Neonatology…..part 2 Flashcards
Scalp layers
S- skin A-aponeurosis = glea L-loos ct =subglea P-periosteum S-sull bone
Caput succedaneum
- serosanguinus fluid
- SC tissue
- cross suture + shift with postining
- soft spongy- pitting edama **
- resolve 48-72 hrs
Cephalohematoma
-blood bt bone and priosteium
- stops at sutre lines
-occipital and prital may bilateral
Firm initially: 48 more fluctuate
Resolve by 2w-3m
Subgleal hge
-subgleal spase can hold up to 240 ml of blood
-rupture of emissary veins
-cross sutures
- may extend from eys to nap of neck
-firm-fluctuations boggy - dependant swiiling
Sever anemia + hypovolemic shock
2w-3w
-high morbidity
** assessment hourly+CBC
-vital , perfusion
-scalp
Chang in loc
Noenatal Respiratory distress syndrome RDS
Increase risk 1. Male sex 2. Maternal diabetes 3. Perinatal asphyxia 4. Hypothermia 5. C/S delivery 6. Multiple pregnancy
Decrease risk 1. Chronic intrauterine stress 2. PROM = prolonged rupre of mm 3. IUGR/SGA = intrautrine growth retardation \ small for gesttional age 4. Antenatal glucocorticoid 5. Maternal HTN, toxemia 6. Tocolytic agent
كل ما نقص وزنه او كلما كان preterm - زاد الرسك
RDS signs
Progressive signs of respiratory distress within 4 hours of birth:
Tachypnea Grunting Subcostal / Intercostal recession Nasal Flaring Cyanosis
Radio • diffuse reticular
granular • air bronchograms • ground-glass
appearances
Prevention of RDS
— management
Prevention:
Tocolytics to inhibit premature labor.
Antenatal corticosteroid therapy:
►
They induce surfactant production and accelerate fetal lung maturation.
►
indicated in pregnant women 24-34 weeks’ gestation at high risk of preterm delivery within the next 7 days. ►
Optimal benefit begins 24 hrs after initiation of therapy and lasts seven days.
Dexa or betamethasone
—— Early CPAP administration in the delivery room.
Any neonates require assisted ventilation with (FiO2)
of >0.40 should receive intratracheal surfactant as
soon as possible, preferably within 2 hours after
birth.
• maintain a pH of 7.25-7.35 • PaO2 of 50-70 mm Hg • carbon dioxide pressure (PCO2) of 40-65 mm Hg.
Transient tachypnea of newborn TTN
Rf • Risk factors – cesarean section, IDM,
maternal asthma
## Usually present at birth • Improves over first 12 – 24 hours • Alone should not necessitate ventilation
MAS
Meconium is composed of : • Epithelial cells, fetal hair, mucus, bile.
• It is a sterile compound made up
primarily of water (75 %), with mucous
glycoproteins, lipids and proteases.
MAS patho
Airway obstruction. chemical pneumonitis. Surfactant dysfunction.
MAS x-ray
Hyperinflated lung Flattened diaphragm Coarse irregular patch infiltration PAL
Pneumothorax
Pneumomediastinum 25%
MAS management
Ventilation strategies
Avoid air leak, check CXR with acute
deterioration Prevent pulmonary hypertension -
generous O2
• Antibiotics (ampicillin, gentamicin) • Surfactant ????? • Inhaled Nitric Oxide
Neonatal pneumonia
Common organisms:
•GBS
•gram–ve organisms (e.g. E.Coli , Klebsiella,Pseudomonas). •Staph. aureus, Staph. Epidermidis •Candida. •acquired viral infections (e.g., HSV, CMV).
Management
• I n i t i a t e ampicillin and gentamicin
IV; modify according to culture
results and continue therapy for 14
days. • I f there is a fungal infection, an
antifungal agent is used.
Air Leak Syndromes
-RF
RF : • MV,MAS, surfactant therapy without
decreasing pressure support in ventilated
infants
vigorous resuscitation, • Prematurity • Pneumonia
pneumothorax Pneumomediastinum
It can occur with aggressive ETT insertion, Ryle’s feeding tube
insertion, lung disease, MV, or chest surgery (e.g., TEF). Pneumopericardium Pneumoperitoneum Subcutaneous emphysema
@@ needle aspiration btw 4th and 5th rib
Tension pneumothorax
a life-threatening condition→ Decrease cardiac output and obstructive shock. urgent drainage prior to a radiograph is mandatory.
Needle aspiration in air leak syndrome #pneumothorax
@lat apporch
Bet ant axillary and mid Bet 4th and 5th ribs #saver
Ant approach #injry of vs
2nd ICS mid clavicle line
Diaphragmatic hernia
Herniation of abdominal viscera into the thorax • Result from failure of the pleuroperitoneal canal to close
at ~ 8th wk of gestation or early return of midgut to the
peritoneal cavity • Most challenging and frustrating of all neonatal surgical
emergencies
• Presentation
– most commonly in left side. – Sever respiratory distress. – Cyanosis. – Sunken abdomen. – Bowel sound may be heard in the chest.
