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Zero Paeds > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What does surface tension do to lung compliance?

A

Reducing the surface tension with surfactant increases the lung compliance ie less force is needed to expand the lungs.

As alveoli expand the surfactant thins out making it difficult to expand further - this promotes equal expansion of all alveoli.

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2
Q

When do are cells mature enough to start producing surfactant?

A

Type II alveolar cells mature enough and start surfactant production between 24 and 34 weeks gestation.

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3
Q

Why might a baby be hypoxic during delivery and what can this lead to?

A

Contractions may mean placenta is unable to carry out normal gas exchange –> hypoxia and anaerobic respiration will drop petal heart rate –> bradycardia

Extended hypoxia leads to hypoxic-induced encephalopathy (HIE) with potential long term consequences eg CP.

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4
Q

What are the principles of neonatal resuscitation?

A

WARM THE BABY

  • dry baby, vigorous helps stimulate breathing
  • warm rooms and heat lamp
  • under 28 weeks straight into plastic bag and under heat lamp

CALCULATE APGAR SCORE

  • done at 1min, 5min, 10min whilst resus continues
  • indicator and guide of efforts

STIMULATE BREATHING

  • vigorous drying with a towel
  • head neutral with towel under shoulders
  • check for obstruction eg meconium and aspirate

INFLATION BREATHS
- for gasping or not breathing
- two cycles of 5 breaths (3 secs each) to stim HR and RR
- no response / HR low: 30 secs of breaths
- still no response then use chest compressions with breaths
(air if term, air and O2 is preterm)

CHEST COMPRESSIONS

  • start if HR <60bpm despite inflation breaths protocol
  • ratio 3:1 compressions to breaths

SEVERE SITUATIONS

  • prolonged hypoxia increase risk of HIE
  • consider IV drugs, intubation
  • near or at term and HIE risk then therapeutic hypothermia with cooling
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5
Q

What are the clinical features and possible scores in the APGAR score?

A

APEARANCE / SKIN COLOUR:
0 - blue / pale centrally
1 - blue extremities (normal)
2 - pink

PULSE:
0 - absent
1 - HR<100
2 - HR>100

GRIMACE / reflex irritability to plantar stimulation:
0 - no response
1 - grimace
2 - cry

ACTIVITY / muscle tone:
0 - limp and floppy
1 - some flexion of extremities
2 - active motion

RESPIRATORY EFFORT:
0 - absent
1 - slow or irregular
2 - strong cry, adequate effort

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6
Q

What are the benefits of placental infusion and how long should you do it for?

A

Delayed umbilical cord clamping improves:

  • haemoglobin
  • iron stores
  • blood pressure
  • reduced intraventricular haemorrhage
  • reduced necrotising enterocolitis
  • increase neonatal jaundice requiring phototherapy

Normal: at least 1min before clamping

Needing resus: do not delay resus

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7
Q

What things are done immediately after birth?

What happens out of the delivery room?

A
  • dry the baby
  • clamp umbilical cord
  • skin to skin (improves: warm, calm, interaction, feeding)
  • warm with hat and blankets
  • vitamin K
  • label the baby
  • measure weight and length

After:

  • initiate breast or bottle feeding when baby is alert
  • newborn exam within 72 hours
  • blood spot screening test
  • newborn hearing test
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8
Q

What is tested for in the blood spot screening test?

A

The heel-prick test is done on DAY 5, prick heel for 4 drops of blood onto screening card. Nine congenital conditions:

  • sickle cell disease
  • CF
  • congenital hypothyroidism
  • phenylketonuria
  • medium chain acyl-CoA dehydrogenase deficiency MCADD
  • maple syrup urine disease MSUD
  • Isovaleric acidaemia IVA
  • glutamic acuduria type 1 GA1
  • homocystinuria

Results take 6-8weeks

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9
Q

When is the newborn examination done?

