Neonatology Flashcards
What score is used for newborns?
Apgar
What does the apgar score look at?
Appearance Pulse Grimace Activity Respiration
What is the maximum score for Apgar?
10
2 for each category
What is a low, moderate low and normal apgar?
0-3 very low
4-6= moderate low
7-10= normal
What are some common birth injuries?
Caput succedaneum Cephalohaematoma Facial paralysis Erb's palsy Fractured clavicle
What is caput succedaneum?
Oedema collection on scalp
Crosses sutures lines and normally no discolouration
What is caput succedaneum associated with?
Traumatic, prolonged or instrumental delivery
What is cephalohaematoma?
Traumatic subperiosteal haematoma
Does not cross suture lines and commonly causes skin discolouration
What are the complications of cephalohaematoma?
Anaemia
Jaundice as it breaks down
What is facial paralysis associated with?
Forceps delivery
What is Erbs palsy?
Injury to C5/6 nerve repps
What is Erbs palsy associated with?
Shoulder dystocia
Traumatic or instrumental delivery
Large birth weight
What is the presentation of Erbs palsy?
Weakness of shoulder abduction and external rotation, arm flexion and finger extension
What is a fractured clavicle associated with?
Shoulder dystocia
Traumatic or instrumental delivery
Large birth weight
What investigations are done for a fractured clavicle?
US
XR
What can cause neonatal hypoglycaemia?
Maternal DM IUGR Prematurity Hypothermia Sepsis Inborn errors or metabolism
What is the management of neonatal hypoglycaemia?
Monitoring
IV 10% glucose
What is hypoxic ischaemic encephalopathy?
Hypoxia during birth casing encephalopathy
What is the presentation of hypoxic-ischaemic encephalopathy?
Mild= poor feeding, general irritability Moderate= poor feeding, lethargy, hypotonia Severe= reduced consciousness, apnoea, flaccid, reduced reflexes
What are the risks with hypoxic ischaemic encephalopathy?
Death- up to 50%
Cerebra palsy up to 90%
What is the management of hypoxic ischaemic encephalopathy?
Supportive
Theraputic hypothermia
What is the mechanism of action of therapeutic hypothermia?
Reduce inflammation and neurone loss after acute hypoxic injury
What is neonatal abstinence syndrome?
Withdrawal symptoms in neonates of mothers with substance abuse
What substances cause NAS?
3-72 hours= opiates, alcohol, SSRIs 24 hours-21 days= methadone, BZDs Cocaine Alcohol Nicotine
What is the presentation of NAS?
Irritability, not settling Tremors, seizures Sweating, unstable temperature Tachypnoea Poor feeding Hypoglycaemia
What is the management of NAS?
Monitoring and support SSRI= doesn't require medical mx Mod to severe -opiate= oral morphine sulphase -non opiate= oral phenbarbitone
What causes jaundice <24 hours?
Always pathological
Sepsis
HAemolysis
What causes jaundice 24 hours-2 weeks?
Physiological Breast milk Polycythaemia Sepsis HAemolysis Caphalohaematoma
What causes jaundice >2 weeks?
Breast milk Hypothyroid Pyloric stenosis Cholestasis HAemolysis Infection Hepatitis
What causes physiological jaundice?
Short RBC lifespan
Relative polycythaemia
Relative immaturity of liver function
What investigations are done for jaundice?
FBC, blood film
Split bilirubin
Direct Coombs test
Suspect nfection= blood and urine cultures
How and when is jaundice treatment?
Treatment threshold charts
Unconjugated= phototherapy
Severe= exchange transfusions
What is a complication of jaundice?
Kernicterus
What is kernicterus?
Brain damage due to excessive unconjugated bilirubin
Floppy, drowsy abby with poor feeding
What are the complications of kernicterus?
Cerebral palsy
Learning difficulties
Deafness
What causes transient tachypnoea of the newborn?
Delay in clearance of foetal lung fluids
What is a risk factor for transient tachypnoea of the newborn?
C section
What is the presentation of transient ytcahypnoea of the newborn?
Within first few hours
Tachypnea, grunting
Normal gases
What is the investigation and management of transient tachypnoea of the newborn?
CXR= hyperinflation, fluid in horizontal fissue
Supplementary oxygen
Who is meconium aspiration seen in?
Post term babies more commonly
What is the presentation of meconium aspiration?
Cyanosis, apnoea
Increased work of breathing
Grunting
What is the management of meconium aspiration?
Suction
Airway support
Surfactant
What is sepsis?
Life threatening organ dysfunction caused by dysregulated host response to infection
What are the causative bacteria of sepsis in neonates?
Group B strep= most common
E. coli
Listeria
What is the presentation of sepsis?
Fever or hypothermia Non speficic Jaundice Mottled skin, cyanosis Reduced conciousness Reduced tone Poor feeding, change in behaviour, inconsolable
What is the management of sepsis?
Sepsis 6
What antibiotics are given in neonatal sepsis?
IV ben pen and gentamicin
