newborn/ premie Flashcards
What does APGAR look at?
heart rate resp effort muscle tone (activity) reflex irritability (grunting) colour (appearance)
APGAR scoring?
HR: 2 if >100. 1 if <100. 0 if absent
Resp effort: 2 regular, strong cry. 1 gasping/ irregular. 0 absent
Muscle tone 2 well flexed, active. 1 some flexion, slightly hypotonic. 0 flaccid
reflex irritability 2 cry, cough. 1 grimace. 0 none
Appearance 2 pink all over. 1 pink w blue extremities 0 blue/ pale
Neonatal hypoglycaemia Mx
Bolus 10% dextrose
if mother received opioid analgesia, infant gets this
naloxone
to prevent resp depression
Newborn severe lactic acidosis mx
sodium bicarb
Nitrogen washout test (Hyperoxia test)
used to differentiate between cardiac and resp causes of cyanosis.
e.g. infant given 100% oxygen for 10min. ABG taken before and after.
If significant improvement, likely problem w oxygenation (resp)
If pO2 still <15kPa indicates cyanotic CHD - TOF, TGA, tricuspid atresia
small white pearls along midline of palate
epstein pearls
resolve spontaneously
port wine stain
present from birth due to vascular malformation of dermal capillaries.
may be assoc w sturge weber syndrome if along distribution of trigeminal n
Guthrie tests for?
SCA CF Congenital hypothyroidism PKU MCADD
Hearing screening
evoked otoacoustic emission to test cochlear function
If abnormal hearing screening?
automated auditory brainstem response (AABR) done
And if abnormal -> refer to paed audiologist
Hypoxic ischaemic encephalopathy causes
significant hypoxic event immediately before/ during labour or delivery
- placental abruption, ruptured uterus, excessive uterine contractions
- cord compression (inc shoulder dystocia), cord prolapse
- preeclampsia w IUGR
- compromised fetus (IUGR, anaemia)
HIE may occur postnatally or be caused by neonatal condition e.g. kernicterus, inborn error of metabolism
Hypoxic ischaemic encephalopathy presentation
severe- comatose, severly hypotonic, needs assisted ventilation, prolonged seizures
mod- lethargic, markedly abnormal tone, requires tube feeding, seizures
mild- irritable, mild hypotonia, poor sucking
Hypoxic ischaemic encephalopathy MX
Resp support
aEEG to detect seizures / early encephalopathy
treat seizures w anticonvulsants
monitoring and treatment of hypoglycaemia and electrolyte imbalance
mild hypothermia by wrapping infant in cooling blanket reduces brain damage due to secondary neuronal death from reperfusion
Conditions premies are at higher risk of
Respiratory distress syndrome (surfactant deficiency)
Patent ductus arteriosus
Necrotizing enterocolitis
Intraventricular haemorrhage
RDS surfactant deficiency IX
CXR- ground glass appearance with air bronchograms
RDS antenatal prevention
Steroids.
IM betamethasone 12mg x2 24 hrs apart
RDS management
surfactant therapy Oxygen therapy (optiflow, CPAP, assisted ventilation)
Intraventricular haemorrhage complications + Mx
may impair drainage and reabsorption of CSF -> hydrocephalus
Mx; VP shunt
initial symptomatic relief by CSF removal using LP or tap
necrotizing enterocolitis what is it?
inflammation of the intestine -> necrosis -> perforation
risk factors of necrotizing enterocolitis
preterm infant
formula fed
necrotizing enterocolitis tx
stop oral feeding, give broad spectrum abx
parenteral nutrition to rest bowel
surgery if bowel perforated
Necrotizing enterocolitis IX
Abdo Xray - distended loops of bowel and thickening of bowel wall w intramural gas
If perforated - can be detected on abdo xray / clinically
commonest cause of resp distress in term infants
transient tachypnoea of newborn
What is transient tachypnoea of newborn?