A

within 72 hours of birth and then repeated at 6-8 weeks by GP.

(initial check can be done by midwife or paeds doctor)

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10
Q

What is the blood supply of pre- and post- ductal saturation measurement sites? What is an acceptable difference?

A

Right arm is supplied pre-ductal from right subclavian artery branching of the brachiocephalic trunk before the DA.

Either foot is post-ductal as is supplied from descending aorta after the DA.

Normal sats are above 96%, a 2% difference between pre- and post- ductal reading is allowed.

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11
Q

What do you do when starting / for introduction to NIPE?

A

(intro, wash hands, consent, check identities)
Ask:
- “How, when and what gestation was baby born?”
- “Any problems with mum or baby during pregnancy / labour / delivery?”
- “Is he /she feeding ok? Passing pee and black poo?” (pee within 24hrs and meconium within 48hrs)
- “do you have any particular concerns about baby?”

Be opportunistic - do red reflex if eyes open - listen to heart and lungs if not crying.

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12
Q

Overall parts of NIPE exam?

A

Intro
General Observation

Head
Face

Upper Limbs

Cardiovascular
Respiratory
Abdomen

Genitalia and Anus
Back

Lower Limbs

Primitive Reflexes

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13
Q

In NIPE General Observation what do you do / look at?

A
  • skin (jaundice, cyanosis, bruising)
  • tone (floppiness eg septic, CNS pathology, Down’s)
  • sleepiness / rousable
  • nature of cry
  • measure weight and length (compare centiles)
  • check temp (sepsis)
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14
Q

In NIPE what do you do / look at in Head and Face?

A
  • shape, size, dysmorphology, caput succedaneum, cephalohaematoma, facial injury
  • occipital frontal circumference
  • ant and post fontanelles
  • sutures (overlap is common and normally resolves)
  • ears, skin tags, low set, asymmetry
  • eyes, slight squint normal, epicanthic folds Down’s, purulent discharge infection
  • red reflex (cataracts and retinoblastoma)
  • mouth: clean finger suckling reflex and palpate for cleft, high arch Marfans or Downs
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15
Q

In NIPE what do you do / look at in Shoulders and Arms?

A
  • asymmetry, clavicle fracture
  • arm movements / posture, Erbs palsy
  • palmar crease, single could be Down’s
  • polydactyl is extra, clinodactyly is curved
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16
Q

In NIPE what do you do / look at in Cardiovascular, and in Respiratory?

A
  • femoral, brachial and radial pulses (110-160, PDA causes bounding)
  • radio-radio and radio-femoral delay (Ao coarct)
  • CRT on sternum
  • palpate heart position, dextrocardia
  • auscultate or do before baby cries
  • listen for stridor / grunting
  • look for nasal flaring / intercostal indrawing
  • auscultate
  • count breaths, normally RR 30-60
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17
Q

In NIPE what do you do / look at in Abdomen and Genitals/Anus?
And Back?

A
  • shape, concave may indicate diaphragmatic hernia
  • umbilical stump for hernia or infection
  • palpate for masses or organomegally
  • clear male / female or ambiguous
  • palpate testes and scrotum, descended and no hernia
  • penis for hypospadias, epispadias and urination
  • inspect for patent anus
  • ask about meconium
  • inspect and palpate spine; curvature, spina bifida, pilonidal sinus
  • skin defects / tufts of hair for menigocele, myelomenigocele, spina bifida occulta
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18
Q

In NIPE what do you do / look at in Lower Limbs?

A
  • inspect, talipes equinovarus (club foot) is inversion and high med arch
  • Barlow and Ortolani

Barlow:

  • finds unstable by dislocating it, Barlow Breaks
  • flexed knees and hips
  • push down on femur as you ADDuct
  • click indicates dislocation

Ortolani:

  • Orto for when its Out, clicks back in
  • ABduct the legs and hip should clunk back in
  • push thigh arteriorly
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19
Q

In NIPE what do you do / look at in Primitive Reflexes?

