Newborn management/ ICU conditions

Question 1

What happens straight after delivery

1min after birth

5min after birth

Answer 1

Do-Stimulate baby to take first breath (towel rub, feet tap)
Check - O2 sats (between 60-65
Do - if less than sats –> PPC –> intubate

1min - APGAR 
Check - 7-10 - normla 
<7 
02 sats 80-85 (if not give oxygen --> PPV --> intubate)
HR - >100 , if less PPV 
<60 - CPR (3:1) - epi to umbilical cord 

5mn
o2 90-95% 
-give oxygen
-PPV
HR >100 then CPR 

-keep going till apgar score >7

Question 2

APGAR score

Answer 2

Apperance
Pulse
Grimace
Activity 
Respiration 

Score of 2 = pink, pulse >100, low stimuatlion, active movement, Resp - cry, strong

Score of 0 = blue, pulse absent, abset resp, stimulation and movement

Question 3

Post birth - What do we do?

Answer 3

1. Measure (weight, heigh, head circumference)
2. Cord - 2 arteries 1 vien, clip and clamp
3. Shots and drops - vit K, hep B (if mother infected), PPX - conjuctivits (erthromycin), tx - disease specifc
4. Look - Scalp - fontanels
   - red reflex
   - cleft lip
   - creptiis
   - murmurs
   - lung
   - cord
   - genetalia
   - imperforated anus
   - skin - aundice
   - Ortoloni and barlow manover

Question 4

Respiratory distress syndrome

Answer 4

Path: preterm infants, surfactant deficiencey as immature leading to poor lung compliance, alveolar collapse and atelctasis
RF: Maternal DM, male, second twin
Hist/Exam: first 49-72 hours - RR >60bpm, progressive hypoxaemia, cyanosis, nasal flaring, intercostal retractions, expiatory grunting.
Dx: ABGs, FBC, blood culture (rule out infection)
Xray - hypoextended lungs with atelectasis, grandular or ground glass apeprance of lung parnechyma, poor inflation, lack of focal opacities, promintent air bornchograms,

Tx: CPAP, intubation, surfactant
Pretreat mothers - corticosteroids <34 weeks

Question 5

Transient tachypnea of new born

Answer 5

Path: Self limiting, baby didnt get stimulated enough during birth (e.g c-section)
Patient: term baby, grunting
Dx: Xray - hyper-extended lungs on CXR, perihilar streaking marks
Tx: Peep
(goes away in first 6 hours)

Question 6

Hypoglycacemia

Answer 6

Path: LGA, SGA, DM mum, IUGR
Pt : decrease BG, asymptomatic or - jitters, tremors, seziures, lethargy –> coma
Dx: look for causes of infection
Tx: feed (breast milk)
or if cannot do this –> IV blus D5, then drip of D5 or D10 if above doesnt work.

Question 7

Bronchopulmonary dysplasia (same as RDS in adults) (ICU)

Answer 7

Path: reduced surfactant, decreased amount of alveoli, reduced oxygenation, can get chronic fibrosis. Caused by mechanical ventilation and long term use of oxygen
-more common in Low birth weight babys and preterm and those treated with oxygen for respiratory distress syndorme
Pt: increase oxygen demands, and giving oxygen does not correct this.
Dx: Xray -grand glass opacities , increase oxygnen requirements in first 28 days
Tx: surfactant, corticosteroids
F/U - DPLD

Question 8

Retinopathy of pre maturity (ICU

Answer 8

Path: neoangiogenesis - is worsened by increasing oxygen
Pt: prematurity - increase oxygen requirment
Dx: eye exam - see blood vessesls
Tx: lazer
F/u - glucoma

Question 9

Intraventricular haemorrhage (ICU)

Answer 9

Path: highly avascular lining of ventricles are susceptible to changes in BP, premature babies blood vessels not properly developed
Pt: asymptomatic screen (premature babys all get a screen at less than 3 weks)
-If bleed during screen - increase ICP, and bulging fontaneles and seizure
-comatose = IVH
Dx: cranial doler
Tx: manage ICP - vp shunts, drains
F/u - mental retardation and seizure

Question 10

Necrotising enerteroclotis

Answer 10

Path: dead gut
Pt: premature in ICU with another conditions, then get a blood bowel movement
Dx: get xray - see air in wall of intestine - pnumoatosis intestinalis
Tx: NPO, IV abx, gram negative
-TPN
-Surgery - can lead to short gut syndrome