Neonatology - normal newborn Flashcards

1
Q

Pressure changes after the first breath of a baby

A

Resistance to pulmonary blood flow decreases massively - 6times as much blood can flow through pulmonary arteries.
This leads to increased pressure in Left Atrium.

Meanwhile, pressure in right atrium falls because the placenta is excluded from the circulation: closure of the foramen ovale.

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2
Q

When does the ductus arteriosus close?

A

Normally within the first few hours or days

If there is a duct-dependent lesion, the baby will deteriorate within days

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3
Q

Respiratory changes from fetus to neonate

A

Lung liquid reabsorbed (chest compression during birth squeezes out 1/3. Release of adrenaline promotes the rest)

Surfactant release. Triggered by adrenaline and steroids.

Fall in the capillary pressure due to expansion of alveoliy and the vasodilatory effect of oxygen. respiratory movements commence

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4
Q

By when should the neonate open its bowels

A

Usually first 6 hours

Up to 24hrs

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5
Q

By when should the neonate urinate

A

First 24 hours

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6
Q

By when should the neonate regain its birth weight

A

Newborns lose around 7-10% of their weight

Should regain in ca. 2 weeks

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7
Q

What are the effects of Vit K deficiency in a neonate

A

haemorrhagic disease of the newborn

Can occur in first week of life.. or from week 1-8

Usually mild symptoms eg. bruising, haematemesis, melaena or prolonged bleeding from umbilical stump..
Some suffer INTRACRANIAL HAEMORRHAGE (50% permanently disabled or die)

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8
Q

What is the content of Vit K in breast milk?

A

Poor source of Vit K (wholly breastfed children may develop haemorrhagic disease of the newborn)

Infant formula has much higher content.

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9
Q

Risk factors for haemorrhagic disease of the newborn

A

Wholly breastfed
Mother on anti-convulsants (impair synthesis of Vit K clotting factors)

Infant with liver disease

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10
Q

Prophylaxis for haemorrhagic disease of the newborn (normal mothers vs mothers on anticonvulsants)

A

In normal, give vit K to all infants immediately after birth. Either IM injection or orally over the first 4 weeks (3 doses needed)

If on anticonvulsants, Oral prophylaxis from week 36 and baby should receive IM injection

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11
Q

Outline the hearing screening in the UK

A

Evoked optoacoustic emission (EOAE) testin - earphone is placed over the ear and a sound is emitted which evokes an echo or emission from each ear if cochlear function normal

If abnormal, test with an Automated Auditory Brainstem Response (AABR) audiometry - computer analysis of EEG to a series of clicks
Refer to paediatric audiologist if abnormal

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12
Q

What is the Guthrie test

A

Biochemical screening, on every baby.

Hypothyroidism
Haemoglobinopathies (sickle cell and thalassaemia)
Cystic fibrosis

Inherited metabolic diseases:
PKU
MCAD
MSUD (maple syrup urine disease)
IVA
GA1
HCU

Screening for CF is performed by measuring the serum immunoreactive trypsin.. Raised with pancreatic duct obstruction

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13
Q

What is ultrasound used for antenatally

A
Show babies measurements.
Number of babies.
Abnormalities? (head and spine)
Show position of baby
Check for normal development.
celft lip/palate
Cardiac problems
Spina bifida
Bowel problems
Down syndrome
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14
Q

What is erythema toxicum

A

Neonatal urticaries
Usually appears 2-3 days of age

White pinpoint papules at the centre of an erythematous base

Lesions concentrated on the trunk
They come and go at different site

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15
Q

What are mongolian blue spots

A

Blue/black macular discoloration at the base of the spine and on the buttocks.. occasionally on legs and other parts

Usually in Afro-caribbean or asian infants

Fade slowly over first year. Don’t misdiagnose for a bruise

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16
Q

What are capillary haemangiomas?

A

Pink macules on the upper eyelids, mid-forehead and nape of the neck

Those on the neck become covered in hair.
Those on the eyelids fade within a year.