A
  • MORO reflex: rapidly tipped back –> arms and legs extend
  • SUCKLING reflex: suck index finger in mouth
  • ROOTING reflex: will turn towards tickled cheek
  • GRASP reflex: will graps finger in palm
  • STEPPING reflex: held upright and feet touch a surface they will do stepping motion

When done with exam:

  • thank and allow parents to dress baby
  • explain findings to parents
  • document in NIPE computer system and Red Book
  • arrange Ix or follow up
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20
Q

What skin changes might you see in a NIPE?

A
  • Haemangiomas (near mouth or airway you give propranolol)
  • portwine stain (dont disappear but fade to purple, rarely can be Sturge-Weber)
  • mongolian blue spot
  • cradle cap
  • desquamation
  • erythema toxicum
  • milia
  • acne
  • naevus simplex (“stork bite”)
  • moles
  • transient pustular melanosis
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21
Q

Name 5 birth injuries to know about and what are they?

A 
CAPUT SUCCEDANEUM
(trauma above the periosteum so it does cross the suture lines, oedema, mild skin colour change, resolves in a few days)

CEPHALOHAEMATOMA
(haematoma between skull and periosteum, blood collection, does NOT cross sutures, there is skin discolouration, risk of jaundice and anaemia)

FACIAL PARALYSIS
(forceps delivery causing damage to facial nerve, function returns within months)

ERBS PALSY

  • C5-C6 injured in brachial plexus from shoulder dystocia, traumatic delivery or large birth weight
  • leads weakness in abduction, external rotation, arm flexion, and finger extension
  • give “waiters tip appearance”
  • internally rotated shoulder, extended elbow, flexed pronated wrist, lack of movement
  • function usually returns spontaneously
FRACTURED CLAVICLE
(during birth maybe shoulder dystocia, traumatic or instrumental delivery, NIPE shows lack of movement of arm,  asymmetry, distress on movement, confirm with US or XR, usually heals well, brachial plexus can be damaged)
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22
Q

Common organisms causing neonatal sepsis?

A
  • Group B Strep (GBS) (no problem in mother but give Abx if you find she has it in vagina before birth)
  • E. coli
  • Listeria
  • Klebsiella
  • Staph aureus
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23
Q

Risk factors for neonatal sepsis?

A
  • Vaginal GBS colonisation
  • GBS sepsis in a previous baby
  • Maternal sepsis, chorioamnionitis or fever > 38ºC
  • Prematurity (less than 37 weeks)
  • Early (premature) rupture of membrane
  • Prolonged rupture of membranes (PROM)
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24
Q

Clinical features of neonatal sepsis?

Red flags?

A
  • Fever
  • Reduced tone and activity
  • Poor feeding
  • Respiratory distress or apnoea
  • Vomiting
  • Tachycardia or bradycardia
  • Hypoxia
  • Jaundice within 24 hours
  • Seizures
  • Hypoglycaemia

RED FLAGS

  • Confirmed or suspected sepsis in the mother
  • Signs of shock
  • Seizures
  • Term baby needing mechanical ventilation
  • Respiratory distress starting more than 4 hours after birth
  • Presumed sepsis in another baby in a multiple pregnancy
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25
Q

Treating presumed sepsis in neonates?

A
  • one risk factor or clinical feature: monitor for at least 12 hours
  • two or more risk factors or clinical features: start Abx
  • single red flag: start Abx
  • give Abx within 1 hr of deciding
  • take blood cultures
  • check FBC and CRP
  • LP is infection is strongly suspected or features of meningitis

ANTIBIOTIC:
benzylpenicillin and gentamicin first line

lower risk babies, third gen cephalosporin eg cefotaxime

ONGOING:

Check CRPs

26
Q

What is HIE? When should you suspect it and what causes it?

