Neonatology Flashcards by Jane Keery

All preterm babies should be heated while being stabilised before transfer to the NICU. How should a baby aged > 28 weeks be heated?

Dried and wrapped in a warm towel

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All preterm babies should be heated while being stabilised before transfer to the NICU. How should a baby aged < 28 weeks be heated?

Don’t dry, and place trunk and limbs in a plastic bag loosely tied around the neck

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What respiratory support is required for a preterm baby with a good heart rate and respiratory effort before being transferred to the NICU?

Facial O2 or CPAP

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What respiratory support is required for a preterm baby with poor respiratory effort or signs of respiratory distress before being transferred to the NICU? What medication should also be administered to these babies?

Intubation for mechanical ventilation, also give surfactant

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Describe what is meant by a low, very low and extremely low birthweight baby?

Low = < 2500g, very low = < 1500g, extremely low = < 1000g

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What gestational age would be classified as a late preterm baby?

34-37 weeks

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What gestational age would be classified as a moderately preterm baby?

32-34 weeks

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What gestational age would be classified as a very preterm baby?

28-32 weeks

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What gestational age would be classified as an extremely preterm baby?

< 28 weeks

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Name 3 reasons why premature babies are at increased risk of hypothermia?

Thin skin, large surface area, low subcutaneous fat stores

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How can hypothermia be prevented in a preterm neonate?

Use of an incubator and a hat to prevent heat loss

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Preterm babies have a very fragile gut, which makes them more susceptible to which serious condition affecting the bowel?

Necrotising enterocolitis

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At what age (in weeks) does the suck and swallow reflex develop?

34 weeks

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How are preterm babies aged < 34 weeks usually fed?

IV nutrition while gradually introducing milk via an NG tube

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Many preterm neonates require multiple courses of antibiotics. This can therefore increase the risk of which other type of infection?

Fungal

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Babies who were born preterm receive follow-up for how long to monitor their growth and development?

For the first year of life

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What is the cause of neonatal respiratory distress syndrome?

Lack of surfactant

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What happens to lung compliance in neonatal respiratory distress syndrome?

Decreased

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If a preterm neonate presents with respiratory distress at delivery or within 4 hours of birth, what diagnosis should you suspect?

Respiratory distress syndrome

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What are the 4 main signs of respiratory distress that may be seen in a neonate?

Tachypnoea, grunting, cyanosis and recession

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Neonatal respiratory distress syndrome is mainly a clinical diagnosis which can be confirmed with which investigation? What will this show?

CXR - will show a ‘ground-glass appearance’

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How can neonatal respiratory distress syndrome be prevented pre-delivery?

By giving maternal steroids when there is a risk of preterm delivery

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What medication is used to manage neonatal respiratory distress syndrome?

Surfactant

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What ventilatory management is required for neonates with severe symptoms of respiratory distress syndrome?

Oxygen via mechanical ventilation

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What ventilatory management is required for neonates with mild symptoms of respiratory distress syndrome?

Oxygen via nasal cannula or CPAP

What are the three main complications of mechanical ventilation in a neonate?

Pneumothorax, pulmonary haemorrhage and chronic lung disease

Chronic lung disease (bronchopulmonary dysplasia) is caused by lung tissue inflammation secondary to what things?

RDS, mechanical ventilation and oxygen toxicity

Chronic lung disease (bronchopulmonary dysplasia) can be diagnosed when there is a need for supplemental oxygen to maintain saturations > 95% after what gestational age?

36 weeks

If not prevented, how is chronic lung disease (bronchopulmonary dysplasia) managed?

Supplemental oxygen (usually via a nasal cannula)

Babies who develop chronic lung disease (bronchopulmonary dysplasia) are at increased risk of developing what other respiratory condition in the first year of life?

Bronchiolitis

All premature babies of what gestation will have apnoea?

< 28 weeks

What is the most common cause of apnoea of prematurity?

