Neonatology Flashcards
What are the normal vital signs for a full term newborn?
Heart rate- 120-160bpm
Resp rate- 30-60 breaths per minute
Blood pressure- 70/44, increases from 1 hour after birth
How can a newborn’s breathing be assessed?
Blood gas determination PaCO2 5-6 kPa, PaO2 8-12 kPa Trans-cutaneous pCO2/O2 measurement Capnography Tidal volume 4-6 ml/kg Minute ventilation: Tidal Volume ml/kg x respiratory rate Flow-volume loop.
What is physiological jaundice in newborns?
Appears on Day of life (DOL) 2-3.
Disappears within 7-10 DOL in term infants and up to 21 DOL in premature infants.
What is the threshold for treatment in jaundice in newborns?
250 bilirubin from 3 days old (less if younger) for phototherapy
350 bilirubin from 3 days old (less if younger) for exchange transfusion
What is the cause of weight loss in the first few days of life?
Shift of interstitial fluid to intravascular
Diuresis
It is normal not to pass urine for the first 24 hrs
What are the complications of small babies?
Perinatal Hypoxia Hypoglycaemia Hypothermia Polycythaemia Thrombocytopenia Hypoglycaemia Gastrointestinal problems Hypertension Reduced growth Obesity Ischemic heart disease
What are the parameters for prematurity and birth weight?
Preterm<37w Extremely preterm <28w Low b/w <2500g Very low b/w<1500g Extremely low b/w<1000g
What is the management of acute respiratory distress syndrome?
Give Mum dexamethasone
Get surfactant to lungs by CPAP with catheter, ET tube if need to ventilate
Give caffeine to stimulate breathing center when trying to get off ventilation
What is bronchopulmonary dysplasia?
Scarring of the lung tissue on X-ray, caused by overstretch or atelectasis-collapse of the lungs
Oxygen has free radicals which are toxic to the tissue then see inflammatory changes (raised WCC, oedema)
Scarring makes the lungs stiff and cant breathe properly-problems later in life
Use dexamethasone if babies still ventilated, need to give these babies more calories as will be using lots of energy trying to breathe
What is the definition of apnoea and what is the management?
Not breathing for more than 20 seconds
Caffeine and CPAP
What is the management of intraventricular haemorrhage?
Prevent with steroids
Treat with drainage and manage symptoms
What is NEC?
Necrotising enterocolitis
Develops in first few weeks of life (round 6 weeks)
Distended abdomen. Oedema, erythema, shiny
On X-ray- air that is produced by the bacteria
Ischemic and inflammatory changes
Necrosis of bowel
Surgical intervention is often required
Conservative management is sometimes possible antibiotics and parenteral nutrition
What is the energy traingle
It encompasses the close relationship between hypoglycaemia, hypothermia and hypoxia in a neonate
What can be a cause of plethora?
Polycythaemia
What is erythema toxicum?
Maculo-papular rash 30 – 70% of normal term neonates. Very rare in the pre-term. Rash fades by end of the first week No treatment needed
What are Mongolian blue spots
Blue-grey pigmentations
Often lower back and buttocks
Accumulation of melanocytes.
Common in races with pigmented skin
What are stork marks?
This is a very common flat pink lesion, present at
birth. It is usually located on the forehead, eyelids,
occiput, neck or midline of the back. It may
be V-shaped on the forehead/occiput. The lesions are not pathological so there is no active management needed.
What babies are at risk of hypoglycaemia at birth?
Limited glucose supply -Premature babies -Perinatal stress Hyperinsulinism -Infants of diabetic mothers Increased glucose utilisation -Small and large for gestational age -Hypothermia -Sepsis
What are the symptoms of hypoglycaemia in a neonate?
Jitteriness Hypothermia Temperature instability Lethargy Hypotonia Apnoea, irregular respirations Poor suck / feeding Vomiting High pitched or weak cry Seizures Asymptomatic
What is hypoglycaemia defined as in the neonate and what can affect the bedside reading?
Hypoglycaemia defined as blood sugar <2.6mmol/l
Bedside testing can be inaccurate:
- At low or high levels
- When there is poor perfusion
- When there is polycythaemia
What babies are at risk of hypothermia?
Low birth weight
Babies requiring prolonged resuscitation
How can cold stress be reduced in resuscitation?
Dry quickly Remove wet linens Use warm towels/blankets Provide radiant warmer heat Use heated/humidified oxygen
In what cases of tongue ties should a frenotomy be performed?
Restriction of tongue protrusion beyond the alveolar margins or heavy grooving of tip of tongue and/or feeding is affected
What areas in a newborn should be looked at for retraction in respiratory distress?
Subcostal
Intercostal
Substernal
Suprasternal
What are complications of cleft lip and palate?
Feeding issues -Special bottles and teats -Can still attempt breast feeding Airway problems Associated anomalies -Need hearing screen -Need cardiac echo -Remember trisomies
What are the risk factors for meconium aspiration?
Post dates (aged placenta)
Maternal diabetes
Maternal hypertension
Difficult labour
What is the presentation and investigations of meconium aspiration?
Cyanosis, increased work of breathing, grunting, apnoea, floppiness
Blood gas, septic screen, CXR
What is seen on Chest X-ray in meconium aspiration?
There is hyperinflation of the lungs, flattened diaphragm and widespread patchy areas of collapse evident in coarse irregular densities with areas of over inflation.
What is the management of meconium aspiration?
Suction below cords Give surfactant Airway support Fluids IV antibiotics NO and ECMO Some develop into pulmonary hypertension
What are some causes of failure to pass meconium?
Constipation Large bowel atresia Imperforate anus \+/- fistula Hirschsprungs disease Meconium ileus -think cystic fibrosis
