Neonatology Flashcards
Presentation of RDS in neonates?
Hours after birth, tachypnoea over 60, indrawing/retraction/recession, grunting, nasal flaring, cyanosis
predisposing factors for RDS?
prematurity, male, white, maternal diabetes, CS, hypothermia, second twin
How will RDS lungs appear on xray?
ground glass appearance, air bronchogram
If a fetus is found to have RDS in utero, what dose frequency of betamethasone is given and how soon after if delivery of baby?
2 doses, 12 hours apart then 24 hours later give birth
Purpose of erythromycin in pre term delivery?
Can delay labour by 2 weeks
When is erythromycin useful?
Premature rupture of membranes
Why are tocolytics useful when given alongside steroids?
Allow maximum effect of the steroids
Other than oxygen delivery, what is the main post natal care support needed in RDS?
Temperature regulation
how does transient tachpnoea of the newborn differ to RDS?
more mature babies, 100-120/min, no grunting or indrawing, settles in 24-48 hours
Causes of transient tachpnoea of the newborn?
Increased fluid production by lungs, delayed fluid clearance
What usually clears the lungs of fluid before labour and how does this relate to predisposing factors of TTN?
Catecholeamine surge clears fluid, CS is predisposing factor along with induction before term
How does transient tachypnoea of the newborn appear on xray?
Fluid in horizontal fissures, congested pulmonary venous congestion, wet lung
2 supportive management options for transient tachypnoea of the newborn?
oxygen and parental nutrition (too breathless to feed)
Differentials for transient tachypnoea of the newborn and how this effects management?
pneumoniae and cardiac disease which usually leads to antibiotics being administered before TTN can be diagnosed
After birth what do the following become:
ductus venosus
umbilical vein
umbilical artery
ligamentum venosum
ligamentum teres
medial umbilical ligaments
What type of shunt appears in PPH of the newborn? causes symptoms?
right to left, severe hypoxia, tricuspid regurg, poor flow through pulmonary artery
What can cause PPH of the newborn to occur?
Congenital pneumoniae, meconium aspiration syndrome, infection, diaphragmatic hernia, acidotic or asphyxiated
4 things to manage a baby with PPH of the newborn?
- maintain BP- inotropic support
- oxygen support - high frequency oscillation ventilation
- stop baby moving - paralysing drugs and minimal handling
- Vasodilate pulmonary vessels - NO, tolazoline, prostacyclin, MgSO4
What 4 vasodilators can be given in a newborn suffering PPH?
prostacyclin, MgSO4, NO, tolazoline
what 3 conditions can cause a fetus to pass meconium before they are born?
Asphyxiated, stressed or acidotic
What 6 effects can meconium aspiration syndrome have on the lungs and the newborn in general?
Ball valve effect where air can get passed meconium and overinflates certain areas, pneumothorax, bacterial superinfection, pneumonitis, RDS, surfactant inhibition
How does meconium aspiration syndrome appear on x-ray?
overinflated areas, patchy opacification, pneumothoraces
management of meconium aspiration syndrome?
prevention, paralysis and ventilation, surfactant lavage, antibiotics
Cause of bronchopulmonary dysplasia?
Chorioamnionitis causing inflammation, remodelling and fibrosis
How are babies who suffer bronchopulmonary dysplasia usually born? requirements?
Very preterm and need ventilation
What do babies who suffered bronchopulmonary dysplasia usually develop? why?
emphysema due to damage caused by interventions needed in early life to keep them alive
3 findings on xray of a baby with bronchopulmonary dysplasia?
hazy opacification, cyst formation, overinflated areas
How can oxygen damage to lungs be prevented in babies with bronchopulmonary dysplasia?
HFOV, off oxygen quickly even in hypercapnic states, surfactant replacement, nutrition, diuretics,
What can bile be converted to by bacteria within the intestine (2)?
stercobilin or urobilinogen
What is urobilinogen excreted as by the kidneys?
Urobilin
How does bilirubin travel in the blood and why?
Albumin as water insoluble
What enzyme converts bilirubin in the liver?
glucuronyl transferase
3 main mechanisms that can cause jaundice?
Increased red cell breakdown, reduced conjugation in the liver, biliary obstruction
What is the level of SBR measured in?
umol/l
what do tests total and direct SBR allow for calculation of?
Total = conjugated and unconjugated Direct = conjugated
2 predisposing factors for physiological jaundice in first few days of life?
Raised Hb (usually 18-20g/dL in newborns) and relative dehydration in newborns
does breast milk lead to increased conjugated or unconjugated bilirubin?
unconjugated
How long does jaundice caused by breast milk usually last?
2/3 weeks, rarely longer than 2/3 months