Neonatology - normal newborn Flashcards
Pressure changes after the first breath of a baby
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.
When does the ductus arteriosus close?
Normally within the first few hours or days
If there is a duct-dependent lesion, the baby will deteriorate within days
Respiratory changes from fetus to neonate
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
By when should the neonate open its bowels
Usually first 6 hours
Up to 24hrs
By when should the neonate urinate
First 24 hours
By when should the neonate regain its birth weight
Newborns lose around 7-10% of their weight
Should regain in ca. 2 weeks
What are the effects of Vit K deficiency in a neonate
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)
What is the content of Vit K in breast milk?
Poor source of Vit K (wholly breastfed children may develop haemorrhagic disease of the newborn)
Infant formula has much higher content.
Risk factors for haemorrhagic disease of the newborn
Wholly breastfed
Mother on anti-convulsants (impair synthesis of Vit K clotting factors)
Infant with liver disease
Prophylaxis for haemorrhagic disease of the newborn (normal mothers vs mothers on anticonvulsants)
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
Outline the hearing screening in the UK
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
What is the Guthrie test
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
What is ultrasound used for antenatally
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
What is erythema toxicum
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
What are mongolian blue spots
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
What are capillary haemangiomas?
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
What is physiological jaundice?
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.
Commonest causes of feeding problems
Cleft lip/palate
Prematurity (unable to suck/swallow)
Poor technique leading to poor attachment
GORD
Which symptoms/signs suggest feeding difficulties?
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
Organic red flags in feeding difficulties
Dysphagia Aspiration Apparent pain with feeding Vomiting + Diarrhoea Developmental delay Chronic cardio-respiratory symptoms FTT
Behavioral red flags in feeding difficulties
Food fixation (selective, extreme dietary limitations)
Noxious (forceful and or persecutory) feeding
Abrupt cessation of feeding after a trigger event
Anticipatory gagging
FTT
importance of low birthweight
7% of babies are low birthweight (<2.5kg), but account for 70% of neonatal deaths
What is SGA
Below 10th centile for gestational age
Majority normal, but small
Incidence of congenital abnormalities and neonatal problems is higher if birthweight <2nd centile
What is caput succedaneum
Bruising and oedema of the presenting part extending beyond the margins of the skull bones
Resolves within few days
What is cephalhaematoma
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
What is chignon? similar injuries?
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)
What is a subaponeurotic haemorrhage?
Very uncommon
Diffuse, boggy swelling of scalp on examination, blood loss may be severe.
Lead to hypovolaemic shock and coagulopathy.
Risk factors for congenital brachial nerve palsy
Breech delivery
Shoulder dystocia
Consequences of an upper nerve root pasy
(C5/C6 injury)
Erb palsy with possible phrenic nerve palsy causing an elevated diaphragm
Management of congenital palsies
Most resolve completely
Refer to an orphopaedic or plastic surgeon if not resolved by 3 months.. most recover by 2 years
Facial nerve palsy in newborn
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
Fractures in newborns
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
Sticky eyes are common in neonates. how does it present + management
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
Which pathogens can cause sticky eye in a newborn
S. aureus
P. aeruginosa
Streptococcus
