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Child Health > Newborn > Flashcards

Newborn Flashcards

1
Q

Define a ‘term’baby

A

After 37 weeks completed gestation

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2
Q

What is normal weight for a term infant?

A

2.5 - 4kg

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3
Q

How much weight is put on each day by the baby during the third trimester?

A

24g

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4
Q

In addition to weight gain what happens in the 3rd trimester?

A

Transplacental transfer of;

  • iron
  • vitamins
  • calcium
  • phosphate
  • antibiotics
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5
Q

What four route tasks are carried out on a newborn?

A 
Vitamin K 
Maternal Infection History 
Snuggle bundle 
Maternal vaccination 
Screening tests
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6
Q

Why are newborn babies given vitamin K?

A

To prevent haemorrhage disease of the newborn - clotting disorder which results in spontaneous bleeding - GI, CNS, lungs

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7
Q

How is Vit K administered?

A

Intramuscularly or orally - also present in formula milk

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8
Q

What are the key infections to find out about in maternal history?

A 
Hep B 
Hep C
HIV
Syphilis 
TB 
Group B Strep
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9
Q

What should be done if the baby is at risk of hep B?

A

Very high risk - mother has active disease - immunoglobulin
High risk - baby given immunisation in hospital
Low risk - wait until normal immunisation given

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10
Q

What should be done if the mother has HIV/HCV?

A

RNA/viral load tested, two negatives mean the load is undetectable and the baby is at very low risk

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11
Q

If a baby is at risk of TB what should they be given?

A

BCG

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12
Q

What can cause sepsis in babies?

A

Group B strep from maternal carriage

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13
Q

Describe a snuggle bundle

A

Paper booklet helps mums and dads to care for their babies and educates them on when to get help with common risk factors

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14
Q

What two vaccinations are given to pregnant women?

A

Pertussis (whooping cough)

Influenza

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15
Q

What screening tests are done on new born babies?

A

head to toe examination
hearing screening
hip screening
new born screening card

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16
Q

What is tested for on a newborn screening card?

A

Cystic fibrosis, congenital hypothyroidism, haemoglobinopathies (sickle cell anaemia), metabolic diseases

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17
Q

What should you look for on the head of a newborn?

A 
Overlapping sutures
Fontanelles 
Ventouse/forceps marks 
Mousing 
Cephalhaematoma 
Caput succedaneum 
Measure circumference
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18
Q

What is cephalhaematoma?

A

Brusing/bleeding between the periosteum and epicranial aponeurosis - suture line is not crossed

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19
Q

What is caput succedaneum?

A

Soft tissue swelling - reduces in 12 hours

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20
Q

What do you look for in the eyes of a newborn?

A

Size, distance apart, red reflex, conjunctival haemorrhage, squints, iris abnormality

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21
Q

What is lack of red reflex a sign of?

A

Congenital cataract - serious risk of loss of vision

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22
Q

What do you look for when examining the ears of a newborn?

A

Position, external auditory canal, tags/pits, folding, family history

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23
Q

What do you look for in the mouth of a neonate?

A

Shape, philitrum, tongue tie, palate, neonatal teeth (need removed by dentist), sucking reflex, ebsteins pearls

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24
Q

What is the purpose of looking at the philitrum?

A

Bit between upper lip and nose if its large and smooth it is a sign of foetal alcohol syndrome

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25
Q

What are ebsteins pearls?

A

Small white cysts (made up of skin cells) found on top of the babies mouth, gums and can be on the tip of the penis

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26
Q

What side of the face is affected by a fascial palsy?

A

The side that looks normal - cannot move

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27
Q

How is the newborns heart checked?

A 
Pulses (femoral pulse)
Apex beat 
Heaves/thrills
Heart sounds 
Colour (saturation if CHD screening)
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28
Q

How are the newborns lungs checked?

A 
Chest shape
Nasal flaring 
Grunting 
Tachypnoea 
In-drawing 
Breath sounds
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29
Q

What do you feel/look for in the abdomen of a newborn?

