Neonatology: Term Birth; NIPE Flashcards
Which substances can cause NAS? [+]
Opiates
Methadone
Benzodiazepines
Cocaine
Amphetamines
Nicotine or cannabis
Alcohol
SSRI antidepressants
Describe the CNS [6], vasomotor and respiratory [4] and metabolic / GI [4] symptoms of NAS
CNS:
* Irritability
* Increased tone
* High pitched cry
* Not settling
* Tremors
* Seizures
Vasomotor and respiratory:
* Yawning
* Sweating
* Unstable temperature and pyrexia
* Tachypnoea (fast breathing)
Metabolic and gastrointestinal
* Poor feeding
* Regurgitation or vomiting
* Hypoglycaemia
* Loose stools with a sore nappy area
Describe how you manage NAS
- Monitoring [2]
- Medical management [2]
Monitoring:
- Babies are kept in hospital with monitoring on a NAS chart for at least 3 days (48 hours for SSRI antidepressants) to monitor for withdrawal symptoms.
- A urine sample can be collected from the neonate to test for substances
Medical treatment options for moderate to severe symptoms are:
* Oral morphine sulphate for opiate withdrawal
* Oral phenobarbitone for non-opiate withdrawal
Fetal alcohol syndrome refers to certain effects and characteristics that are found in children of mothers that consumed significant alcohol during pregnancy
What are they? [+]
- Microcephaly (small head)
- Thin upper lip
- Smooth flat philtrum (the groove between the nose and upper lip)
- Short palpebral fissure (short horizontal distance from one side of the eye and the other)
- Cardiac malformations
- Learning disability
- Behavioural difficulties
- Hearing and vision problems
- Cerebral palsy
What is the most common cause of neonatal jaundice?
Rhesus disease
ABO incompatbility
Physiological
Sepsis
What is the most common cause of neonatal jaundice?
Rhesus disease
ABO incompatbility
Physiological
Sepsis
How soon after birth should a baby pass their first meconium poo?
Before birth
Within 24 hrs
Within 48 hrs
Within 72 hrs
How soon after birth should a baby pass their first meconium poo?
Before birth
Within 24 hrs
Within 48 hrs
Within 72 hrs
How soon after birth should a baby pass their first urine?
Before birth
Within 24 hrs
Within 48 hrs
Within 72 hrs
How soon after birth should a baby pass their first urine?
Before birth
Within 24 hrs
Within 48 hrs
Within 72 hrs
What is acceptable weight loss for baby of first week of life? [1]
Why does this occur? [1]
10%
- Due to water loss
Explain if vaginal bleeding is normal in a new born [1]
vaginal bleeding is normal early on
- due to withdrawal from maternal hormones
Describe the transition of colour of meconium in normal child [1]
Black –> Green
A baby presents with breast buds - is this normal? [1]
Yes - due to maternal hormone exposure in-utero
How long / often is normal breastfeeding? [1]
Feeding for 20/30 mins every 3/4 hours
- Varies with each baby. Volumes will increase over first couple of days
What is normal observations in neonates:
- HR
- RR
- O2 Sats
- temp
- Behaviour scores
HR: 110-160
RR: 30-60
O2 sats: > 95%
Temp: 36.5-37.4
Behaviour scores: 0
What is Jitteriness? [1]
How do you differentiate between a seizure in a newborn and Jitteriness? [1]
Jitteriness: immaturity of muscle spindle fibres - trying to find resting state
Seizure: if you hold a limb, seizure will continue; Jitteriness: will not
A baby is born with polcythemia.
What other abnormality might they have and why? [1]
Hypoglycaemia - due to energy demands to of +rbc
Ceftriaxone is CI in newborns
- binds to albumin and bilirubin - so increase risk of jaundice
What may cause neonatal thyrotoxicosis? [1]
IgG / Stimulant thyroid antibodies (e.g. Graves) can pass into placenta and cause neonatal thyrotoxicosis [1]
Define hypoglycaemia in neonates [1]
What is target for higher risk infants? [1]
Most hypoglycaemia is < 2.0 mmol/L
Most target > 2.5 in higher risk babies
Which newborn screening tests are given to neonates? [3]
What do they test for [+]
NIPE:
* Within 72 hrs, then repeated by GP in 6 weeks
Hearing screening:
- Automated oto-acoustic emissions (basic screening for congenital deafness)
- High risk babies: automated auditory brainstem response
Heelprick test (day) 5:
- SCD
- CF
- Hypothyroidism
- 6 Metabolic diseases (including PKU)
Describe the examination steps of NIPE
Ask about FHx of eyes, heart and hips
Ask about feeding, pooing and weeing
General assessment:
- Colour
- Tone
Scalp:
- Feel for sutures and fontanelles for raised / decrease ICP
- Measure head circumference
- Any swellings or lacerations
Eyes:
- Assess for red reflex
Ears:
- Position?
- Skin tags?
Mouth:
- Assess for teeth, soft and hard palate (for clefts)
- Assess rooting and sucking reflex
Body:
- Feel for clavicles
- Palpate for masses or organomegaly
- Ascultate lung fields
Limbs:
- Resp. distress, tone
Heart
- Listen for murmurs
Pulses
- Feel femoral and brachial pulses
Genitals
- Look for urethral meatus
- Assess two testes
- Anus - clean meconium as can miss malformations
Hips:
- Form Ortalani and Bartoli tests
Reflexes:
- Assess for Moro reflex
- Assess for Babinksi reflex
Toes:
- Assess for talipes
Spine
- Assess shape
- Look for sacral pits / dimples
Assess pre and post ductal saturations
- difference should be within 3%
Describe Ortalini and Barlows tests
Barlow - can you dislocate hip?
Ortolani - can you relocate an already dislocated hip
