Neonatology Flashcards
What are some neonatal definitions?
Neonatology is a sub speciality of paediatrics that consists of the medical care of new born infants, especially the ill or premature newborn.
Small for dates - weighing less than the 10th centile for their gestational age
Preterm - <37 weeks
Extremely preterm - <28 weeks
Low birthweight <2500g
Very low birthweight <1500g
Extremely low birthweight <1000g
How are neonates physiologically different and what changes occur after birth?
Ductus arteriosos (protects lungs against circulatory overload, allowing right ventricle to strengthen and carries low oxygen saturated blood) becomes a ligament
Foramen ovale (shunts blood from left atrium to left ventricle) closes
Ductus venosus (gets oxygenated blood via umbilical vein) becomes a ligament
Umbilical vein becomes a ligament
Umbilical arteries become ligaments
Normal heart rate 120-160bpm
Normal respiratory rate 30-60bpm
Have brown fat for thermoregulation
Physiological jaundice occurs in up to 60% terms and 80% prems
Up to 10% weight loss due to shift of ISF to intravascular
Normal not to pass urine for the first 24 hours
What are the common problems associated with being small for dates?
Perinatal hypoxia Hypoglycaemia Hypothermia Polycythaemia Thrombocytopenia Hypoglycaemia GI problems
Longer term: Hypertension Reduced growth Obesity Ischaemic heart disease
What is the routine management and care of a premature baby?
X
What are the short and long term complications with being born prematurely?
Problems can occur in any system
- respiratory distress syndrome
- intraventricular haemorrhage
- periventricular leucomalacia
- necrotising enterocolitis
- persistent ductus arteriosus
- bronchopulmonarh displasia
- retinopathy of prematurity
- post haemorrhagic hydrocephalus
- neonatal abstinence syndrome
- hypoxic ischaemic encephalopathy
What are the potential outcomes of being extremely prematurely born?
Unpredictable at time of birth, you want to ultrasound brain by the end of first week
Prognosis is uncertain even on discharge
Can have: surprising deterioration, or improvement between 2nd and 6th years of life
Roughly: 1/3 die, 1/3 normal or mild disability, 1/3 moderate or severe disability. 1/6 completely normal at 6yrs
What conditions are benign and/or likely to resolve spontaneously?
Erythema toxicum
Mongolian blue spots
Port wine stain
Strawberry naevus
What problems may require further investigation and follow up?
Hypoglycaemia Hypothermia Tongue ties Bilious vomiting Respiratory distress Spinal dimples
What is cleft lip and palate?
Maxillary and medial processes fail to merge, usually around 5 weeks gestation. Will have feeding issues, airway problems, and some associated anomalies
What is:
Talipes
Congenital dislocation of the hip
Accessory digits?
Talipes: medial or lateral deviation of the foot, often positional and requires no therapy other than physio
DDH is when femur slips out of the socket due to shallow acetabulum. Treatment is to relocate head of femur so the hip develops normally. Via pavlik harness or reduction.
Accessory digits are extra fingers or toes. Can be removed. Fusion is also common
What are:
Undescended tedtis and hypospadias
Coccygeal pits?
Undescended testes is when there is absence of the testes in the scrotum and cannot manipulated in
Hypospadia is when the opening of the urethra is on the underside of the penis, not on the tip
Coccygeal pits (spinal dimples) can reveal more serious abnormality such as spins birdie occulta. If high, off midline or large do spinal imaging
What are:
Heart murmurs
Cataracts
Tongue ties?
Heart murmurs are sounds made by turbulent blood in the heart
Cataracts are clouding of the lens in the eye, could lead to blindness. Needs opthalmology check
Tongue ties are when babies have a short +/- thickened frenulum, mostly don’t require treatment however if tongue protrusion is restricted and feeding is affected can do frenotomy
What is the pathophysiology of and management of early neonatal jaundice?
Causes include: haemolytic, ToRCH, physiological, breastfeeding, sepsis
Treatment: treat underlying cause, hydrate, phototherapy, exchange transfusion, immunoglobulin
What acute conditions require neonatal intensive care, how to they affect babies long term and how are they managed?
Sepsis: group B strep, E. coli
Presents with pyrexia or hypothermia, poor feeding, lethargy or irritable, jaundice, tachnyoea, hypo or hyperglycaemia, floppy, asymptomatic.
Managed: NNU, partial septic screen, blood gas, consider CXR, LP, IV penicillin and gentamicin 1st line, 2nd line is IV vancomycin and gentamicin. Add metronidazole if surgical/abdominal concerns, fluid management and treat acidosis, monitor vital signs and support systems as required. Can lead to death <12 hours.
ToRCH (toxoplasmosis, rubella, cmv, herpes) may result in IUGR, brain calcification, neurodevelopmental delay, visual impairment, recurrent infections
Transient tachypnoea of the newborn
Present with grunting, tachynpoea, oxygen requirement, normal gases. Management is supportive, antibiotics, fluids, 02, airway support. Usually self limiting
Meconium aspiration
Meconium is inhaled into the lungs, presents with cyanosis, increased work if breathing, grunting, apnoea, floppiness. If born with myconium in lungs, suction, airway support, fluids and antibiotic vis IV, give surfactant, may need NO or ECMO. Most do well, some develop PPHN
Hypothermia: incubator, sepsis screen and antibiotics, thyroid function, monitor blood glucose
Birth asphyxia: lack of oxygen leading to multi organ dysfunction. Can develop hypoxic ischaemic encephalopathy. Management for moderate to severe is therapeutic cooling, treat seizures, cardiac support, resp support, monitor for renal and liver failure, fluid restriction, supportive.