Immature respiratory drive

What management is required for preterm babies who have apnoeic episodes occurring frequently in succession?

Mechanical ventilation

What medication is given to all preterm babies daily in order to stimulate their respiratory centre to initiate breaths?

Caffeine

Periventricular leukomalacia is a complication of prematurity which follows what event?

Ischaemic brain injury

Preterm babies are at increased risk of developing intraventricular haemorrhage. This is a bleed into the ventricles which originates from where?

Germinal matrix

Both periventricular leukomalacia and intraventricular haemorrhage are usually asymptomatic. How would these usually be detected?

Cranial ultrasound

A sudden deterioration in the clinical state of a neonate with prolonged apnoea, bradycardia or a rapid drop in haemoglobin should make you consider what diagnosis?

Intraventricular haemorrhage

How should intraventricular haemorrhage in a neonate be managed?

Weekly cranial ultrasound scans throughout the hospital stay

What is the most significant complication of an intraventricular haemorrhage in a neonate?

Hydrocephalus

If intraventricular haemorrhage is severe and associated with complications such as hydrocephalus, what are some long-term adverse outcomes that can occur?

Cerebral palsy, visual impairment, intellectual disability

When does necrotising enterocolitis typically present?

The 2nd or 3rd week of life

What is the classic triad of symptoms which would be seen in a neonate with necrotising enterocolitis?

Bilious vomit, abdominal distension and bloody stools

Necrotising enterocolitis is predominantly a clinical diagnosis; however, what investigation may be useful as a supportive test?

AXR

An AXR showing gas in the bowel, known as 'pneumatosis intestinalis' is pathognomonic of which condition?

Necrotising enterocolitis

If an AXR of a neonate with necrotising enterocolitis shows free air in the abdomen- what complication has occurred?

Bowel perforation

How can necrotising enterocolitis be prevented?

By introducing feeds gradually, preferably with breast milk

How is necrotising enterocolitis managed?

Intensive care support, stop feeding, analgesia and antibiotics

If a neonate has a large length of bowel removed as a complication of necrotising enterocolitis, this can cause what complication?

Short gut syndrome

What are the two main conditions which are more commonly seen in term babies, compared to preterm babies?

Meconium aspiration syndrome and hypoxic ischaemic encephalopathy

How soon after delivery should meconium be passed?

Within 48 hours

A history of meconium stained amniotic fluid and respiratory distress at delivery is suggestive of what diagnosis?

Meconium aspiration syndrome

What pathology seen in neonates may cause a CXR to show hyperinflated lung fields with areas of collapse and consolidation, resulting in a patchy appearance?

Meconium aspiration syndrome

What treatments can be given to neonates with meconium aspiration syndrome to maintain oxygen saturations and to help reduce pulmonary artery constriction?

Mechanical ventilation and surfactant

What treatment can be given to babies with severe persistent pulmonary hypertension of the newborn to reduce pulmonary arterial pressures?

Inhaled nitric oxide

Hypoxic ischaemic encephalopathy is diagnosed when?

When a term neonate shows neurological abnormalities

How soon do the neurological abnormalities associated with hypoxic ischaemic encephalopathy develop?

They are noticeable at birth and develop over 72 hours

A history of foetal distress in utero or during delivery, along with neurological features in the neonate is suggestive of what diagnosis?

Hypoxic ischaemic encephalopathy

In neonates with hypoxic ischaemic encephalopathy, what investigation is carried out around day 7 to assess the location and extent of brain damage?

Brain MRI

What treatment option can be used to reduce the effect of reperfusion injury in neonates with hypoxic ischaemic encephalopathy?

Therapeutic hypothermia

If left untreated, neonatal jaundice can lead to what complication? This can cause what other problems?

Kernicterus- potentially leading to deafness and cerebral palsy

Jaundice within what timeframe in a neonate is always abnormal?

The first 24 hours after birth

What is the most common cause of unconjugated jaundice in a neonate?

