Neonatology Flashcards

Question

What are the most common causative organisms for transplacental infection?

Answer 1

Listeria monocytogenes TORCH viruses

Answer 2

GBS E. Coli

Answer 3

Environmental Infection from central lines or endotracheal tubes Spina bifida

Answer 4

Gram positive = Staphylococcus epidermidis/aureus or Enterococcus Faecalis Gram negative = E. coli, Pseudomonas, Klebsiella

Answer 5

Preterm birth as any baby born alive before 37 weeks of pregnancy are completed.

Answer 6

Extremely preterm = <28 weeks Very preterm = 28-32 weeks Moderate to late preterm = 32-37 weeks

Answer 7

Intraventricular Haemorrhage Retinopathy of prematurity Poor suck and swallow ↑risk of adverse neurodevelopment outcomes/learning disabilities

Answer 8

↑ risk of PDA + CHD

Answer 9

Neonatal Respiratory Distress Syndrome Chronic lung disease Apnoea of prematurity

Answer 10

Necrotising Enterocolitis Jaundice Poor milk tolerance

Answer 11

Hypoglycaemia Hypothermia Immunocompromise

Answer 12

Defined as <2.6mmol/l Preterm/ IUGR are more at risk due to poor glycogen stores and ↓ enzyme function Jittery, drowsy, apnoea ⇢ seizures ⇢ permanent neurological damage if prolonged Tx = regular monitoring of BMs, milk feed early and often. Can give IV dextrose if really bad

Answer 13

Don’t temperature regulate if <1.5kg, ↑SA:Vol, not much subcutaneous fat Keep warm in incubator, cover baby, heated mattress ↑ energy consumption to keep warm = hypocalcaemia, hypoglycaemia, hypoxia

Answer 14

Haemorrhage into the ventricular system of the brain, usually happens spontaneously or due to trauma during birth Usually occurs in first 72 hours of life

Answer 15

Absent moro/drop reflex Bulging fontanelles Sleepy Transfontanelle USS if <32weeks or known IUGR

Answer 16

Neonate has immature retinal vessels Angiogenesis happens in response to an increase in O2 Giving high O2 = rapid and unstructured angiogenesis leading to an inefficient supply to the retina Leads to a visual impairment

Answer 17

weekly/fortnightly screening from ophthalmologist if premature or low birth weight Laser photocoagulation/ anti-VEGF injections/ surgery if retinal detachment

Answer 18

Surfactant is produced by type 2 pneumocytes and reduces the amount of surface tension within the alveoli by creating a barrier between air and water Makes alveoli less likely to collapse and easier to inflate

Answer 19

Surfactant is only produced AFTER 28 WEEKS Cortisol, thyroxine and prolactin stimulate Insulin inhibits

Answer 20

If baby is born preterm then they have less surfactant so are more susceptible Insufficient surfactant = ↑ surface tension in the alveoli = ↑ risk of collapse Diabetic mothers are more prone to having babies with RDS as insulin inhibits surfactant production

Answer 21

At or within 4 hours of birth: Tachypnoea - > 60 breaths per minute Breathing difficulties → subcostal and sternal recessions + nasal flaring Grunting on expiration → trying to create a positive airway pressure to maintain functional residual capacity! Cyanosis if really severe

Answer 22

Pulse oximetry monitor pO2 and HR Sats should be maintained at 91-95%

Answer 23

Blood gases - Capillary or umbilical? Monitoring for acidosis (Respiratory or metabolic + hypoxia) U&E - Electrolyte imbalances Blood culture - Rule out sepsis LFTs BM FBC

Answer 24

CXR - changes Echo - PDA

Answer 25

Oxygen therapy Can give via high flow cannula or CPAP or mechanically (last resort) Surfactant Give steroids to mam if PROM between 28-32 weeks Surfactant replacement therapy via endotracheal tube Antibiotics until >3-5 days if blood cultures are negative Small volume feeds via a tube once breathing is stabilised to stimulate gut development General supportive therapy

Answer 26

Reticulocytes (RBC precursor) ⇢ Erythrocytes ⇢ Haem + Globin (macrophages in spleen and bone marrow) Globin → Erythropoeisis Haem ⇢ Iron → Erythropoeisis In the liver = Unconjugated Bilirubin → Conjugated Bilirubin In the terminal ileum = Conjugated bilirubin ⇢ Urobilogen → Stercobilin OR some is reabsorbed using bacterial enzymes from gut flora

Answer 27

Pre-hepatic Unconjugated Bilirubin Anything that ↑ rate of haemolysis e.g. haemaglobinopathies (sickle cell, thalassaemias, G6PD) Hepatic Conjugated Bilirubin Builds up in blood due to ↓ efficiency of liver to break down haemoglobin Post-hepatic Conjugated Bilirubin - Bilirubin does not drain into the biliary system via bile

Answer 28

First 24 hours = NOT NORMAL 24 hours - 14 days = NORMAL 14+ days = NOT NORMAL

Answer 29

Pre hepatic due to ↑ haemolysis Sepsis via a congenital infection Haemolytic Disease of the newborn (ABO incompatibility, Rhesus incompatibility) Haemaglobinopathy e.g. spherocytosis, sickle cell, thalassaemia, G6PD

Answer 30

MOther is blood group O BA-By is blood group A or B Blood antibodies are usually IgM so can’t cross the placenta but in this case they are IgG so can cross placenta and haemolyse foetal RBCs

Answer 31

Severe jaundice that peaks in first 12-72 hours Normal/slightly ↓ Hb No hepatosplenomegaly