A

Movement with respiration, distention, hernia, umbilicus, bile strained vomit, passage of meconium, anus (fissure)

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30
Q

Describe the genitourinary examination of the newborn

A

Passage of urine, normal genitalia, undescended testes, hypospadius

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31
Q

What is hypospadius?

A

Urethra is on the underside of the penis

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32
Q

Describe the MSK examination of the newborn

A

Movement, posture, tone, spine, limbs, digits

Hips - barlow and ortolani

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33
Q

Name four primitive reflexes

A

Suck
Rooting
Moro
ATNR (turn baby and it will stick its opposite arm out)

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34
Q

Name the common skin condition >50% of babies get after birth

A

Erythema toxicum

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35
Q

What is looked for on a newborns skin?

A

Birth marks, ‘port wine stain’ - abnormality of blood vessels, mongolian blue spot (common in darker skin)

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36
Q

How is central access achieved in neonates?

A

Umbilical route

37
Q

What is the neonate period?

A

Birth to 28 days

38
Q

What score is used to assess the health of neonates?

A

Apgar

39
Q

Describe the Apgar score

A 
Appearance 
Pulse 
Grimace 
Activity 
Respiration
40
Q

State the normal neonatal heart rate

A

120-140/160

41
Q

State the normal neonatal temperature

A

36.5-37.4

42
Q

State the normal neonatal heart rate

A

40-60

43
Q

What should neonatal oxygen sats be?

A

> 95%

44
Q

What should neonatal cap refill be?

A

2-3 seconds

45
Q

What is the effect on the lungs if a baby gets cold?

A

Surfactant doesn’t work

46
Q

Name the three conditions in a neonate that are all linked

A
  • hypothermia
  • hypoxia
  • hypoglycaemia
47
Q

What should be done in babies with neurological ischaemia?

A

Therapeutic cooling, stops cerebral palsy in 1 baby in 8

48
Q

What types of infection are associated with each of the ‘natal’ phases?

A

Antenatal - bacterial
Perinatal - viral
Postnatal - fungal

49
Q

What is the risk factor for perinatal infections?

A

Ruptured membranes

50
Q

Name the common sites of infection in neonates

A

Blood stream
CNS - meningitis
Respiratory - pneumonia
GU - UTI

51
Q

Name the organisms which often cause bacterial infections

A

Group B Strep
E.coli
Listeria myocyotgenes
Staph aureus/epidermidis

52
Q

What are the common viral infections that present in neonates?

A 
Cytomegalovirus 
Parvovirus 
Herpes 
Enteroviruses 
HIV/Syphilis
53
Q

What is given to babies with herpes virus?

A

Aciclovir

54
Q

Describe hypoxic ischaemic encephalopathy

A

Perinatal asphyxia leads to multi organ damage, baby will have poor apgar score and active resuscitation is required

55
Q

Where is hypoxic ischaemia encephalopathy more common?

A

Developing countries - less advanced resuscitation equipment

56
Q

Name four respiratory diseases that can present in term infants

A

Transient tachypnoea - fluid in the lungs
Pneumothorax (spontaneous or due to resus)
Respiratory distress syndrome
Pneumonia

57
Q

What cardiovascular disease can present in term infants?

A

Heart failure - hydrops

Persistent pulmonary hypertension of the newborn - Failure to adapt

58
Q

What is hydrops fetalis?

A

Accumulation of fluid leads to oedema

59
Q

What causes hydrops fetalis?

A

anaemia, chromosomal defect, idiopathic, rhesus disease

60
Q

Name five congenital cardiac diseases

A 
Tetralogy of fallot 
Transposition of the great arteries 
Coarctation of the aorta 
Total anomylous Pulmonary Venous Drainage 
Hypo plastic heart
61
Q

Name two congenital respiratory diseases how will they present?

