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Neonatology Flashcards

1
Q

Name 7 functions of the placenta?

A
  • Fetal homeostasis
  • Gas exchange
  • Nutrient transport to fetus
  • Waste product transport from fetus
  • Acid base balance
  • Hormone production
  • Transport of IgG
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2
Q

What is meconium?

A

Earliest stool of a newborn. Meconium is composed of materials ingested during the time the infant spends in the uterus: intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile and water.

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3
Q

Describe an overview of fetal circulation?

A

Oxygenated blood is supplied by the umbilical vein
Some of that blood is directed to the ductus venous (shunts blood to IVC) and then IVC and some enters the liver
Blood goes from IVC to RA and most goes RA to LA through foramen ovale
This blood goes to LV and supplies carotids and ascending aorta
Some of the blood from the RA enters RV and is pumped into PA
In fetus the PA and aorta are connected by the ductus arteriosus which directs most of the partially oxygenated blood away from the lungs and to the lower body.

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4
Q

In the fetus what are the PA and the aorta connected by?

A

Ductus arteriosus

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5
Q

What is the name of the shunt between the RA and LA in the fetus? Function?

A

Foramen ovale

Directs most of oxygenated blood away from lungs which don’t need it as they aren’t functioning

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6
Q

Function of the ductus venosus?

A

Shunts blood to IVC allowing most of oxygenated blood to bypass the liver

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7
Q

Describe circulatory transition at birth?

A

With first breath pulmonary vascular resistance falls and systemic resistance rises
Decrease in RA pressure and increase in LA results in closure of the foramen ovale (forming fossa ovalis)
Ductus venosus closes off after birth becoming the ligamentous venous and umbilical vein becomes ligamentum teres
Over first few hrs the ductus arterioles functionally shuts and it anatomically shuts within 7-10 days forming the ligementum arteriosum

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8
Q

What embryological remnant does the foramen ovale become?

A

fossa ovalis

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9
Q

What embryological remnant does the ductus venous become?

A

ligamentum venosus

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10
Q

What embryological remnant does the umbilical vein become?

A

ligamentum teres

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11
Q

What embryological remnant does the ductus arteriosus become?

A

ligamentum arteriosum

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12
Q

What type of cell produces surfactant? What is the function of surfactant?

A

Type 2 alveoli cells

Reduces surface tension in the lungs

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13
Q

Name 5 third trimester adaptations?

A

Surfactant production
Accumulation of glycogen in liver, muscle and heart
Accumulation of brown fat between scapulae and around internal organs
Accumulation of subcutaneous fat
Swallowing and inhalation of amniotic fluid to help lungs grow and practice breathing

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14
Q

What is the function of brown fat?

A

Turns food into body heat

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15
Q

Why do babies with low amniotic fluid have higher risk of hypo plastic lungs?

A

In the third trimester babies are swallowing and inhaling amniotic fluid to practice breathing and help the lungs grow so if less of this lungs may not grow properly

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16
Q

What chemicals are increased at onset of labour?

A

Catecholamines

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17
Q

What happens in baby’s lungs during delivery and labour?

A

Synthesis of lung fluid stops
Vaginal delivery squeezes lungs in baby to get rid of the fluid, rest of fluid the baby has to absorb which is done by crying.

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18
Q

Initially how much of their birth weight may babies lose?

A

10%

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19
Q

What can usually shift the oxygen dissociation curve to the right (ie make oxygen offloaded more readily)?

A

Increased CO2
Increased H+ (so decreased pH)
Increased temperature
Increase 23 BPG which is a product of respiration
So basically if got a higher rate of respiration all these things will increase which in turn causes you to offload oxygen more readily which is what you want

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20
Q

Why is thermoregulation important in newborns?

A

They have a large surface area to mass ratio and babies can’t shiver

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21
Q

Why are babies at risk of hypoglycaemia?

A

They can’t necessarily feed straight away and they are interrupted from the placental glucose supply

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22
Q

Explain physiological anaemia of babies? What time period?

A

Fetal Hb interacts less with 23BPG so curve is to left and means has a higher affinity for O2. When born the curve starts to move to the right by adult Hb is synthesised slower than metal Hb broken down so can get physiological anaemia in mot babies at 8-10 weeks.

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23
Q

Explain physiological jaundice of babies?

A

Fetal Hb is broken down quickly and as the conjugating pathways are not quite mature get a rise in unconjugated bilirubin which is generally not harmful.

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24
Q

What is the neonatal period?

