Neonatology Flashcards
How long does the neonatal period last?
28d
What are milia and how should they be treated?
1-2mm pearly, white papules caused by retention of keratin in dermis
Will resolve spontaneously
Describe erythema toxicum:
Harmless red blotches often with central white pustule
What is cradle cap?
Large, greasy yellow or brown scales on scalp
Describe a port-wine stain:
Vascular malformation of superficial dermal capillaries
Pink to deep red/purple patches, often unilateral with distinct cut off
Describe (Mongolian) blue spots:
Blue lesion present at births, usually on buttocks or base of spine
What causes petechial and subconjunctival haemorrhages in neonate?
Suffusion of face during delivery
What are some important causes of sticky eye in the neonate to rule out?
Ophthalmia neonatorum or chlamydia
How can laryngomalacia present?
Stridor, feeding difficulties, choking, poor weight gain
How can neonatal jaundice be primarily investigated?
Transcutaneous bilirubin levels can be measured by midwives
What are some physiological causes of jaundice in the neonate?
Increased bilirubin production due to shorter RBC lifespan
Decreased bilirubin conjugation due to hepatic immaturity
Absence of gut flora impeded elimination of bile pigment
Exclusive breastfeeding
What are some causes of jaundice within 24h of birth?
Sepsis
Rhesus haemolytic disease
ABO incompatibility
Red cell anomalies (spherocytosis, G6PDH def.)
What are some causes of prolonged jaundice in neonates?
Breastfeeding
Sepsis
Hypothyroidism
CF
Biliary atresia (yellow urine, pale stools)
Galactosemia, congenital infections, haemolysis
How should bilirubin levels be used to decide management in neonatal jaundice?
Plot SBR on personalised NICE graph to decide if treatment is required
What are the management options for neonatal jaundice requiring treatment?
Phototherapy and exchange transfusion
How does phototherapy work in treating neonatal jaundice?
Uses light energy to convert bilirubin to soluble products that can be excreted
What are some side effects of phototherapy for neonatal jaundice?
Eye damage, diarrhoea, fluid loss, separation from mother
How does exchange transfusion work in treating neonatal jaundice?
Uses warmed blood, 160ml/kg, to remove bilirubin
Given ideally via umbilical vein IVI
What is kernicterus?
Acute bilirubin encephalopathy with lethargy, poor feeding, hypertonicity, shrill cry
What are some long term consequences of kernicterus?
Athetoid movements, deafness and lower IQ
When can a leak of fetal red cells into the maternal circulation occur?
Threatened miscarriage APH Trauma Amniocentesis + CVS ECV
What is the cause of respiratory distress syndrome in a newborn?
Deficiency in alveolar surfactant leads to atelectasis and re-inflation with each breath exhausts baby leading to resp failure
What are some signs of respiratory distress syndrome?
Increased work of breathing within 4h of birth Tachypnoea Grunting Nasal flaring, intercostal recession Cyanosis
How can respiratory distress syndrome be prevented?
Betamethasone/dexamethasone offered to those at risk of pre-term delivery from 23-35 weeks
What O2 sats should be aimed for when treating respiratory distress syndrome and why?
85-93% to reduce risk of retinopathy and bronchopulmonary dysplasia
What is the causes of bronchopulmonary dysplasia?
Barotrauma, oxygen toxicity and airway infections, as a result of prolonged ventilation + O2
What can cause pulmonary hypoplasia?
Oligohydramnios, PROM, diaphragmatic hernia
What are some signs of necrotising enterocolitis?
Abdo distension Blood/mucus PR Tenderness Shock, DIC Mucosal sloughing Pneumatosis intestinalis
What is the cause of haemorrhagic disease of the newborn?
No enteric bacteria to make vit K so get bleeding/bruising, raised PT and PTT
What is the cause of transient tachypnoea of the newborn? When is it more commonly seen?
Delayed resorption of fluid in the lungs
More common following C-sections
What is the first step in neonatal life support?
Dry and stimulate baby and place under radiant heat
What scoring system is used in neonatal life support?
AGPAR
What is the definition for chronic lung disease in newborns?
Requiring oxygen for >28 days
What are some signs of intraventricular haemorrhage and why is it more common in premature babibes?
Seizures, bulging fontanelles, cerebral irritability
BVs unsupported
Describe retinopathy of prematurity:
Disorganized growth of retinal blood vessels which may result in scarring and retinal detachment
Can be due to O2 toxicity or hypoxia
What is the treatment for retinopathy of preamturity?
Diode laser therapy
When should newborns be screened for retinopathy of prematurity?
Screen at 30-31 weeks if ≤27 weeks or at 28-35 days of life
What are the likely causative organisms of early onset (within 48h) neonatal sepsis?
GBS, E. coli, Listeria
What are the likely causative organisms of late onset neonatal sepsis?
Coagulase negative staph, S. aureus, E. coli, GBS
Describe some ways in which neonatal sepsis may present:
Labile temperature, lethargy, poor feeding, resp distress, collapse, DIC
What are some risk factors for early onset neonatal sepsis?
ROM >18h, maternal infection, mother GBS carrier,
preterm labour, fetal distress, breaks in neonatal skin
What are some risk factors for late onset neonatal sepsis?
Central lines, catheters, congenital malformations,
severe illness, malnutrition, immunodeficiency
What antibiotics should be given in early onset neonatal sepsis?
Broad spec e.g. benpen + gent
What antibiotics should be given in late onset neonatal sepsis?
Broad spec e.g. flucloxacillin + gent
What are some cause of hypotonia in the newborn?
Sepsis Hypoglycaemia Dehydration, poor nutrition Hypoxic-ischemic encephalopathy Myopathy Maternal drugs
What are some advantages to breastfeeding?
Less insulin resistance, HTN and obesity Protect from infection Promote growth of enteric bacteria Contraceptive Protection from breast cancer Bonding
What are some problems associated with breastfeeding?
Breast engorgement, breast abscess, sore nipples, mastitis
Describe standard infant formula milk:
Cow’s milk humanised by reducing solute load and
modifying fat, protein and vitamin content
Describe follow on formula milk:
Protein is casein based rather than whey (used in standard), delaying stomach emptying and allowing less frequent feeds
Why is hydrolized formula milk used?
Cows’ milk allergy
How much milk do babies need a day?
150ml/kg/day
Usually over 4-6 feeds
Describe weaning and when it should occur:
Introduce solids at 6 months by offering finger food with or without purée
What does APGAR stand for?
Activity Pulse Grimace Appearance Respiration
What is a normal APGAR score?
7+