Physiological jaundice

Is breast milk jaundice in a neonate conjugated or unconjugated?

Unconjugated

If a neonate has conjugated jaundice, what is the most important pathology to rule out?

Biliary atresia

If treatment is required, what is first line for unconjugated neonatal jaundice?

UV phototherapy

If UV phototherapy is not decreasing the bilirubin levels in a neonate with jaundice, what is the next line management option?

Exchange transfusion

What investigation is used to rule out biliary atresia in a neonate with conjugated neonatal jaundice?

Abdominal ultrasound

Physiological jaundice in neonates usually begins after 24 hours, peaks around day 5 and should return to normal by when?

2 weeks

Jaundice in a term baby aged 2 weeks or more is known as what?

Prolonged jaundice

Which babies are more prone to developing prolonged jaundice- breastfed or bottlefed neonates?

Breastfed

An infection in a neonate is classed as post-natal if it occurs how long after delivery?

72 hours

Which congenital infection causes severe anaemia leading to hydrops foetalis?

Parvovirus

What is the most common organism causing perinatal infection of a neonate?

Group B strep

How are peri and postnatal neonatal infections treated?

IV antibiotics

What diagnosis should you suspect in a neonate with non-specific signs such as poor feeding, vomiting, jaundice, respiratory distress, irritability and sometimes seizures?

Neonatal infection

When does maternal Grave's disease affect a foetus? How is this treated?

The first 2 weeks of life- treated with anti-thyroid drugs

What diagnosis should be considered in a neonate with tremors, a high-pitched cry and temperature instability?

Neonatal withdrawal

Use of what drug during pregnancy is associated with stained teeth and hypoplasia of teeth enamel in the child?

Tetracyclines

Use of what drug during pregnancy is associated with nasal hypoplasia and hypoplastic phalanges in the child?

Warfarin

What structures herniate through the diaphragm in a congenital diaphragmatic hernia?

Liver, spleen and bowel

Is congenital diaphragmatic hernia more common in boys or girls?

Boys

What happens to the lungs in babies with congenital diaphragmatic hernia?

They are underdeveloped (pulmonary hypoplasia)

How is congenital diaphragmatic hernia usually diagnosed?

On antenatal ultrasound

How does a baby with congenital diaphragmatic hernia appear at birth?

Respiratory distress and a scaphoid (concave) abdomen

What happens to heart and lung sounds in a baby with congenital diaphragmatic hernia?

There will be no breath sounds on the affected side and heart sounds may be displaced

On radiography, loops of bowel in the thorax and mediastinal shift is suggestive of what diagnosis?

Congenital diaphragmatic hernia

How are babies with congenital diaphragmatic hernia treated initially?

Ventilation and NG tube

How is congenital diaphragmatic hernia treated definitively?

Surgical repair

At what age should a cleft lip be repaired?

4 months

At what age should a cleft palate be repaired?

1 year

What happens in craniosynostosis?

Some of the sutures of the skull fuse prematurely

At what age should the sutures of the skull fuse normally?

18-24 months

What is the main clinical feature of craniosynostosis?

Abnormal head shape

How is craniosynostosis treated?

Surgery

What happens to a baby's head if they have plagiocephaly?

Flattening on one side with protrusion on the opposite side

What is the cause of positional plagiocephaly?

Lying on the affected side of the head preferentially

What three groups of infants are at particular risk of hypoglycaemia as a neonate?

Those with diabetic mothers, those whose mothers have taken beta blockers and those with IUGR

How is hypoglycaemia in a neonate prevented?

Feeding soon after birth and at regular intervals thereafter

In neonates at risk of developing hypoglycaemia, glucose levels should be kept above what value?

2.6mmol/L

If oral and NG feeds are not sufficient to treat hypoglycaemia, what other options can be considered?

Buccal or IV dextrose

What diagnosis should always be considered in babies presenting shortly after birth with lethargy, poor feeding and abnormal neurological signs?

Inborn errors of metabolism