A

Hypoxic Ischaemic Encephalopathy
(severe hypoxia can lead to brain damage and even CP and death)

Suspect:

  • hypoxia during perinatal / intrapartum
  • acidosis pH<7 on umbilical ABG
  • poor Apgar scores
  • evidence of multi organ failure
Causes:
anything that causes oxygen deprivation
- maternal shock
- intrapartum haemorrhage 
- prolapsed cord and compression
- nuchal cord (wrapped around neck)
27
Q

What are the Sarnat Staging grades of HIE?

A

MILD

  • Poor feeding, generally irritability and hyper-alert
  • Resolves within 24 hours
  • Normal prognosis

MODERATE

  • Poor feeding, lethargic, hypotonic and seizures
  • Can take weeks to resolve
  • Up to 40% develop cerebral palsy

SEVERE

  • Reduced consciousness, apnoeas, flaccid and reduced or absent reflexes
  • Up to 50% mortality
  • Up to 90% develop cerebral palsy
28
Q

Management of ie? Critieria?

A

supportive: ventilation, nutrition, acid base balance, treat seizures etc

THERAPEUTIC HYPOTHERMIA

TOBY criteria,
≥36 weeks
need one from A and one from B

A:

  • Apgar <5 after 10mins of birth
  • continued resus 10mins after birth
  • pH <7.0 within 60 mins (umbilical, artery, venous, capillary)
  • Base Deficit ≥16 within 60…etc

B:

  • altered state of consciousness (response to stimuli)
  • abnormal tone, flaccid
  • abnormally primitive reflexes (weak suck or weak Moro response)

Neonatal ICU, rectal probe temp between 33 and 34 for 72 hours. The warmed over 6 hours.

Reduce neurone loss after the acute hypoxic injury.

29
Q

How is bilirubin excreted?

A

RBC breakdown and release unconjugated bilirubin

Liver conjugates the bilirubin

Conjugated bilirubin is excreted in faeces or urine
(some is reabsorbed by small intestine)

(Phototherapy - causes isomers of bilirubin that can be excreted.)

30
Q

What is physiological jaundice?

A

Lots of RBCs in foetus and neonate, more fragile than adult RBCs;
Less developed liver function;
In womb the bilirubin is usually excreted via the placenta;
After birth this cannot happen and there is a normal rise in bilirubin from 2-7days. Resolves by day 10.

Prem:
Premature babies get neonatal jaundice as they have less functioning liver; increased risk of kernicterus.

31
Q

Causes of neonatal jaundice?

A

Increased PRODUCTION:

  • haemolytic disease of the newborn
  • ABO incompatibility
  • haemorrhage
  • intraventricular haemorrhage
  • cephalo-haematoma
  • polycythaemia
  • sepsis and DIC
  • G6PD deficiency

Decreased CLEARANCE:

  • prematurity
  • breast milk jaundice
  • neonatal cholestasis
  • extrahepatic biliary atresia
  • endocrine disorders (hypothyroid and hypopituitary)
  • Gilbert syndrome

Jaundice with 24 HOURS of life is pathological. Urgent Ix and Mx. Sepsis is common so treat as that if any other features or risk factors.

32
Q

What is breast milk jaundice?

A

Breast fed babies more likely to have neonatal jaundice because:

  • components of breast milk inhibit liver processing bilirubin
  • babies become dehydrated if not feeding adequately
  • inadequate feed leads to slow stool passage which increases intestinal absorption of bilirubin

Breast feeding benefits still out way these risks of breast milk jaundice. Offer extra support and advice.

33
Q

What happens in haemolytic disease of the newborn?

A

Rhesus D -ve mother has a RhD+ve baby. There is a sensitisation event (eg previous RhD+ pregnancy, amniocentesis, fall, etc) and mother developed antibodies to RhD.

Her RhD IgG antibodies will attach to the RBCs of the foetus.