Scaphoid abdomen
Diaphragmatic hernia management
Diaphragmatic hernia IMMEDIATE Intubation \+ Stomach Decompression by NGT Avoid bag/mask ventilation. • Can fill up the bowel in the chest with air • Impairs ventilation. • Pushes heart over.
IDM
The Infant of a Diabetic Mother Is infant born to a mother with diabetes or gestational diabetes.
severity of the problem depend on the severity of maternal diabetes.
Perinatal and Neonatal Complications of IDM
- Disorders of fetal growth • Intrauterine and perinatal asphyxia • Hypoglycemia • Respiratory distress syndrome
- Hypertrophic Cardiomyopathy • Polycythemia • Hyperbilirubinemia • Hypocalcemia
Neonatal hyperinsulinemia results in neonatal
hypoglycemia
Macrosomia
Macrosomia
• Birth Weight > 4000 g or > 90 th %-ile • Incidence 15 to 45% among IDM • Increased rate of C-section • Birth Trauma
shoulder and body dystocia
brachial plexus injury
facial nerve injury
clavicular or humeral fractures asphyxia abdominal trauma
Signs of Hypoglycemia of IDM
Signs of Hypoglycemia
• Tremors • Jitteriness • Irritability • Lethargy • Apnea
• Cyanosis • Hypothermia • Weak or high
pitched cry • Poor feeding • Seizures
Small for Gestational Age
weights below the 10 percentile for their gestational age
IUGR: is a term used by OB to describe a pattern of growth over a period of time.
IUGR
Rf
Symmetricl - the baby's head and body are proportionately small. may occur when the foetus experiences a problem during early development. ####
• Multiple pregnancy. • High altitude. • Drugs like anticoagulants, anticonvulsants. • cardio-vascular disease-preeclampsia,
hypertension, cyanotic heart disease, cardiac
disease , diabetic vascular lesions. • Chronic kidney disease • Nutritional.
baby’s brain is abnormally large when compared to the liver. may occur when the foetus experiences a problem during later development
Fetal Risk Factors • Congenital infection. • A birth defect – (cardiovascular, renal, anencephally, limb defect, etc). • A chromosome defect- – trisomy-18 (Edwards’ syndrome),21(Down’s syndrome), 16, 13, xo (turner’s syndrome. placental insufficiency.
IUGR complications
IUFD. • Birth asphyxia • Meconium aspiration • Neonatal hypoglycemia • Hypothermia • Abnormal neurological development
CRITERIA FOR PERINATAL ASPHYXIA
- Prolonged metabolic or mixed acidemia (pH < 7.00)
on an umbilical cord arterial blood sample 2. Persistence of an Apgar score of 0-3 for > 5 minutes 3. Clinical neurological manifestations e.g. seizure,
hypotonia, coma or hypoxic-ischaemic
encephalopathy in the immediate neonatal period 4. Evidence of multiorgan system dysfunction in the
immediate neonatal periods
Asphyxia management
MANAGEMENT
• Oxygenation & ventilation • Adequate perfusion • Normal glucose & calcium • Normal hematocrit • Treat seizure
Preterm labor
higher the number of fetuses in the pregnancy the greater the risk for prematurity.
Multiple pregnancy
CONGENITAL ANOMALIES
Increase four times in monochorionic type.
Tracheoesophageal Fistula
Etiology: failure in mesenchymal separation of upper foregut
Clinical Presentation
choking on 1st feed coughing cyanosis excessive salivation aspiration pneumonia
VACTERL
VATER and VACTERL
V vertebral anomalies or VSD A anorectal malformation C cardiac anomalies (common) T TEF= Tracheoesophageal Fistula
E esophageal atresia R renal abnormalities L
limb/radial malformation
• Diarrhea • Acute diarrhea • Persistent diarrhea • Dysentery • Chronic diarrhea
Diarrhea
• Ty p i c a l l y, p e r s i s t e n t loose or watery stools occurring at least three times a
day (consistency is more important than frequency or volume). • Infants and toddlers: > 10 g/kg/day and in older children: > 200 g/day. • Note: From birth to 4th month Breast fed: 1-7 motions I day is normal.
• Acute diarrhea
• Start acutely, less than 14 days. • Pe r s is t e n t d ia rr h e a
• Started as acute diarrhea (watery or dysentery) but persist more than 14
days. • Dysentery
• Is an acute diarrhea with visible blood in stool. • Chronic diarrhea
• Diarrhea of gradual onset, lasting for more than 14 days or recurrent due to
non infectious cause.
PAT H O P H YS I O L O G Y
• Osmotic • Secretory • Motility disorder • Decreased surface area
• Osmotic:
• Due to presence of non-absorbable solutes in GIT that lead to osmotic load
then shift of water to intestinal lumen.
• Secretory:
• Damaged absorptive villi cells that lead to excessive secretions & diminished
absorption • Entero toxins release that lead to excessive intestinal secretions.
• Motility disorder
• hypermotility that cause decrease transit time.
• hypomotility that lead to stasis and bacterial overgrowth.
• Decreased surface area act like motility disorder and osmotic.
