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Paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

when does the foetal heart start to beat and at what period is the heart development most critical?

A

starts to beat week 4

critical period is day 20-50

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2
Q

what is the oxygen saturation of the foetal circulation?

A

60-70%

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3
Q

what is the function of the ductus arteriosus?

A

protects lungs against circulatory overload
allows right ventricle to strengthen
carries low oxygen saturated blood

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4
Q

what does the ductus venosus connect?

A

connects umbilical vein to the IVC

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5
Q

what carries mostly oxygenated blood…

  • ductus arteriosus?
  • ductus venosus?
A

ductus venosus

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6
Q

what carries low oxygen saturated blood..

  • ductus arteriosus ?
  • ductus venosus ?
A

ductus arteriosus

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7
Q

what is the normal heart rate of a full term new born?

A

120-160 bpm

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8
Q

what is the normal blood pressure of a full term newborn…

  • 1 hour after birth?
  • 1 day after birth?
  • 3 days after birth?
A

1 hour - 70/44
1 day - systolic 70-79, diastolic 42 +/- (12)

3 days - systolic 77 +/- (12), diastolic 49 +/- (10)

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9
Q

what is the normal respiratory rate of a full term new born?

A

30-60/min

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10
Q

when it is considered bradycardia and tachycardia in a full term newborn?

A

tachycardia > 160bpm

bradycardia < 100bpm

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11
Q

what is the normal blood gas values of a newborn?

A

PaC02 5-6 kPa (adult 5-5.5kPa)

Pa02 8-12 kPa (adult 6-13kPa)

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12
Q

how can you measure a babies respiratory system?

A 
blood gas 
transcutaneous pC02/02 measurement 
capnography 
minute ventilation 
flow-volume loop 
tidal volume
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13
Q

when does physiological jaundice normally appear and disappear?

A

normally appears day 2-3 of life

disappears within 7-10s of life (up to 21 days in premature)

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14
Q

what is the main consequence associated with neonatal jaundice?

A

irreversible changes in the brain - kernicterus

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15
Q

what is the treatment for physiological jaundice in neonates?

A

blue light

- converts jaundice (lipid soluble) into water soluble form and increases oxidation of bilirubin

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16
Q

what is the treatment for physiological jaundice in a new born?

A

phototherapy (blue light)

if severe - exchange transfusion

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17
Q

at what levels of bilirubin would you consider an exchange transfusion to treat the jaundice?

A

> 250 micromol/L

18
Q

weight loss of up to 10% is normal in a term new born baby. why is this?

A

loss of fluid due to shift of interstitial fluid to intravascular fluid
diuresis

19
Q

what is there an increased loss of fluid through the kidney in a pre mature baby?

A
  • decreased GFR
  • reduced Na reabsorption
  • decreased ability to concentrate or dilute urine
20
Q

what is the change in a newborns Hg and RBC?

A

10% of foetal RBC production at day 10
born with 15-20Hg g/L but decreases to 11.4 g/l by week 10
by week 20 it increases to 12 g/L

21
Q

list causes of being small for dates / IUGR.

A

maternal;

  • pre eclampsia toxaemia
  • poor nutrition
  • smoking
  • diabetes

foetal

  • chromosomal i.e. tiresome 18 Edwards syndrome
  • infection i.e. CMV
  • twin-twin transfusion

placental

  • placental abruption
  • placental praaevia
22
Q

what are the common problems associated with being small for dates/ IUGR?

A 
perinatal hypoxia 
hypoglycaemia
hypothermia
polycythaemia
thrombocyopenia
hypoglycaemia
gastrointestinal problems i.e. NEC
23
Q

what are some of the long term problems associated with being small for dates/ IUGR?

A

hypertension
reduced growth
obesity
ischaemic heart disease

24
Q

at what birth weight is a baby small for dates (IUGR)?

A

< 2.5 kg (5.5lb)

25
Q

at what gestation is preterm and extremely preterm?

A

< 37 weeks = preterm

< 28 weeks = extremely preterm

26
Q

name some of the complications associated with prematurity.

A 
respiratory distress syndrome
intraventricular haemorrhage 
periventricular leukomalacia
necrotising entero-colitis 
patent ductus arteriosus 
broncho-pulmonary dysplasia 
retinopathy of prematurity 
post-hemorrhagic hydrocephalus 
neonatal abstinence syndrome
hypoxic ischaemic encephalopathy
27
Q

how can you prevent respiratory distress syndrome?

A

antenatal steroids to women who are at risk of preterm labour

28
Q

what is the treatment for respiratory distress syndrome?

A

surfactant
non-invasive support (N-CPAP)
minimal ventilation

29
Q

what is bronchopulmonary dysplasia and what causes it?

A

overstretched lungs due to volu-baro trauma
(mechanical ventilation and/or long-term oxygen)

lungs try to repair resulting in scarring

30
Q

what is the treatment for bronchopulmonary dysplasia?

A

nutrition and growth

steroids

31
Q

how would you treat a pre mature baby who has apnoea, irregular breathing and/or desaturations?

A

caffeine

N-CPAP (continued positive airway pressure)

32
Q

how can you prevent inter-ventricular haemorrhage in a premature baby?

A

antenatal steroids to a mother who is at risk of a premature birth

33
Q

what is periventricular leukomalacia?

A

death of brain tissue surrounding the ventricles
creates holes within the brain
sometimes linked to intraventricular haemorrhage

34
Q

what problems does a patent ductus arterosus cause and how?

A

pressure in the aorta is greater than the pulmonary artery therefore blood shunts from the aorta to pulmonary artery (left-right shunt)

results in excess blood in the pulmonary circulation
= over-perfusion of lungs
= lung oedema

also means less blood is in the systemic circulation
= systemic ischaemia

35
Q

what are the consequences associated with PDA?

A

worsening of respiratory symptoms
retention of fluids (low renal perfusion)
gastrointestinal problems (ischaemia)

36
Q

what is necrotising enterocolitis?

A

ischaemia and inflammation of the intestinal
associated with prematurity
causes necrosis of the bowel

37
Q

what is the management options for necrotising enterocolitis?

A

surgery

conservative

  • antibiotics
  • parenteral nutrition (NG tube)
38
Q

when is there often a deterioration post-discharge of a premature baby?

A

between 2nd and 6th years of life

39
Q

what is the outcome of prematurity?

A

1/3rd dies
1/3rd have normal or mild disability
1/3rd have severe disability for lifetime

1 in 6 is entirely normal by 6 yrs

40
Q

a neonate which is otherwise health has minor desaturations and apnoea. how would you manage this patient?

A

caffeine

N-CPAP

Paediatrics (26 decks)

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