In the foetus this causes erythroblastosis fetalis (making lots of RBCs) and once born, without the placenta to clear bilirubin the neonate has haemolytic, anaemia and high bilirubin levels.

34
Q

Prevention of HDN?

A
  • test for D antibodies in all RhD-ve mothers
  • give anti-D to RhD-ve mothers at 28 and/or 34 weeks (prophylaxis to sensitisation binds to Rh Ag)
  • if there is an event in 2nd or 3rd trimester the give large dose of anti-D and Kleihauer test
35
Q

When should you give anti-D ASAP? (within 72hrs)

A
  • delivery of a Rh +ve infant, whether live or stillborn
  • any termination of pregnancy
  • miscarriage if gestation is > 12 weeks
  • ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
  • external cephalic version
  • antepartum haemorrhage
  • amniocentesis, chorionic villus sampling, fetal blood sampling
  • abdominal trauma
36
Q

When is physiological jaundiced called “prolonged jaundice”?

A
  • more than 14 days in full term
  • more than 21 days in prems

Look for an underlying cause:

  • biliary atresia
  • hypothyroidism
  • G6PD deficiency
37
Q

Management of jaundice in neonates?

A

Plot total bill level on treatment threshold charts.
(thresholds for phototherapy and for transfusions)

PHOTOTHERAPY:
converts unconjugated bili into isomers that can be excreted.
light box and eye protection, double therapy = double boxes

EXCHANGE transfusion:
remove and replace blood.

Kernicterus is the worry - bili crosses BBB; permanent CNS damage; floppy, drowsy baby, poor feeding; CP, learning disability, deafness.

38
Q

What are the weeks for extreme preterm, very preterm and moderate / late preterm?

A

<28 weeks: extreme preterm

28 – 32 weeks: very preterm

32 – 37 weeks: moderate to late preterm

(Prematurity = birth before 37 weeks gestation)

Associated with:

Social deprivation
Smoking
Alcohol
Drugs
Overweight or underweight mother
Maternal co-morbidities
Twins
Personal or family history of prematurity
39
Q

How can you try and delay birth?

A

Hx of prem or cervical length <25mm before 24weeks\;

  • prophylactic vaginal progesterone suppository
  • prophylactic cervical cerclage suture in cervix to hold it closed

Preterm labour has started:

  • tocolysis with NIFEDIPINE, a CCB which suppresses labour
  • maternal CORITCOSTEROIDS; at 35 weeks to improve neonatal morbidity
  • IV Mg SULPHATE; before 34 weeks to protect babies brain
  • delayed CORD clamping or cord milking; increase circulating volume and Hb
40
Q

What are the short term and long term effects of prematurity?

A

Early life:

  • Respiratory distress syndrome
  • Hypothermia
  • Hypoglycaemia
  • Poor feeding
  • Apnoea and bradycardia
  • Neonatal jaundice
  • Intraventricular haemorrhage
  • Retinopathy of prematurity
  • Necrotising enterocolitis
  • Immature immune system and infection

Long term:

  • Chronic lung disease of prematurity (CLDP)
  • Learning and behavioural difficulties
  • Susceptibility to infections, particularly respiratory tract infections
  • Hearing and visual impairment
  • Cerebral palsy
41
Q

What is apnoea of prematurity? How is it managed?

A

Breathing stops for 20secs, there is oxygen desaturation and bradycardia.

Common in prems, esp <28weeks

Due to immaturity of ANS

Apnoea monitor and:

  • tactile stimulation to restart breathing
  • intravenous caffeine
42
Q

What is the pathophysiology of ROP?

A

Normally:
retinal vessel growth starts at 16 weeks and is complete by 37-40 weeks, it is stimulated by hypoxia.

Prem babies:
requires O2, the O2 removes the stimulation for retinal vessel growth. The when O2 is stopped the new hypoxia stimulates neovascularisation and scarring. Can lead to retinal detachment.

43
Q

What is “plus disease”?

