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
What is it present in breast milk that produces neonatal jaundice and why?
Beta-glucoronidase prevents bilirubin binding to albumin
3 causes of neonate developing polycythaemia?
TTTS, diabetic mother, IUGR
What type of bruising on the head of a neonate can occur with excess RBC breakdown?
Cephalohaematoma
What is Criggler-Najjar syndrome that causes jaundice?
Deficient glucuronyl transferase
5 Endocrine/IEM causes of jaundice in newborns?
tyrosinaemia, galactosaemia, hypo thyroidism, hypopituitarism, hypoadrenalism
If a baby appears ill and jaundiced what do you immediately suspect the cause to be?
Sepsis
What is erythroblastosis fetalis and what causes it?
process of haemolytic anaemia in the womb cause by rhesus disease where erythroblasts present in blood stream
What is hydrops fetalis and what occurs as a result of it?
Severe fetal anaemia, high output cardiac failure, accumilation of fluid in lungs, tissues, heart, ascites
What investigations are usually performed into early neonatal jaundice? (inc a test for autoantibodies of RBC)
SBR (total and direct), sepsis screen for TORCH, Coombs test, blood group, FBP, G-6PD deficiency
2 enzyme deficiencies that can lead to haemolysis and jaundice?
G-6PD deficiency or pyruvate kinase
Causes of conjugated forms of jaundice in newborn?
Neonatal hepatitis syndrome, hep A/B/C, biliary atresia, choledochal cyst, inspissated bile, alagille syndrome, prolonged TPN
What can cause neonatal hepatitis syndrome?
CF, alpha 1 antitrypsin deficiency, sepsis, TORCH, galactosaemia, tyrosinosis, hypermethioninaemia
How do you investigate biliary atresia?
HIDA scan - radioisotope
What procedure is needed for biliary atresia?
Kasai procedure
When is the appearance of jaundice abnormal..?
day 1 after delivery and lasting for more than 14 days
Blood and urine investigations into cholestasis?
Alpha1 antitrypsin levels, TORCH screen, FBP, LFT, urine organic acids and amino acids, blood culture, fasting glucose/lactate/AA
When is an USS on the gallbladder and biliary tree best performed?
Fasting for 4 hours
What is given 3 days before a HIDA scan and what dosage?
Phenobarbitone 5mg/kg/day
What can occur as a complication of raised bilirubin?
Kernicterus
What happens in kernicterus
bilirubin deposits in basal ganglia and leads to bilirubin encephalopathy
Symptoms of kernicterus and specifically bilirubin encephalopathy?
Back arching, high pitched cry, lethargy, abnormal tone
What morbidities can develop from kernicterus?
cerebral palsy, sensorineural deafness, visual impairments
What does phototherapy convert bilirubin into and why is this able to be eliminated from circulation?
lumirubin but structural isomerisation causing unconjugated to become water soluble
How much blood volume is usually used in exchange transfusions?
twice the babies blood volume
What 4 conditions warrant an exchange transfusion over phototherapy?
if there are electrolyte imbalances, low BP, thrombocytopenia, hypoglycaemia
Define sensitivity?
ability of a test to identify those who have the disease
Define specificity?
Ability of a test to correctly identify those who dont have the disease
If it has high sensitivity what does this mean?
Picks up all those who have the disease
If it has high specificity what does that mean?
excludes all those who dont have the disease
When is heel prick testing performed on new borns?
Day 5 usually (5-8)
name 6 conditions that are screened for in newborns?
PKU, MCADD, congenital hypothyroidism, sickle cell, CF, homocystinuria
What is the inheritance pattern of PKU?
autosomal recessive
What is lacking in PKU?
The enzyme to convert phenylalanine into tyrosine
What is phenylalanine broken down into in those suffering PKU and how is it excreted?
Broken down into phenyl ketones excreted in urine
What damage can PKU cause to an individual?
Mental retardation, epilepsy, seizures, behavioural issues
What cannot be generated in a neonate suffering with MCADD?
cannot generate ketones
What does MCADD lead to?
hypoglycaemia, hepatic encephalopathy, sudden infant death syndrome
Management of MCADD?
avoid fasting, measure levels during illness and stress management
2 reasons that steroids are given to babies preterm?
Prevent RDS and intrraventricular haemorrhage
Why is MgSO4 given to babies preterm?
protects neurodevelopmental outcomes
5 things looked at on the apgar score?
HR, RR, muscle tone, reflexes, colour
How is apgar scored for each category?
HR - absent (0), below 100 (1), above 100 (2)
RR - absent (0), slow (1), normal/fast (2)
Muscle tone - limp (0), decreased (1), normal (2)
Reflexes - absent (0), decreased (1), normal (2)
Colour - blue (0), pink with blue extremities (1), pink (2)
What can and cannot be interpretted on a capillary blood gas compared to an arterial blood gas?
CBG can gain correct information on pCO2, pH and HCO3 but not pO2
Which thoracic vertebrae should the endotracheal tube be found between?
T1 and T3
2 signs of tension pneumothorax on xray?
Decreased lung markings and tracheal deviation
How do you manage a pneumothorax?
Needle thoracocentesis followed by chest drain insertion
What can be applied to the chest wall to identify pneumothorax in an neonate?
Translumination with fibreoptic light
What 3 things are given to avoid osteopenia of the newborn?
Phosphate, vitamin D and calcium
What are the fluid requirements for preterm neonates on day 1/2/3/4/5 after birth?
1 - 60ml/kg/day 2 - 80ml/kg/day 3 - 100ml/kg/day 4 - 120ml/kg/day 5 - 150ml/kg/day
When and how do neonates usually recieve immunity?
IgG maternal transfer in 3rd trimester
If a neonate develops jaundice within 24 hours of birth what are the 5 most likely causes?
Rhesus incompatibility, ABO incompatibility, Spherocytosis, congenital infection, g6PD deficiency
If a neonate develops jaundice 2 days to 3 weeks of age what are the 4 most likely causes?
physiological, breast milk jaundice, infection or crigler najar syndrome
If a neonate has jaundice past 3 weeks of age are you worries?
yeah - any of above conjugated and unconjugated causes throughout this flashcard set
3 main side effects of phototherapy the neonate may experience?
inability of temperature regulation, macular rash, bronze discolouration to skin
Why can a faint systolic murmur be heard in early life?
patent ductus arteriosus
If a baby is symptomatic with patent ductus arteriosus what 3 things can you give to close the duct?
Prostaglandin synthetase inhibitors, indomethecin, ibuprofen
What can be given to prevent apnoea?
Caffeine
Established neonate on enteral feeds 1 week later stops tolerating feeds, aspirating large volumes and distended abdomen, what is initial diagnosis?
necrotizing enterocolitis
What long terms complications of prematurity can arise?
retinopathy of prematurity, hearing impairments, bronchopulmonary dysplasia and emphysema, neurodevelopmental issues (CP/learning difficulties/behvioural/fine motor/poor attention span/delayed language)
