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Child and Family Health > Neonatology > Flashcards

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
Q

Normal heart rate of a newborn baby?

A

120-140/60

Preterm babies more likely to be close to 160

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26
Q

Define antenatal, perinatal and postnatal?

A

Antenatal: before birth; during or relating to pregnancy
Perinatal: Pertaining to theperiodimmediately before and after birth. Theperinatal periodisdefinedin diverse ways. Depending on thedefinition, it starts at the 20th to 28th week of gestation and ends 1 to 4 weeks after birth.
Postnatal: Period after child birth

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27
Q

Common type of bacterial infection in newborns?

A

Group B Strep - this is a subcategory of beta haemolytic strep (can cause neonatal meningitis and pneumonia- could be a cause of respiratory distress)

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28
Q

Describe classifications of strep?

A

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

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29
Q

What is transient tachypnoea of newborn and how does it present?

A

Diagnosis of exclusion

Baby tends to be grunting shortly after delivery and rapid breathing, fluid is also seen on CXR

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30
Q

What babies tend to get TTN?

A

Generally big healthy babies born by section as this means the lungs are not squeezed so a larger amount of fluid remains

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31
Q

Treatment of TTN?

A

Need to first exclude infection

Generally don’t need any formal treatment

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32
Q

Why and when are antenatal steroids given?

A

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.

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33
Q

What is persistent pulmonary hypertension of the newborn/ RDS?

A

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.

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34
Q

Presentation of persistent pulmonary hypertension of the newborn?

A

Tachypnoea, RR increased, grunting, upper intercostal recession, nasal flaring, cyanosis, worsens with time

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35
Q

Complications of persistent pulmonary hypertension of the newborn?

A

Lung damage leading to chronic lung disease

Pneumothorax

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36
Q

Treatment of persistent pulmonary hypertension of the newborn?

A

Antenatal steroids is suspect prematurity

Surfactant replacement when born

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37
Q

Heart disorders in neonates are less or more common than respiratory?

A

Less

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38
Q

What is hydros foetalis and rhesus disease?

A

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.

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39
Q

Do congenital heart defects usually present right away?

A

No

May take a few hours or can go unnoticed if not severe

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40
Q

4 components of the tetralogy of fallot?

A

Pulmonary stenosis, RV hypertrophy, VSD, overriding aorta

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41
Q

What happens in transposition of the great arteries?

A

Aorta and PA are switched by baby often has other defects that allow them to live

42
Q

What happens in coarctation of the aorta? What are the signs?

A

Narrow part of the aorta

Absent leg pulses on baby exam and high BP in arms but lower/ normal in the legs

43
Q

What is total anomalous pulmonary venous drainage?

A

Congenital heart disease where all 4 PV drain to the systemic venous circulation

44
Q

What is hypo plastic left heart?

A

Left side of heart not formed correctly

45
Q

What heart conditions may go unnoticed?

A

Small ASD (incomplete closure of foramen ovale) and small VSD

46
Q

Two congenital respiratory diseases?

A

Tracheooesphageal fistula

Diaphragmatic hernia

47
Q

Baby with blue episodes when swallowing?

A

Tracheo oesophageal fistula

48
Q

Diaphragmatic hernia is associated with lung _____

A

hypoplasia

49
Q

Define preterm, term and post term? How is due date calculated?

A

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
Q

Define extremely preterm and very preterm?

A
  • Extremely preterm= less than 27 weeks completed

* Very preterm= less than 32 weeks

51
Q

What is a normal newborn baby weight? What is SGA and LGA?

A

“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
Q

9 risk factors for prematurity?

A 
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
Q

How do help preterm babies stay warm?

A

Cosy bags under heater, prewired incubators and mattresses

54
Q

What is TPN?

A

Total parenteral nutrition

IV feeding

55
Q

Why do premature babies have problems with feeding? Solutions?

A

Limited reserves, gut immaturity, immature metabolic pathways
Mum stores breastmilk so baby can eat when able
Sometimes babies given TPN

56
Q

Why is risk of sepsis higher in premature babies?

A

Immature immune system, lots of lines and tubes in intensive care

57
Q

Premature baby system immaturity resp problem ?

A

RDS

58
Q

Premature baby system immaturity cardio problem ?

A

Patent ductus arterioles as no mechanics for it to close when born early

59
Q

Premature baby system immaturity brain problem ? What antenatal treatment reduces incidence?

A 
intraventricular haemorrhage (bleeding into fluid filled areas inside brain) attributed to fragility of brain vasculature. Can cause neurodevelopment delay.
STEROIDS
60
Q

Premature baby system immaturity GI problem ?

A

nectrotising enterocolitis in extreme preterm, bacteria easily cross gut lumen

61
Q

Premature baby system immaturity ophthalmology problem ?

