Newborn Lectrues Flashcards
Preterm birth def?
<37 weeks
Low birth weight defs
Low: <2500 g
Very Low: <1500 g
Extremely low: <1000 g
Why preterm neonates more prone to infection
Low IgG
Absent IgM/IgG
Absent adaptive immune system
Necrotising Enterocolitis sx
loss of apetite
distended tender abdomen
sepsis
Mx of necrostising enterocolitis
stop enteral feeds
give broadspectrum abx
Necrotising enterocolitis complications
high mortality
short gut syndrome
what rash is this?
Erythema toxicum
- central papule (yellow), erythamatous peripheral
- last days up to a week
- everywhere but palms and soles
- caused by esinophils
What rash is this?
Haemangioma (birth mark)
aka strawberry naevi
Endothelia tumour
What rash is this?
Blue spot
over sacrum, buttocks and lower limb
fades by 4 years
melanocyte infiltiration
What is this rash
Salmon patch
aka angel kiss
What is this rash
Portwine stain ( capillary malformation)
if in trigeminal could lead to intercranial arterial calcification
a- barlow
b- ortolani
- detects hop displacement
What is this?
Cephalhaematoma
subperipheral haemorrhage due to forceps in delivery
Resolves by 6th week
Increased jaundice
Vitmin K for newborns?
Breast milk doesnt have it
Could cause bleeding disorder
Mx of neonatal jaundice
If billirubin high use phototherapy (blue light breaks H bonds, making it polar, allowing its removal)
If very high, use exchange transfusion
Blood test for neonates screening?
Guthrie test
5-7th day by midwife
Phylketonuria, TSH, haemoglobulinopathies, CF
Signs of resp distress in neonates
Cyanosis
High RR
Subcostal recession
Expiratory grunting
Nasal flaring
Respiratory distress syndrome management
Surfactant therapy
or antinatal steroids
what is Transient tachypnoea (TTN)
term infants with mature lungs, delay in clearing the lung fluid
Risk factor for transient tachypnoea of newborn
Caesarean section
Mx of transient tachypnoea of newborn
nasal CPAP, o2, stop feeds
What is Meconium aspiration syndrome
Fetal hypoxia/distress -> meconium passed inside utero -> fetal aspiration
Consequences of Meconium aspiration syndrome
Airway obstruction
Chemical pneumonitis
Surfactant inactivation
How to diagnose an air leak in newborn
trans-illumination
What is laryngomalacia
soft immature larynx cartilage collapses
casues inspiratory stridors
Which immunoglobulin is passed through the placenta
IgG
What factors increase the affinity of Haemoglobin for O2 on Hb oxygen dissociation curve
Increased pH
Decreased temperature
Decreased 2,3 dihydroxybutanedioic DPG acid
How are maternal and fetal 2,3 DPG levels different?
30% higher in mother than fetus
Blood vessels within the placenta
Umbilical vein
2* Umbilical arteries
Origin of umbilical arteries
Iliac artery
3 vessels that change between fetus and newborn stages
Ductus arteriosus (Pulmonary-aorta)
Foramen Ovale (R-L atria)
Ductus venosus (umbilical v. - inferior vena cava)
After birth what happens to: Umbilical vein
Ligamentum teres (umbilicus to liver)
Mesentery becomes falciform ligament
After birth what happens to: Ductus arteriosus
Ligamentum arteriosus
What causes the closure of ductus arteriosus
mediated by prostoglandin inhibition and rise in PaO2
After birth what happens to: umbilical arteries
constict, some parts remain patent supplying the urinary bladder
Cerebral palsy
Non progressive disorder of movement and posture caused by injury to IMMATURE brain
Def of Birth asphyxia
Interruption of delivery of o2 to fetus causing:
- delayed breathing
- Low HR
- Acidosis
- Impaired muscle tone and reflexes
How to identify birth asphyxia
Apgar score
Cord gas: pH<7.15
Apgar score
HR: Absent 0, <100 1, 100 2
Resp effort: Absent 0, gasp/irreg 1, regular 2
Muscle tone: limp 0, some flexion 1, acitve 2
Response: nil 0, grimace 1, cry/cough 2
Central colour: white 0, blue 1, pink 2
Apgar score interprrtation
Repeated at 1, 5 and 10th minutes
8-9 good condition
<5 bad news!!