A

Tracheo-oesphageal fistula
Diaphragmatic hernia
Pulmonary hypertension and RDS

62
Q

State two neurological congenital disorders

A

Microcephaly

Spina bifida

63
Q

Describe one renal congenital syndrome

A

Potters - renal agenesis - no urnine/amniotic fluid leads to lung problems - pulmonary hypoplasia

64
Q

Define preterm

A

Birth occurs before 37 completed weeks of gestation

65
Q

Define term

A

Birth occurs between 37 and 42 weeks of completed gestation

66
Q

Define post term

A

Birth occurs after 42 completed weeks of gestation

67
Q

What is the difference between extreme and very preterm?

A

extreme - <27 weeks

very - <32 weeks

68
Q

What are the risk factors for a preterm infant?

A
  • complications in pregnancy
  • twins
  • maternal age
  • smoking/drinking/drugs
  • ethnicity
  • IVF
  • poor nutrition/miscarriages/abortions
  • <6 months between pregnancies
  • abnormally shaped uterus
  • > 2 preterm deliveries increases risk of another
69
Q

What causes hypothermia in preterm infants?

A

Low admission temperature (ambulance), low BMR, stressful birth, minimal muscular activity, no subcutaneous fat, large surface area: body mass

70
Q

Why do preterm babies have increased risk of nutritional compromise?

A

Limited nutrient reserves, gut immaturity, immature metabolic pathways, increased nutrient demands

71
Q

How are preterm babies fed?

A

Breast milk, donor breast milk (prescription only), total parental nutrition may be required, formula

72
Q

What is the difference between early and late onset neonatal sepsis?

A

Early - bacteria acquired before/during delivery

Late - bacteria acquired after delivery (nosocomial/community sources)

73
Q

Which organisms often cause EOS?

A

Group B strep, gram negatives (e.coli)

74
Q

Which organisms often cause LOS?

A

Coagulase -ve staph, gram negatives, staph aureus

75
Q

Why are preterm babies at increased risk of neonatal sepsis?

A

Immature immune system, intensive care environment - tubes and lines

76
Q

How is neonatal sepsis managed?

A

Prevention, hand washing, vigilant infection screening, supportive measures, judicious use of antibiotics

77
Q

What antibiotics are used in neonatal sepsis?

A

Benzylpenicillin and gentamicin until cultures obtained

78
Q

What is respiratory distress syndrome?

A

Lack of surfactant causes immature lung due to hyaline membrane disease

79
Q

How can RDS arise?

A

Primary - surfactant deficiency/structural immaturity

Secondary - intubation/ventilation can cause damage meaning the baby cannot clear secretions

80
Q

What are the clinical features of RDS?

A

Tachypnoea (grunting, nasal flaring, cyanosis)

Respiratory distress

81
Q

How is RDS managed?

A

Maternal steroids
Surfactant
Ventilation

82
Q

Describe patent ductus arteriosus

A

No mechanism to close if baby is born preterm leads to a higher burden on the heart and inadequate oxygenation

83
Q

How does a intraventricular haemorrhage arise?

A

Blood vessels in a preterm baby are fragile and break easily leading to bleeding in the brain which can cause nerve damage

84
Q

How is an intraventricular haemorrhage diagnosed?

A

Anterior fontanelle ultrasound

85
Q

Describe the different types of intraventricular haemorrhage

A

Grade 1 and 2 - neurodevelopmental delay up to 20%, mortality 10%
Grade 3 and 4 - neurodevelopmental delay up to 80%, mortality 50%

86
Q

What can prevent intraventricular haemorrhage?

A

Anti-natal steroids

87
Q

What is a serious gut pathology that can occur in preterm infants?

A

Necrotising Enterocolitis

88
Q

Describe Necrotising Enterocolitis

A

Immature gut meconium is only passed after birth - in extreme preterm babies the gut cannot handle the milk so the bacteria translocated across the lumen into the blood leading to a sepsis like picture

89
Q

What may happen in Necrotising Enterocolitis ?

A

Gut may rupture and require surgery

Child Health (12 decks)

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