A

ROP plus tortuous vessels and hazy vitreous humour.

44
Q

When do you screen for ROP?

A

Babies born before 32 weeks and under 1.5kg should be screened, starts at:

  • gest age 30-31weeks if born <27weeks
  • at 4-5weeks age if born >27weeks

Repeat screening every 2 weeks until normal vessel growth enters zone 3 ie past the ora serrata, normally at 36 week gest age

45
Q

Treatment for ROP?

A

1st:
- transpupillary laser photocoagulation to destroy neovascularisation

2nd:

  • cryotherapy
  • injections of intravitreal anti-VEGF
  • surgery if retinal detachment occurs
46
Q

Pathophysiology of respiratory distress syndrome?

Complications?

A

Inadequate surfactant leads to high surface tension and atelectasis as expansion is difficult.
This leads to hypoxia, hypercapnia and resp distress.

SHORT TERM complications:

  • pneumothorax
  • infection
  • apnoea
  • intraventricular haemorrhage
  • pulmonary haemorrhage
  • necrotising enterocolitis

LONG TERM complications:

  • chronic lung disease of prematurity
  • retinopathy of prematurity is more common and severe in RDS
  • neuro, hearing and visual impairment
47
Q

Management of RDS?

A

Antenatal steroids (dexamethasone) to mother in preterm labour increases surfactant production.

Prem neonates may need:

  • intubation and ventilation
  • endotracheal surfactant
  • CPAP via nasal mask
  • supplemental O2 to maintain sats at 91-95%
48
Q

What is necrotising enterocolitis (NEC)?

Risk factors?

A

Affects prems where bowel becomes necrotic. Life threatening emergency. Perforation –> peritonitis and shock.

Causes unclear, risk factors:

  • very low birth weight or very prem
  • formula feeds increase incidence
  • resp distress and ventilation
  • sepsis
  • PDA or other congenital heart disease
49
Q

How does NEC present?

What Ix do you do?

A
  • intolerance to feeds
  • vomiting, particularly with green bile
  • generally unwell
  • distended tender abdomen
  • absent bowel sounds
  • blood in stool

INVESTIGATIONS:

Bloods:

  • FBC for thrombocytopenia and neutropenia
  • CRP
  • capillary blood gas for acidosis
  • blood cultures

AXR may show;

  • dilated loops of bowel
  • bowel wall oedema
  • pneumonitis intestinalis (gas in bowel)
  • pneumoperitoneum
  • gas in portal veins
50
Q

Management and complications of NEC?

A
  • nil by mouth NBM
  • total parenteral nutrition TPN
  • Abx
  • NG tube can train fluid and gas from intestines

Surgical emergency:

  • some recover medically
  • some require removal of dead tissue and may be left with a stoma

COMLICATIONS:

  • Perforation and peritonitis
  • Sepsis
  • Death
  • Strictures
  • Abscess formation
  • Recurrence
  • Long term stoma
  • Short bowel syndrome after surgery
51
Q

What substances can cause neonatal abstinence syndrome (NAS)?

A
  • opiates
  • methadone
  • benzodiazepines
  • cocaine
  • amphetamines
  • nicotine or cannabis
  • alcohol
  • SSRI antidepressants
52
Q

Signs and Sx of NAS?

A

CNS:

  • Irritability
  • Increased tone
  • High pitched cry
  • Not settling
  • Tremors
  • Seizures

Vasomotor and respiratory:

  • Yawning
  • Sweating
  • Unstable temperature and pyrexia
  • Tachypnoea (fast breathing)

Metabolic and gastrointestinal:

  • Poor feeding
  • Regurgitation or vomiting
  • Hypoglycaemia
  • Loose stools with a sore nappy area
53
Q

Management of neonatal abstinence syndrome?