A

Up to 28 days of life

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25
Normal heart rate of a newborn baby?
120-140/60 | Preterm babies more likely to be close to 160
26
Define antenatal, perinatal and postnatal?
Antenatal: before birth; during or relating to pregnancy Perinatal: Pertaining to the period immediately before and after birth. The perinatal period is defined in diverse ways. Depending on the definition, it starts at the 20th to 28th week of gestation and ends 1 to 4 weeks after birth. Postnatal: Period after child birth
27
Common type of bacterial infection in newborns?
Group B Strep - this is a subcategory of beta haemolytic strep (can cause neonatal meningitis and pneumonia- could be a cause of respiratory distress)
28
Describe classifications of strep?
Alpha haemolytic: Strep pneumonia and strep viridians Beta haemolytic: Group A (strep pyogenes throat and skin infections) Group B (neonatal meningitis) and Group C Non haemolytic: Enterococci in the gut
29
What is transient tachypnoea of newborn and how does it present?
Diagnosis of exclusion | Baby tends to be grunting shortly after delivery and rapid breathing, fluid is also seen on CXR
30
What babies tend to get TTN?
Generally big healthy babies born by section as this means the lungs are not squeezed so a larger amount of fluid remains
31
Treatment of TTN?
Need to first exclude infection | Generally don't need any formal treatment
32
Why and when are antenatal steroids given?
They are given when baby expected to be premature as they speed up lung development by up regulating cells that produce surfactant giving the baby a much higher chance of survival. They also reduce incidence of intraventricular haemorrhage.
33
What is persistent pulmonary hypertension of the newborn/ RDS?
Relative surfactant deficiency due to prematurity as surfactant is not produced until late on in pregnancy RDS and PPHN seem to be used interchangeably but RDS i think refers specifically to PPHN caused by prematurity and surfactant deficiency but PPHN could also be cause by some sort of congenital abnormality meaning pressure in lungs doesn't fall.
34
Presentation of persistent pulmonary hypertension of the newborn?
Tachypnoea, RR increased, grunting, upper intercostal recession, nasal flaring, cyanosis, worsens with time
35
Complications of persistent pulmonary hypertension of the newborn?
Lung damage leading to chronic lung disease | Pneumothorax
36
Treatment of persistent pulmonary hypertension of the newborn?
Antenatal steroids is suspect prematurity | Surfactant replacement when born
37
Heart disorders in neonates are less or more common than respiratory?
Less
38
What is hydros foetalis and rhesus disease?
Hydrops is fluid disorder with pericardial effusions, pleural effusions and ascites Rhesus is when antibodies in pregnant woman blood destroy the babies blood cells and it can lead to hydrops.
39
Do congenital heart defects usually present right away?
No | May take a few hours or can go unnoticed if not severe
40
4 components of the tetralogy of fallot?
Pulmonary stenosis, RV hypertrophy, VSD, overriding aorta
41
What happens in transposition of the great arteries?
Aorta and PA are switched by baby often has other defects that allow them to live
42
What happens in coarctation of the aorta? What are the signs?
Narrow part of the aorta | Absent leg pulses on baby exam and high BP in arms but lower/ normal in the legs
43
What is total anomalous pulmonary venous drainage?
Congenital heart disease where all 4 PV drain to the systemic venous circulation
44
What is hypo plastic left heart?
Left side of heart not formed correctly
45
What heart conditions may go unnoticed?
Small ASD (incomplete closure of foramen ovale) and small VSD
46
Two congenital respiratory diseases?
Tracheooesphageal fistula | Diaphragmatic hernia
47
Baby with blue episodes when swallowing?
Tracheo oesophageal fistula
48
Diaphragmatic hernia is associated with lung _____
hypoplasia
49
Define preterm, term and post term? How is due date calculated?
Preterm= a birth that occurs before 37 completed weeks of gestation Term= a birth between 37 and 42 weeks of gestation Post term= a birth occurring after 42 weeks of gestation Pregnancy due dates calculated= 40 weeks
50
Define extremely preterm and very preterm?
* Extremely preterm= less than 27 weeks completed | * Very preterm= less than 32 weeks
51
What is a normal newborn baby weight? What is SGA and LGA?
“Normal” weight 2.5 kg – 4.0 kg Over 4.0 Kg, large for gestational age, LGA Under 2.5 kg, small for gestational age, SGA
52
9 risk factors for prematurity?