Answer 32

Cord blood samples to find cause Infection - TORCH screen Hb (normal or slightly low) Blood group Direct Coombs test LFTs

Answer 33

Ventilation + high flow + PEEP Drainage of severe fluid overload e.g. ascites/pleural effusion + IV furosemide if CCF + fluid limitation Correction of anaemia IM vitamin K for clotting

Answer 34

``` Rhesus negative (rr) mother and rhesus positive father (Rr) = Rhesus positive baby = baby is incompatible with mother ``` Blood mixes at birth and maternal immune system becomes sensitised i.e. maternal IgG production in first pregnancy Problem for later pregnancies is that maternal IgG crosses the placenta causing haemolysis of foetal RBCs

Answer 35

Jaundice - early and more severe than in ABO incompatability + Kernicterus Hepatospelnomegaly as liver trying to produce more RBCs and liver and spleen taking up more RBCs Thrombocytopaenia/coagulopathys/hypoalbuminaemia - ↑RBC production at expense of albumin (oedema) Anaemia → congestive cardiac failure → oedema Hydrops fetalis

Answer 36

Maternal blood group, Rhesus status

Answer 37

Cord blood sampling/ foetal blood | ↓ Hb levels, Rh+

Answer 38

High risk = intensive phototherapy + extra water Manage coagulopathy Daily folic acid for 6 months to ↑RBC Check for anaemia every 1-2 weeks for 12 weeks - transfuse as packed red cells if Hb <7g/dl or symptomatic. Do audiology screening if transfuse

Answer 39

↑ Hb at birth so ↑ breakdown of RBCs (pre-hepatic) Liver doesn’t fully mature until after 2 weeks (hepatic) Lack of gut flora to reabsorb conjugated bilirubin/eliminate bile pigments (post-hepatic) Could also be breast milk jaundice. Cause is unknown but normally resolves around 6 weeks

Answer 40

Jaundice after 14 days Chalky white stools and dark urine that stains the nappy

Answer 41

Breast milk jaundice (unknown mechanism) - high unconjugated bilirubin Infection Hypothyroidism (↓rate of conjugation) High GI obstruction e.g. pyloric stenosis Haemolytic anaemia e.g. spherocytosis

Answer 42

Biliary atresia is concerning cause Lumen of biliary tree is absent/blocked leading to an occlusion Healthy term baby + persistent jaundice + hepatosplenomegaly + high conjugated bilirubin Diagnose via cholangiogram and needs surgical management + assessment at specialist liver unit

Answer 43

Treatment threshold graph to interpret bilirubin levels (gestation specific as if ↓ gestation then ↓ level of bilirubin for neurological problems). Has 2 lines: one for phototherapy, one for exchange transfusion and if on/above these lines then have to start the treatment

Answer 44

Measure SERUM BILIRUBIN if in first 24 hours of life OR <35 weeks gestational age Measure transcutaneously if after 24 hours or if >37 weeks GA

Answer 45

Conjugated and unconjugated bilirubin levels Coombs/ direct antiglobulin test (+ve in antibody mediated anaemias) FBC + blood film (anaemia + can visualise abnormalities) TFTs (hypothyroidism is a cause of prolonged jaundice) U&Es - dehydration? LFTs - neonatal cirrhosis/damage

Answer 46

Light from the blue-green wave converts unconjugated bilirubin to a harmless substance that can be excreted in the urine

Answer 47

Not harmful but disrupts care e.g. breastfeeding/cuddles with mum so only start if on or above the treatment line Baby must be naked except nappy and have eyes covered as bright light is harmful Also has a risk of temperature disturbance so monitor temperature + macular rash Stop when bilirubin has fallen below the treatment line (measure serum bill regularly)

Answer 48

Removal of foetal blood through arterial line/umbilical vein and replace with donor blood via peripheral line/umbilical vein Done if unresponsive to phototherapy

Answer 49

Encephalopathy due to deposition of unconjugated bilirubin in the basal ganglia and brainstem nuclei Happens due to ↑ unconjugated bilirubin to a level that is greater than the albumin binding-capacity Unconjugated bilirubin is fat soluble so can cross the blood brain barrier

Answer 50

Lethargic/Poor feeding Irritable Seizures Hypertonia + lying with an arched back (opisthotonos)

Answer 51

Choreoathetoid Cerebral Palsy Learning difficulties Sensorineural deafness

Answer 52

Preterm bowel is vulnerable to ischaemic insult and bacterial invasion = tissue death Occurs within first 2-3 weeks of feeding

Answer 53

Feeding intolerance Distended abdomen Bloody stools

Answer 54

Rigler’s sign (gas in and out of bowel) Dilated bowel loops Bowel wall oedema Pneumoperitoneum

Answer 55

Acute Respiratory Distress Syndrome Transient tachypnoea of the newborn (excess fluid in lungs. should resolve within 24hrs) Meconium Aspiration (resp distress in the neonate born through meconium stained amniotic fluid which cannot be otherwise explained) Bronchopulmonary dysplasia/Chronic lung disease (need for supplemental O2 28 days after birth)

Answer 56

Defects of the abdominal wall that occur in utero and result in herniation of the gastric contents There is a lack of a protective sac in gastroschisis which exposes the intestines to amniotic fluid in utero, leading to a thick inflammatory film

Answer 57

Caesarean to reduce risk of sac rupture Staged repair (surgery)

Answer 58

Vaginal delivery Go to theatre asap after being born i.e. 4 hours