Newborn Flashcards
Define a ‘term’baby
After 37 weeks completed gestation
What is normal weight for a term infant?
2.5 - 4kg
How much weight is put on each day by the baby during the third trimester?
24g
In addition to weight gain what happens in the 3rd trimester?
Transplacental transfer of;
- iron
- vitamins
- calcium
- phosphate
- antibiotics
What four route tasks are carried out on a newborn?
Vitamin K Maternal Infection History Snuggle bundle Maternal vaccination Screening tests
Why are newborn babies given vitamin K?
To prevent haemorrhage disease of the newborn - clotting disorder which results in spontaneous bleeding - GI, CNS, lungs
How is Vit K administered?
Intramuscularly or orally - also present in formula milk
What are the key infections to find out about in maternal history?
Hep B Hep C HIV Syphilis TB Group B Strep
What should be done if the baby is at risk of hep B?
Very high risk - mother has active disease - immunoglobulin
High risk - baby given immunisation in hospital
Low risk - wait until normal immunisation given
What should be done if the mother has HIV/HCV?
RNA/viral load tested, two negatives mean the load is undetectable and the baby is at very low risk
If a baby is at risk of TB what should they be given?
BCG
What can cause sepsis in babies?
Group B strep from maternal carriage
Describe a snuggle bundle
Paper booklet helps mums and dads to care for their babies and educates them on when to get help with common risk factors
What two vaccinations are given to pregnant women?
Pertussis (whooping cough)
Influenza
What screening tests are done on new born babies?
head to toe examination
hearing screening
hip screening
new born screening card
What is tested for on a newborn screening card?
Cystic fibrosis, congenital hypothyroidism, haemoglobinopathies (sickle cell anaemia), metabolic diseases
What should you look for on the head of a newborn?
Overlapping sutures Fontanelles Ventouse/forceps marks Mousing Cephalhaematoma Caput succedaneum Measure circumference
What is cephalhaematoma?
Brusing/bleeding between the periosteum and epicranial aponeurosis - suture line is not crossed
What is caput succedaneum?
Soft tissue swelling - reduces in 12 hours
What do you look for in the eyes of a newborn?
Size, distance apart, red reflex, conjunctival haemorrhage, squints, iris abnormality
What is lack of red reflex a sign of?
Congenital cataract - serious risk of loss of vision
What do you look for when examining the ears of a newborn?
Position, external auditory canal, tags/pits, folding, family history
What do you look for in the mouth of a neonate?
Shape, philitrum, tongue tie, palate, neonatal teeth (need removed by dentist), sucking reflex, ebsteins pearls
What is the purpose of looking at the philitrum?
Bit between upper lip and nose if its large and smooth it is a sign of foetal alcohol syndrome
What are ebsteins pearls?
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
What side of the face is affected by a fascial palsy?
The side that looks normal - cannot move
How is the newborns heart checked?
Pulses (femoral pulse) Apex beat Heaves/thrills Heart sounds Colour (saturation if CHD screening)
How are the newborns lungs checked?
Chest shape Nasal flaring Grunting Tachypnoea In-drawing Breath sounds
What do you feel/look for in the abdomen of a newborn?
Movement with respiration, distention, hernia, umbilicus, bile strained vomit, passage of meconium, anus (fissure)
Describe the genitourinary examination of the newborn
Passage of urine, normal genitalia, undescended testes, hypospadius
What is hypospadius?
Urethra is on the underside of the penis
Describe the MSK examination of the newborn
Movement, posture, tone, spine, limbs, digits
Hips - barlow and ortolani
Name four primitive reflexes
Suck
Rooting
Moro
ATNR (turn baby and it will stick its opposite arm out)
Name the common skin condition >50% of babies get after birth
Erythema toxicum
What is looked for on a newborns skin?
Birth marks, ‘port wine stain’ - abnormality of blood vessels, mongolian blue spot (common in darker skin)
How is central access achieved in neonates?
Umbilical route
What is the neonate period?
Birth to 28 days
What score is used to assess the health of neonates?
Apgar
Describe the Apgar score
Appearance Pulse Grimace Activity Respiration
State the normal neonatal heart rate
120-140/160
State the normal neonatal temperature
36.5-37.4
State the normal neonatal heart rate
40-60
What should neonatal oxygen sats be?
> 95%
What should neonatal cap refill be?
2-3 seconds
What is the effect on the lungs if a baby gets cold?
Surfactant doesn’t work
Name the three conditions in a neonate that are all linked
- hypothermia
- hypoxia
- hypoglycaemia
What should be done in babies with neurological ischaemia?
Therapeutic cooling, stops cerebral palsy in 1 baby in 8
What types of infection are associated with each of the ‘natal’ phases?
