Neonatology from busy SpR Flashcards
Breastfeeding + Aspirin
Risk Reye’s sydnrome
BF + Bromocriptine/carberfoline
Suppressess lactation
BF + Caribmazole
Affect neonatal thyroid function, nodular goitre
BF + Chlorampheniclol
Leucopenia, aplastic anaemia acid
BF + cyclophosphamide
Discotinune during BF and for 36hr after stopped
BR + diazepam
Lethargy, drowiness, hyperbilirubimae
Erbs
- Nerve roots
- Cause
- Symptoms
C5/C6
Excessive displacement of head to the opposite side or depression of the shoulder on same side
Medially roasted and forearm pronated (waiters tip), sensory loss of lateral side of arm/
Klumpke’s
- Nerve roots
- Cause
- Symptoms
C8/T1
Small muscles of claw hand, sensory loss of medial side of arm
What are the 4 key adaptations of the fetal circulation?
- Ductus venous
(oxygenated blood coming from placenta umbilical vein, divides 1 to liver and ductus arterioles into inferior vena cava) - Forman ovale - semi oxygenated blood from IVC & SVC into R atrium shunts to L side of heart (low pressure) and into aorta
- Ductus arteriosus - blood in pulmonary artery is connects to ductus arteriosus, placenta releases prostaglandin which keeps this open
- Umbilical arteries - blood from aorta sends blood to body, common iliac which splits into internal. Umbilical arteries carrying deoxygenated blood back to placenta
What are the remnants of each fetal adaptation called after birth?
Foramen vale - fossa ovalis
Ductus arteriosus - ligament arteriosus
Umbilical arteries - proximal superior vesical arteries, distal medial umbilical arteries
Umbilical vein - round ligament of the liver
Ductus venous - ligament venous
What proportion of adults have a patent foramen ovale?
25-30%
In what conditions is the foramen ovale less likely to close?
Born premature
Congenital rubella infection
In what % of cases is a patent ductus arteriosus isolated?
90%
10% other congenital heart defects (tetralogy- necessary for survival)
Pink upper limbs, blue lower limbs
How common are cardiac congenital malformation
7-8/1000
6-10% all infant mortality
How often does neonatal examination fail to detect CHD?
50%
What is eisenmenger syndrome?
Left to right heart shunt that not corrected leading to pulmonary HTN, R ventricular becomes hypertrophied. R to L shunt.
Hypoxia - polycythemia, clubbing
How is combined pulse oximetry measured in neonate
Pre-ductal - Right hand
Post-ductal - any foot
Improves detect of CHD to 90%
What is considered a normal combined pulse oximetry?
Both >95% and less to equal to 2% difference
At birth lower, in health term baby does not reach 90% in 1st 5 mins and gradient remains
Screening normally done 4-12 hours after birth
How to calculate APGARs
What scores of APGAR are considered normal?
> 7 are good
4-6 fairly low
<3 criticality low
Normally measured at 1 and 5 mins
Draw diagram showing location caput, cephalohaematoma, subgleal haemorrhage, extradural haemorrhage
Cephalohaematoma
- How common
- Location
- Association
- When does it present
1%
bleeding beneath periosteum, does not cross suture line
Associated with jaundice
May not appear until 2nd day of life, takes severeal weeks to disappear
Subglaleal hemorrhage
- How common
- Location
- Association
- RF
- Rare
- Bleeding beneath aponeurosis, crosses midline
- Associated with shock, anaemia, neonatal death
- Increased risk ventouse delivery
How to sub-arachnoid haemorrhage occur? Progonsis>
Small vessels normally veins
Silent bleed, may present with fits
Good prognosis
Sub dural haemorrhage association, outcomes
Associated with excessive moulding forces or difficult delivery of head
Large infra-tentorial bleeds associated with poor outcome
How common is intra-ventricular haemorrhage?
What is associated with poorer outcomes
2% normal babies at term, increased in preterm
Poorer prognosis if brain parenchyma involved
50% cerebral palsy if post haemorrhage hydrocephalus
What is periventricular leukomalacia?
- Biggest risk factor
- Outcomes assocated
White-matter brain injury near lateral venticules
- Most likely to affect preterm infants, <1500g
- Can manifest as cerebral palsy >50%
Rate of stillbirth in UK
Stillbirth risk at 39 weeks
1 in 200
39/40 1/1000
Draw neonatal resuscitation flow diagram
How many insufflation breaths?