Grades of hypoxis ischaemic encephalopathy
I - hyperventilation
II- I + seizures
III- II + comatose
Mx of Hypoxic ischaemic encephalopathy
total body cooling for 72 hours at 33.5 C
Pathology of interventricular haemorrage in newborn?
Vascular germinal matrix with fragile vessels in preterm (24-32 weeks)
Fluctuating blood flow
Mx of interventicular management of newborn
corticosteroid before preterm delivery
Main complication post interventricular haemorrhage
post haemorrhagic hydrocephalus
Prevention of post haemorrhagic hyrocephalus
DRIFT
Washing out the ventricles after IVH to remove the neurotoxins
Def of periventricular leucomalacia
White matter damage
Caused by ischaemia/inflammation
Mx of periventricular leucomalacia
no treatment
prevention by giving MgSO4 to mother during preterm labour
Which brain injuries are more common in full term brain? which ones in preterm?
full term: acute hypoxic ischaemia of the basal ganglia (grey matter)
preterm: periventricular white matter / interventricular haemorrhage
Bacterial causes of neonatal meningitis
Group B strep
E coli
Listeria
Long term complications of neonatal meningitis
Deafness
Hydrocephalus
Poor neurodevelopment
Rx for neonatal meningitis
cefotaxime
What causes this
cutaneous candidiasis
Rx for neonatal candida infection
Local or oral treatment with nystatin or miconazole
Necrotising enterocolitis pathology
Injury to mucosa
- > substrate for bacteria to multiplying the gut
- > invasion of the gut wall by gas producing bacteria
- > ileus and perforation
Which Hepetitis virus can be passed to fetus and at what stage is it passed?
Hep B
Vertical transmission during labour (40% risk)
Hep B screening during pregnancy
Hep B surface antigen tested in all
If positive, Hep e antigen and antibodies also tested
Prevention of neonatal Hep B/e infection
If no Hep E : 4 doses of Hep B vaccine + 1 dose of Hep B immunoglobulin
If Hep E present: 4 doses of Hep B vaccine only
At what stage is HIV passed to fetus?
transplacental
during labour
breast milk
(25% risk)
Vaccinations to neonates
Hep B
BCG (if going abroad to TB in india/africa)
How long is breast feeding recommended for
first 6 months of life
Newborn screen blood test age
5-8 days
Which conditions tested for in heel prick test
hypothyroid
CF
Sickle cell disease
inherited metabolic disorders ( phenylketonuria, MCADD, etc)
Indications for abx for mastitis
Infected nipple fissure
Sx not improving >24 hrs with milk removal
Brest milk culture positive
Mastitis abx
Flucloxicillin
Because its staph, ffs Kav
Another flashcard I have to go through because of you
RFs for sudden infant death syndrome
prone sleeping
parental smoking
bed sharing
hypethermia
prematurity
Foetal alcohol syndrome
Hypoplastic upper lip
Microcephaly
Smooth philtrum
Philtrum
fold on upper lip
Pier Robins syndrome 3 fx
cleft palate,
retrognathia (abnormal jaw)
glossoptosis (obstruction by tongue)
Albinism defect
Tyrosinase defect
Sx of phenylketonuria
Musty odour skin and urine
Sx of cystinuria
recurrent kidney stones
5 alpha reductase deficiency sx
female-looking until puberty
penis at twelve syndrome
Hormone responsible for male internal reproductive tract development
Testosterone
Hormone responsible for male external reproductive tract development
DHT