Antenatal - bacterial
Perinatal - viral
Postnatal - fungal
What is the risk factor for perinatal infections?
Ruptured membranes
Name the common sites of infection in neonates
Blood stream
CNS - meningitis
Respiratory - pneumonia
GU - UTI
Name the organisms which often cause bacterial infections
Group B Strep
E.coli
Listeria myocyotgenes
Staph aureus/epidermidis
What are the common viral infections that present in neonates?
Cytomegalovirus Parvovirus Herpes Enteroviruses HIV/Syphilis
What is given to babies with herpes virus?
Aciclovir
Describe hypoxic ischaemic encephalopathy
Perinatal asphyxia leads to multi organ damage, baby will have poor apgar score and active resuscitation is required
Where is hypoxic ischaemia encephalopathy more common?
Developing countries - less advanced resuscitation equipment
Name four respiratory diseases that can present in term infants
Transient tachypnoea - fluid in the lungs
Pneumothorax (spontaneous or due to resus)
Respiratory distress syndrome
Pneumonia
What cardiovascular disease can present in term infants?
Heart failure - hydrops
Persistent pulmonary hypertension of the newborn - Failure to adapt
What is hydrops fetalis?
Accumulation of fluid leads to oedema
What causes hydrops fetalis?
anaemia, chromosomal defect, idiopathic, rhesus disease
Name five congenital cardiac diseases
Tetralogy of fallot Transposition of the great arteries Coarctation of the aorta Total anomylous Pulmonary Venous Drainage Hypo plastic heart
Name two congenital respiratory diseases how will they present?
Tracheo-oesphageal fistula
Diaphragmatic hernia
Pulmonary hypertension and RDS
State two neurological congenital disorders
Microcephaly
Spina bifida
Describe one renal congenital syndrome
Potters - renal agenesis - no urnine/amniotic fluid leads to lung problems - pulmonary hypoplasia
Define preterm
Birth occurs before 37 completed weeks of gestation
Define term
Birth occurs between 37 and 42 weeks of completed gestation
Define post term
Birth occurs after 42 completed weeks of gestation
What is the difference between extreme and very preterm?
extreme - <27 weeks
very - <32 weeks
What are the risk factors for a preterm infant?
- 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
What causes hypothermia in preterm infants?
Low admission temperature (ambulance), low BMR, stressful birth, minimal muscular activity, no subcutaneous fat, large surface area: body mass
Why do preterm babies have increased risk of nutritional compromise?
Limited nutrient reserves, gut immaturity, immature metabolic pathways, increased nutrient demands
How are preterm babies fed?
Breast milk, donor breast milk (prescription only), total parental nutrition may be required, formula
What is the difference between early and late onset neonatal sepsis?
Early - bacteria acquired before/during delivery
Late - bacteria acquired after delivery (nosocomial/community sources)
Which organisms often cause EOS?
Group B strep, gram negatives (e.coli)
Which organisms often cause LOS?
Coagulase -ve staph, gram negatives, staph aureus
Why are preterm babies at increased risk of neonatal sepsis?
Immature immune system, intensive care environment - tubes and lines
How is neonatal sepsis managed?
Prevention, hand washing, vigilant infection screening, supportive measures, judicious use of antibiotics
What antibiotics are used in neonatal sepsis?
Benzylpenicillin and gentamicin until cultures obtained
What is respiratory distress syndrome?
Lack of surfactant causes immature lung due to hyaline membrane disease
How can RDS arise?
Primary - surfactant deficiency/structural immaturity
Secondary - intubation/ventilation can cause damage meaning the baby cannot clear secretions
What are the clinical features of RDS?
Tachypnoea (grunting, nasal flaring, cyanosis)
Respiratory distress
How is RDS managed?
Maternal steroids
Surfactant
Ventilation
Describe patent ductus arteriosus
No mechanism to close if baby is born preterm leads to a higher burden on the heart and inadequate oxygenation
How does a intraventricular haemorrhage arise?
Blood vessels in a preterm baby are fragile and break easily leading to bleeding in the brain which can cause nerve damage
How is an intraventricular haemorrhage diagnosed?
Anterior fontanelle ultrasound
Describe the different types of intraventricular haemorrhage
Grade 1 and 2 - neurodevelopmental delay up to 20%, mortality 10%
Grade 3 and 4 - neurodevelopmental delay up to 80%, mortality 50%
What can prevent intraventricular haemorrhage?
Anti-natal steroids
What is a serious gut pathology that can occur in preterm infants?
Necrotising Enterocolitis
Describe Necrotising Enterocolitis
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
What may happen in Necrotising Enterocolitis ?
Gut may rupture and require surgery