``` Maternal age- teenage or over 40 Smoking, alcohol and illicit drugs Poverty Ethnic minorities Multiple pregnancy Interval less than 6 months between pregnancies Conceiving through IVF Poor nutrition Some chronic conditions ```
53
How do help preterm babies stay warm?
Cosy bags under heater, prewired incubators and mattresses
54
What is TPN?
Total parenteral nutrition | IV feeding
55
Why do premature babies have problems with feeding? Solutions?
Limited reserves, gut immaturity, immature metabolic pathways Mum stores breastmilk so baby can eat when able Sometimes babies given TPN
56
Why is risk of sepsis higher in premature babies?
Immature immune system, lots of lines and tubes in intensive care
57
Premature baby system immaturity resp problem ?
RDS
58
Premature baby system immaturity cardio problem ?
Patent ductus arterioles as no mechanics for it to close when born early
59
Premature baby system immaturity brain problem ? What antenatal treatment reduces incidence?
``` intraventricular haemorrhage (bleeding into fluid filled areas inside brain) attributed to fragility of brain vasculature. Can cause neurodevelopment delay. STEROIDS ```
60
Premature baby system immaturity GI problem ?
nectrotising enterocolitis in extreme preterm, bacteria easily cross gut lumen
61
Premature baby system immaturity ophthalmology problem ?
Retinopathy | Need to screen till retina is fully vascularised
62
Premature baby system immaturity endo problem ?
Hypoglycaemia and hyponaetremia in early stages. Osteopenia of prematurity in later stages.
63
In neonatal exam what is being looked for in the head?
Fontanelles and sutures
64
What are fontanelles?
A fontanelle is an opening in a baby's skull where the skull bones have not yet grown and joined together. Fontanelles allow the bones of the skull to move so the baby's head can change shape during delivery.
65
What is being looked for in eyes in neonate exam? What's normal?
``` Size Red reflex- want to see this Conjunctival haemorrhage- sometimes from birth important to note so not mistaken later as NAI Squints (frequent) Iris abnormality ```
66
What is being looked for in ears in neonate exam?
``` Position External auditory canal Tags/pits Folding Family history of hearing loss ALL BABIES GET A FORMAL HEARING CHECK BY AUDIOLOGY TOO ```
67
What is being looked for in mouth in neonate exam?
Shape Philtrum (clefts) Tongue tie Palate Neonatal teeth (these are due to underlying medical issues and may cause issues with feeding) Ebsteins pearls (small cysts that usually disappear on their own) Sucking/rooting reflex
68
What is being looked for in the face in neonate exam?
Facial palsy Dysmorphism Signs of things like FAS
69
What is being looked for in the cardio portion of neonate exam?
``` Colour/Saturation (SaO2) CHD screening Pulses: femoral Apex Thrills/heaves Heart sounds ```
70
What is being looked for in the GI portion of neonate exam?
``` Moves with respiration Distension Hernia Umbilicus Bile stained vomiting Passage of meconuim Anus is patent ```
71
What is being looked for in the GU portion of neonate exam?
Normal passage of urine Normal genitalia Undescended testes Hypospadius (opening of urethra on underside of penis)
72
What is being looked for in the MSK portion of neonate exam?
Movement & posture Limbs and digits (all fingers and toes) Spine Hip examination
73
What is being looked for in the neurological portion of the neonate exam?
``` Alert, responsive Cry Tone Posture Movement Primitive reflexes ```
74
What does Moro reflex?
Loss of support for baby's neck causes it to spread out arms
75
Causes of respiratory distress in a newborn?
Infection- pneumonia gram negs and group b strep RDS TTN Pneumothorax
76
Examples of gram neg organisms?
Neisseria | Coliforms- e.coli and klebsiella
77
Describe trisomy 21
Downs syndrome Signs: Decreased or poor muscle tone Flattened facial profile and nose Small head, ears, and mouth Upward slanting eyes, often with a skin fold that comes out from the upper eyelid and covers the inner corner of the eye Wide, short hands with short fingers A single, deep, crease across the palm of the hand Often have learning difficulties and may be slower to reach developmental milestones. There is a large range however as some people affected worse than others.
78
Describe trisomy 18
Edwards syndrome Very bad outcome most babies don't survive longer than hours or days, occasionally up to a year Physical signs of Edwards' syndrome include: low birthweight a small, abnormally shaped head, jaw and mouth a cleft lip and palate heart and kidney problems feeding problems – leading to poor growth breathing problems hernias in the wall of their stomach (where internal tissues push through a weakness in the muscle wall) bone abnormalities – such as a curved spine frequent infections of the lungs and urinary system a severe learning disability