A

Known substances use mothers have alert in notes so neonate can have extra support…

Monitor babies on a NAS chart for at least 3 days (48 hours for SSRIs)

Test for substances in neonatal urine

(gentle handling and dim light for neonate)

Moderate to severe Sx:
- oral morphine sulphate for opiate withdrawal
- oral phenobarbitone for non-opiate withdrawal
(gradually wean off, little treatment for SSRI NAS)

Consider:

  • testing for hep B, C and HIV
  • safeguarding and social environment
  • safety net
  • Paeds and social services follow up
  • suitability of breastfeeding in substance use
54
Q

What are the characteristics of metal alcohol syndrome?

A
  • microcephaly
  • thin upper lip
  • smooth flat philtrum (gap between nose and mouth)
  • short palpebral fissure (eye lids)
  • learning disability
  • behavioural difficulties
  • hearing and vision problems
  • cerebral palsy
55
Q

Features of congenital rubella syndrome and how can you avoid?

A
  • congenital cataracts
  • congenital heart disease (PDA and pulm stenosis)
  • learning disability
  • hearing loss

Doubt of rubella immunity? Test before pregnant, get MMR vaccine and again 3 months later.

Pregnant cannot have vaccine as it is live. Give vaccine after birth.

56
Q

Most people have had chicken pox, what happens if a pregnant woman hasn’t?

A
  • can give IV varicella immunoglobulins within 10 days of exposure
  • if rash develops and they are past 20 weeks give acyclovir within 24hrs

If infection occurs:

  • mother pneumonitis, hepatitis, encephalitis
  • fetal varicella syndrome
  • severe neonatal varicella infection

CONGENITAL VARICELLA SYNDROME:

  • foetal growth restriction
  • microcephaly, hydrocephalus and learning disability
  • scars and skin changes in dermatomes
  • limb hypoplasia
  • cataracts and chorioretinitis
57
Q

What happens in congenital CMV?

A

CMV infection in pregnancy (spread via asymptomatic children). Most cases do not cause congenital problems:

  • Fetal growth restriction
  • Microcephaly
  • Hearing loss
  • Vision loss
  • Learning disability
  • Seizures
58
Q

What happens in congenital toxplasmosis?

A

Toxoplasma gondii infection from cat faeces.
Higher risk later in pregnancy.

Triad:

  • intracranial calcification
  • hydrocephalus
  • chorioretinitis
59
Q

What happens in congenital zika syndrome?

A

Aedes mosquito or sex with infected person. (minimal to flu like Sx in adults)

Congenital:

  • microcephaly
  • foetal growth restriction
  • other intracranial abnormalities eg ventriculomegaly and cerebella atrophy

Pregnant women that may have zika should have viral PCR and antibody test. Closer monitoring, no treatment.

60
Q

Sudden infant death syndrome (SIDS) or “cot death”:

  • risk factors?
  • minimising risk?
  • support?
  • CONI?
A

Risk Factors:

  • prematurity
  • low birth weight
  • smoking during pregnancy
  • male baby (only slightly increased risk)

Minimising risk:

  • Put the baby on their back when not directly supervised
  • Keep their head uncovered
  • Place their feet at the foot of the bed to prevent them sliding down and under the blanket
  • Keep the cot clear of lots of toys and blankets
  • Maintain a comfortable room temperature (16 – 20 ºC)
  • Avoid smoking. Avoid handling the baby after smoking (smoke stays on clothes).
  • Avoid co-sleeping, particularly on a sofa or chair
  • If co-sleeping avoid alcohol, drugs, smoking, sleeping tablets or deep sleepers

OSCE station:
worried about SIDS, previous SIDS, understand anxiety, dont imply blame, no causes just increase risk, positives: there are lots of things we can do to minimise the risk

SUPPORT:
- lullaby trust help give support and bereavement services

CONI:

  • care of next of kin team
  • supports parents with their next infant after SIDS
  • home visits, resus training,, movement and breathing monitors

Zero Paeds (38 decks)

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