Sometimes called strawberry birthmarks

17
Q

What is physiological jaundice?

A

Most babies will become mildly or moderately jaundiced between day 2- 2 weeks of age.
Normally has no underlying cause, it is a physiological adaptation to transitioning from fetus (rise in bilirubin).

All other causes must be considered.

18
Q

Commonest causes of feeding problems

A

Cleft lip/palate
Prematurity (unable to suck/swallow)

Poor technique leading to poor attachment

GORD

19
Q

Which symptoms/signs suggest feeding difficulties?

A
Prolonged mealtimes
Food refusal for <1 month
Disruptive and stressful mealtimes
Lack of appropriate independent feeding
Nocturnal eating in toddler
Distraction to increase intake
Prolonged breast or bottle-feeding
Failure to advance textures
20
Q

Organic red flags in feeding difficulties

A
Dysphagia
Aspiration
Apparent pain with feeding
Vomiting + Diarrhoea
Developmental delay
Chronic cardio-respiratory symptoms
FTT
21
Q

Behavioral red flags in feeding difficulties

A

Food fixation (selective, extreme dietary limitations)
Noxious (forceful and or persecutory) feeding
Abrupt cessation of feeding after a trigger event
Anticipatory gagging
FTT

22
Q

importance of low birthweight

A

7% of babies are low birthweight (<2.5kg), but account for 70% of neonatal deaths

23
Q

What is SGA

A

Below 10th centile for gestational age

Majority normal, but small

Incidence of congenital abnormalities and neonatal problems is higher if birthweight <2nd centile

24
Q

What is caput succedaneum

A

Bruising and oedema of the presenting part extending beyond the margins of the skull bones

Resolves within few days

25
Q

What is cephalhaematoma

A

From bleeding below the periosteum, confined within the margins of the skull sutures

usually invovles the parietal bone

Centre of haematome feels soft

Resolves over several weeks

26
Q

What is chignon? similar injuries?

A

Oedema and bruising from Ventouse delivery

other instrumental/birth soft tissue injuries:
Bruising to face after face presentation

Abrasion to skin from scalp electrodes applied during labour
or accidental scalpel incision at C-section

forceps can mark face from pressure of blades (transient)

27
Q

What is a subaponeurotic haemorrhage?

A

Very uncommon
Diffuse, boggy swelling of scalp on examination, blood loss may be severe.

Lead to hypovolaemic shock and coagulopathy.

28
Q

Risk factors for congenital brachial nerve palsy

A

Breech delivery

Shoulder dystocia

29
Q

Consequences of an upper nerve root pasy

A

(C5/C6 injury)

Erb palsy with possible phrenic nerve palsy causing an elevated diaphragm

30
Q

Management of congenital palsies

A

Most resolve completely

Refer to an orphopaedic or plastic surgeon if not resolved by 3 months.. most recover by 2 years

31
Q

Facial nerve palsy in newborn

A

Can be from compression of the facial nerve against the mother’s ischial spine.. Facial weakness on crying with an open eye.

Usually transient. Methylcellulose drops for the eye may be needed

32
Q

Fractures in newborns

A

Clavicle from shoulder dystocia (eg. hear a snap at delivery or reduced arm movement on affected side)
-several days lated, there may be a lump or clavicle

Prognosis is excellent, no treatment required

HUMERUS/FEMUR - usually mid-shaft. At breech deliveries. Deformity, reduced movement of limb and pain on movement.
Heals rapidly with immobilisation

33
Q

Sticky eyes are common in neonates. how does it present + management

A

Starting from 3rd or 4th day.
Yellow discharge from the corner of the eye and formation of a crust.
Sometimes due to blockage of tear duct (narrow) by debris and fluid.
Struggle to produce tears in first few months so clearage is hard

Simple cleaning measures: frequently bathed with sterile water to help it clear

34
Q

Which pathogens can cause sticky eye in a newborn

A

S. aureus
P. aeruginosa
Streptococcus