5
Acceptable pre ductal SPO2 at 2, 5 and 10 mins
2 65%
5 85%
10 90%
Before what gestation should be wrapped in plastic bag?
<32 weeks
For inflamtion breaths what inflation pressures should be used <32 or >32
<32 25cm H20
>32 30 cm H20
Start in air
What % of oxygen should be used
>32
28-32
< 28
> 32 21%
28-32 21-30%
<38 30%
Ratio chest compressions to inflations
3:1
What should the temperature of delivery room be in neonatal resuscitation?
26C
How common is physiological neonatal jaundice?
When does is present in term and preterm infant?
30-50 term neonates, unconjugated
Term neonates - D3
Preterm neonate - D5
Does not present in 1st 24hrs
What is jaundice considered pathological?
Conjugated
Marked jaundice >250-300 micro mol/L
Prolonged >10 days term/14 days preterm
Occurs 1st 24 hrs
Accosted with other illness
Causes of haemolytic neonatal jaundice
Rhesus disease, ABO haemolytic disease of glucose-6-phosphate dehydrogenase deficiency, hereditary spherocytosis, pyruvate kinase deficiency, polycythaemia, TTTS, haemoglobinopathies
What can high levels of unconjugated bilirubin cause in neonate?
Kericterus - crosses BBB
basal ganglia involved, athetoid cerebral palsy + deafness, seizures, neonatal death
More likely extreme preterm, sepsis, acidosis
How is jaundice treated>
Phototherapy
Exchange transfusion - based on unconjugated bilirubin concerntaiton
Inheritance of Glucose-6-phosphate dehydrogenase deficiency
X linked recessive
Which clotting factors of vitamin K dependant?
2, 7, 9, 10
What is haemorrhage disease of the newborn
Babies relative low vitamin K and can suffer harmorrhagic complications which can be fatal
How is the risk of haemorrhage disease of the newborn minimised?
1mg vit K fine at birth
PO regime’s available 2mg
Which babies required additional vitamin K?
If give oral vitamin K at birth and breast-fed
2mg at 1 week and 1 monthly until weaned
Which babies at high risk of HDN?
Pre-term
- Small for gestation age
- Badly bruised
- Breech deliveries
- Operative delivery
- Maternal anti-convulsant therapy
- Maternal / neonatal liver disease
- Admission to SCBU
- Poor feeding
How common is RDS before 32 weeks & term?
<32 40-50%
Term 2/1000
NNT for AN steroid to prevent RDS/NND/IVH < 31 weeks and >34 weeks
<31 5
>34 94
How common is TTN
- term
- CS before labour
- CS in labour
- VD
- term 6/1000
- CS before labour 35/1000
- CS in labour 12/1000
- VD 5/1000
Complications of preterm
Resp
- RDS, TTN, chronic lung disease
- Apnoea of prematurity
Neuro
- ICH, IVH, HIE
Infection
NEC
Retinopathy
Anaemia
Patent ductus arteriosus
Which tests included in health prink test
Sickle cell
CF
Congeitnal hypothyroid
PKU
MCADD
Mayple syrup urine disease
Isovaleric acidaemia
Glutaaric aciduria type 1
homocystinuria
Which neonates at risk of neonatal hypoglycaemia
DM mothers
Mother taken BB
IUGR
How to Dx neonatal hypoglycaemia?
A value <1.0mmol/l at any time
A single value <2.5mmol/l in a neonate with abnormal clinical signs
A value <2.0mmol/l and remaining <2.0mmol/l at next measurement in a baby with a risk factor for impaired metabolic adaptation and hypoglycaemia but without abnormal clinical signs.
Treatment neonatal hypoglycaemia
Buccal dextrose + feeding plan if 1-1.9
<1 or persistent - medical R/V
Fetal blood volume is what proportion of body weight?
10-12%
Additional blood from delayed cord clamping if baby 3500g 1
166ml
How common is neonatal hip dysplasia
0.5-1.5%
Risk factors for neonatal hip dysplasia?
Female 8:1
Fix (6% sibiling, 12% parent)
Breech
Multiple preg
1st preg
LGA
Oligo
Postural and non portal abnormality - club foot, torticollis
How common hip dysplasia bilateral? Which leg more likely to be effected
20-40% bilateral
L > R x 3