79
What is anencephaly?
Anencephaly is the absence of a major portion of the brain, skull, and scalp that occurs during embryonic development. It is a cephalic disorder that results from a neural tube defect. Baby won't survive long after birth.
80
What does chromosome microarray test for? Limitations?
Looks for extra or missing chromosomes | Wont be able to tell anything if it is a balanced mutation
81
Overview of different genetic tests?
Karotyping: visualisation of chromosomes in metaphase at mitosis and staining Chromosome microarray: patient DNA with control sample to detect any chromosome imbalance FISH: Fluroscent dye attach to probe DNA attaches to area of interest, allows detection of presence of specific genes PCR: sequencing of short sets of DNA as reaction allows you to amplify them NGS: technology that allows DNA or RNA to be sequenced more economically, massive amounts for much less cost
82
Risk factors for neonatal sepsis?
Group B Streptococcus colonization (Up to 20% of women are asymptomatic carriers) Prolonged Rupture of Membranes (PROM) more than 18 hours at any gestation Significant GBS bacteriuria during the current pregnancy (>104 cfu/mL) Maternal temperature greater than 38ºC during labour Chorioamnionitis (infection and inflammation of fetal membranes often due to bacteria tracking from vagina to uterus) Sustained intrapartum fetal tachycardia Prior delivery of an infant with GBS disease
83
Describe difference between small for gestational age and low birth weight?
Small for gestational age= baby is small for the week it was born Low birth weight= the baby has low weight ie a baby can have a low birth weight but that be normal for its gestational age as it was premature
84
Effect of smoking on pregnancy?
All smokers have placentas that are more hypoxic and smokers placentas tend to be much smaller. Smokers tend to have smaller babies.
85
Normal temperature range for newborns?
36.5-37.4
86
Signs of hypoglycaemia in a neonate?
Temperature instability Seizures (if baby presents with seizures in postnatal ward first thing check) Drowsy or agitated May present like an infection
87
Describe anti-Cw antibodies and others to red blood cells?
There are a few types of red blood cell antibodies but these basically cross the placenta and destroy the red blood cells in the baby which can cause haemolytic disease of the newborn
88
What is the significance of very early in jaundice in newborn?
Jaundice before 24hrs of age is generally not physiological
89
Why is it important to investigate jaundice in a newborn?
Unconjugated bilirubin can cross the BBB and cause a type of cerebral palsy
90
Treatment of jaundice in babies?
Blue light therapy
91
Normal resp rate in a new born?
40-60 breath per minute
92
In any unwell neonate what cause must you always consider?
Infection/ Sepsis
93
Automatic response when considering sepsis in a baby?
Start antibiotics
94
Describe the heel prick test at day 5?
Baby screening test PKU (decreased metabolism of phenylalanine causes massive delays if not known about but if you know start diet and normal intellect), CF most common gene, hypothyroidism (can start thyroxine straight away and normal development), MCAD, sickle cell
95
What is the definition of prolonged jaundice in a baby?
``` Term= anything up to 2 weeks in term baby Preterm= up to 3 weeks in preterm babies ```
96
What type of jaundice are you worried about early on vs late on?
Early on worried about unconjugated bilirubin as this can cross the BBB Late on worried about conjugated bilirubin as this could be a sign of something serious e.g. biliary atresia
97
'Too early' jaundice (before 24hrs) usually is caused by?
haemolytic disease
98
Too high bilirubin between 24hrs and 2 weeks of age is often due to? (THIS REQUIRES BLUE LIGHT TREATMENT)
Mild dehydration/insufficient milk supply (breast-feeding jaundice) Haemolysis Breakdown of extravasated blood (e.g. cephalhaematoma, bruising, CNS haemorrhage, swallowed blood) Polycythaemia  (increased RBC mass) Infection - a more likely cause during this time Increased enterohepatic circulation (e.g. gut obstruction)
99
2 causes thinking if jaundice after 2 weeks in term baby and it's conjugated bilirubin?
Biliary atresia | Hepatitis
100
What is biliary atresia?
Disorder where biliary tree doesn't form properly so bile builds up in the liver and damages it
101
Signs of biliary atresia?
Pale and pasty stool Darker urine Jaundice Liver may harden and abdomen become swollen
102
Continous machinery murmur and a bounding pulse?
Patent ductus arteriosus

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