Neonatology Flashcards
1
Q
what age is preterm baby
A
<37wks
2
Q
what age is a term baby
A
> 37wks and <41wks
3
Q
what age is a post term baby
A
> 41 wks
4
Q
normal birth weight
A
2.5-4kg
5
Q
overweight birth weight?
A
> 4kg
6
Q
underweight birth weight?
A
<2.5kg
7
Q
features to ask about labour/birth?
A
spontaneous/induced
cephalic/breech?
C section?
8
Q
describe oygen supply to the foetus during birth
A
has a rich supply of Hb in the blood
labour is hypoxic and so foetal Hb helps release O2 when needed
9
Q
what may lead to lowered fHb leading to hypoxia during labour
A
smoking
pre-eclampsia
prolonged labour
10
Q
describe some features o perinatal adaptation straight after birth
A
first breath alveolar expansion change form foetal to adult circulation decreased pulmonary artery pressure increased PO2
11
Q
what is the apgar score
A
objective score of perinata adaptation
>8 is healthy
12
Q
why is skin to skin contact important for neonate
A
forms attachment with neonate to mother
hormonal and emotional response
13
Q
true/false - term infants typically have a low calorie intake in the first 24 hours
A
true
14
Q
potential complications/features of haemorrhagic disease of the newborn
A
GI bleed
intracranial haemorrhage
epistaxis
15
Q
preventing haemorrhagic disease of the newborn?
A
IM vitamin K
16
Q
when would you give heb B vaccine
A
usually given as part of routine but if mother has it with high viral load then may be immediate
severe- hep B Ig
17
Q
risk of HIV/hep C to newborn if there is low viral load?
A
minimal
18
Q
when would you immediately offer the BCG vaccine
A
if it is an at risk family for TB
19
Q
routine vaccination antenatal and postnatal
A
maternal influenza and pertussis
routine vaccine at 8 weeks
hep B at routine or birth and BCG if needed
20
Q
what is screened for on newborn screening card and what day is it done
A
day 5 CF hypothyroidism haemoglobinopathies metabolic conditions
21
Q
what to do if CF is +ve on newborn screening card
A
sweat test
genetic screening
22
Q
parental habits to advise to promote health
A
smoking alcohol drug use diet social interaction feeding vaccination sleep position baby box
23
Q
components of the apgar score
A
pulse respiration appearance grimace activity
24
Q
normal Resp rate of a neonate
A
40-60 resp/min
25
normal HR of a neonate
120-140BPM
26
key things to assess in a sick infant?
```
HR and RR
BP
work of breathing
CRT
colour
SaO2
jaundice
tone
vomit
feed
growth
```
27
key parts of maternal hx to consider in sick infant?
PMHx
issues
delivery
drugs
28
initial management of sick term infant?
```
temp
airway and breathing with O2
fluids and inotropes
glucose and acid base
abx if needed
```
29
what is hypoxic ischaemic encephalopathy
multi organ system damage due to tissue hypoxia
30
birth related respiratory conditions
hypoxic ischaemic encephalopathy
TTN
PTX
31
birth related cardiac conditions
PPHN
| heart failure due to rh disease, chromosome, hydrops foetalis
32
congenital neuro conditions
myotonic dystrophy
| spina bifida
33
congenital resp conditions
diaphragmatic hernia
| TOF
34
congenital cardiac conditions
```
tetrology of fallot
transposition of great arteries
HLHS
aortic coarctation
TAVPD
ASD/VSD
```
35
sites of infection in neonate
```
CNS
resp
skin, bone
GI
GU
Blood
```
36
bacterial causes of infection in neonate
```
syphilis
listeria
staph aureus/epidemidis
e coli
group b strep
```
37
viral causes of infection in neonate
```
HIV
toxoplasma
parovirus
herpes
enterovirus
CMV
rubella
```
38
what is a moderate preterm infant
32-37 weeks
39
what is a very preterm infant
28-32 weeks
40
what is an extremely preterm infant
<28 weeks
41
factors increasing chance of infant mortality in first year of life
low birth weight
| preterm delivery
42
what has lead to increase in premature babies over years
increasing maternal age
increased rate of complication
more c section
greater infertility treatment
43
risk factors for prematurity
```
twins
>2 preterm babies
older age
IVF
smoking, drugs, alcohol
abnormal uterus
<6m between pregnancies
poor nutrition, high blood pressure, diabetes
```
44
what risks to pregnancy does smoking carry
premature birth
| miscarriage
45
true/false - babies <30wks are managed the same a term babies
false - babies 31-33 can be managed similarly, or not, and >33 weeks are managed similar
<30 weeks need more intense management
46
causes of hypothermia in preterm neonates
low BMR
little s/c fat
low muscle activity
high surface area
47
methods of heat loss in preterm neonates
conduction
radiation
convection
evaporation
48
management of heat loss in preterm neonates
```
wrap/bags
hat
transwarmer mattress
prewarmed incubator
skin to skin care
```
49
increased risk of growth and nutritional compromise in preterm?
