weeks and some over 23 weeks
- will likely need TPN feed initially, then slowly introducing NG feeds
- reduce infection risk
- keep walk in intubation
- respiratory support
Give 3 respiratory complications of prem birth
- resp distress syndrome
- surfactant deficient lung disease
- chronic lung disease
- recurrent apnoea
Give 2 cardio complications of prem birth and briefly describe how they’re managed
- poor contracility and hypotension: dopamine, adrenaline infusions/ inotrope support, fluid resus, NSAID administration
- PDA: NSAIDs and indomethacin, if fail surgical ligation
Give 3 neuro complications of prem brith
- intravascular haemorrhage
- seizures
- post haemorrhagic ventricular dilation
- developmental delay
- cerebral palsy
Give 2 GI complications of prem birth
- immature gut causing feeding intolerance
- necrotising enterocolitis
Give 5 benefits to breast feeding
- bonding with baby
- antibodies protect from URTIs, influenza, otitis media, asthma and eczema
- hormones for development
- reduced risk of sudden infant death syndrome
- reduced obesity and type 2 diabetes risk
- long chain poly unsaturated fatty acids are good for brain development
- environmental and financial benefits
- suckling promotes uterine contractions so reduced post partum haemorrhage risk
- visual acuity is higher
give 3 common problems with breast feeding
- its hard work, and somtimes never works
- weening can be challenging
- can make nipples sore and cracked
- breast engorgement can be painful
- mastitis is common
- can get thrush on nipples
- break milk supply can be low
How is mastitis managed?
- flucloxacillin for 7-10 days
- continue breast feeing
- Ibuprofen
- hot and cold compress
Give 3 contraindications to breast feeding
- HIV
- amiodarone
- antimetabolites
- carbimazole
- opiates
- many other drugs- check bnf
how much formula is needed and for how long
- after 7 days they need 150mls/kg/day
- 200g if prem and 100g if large for age
- feed 4-6 times per day
- wean at 6 months
What are the different types of formula milk
- standard: cows milk with modified fat, protein and vitamin content
- follow on: casein based protein component, delays stomach emptying so less frequent feeds
- hydrolysed formulas: if cows milk allergy
- specialist milks: for gord, malabsorbtion or metabolic diseases
- soya products arnt recommended as they have oestrogen in which could affect immune and thyroid function
What is involved in a newborn screening examination
- eyes: red reflex absent= cateracts and white= retinoplastoma
- heart: listen for CHD and resp distress signs
- hips: for DDH which barlow and ortolani manoeuvers
- testes: check descent
- general examination- blue spots, spina bifida, downs and other trisomy characteristics etc
State as many of the 9 things screened for on the blood spot screening test as you can
- congenital hypothyroid (TSH)
- cystic fibrosis (immunoreactive trysinogen)
- phenylketonuria
- sickle cell disease and B thalassaemia major
- MCADD
- isovaleric acidaemia
- glutaric aciduria type 1
- homocystinuria
- maple syrup urine disease
when are hearing tests done?
- after 4 weeks if hospital based
- after 5 if in community
- and at 5 yrs (also get sight done)
Describe the screening tests that take place during pregnancy
- HIV, Hep B and syphilis at 8-12 weeks
- combined test at 10-14 weeks - blood test for trisomies 13,18 and 21 + nuchal translucency on USS
- rhesus disease screening
- anaemia screen at 28 weeks
- chorionic villus sampling at 11-14 weeks or amniocentesis at 15 weeks for definitive diagnosis if combined test suspicious
How is gestational diabetes screened for and who gets screened?
- oral glucose tolerance test at 24-28 weeks
if: - overweight
- diabetes in pregnancy before
- had a baby weighing 4.5kg or more before
- close relative with diabetes
- SE asian, black caribbean or middle eastern origin
Describe the foetal circulation
- Blood oxygenated at placenta, enters IVC via ductus venosus on umbilical vein
- IVC-> RA -> RV -> PA
- most blood in PA goes to aorta via PDA, some goes to lungs
- lungs -> LA-> LV -> Aorta
- aorta -> body-> umbilical arteries -> placenta
What is vaccinated against?
Diptheria tetanus pertussis polio h. influenza meningitis (Hib/MenC and ACWY) rotavirus rubella measles mumps VZV
What is diphtheria?
gram +ve bacteria releases toxin causing upper airway swelling and lymphadenopathy which can result in resp failure, circulatory collapse, coma and death
What is tetanus?
toxin from clostridium tetani (found in soil/ manure and enters through broken skin) causes local muscle spasm (lockjaw, back spasms etc) and then generalised spasm-> painful and can affect respiratory effort
What is pertussis
Droplet spread bacteria with 3 phases:
1. catarrhal phase (1-2 weeks)- like viral URTO
2. paroxysmal phase (100 day cough)- intense coughing fits for several mins with loud inspiratory whoop
3. convalescent phase- chronic cough lasting weeks
Complications inc . pneumonia, bronchicetasis, vomiting, brain hypoxia.
Need deep nasophayngeal swab to diagnose
What is poliomyelitis
Enterovirus spread by faecal oral transmission.
Usually affects children <5 yrs, many will get subclinical corzyal symptoms, some flu like headache, fever, sore throat etc and 5% get sudden onset paralysis which is often fatal
What is haemophilus infuenza
Common resp spread bacterial infection causing pneumonia, bacteraemia, pericarditis, osteomyelitis and epiglottitis inparticular.
When are the Hib/ MenC and MenACWY vaccines given?
Hib/ menC at 12 months and menACWY at 14 yrs
what is rotavirus
common cause of gastroenteritis, vaccine protects against 5 serotypes