A

Retinopathy

Need to screen till retina is fully vascularised

62
Q

Premature baby system immaturity endo problem ?

A

Hypoglycaemia and hyponaetremia in early stages. Osteopenia of prematurity in later stages.

63
Q

In neonatal exam what is being looked for in the head?

A

Fontanelles and sutures

64
Q

What are fontanelles?

A

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
Q

What is being looked for in eyes in neonate exam? What’s normal?

A 
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
Q

What is being looked for in ears in neonate exam?

A 
Position
External auditory canal
Tags/pits
Folding
Family history of hearing loss
ALL BABIES GET A FORMAL HEARING CHECK BY AUDIOLOGY TOO
67
Q

What is being looked for in mouth in neonate exam?

A

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
Q

What is being looked for in the face in neonate exam?

A

Facial palsy
Dysmorphism
Signs of things like FAS

69
Q

What is being looked for in the cardio portion of neonate exam?

A 
Colour/Saturation (SaO2)
CHD screening
Pulses: femoral
Apex
Thrills/heaves
Heart sounds
70
Q

What is being looked for in the GI portion of neonate exam?

A 
Moves with respiration
Distension
Hernia
Umbilicus
Bile stained vomiting
Passage of meconuim
Anus is patent
71
Q

What is being looked for in the GU portion of neonate exam?

A

Normal passage of urine
Normal genitalia
Undescended testes
Hypospadius (opening of urethra on underside of penis)

72
Q

What is being looked for in the MSK portion of neonate exam?

A

Movement & posture
Limbs and digits (all fingers and toes)
Spine
Hip examination

73
Q

What is being looked for in the neurological portion of the neonate exam?

A 
Alert, responsive
Cry
Tone
Posture
Movement
Primitive reflexes
74
Q

What does Moro reflex?

A

Loss of support for baby’s neck causes it to spread out arms

75
Q

Causes of respiratory distress in a newborn?

A

Infection- pneumonia gram negs and group b strep
RDS
TTN
Pneumothorax

76
Q

Examples of gram neg organisms?

A

Neisseria

Coliforms- e.coli and klebsiella

77
Q

Describe trisomy 21

A

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
Q

Describe trisomy 18

A

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
Q

What is anencephaly?

A

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
Q

What does chromosome microarray test for? Limitations?

A

Looks for extra or missing chromosomes

Wont be able to tell anything if it is a balanced mutation

81
Q

Overview of different genetic tests?

A

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
Q

Risk factors for neonatal sepsis?

A

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
Q

Describe difference between small for gestational age and low birth weight?

A

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
Q

Effect of smoking on pregnancy?

A

All smokers have placentas that are more hypoxic and smokers placentas tend to be much smaller. Smokers tend to have smaller babies.

85
Q

Normal temperature range for newborns?

A

36.5-37.4

86
Q

Signs of hypoglycaemia in a neonate?

A

Temperature instability
Seizures (if baby presents with seizures in postnatal ward first thing check)
Drowsy or agitated
May present like an infection

87
Q

Describe anti-Cw antibodies and others to red blood cells?

A

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
Q

What is the significance of very early in jaundice in newborn?

A

Jaundice before 24hrs of age is generally not physiological

89
Q

Why is it important to investigate jaundice in a newborn?

A

Unconjugated bilirubin can cross the BBB and cause a type of cerebral palsy

90
Q

Treatment of jaundice in babies?

A

Blue light therapy

91
Q

Normal resp rate in a new born?

A

40-60 breath per minute

92
Q

In any unwell neonate what cause must you always consider?

A

Infection/ Sepsis

93
Q

Automatic response when considering sepsis in a baby?

A

Start antibiotics

94
Q

Describe the heel prick test at day 5?

A

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
Q

What is the definition of prolonged jaundice in a baby?

A 
Term= anything up to 2 weeks in term baby
Preterm= up to 3 weeks in preterm babies
96
Q

What type of jaundice are you worried about early on vs late on?

A

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
Q

‘Too early’ jaundice (before 24hrs) usually is caused by?

A

haemolytic disease

98
Q

Too high bilirubin between 24hrs and 2 weeks of age is often due to? (THIS REQUIRES BLUE LIGHT TREATMENT)

A

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 causeduring this time
Increased enterohepatic circulation (e.g. gut obstruction)

99
Q

2 causes thinking if jaundice after 2 weeks in term baby and it’s conjugated bilirubin?

A

Biliary atresia

Hepatitis

100
Q

What is biliary atresia?

A

Disorder where biliary tree doesn’t form properly so bile builds up in the liver and damages it

101
Q

Signs of biliary atresia?

A

Pale and pasty stool
Darker urine
Jaundice
Liver may harden and abdomen become swollen

102
Q

Continous machinery murmur and a bounding pulse?

A

Patent ductus arteriosus

Child and Family Health (9 decks)

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