lower reserves
gut immaturity
immature metabolic pathways
increased nutritional demand
50
why are preterm neonates at increased risk of sepsis
indwelling lines
intensive care
immature immune system
51
causes of NRDS
structural immaturity
alveolar damage from exudate
surfactant deficiency
secondary pathology
52
how common is NRDS
75% <29wks
| 10% 32 weeks
53
clinical features NRDS
```
tachypnoea
increased work of breathing
intercostal/subcostal recession
cyanosis
nasal flare
grunting
```
54
management of NRDS
antenatal sreroids - dexamethasone/betamethasone
surfactant replacement
ventilation - CPAP or ET tube
55
physiological action of ductus arteriosus
umbilical blood passes into RA ad crosses foramen ovale to enter aorta or by pulmonary artery to aorta
at birth foramen ovale should close and ductus arteriosus should also close to create adult circulation
56
how many suffer neurodevelopmental delay and mortality in grade 1/2 intraventricular haemorrhage
20%
| 10% mortality
57
how many suffer neurodevelopmental delay and mortality in grade 3/4 intraventricular haemorrhage
80%
| 50%
58
best way to prevent necrotising enterocolitis
breastfeeding
59
pathophysiology of necrotising enterocolitis
major haemodynamic instability and gut ischaemia, leading to gut flora invading the circulatory system
60
late metabolic complications of preterm infants?
osteopaenia of pregnancy
61
early metabolic complications of preterm infants
hypoglycaemia
| hyponatraemia
62
survival at 22 weeks
6%
63
survival at 23 weeks
33%
64
survival at 26%
85%
65
how can CF in neonates lead to bowel obstruction
meconium may build up due to being sticky and can lead to obstruction
66
how may jejunal atresia appear on x ray and how is it managed
high obstruction in jejunum with collapse of the distal bowel loops
surgeryt
67
describe how malrotation can lead to bowel obstruction
congenital malrotation leads to a low DJ flexure in the bowel, with a high caecum
this is prone to volvulus, leading to ischaemia and death of the bowel
68
risk factors for hypoglycaemia in neonates?
small birth weight
low temp
mothers diabetic status
69
presentation of neonatal hypoglycaemia
```
seizure
jittery
sleepy
high pitched cry
hypothermia
```
70
risk factors for severe jaundice
```
prematurity
materal ab
blood group difference
brusing at delivery
infection
```
71
investigation of jaundice in neonates
bilirubin
if treatment required check FBC and antibodies/blood group
if sepsis concern then CRP
72
cause of tachypnoea and what is tachypnoea
```
RR>60
infection
NRDS
TTN
too hot
meconium aspiration
PPHN
NAS
necrotising enterocolitisi
```
73
describe the physiological jaundice seen in term neonates
increased bili due to increased Haem breakdown
decreased uptake and binding in liver so decreased conjugation
decreased excretion so builds up in enterohepatic circulation
74
causes of pathological jaundice <24hr
haemolysis
| hepatitis
75
causes of haemolysis leading to jaundice
ABO mismatch
Rh ab
sepsis
enzyme/cell membrane defects
76
true/false - jaundice <24hr is always pathological
true
77
if there is a high conjugated bilirubin, what is the likely cause of the jaundice
hepatitis
78
investigating pathological jaundice?
```
TSB
maternal blood group and Ab if Rh -ve
baby blood group and coombs test
elution test
FBC
CRP/culture
```
79
what is coombs test
direct antiglobulin test to look for autoimmune haemolytic anaemia
80
what is elution test
testing dirtectly for anti-A or anti B on RBC
81
cause of high bilirubin 24hr to 10days
```
milk dehydration
haemolysis
cephalohaematoma, bruising, CNS haemorrhage, swallowed blood
polycythaemia
infection
increased enterohepatic recycling
haemolysis
```
82
true/false - high bilirubin 24hr-10d is always pathological
false
83
cause of persistent >14d unconjugated bilirubinaemia
```
breast milk jaundice
poor milk intake
haemolysis
infection
hypothyroid
```
84
treu/false - persistent unconjugated bilirubinaemia is always pathological
false - not always but should be investigated in case
85
true/false- persistent conjugated hyperbilirubinaemia is always pathological
true
86
cause of persistent conjugated hyperbilirubinaemia
hepatitis
| biliary atresia
87
causes of neonatal hepaittis
```
toxoplasmosis
rubella
CMV
herpes
syphilis
HIV
varicella
listeria
metabolic disorders
biliary atresia
```
88
typical features of physiological jaundice
staerts day 2, peaks day 5
resolves by day 14
otherwise well
89
typical features pathological jaundice
onset day 1
prolonged past 14
colour of stool and urine
high conjugated bili
90
what % of babies have physiological jaundice
60%, 10% will still be at 1m
91
what is kernicterus
unconjugated bili is toxic to the brain ans can cross the BBB in infancy
92
presentation of kernicterus
```
lethargy
poor feed
seizure
spasticity
hypotonia
arching of neck, back, head
temp instability
```
93
risk of developing kernicterus
high unconj bili >340 or<300 in preterm
| asphyxia, acidosis, hypoxia, hypothermia, sepsis, meningitis, decreased alb binding
94
treatment of jaundice
```
treat cause
hydration
phototherapy
exchange transufsion - rare
IV Ig for isoimmune haemolytic disease with rising bili despite phototherapy OR within 30-50 of needing exchange transfusion
```
95
how to rehydrate as part of treatment for jaundice?
oral feed
breastfed - 8-12 times daily
if formula fed then it should be formula or expressed milk and not water