Risk factors
Caused by delay of resorption of lung fluid
RFs:
elective C-section
maternal diabetes
earlier gestational age
TTN Ix
Xray - fluid in horizontal fissure
Diagnosis of exclusion
- given ambient O2 if required
Meconium aspiration Mx
suction nose, mouth and throat
intubation to suck meconium for lungs
artificial ventilation may be required
Cyanosis soon after birth due to right to left shunting
Assoc w meconium aspiration, birth asphyxia, RDS
Persistent pulmonary HTN of newborn
Early onset <48 h neonatal infection pathogens
GBS
E coli
Listeria
Late onset infection >48h from the envt pathogen
CNS (staph epidermis)
most common
Conjunctivitis within first 48h of life.
purulent discharge and eyelid swelling. gram - diplococcus
neisseria gonorrhoea
conjunctivitis at 1-2wks old
purulent discharge, eyelid swelling, or shortly after birth.
Intracellular organism
Chlamydia trachomatis
Gonoccocal conjunctivitis tx
IV ceftriaxone
clean eye frequently
mother and partner should be checked and treated
Chlamydia conjunctivitis tx
Oral erythromycin for 2 wks
tetracycline eye drops
Clean eye frequently
Mother and partner should be tested and treated.
Neonatal conjunctivitis tx
cleaning w saline or water.
usually resolves spontaneously.
if due to staph or strep –> topical abx eye ointment e.g. neomycin
tracheo-oesophageal fistula assoc w pregnancy sign?
polyhydramnios
tracheo-oesophageal fistula presentation
persistent salivation and drooling from mouth after birth
choking and coughing after feed
cyanotic episodes
-> lung aspiration of saliva/ milk or acid secretions from stomach
VACTERL assoc w TOF
Verterbral, anorectal, cardiac, tracheo-oesophageal, renal and radial limb anomalies
TOF mx
Surgery
Small bowel obstruction in newborn DDx
presents w persistent bile-stained vomiting
or recognised on antenatal USS
meconium may be passed but subsequently delayed or absent
abdo distension
DDx duodenal atresia/ stenosis jejunal/ ileum stenosis malrotation w volvulus meconium ileus meconium plug - thick plug causes lower intestinal obstruction
Bowel Obstruction Ix
Clinical features of abdo distension, bile stained vomiting
Abdo Xray
large bowel obstruction DDx
hirschsprung's rectal atresia (imperforate anus)
Newborn septic screen
FBC- WCC, U&Es Blood culture Chest XRay LP Urine dip + MCS
neonatal hypoglycemia risk factors
<37 wks gestation
babies < 2.5kg
IUGR
maternal GDM
Mom on BBs for preeclampsia
Neonatal hypoglycaemia Mx
ABC
Blood sugar
IV/ oral glucose
neonatal jaundice in first 24h of life?
Rhesus haemolytic disease
ABO incompatibility
G6PD deficiency
Hereditary spherocytosis
neonatal jaundice prolonged (>2 wks) causes?
biliary atresia - raised conj br hypothyroidism galactosaemia Breast milk jaundice congenital infections (e.g. CMV, toxoplasmosis)
Mx of Necrotizing enterocolitis
NBM to rest the bowel
NG tube to decompress bowel.
IV fluids, TPN and IV Abx for 10-14 days - ampicillin/ gentamicin or cefotaxime + metronidazole/ clindamycin.
surgery if deteriorating or perforated/ necrotic bowel suspected.
ophthalmia neonatorum (neonatal conjunctival infection) - complications
if not promptly managed, may lead to permanent visual impairment.
neonatal conjunctival infection ix?
FBC, WCC, CRP, U+Es, Blood cultures.
swabs of the eyes for MCS.
evaluate neonate for any disseminated infection.
common serum results in Kawasaki’s?
raised WCC, CRP and ESR. in the second week of illness, raised Pl
diaphragmatic hernia mx?
intubate baby early to prevent swallowing of air, which can cause expansion of the bowel within chest and further resp compromise.
NG tube passed and suction applied to prevent distension of the intrathoracic bowel.
After stabilisation, hernia repaired surgically.
main complication of diaphragmatic hernia
pulmonary hypoplasia
and pulmonary HTN
ix of oesophageal atresia
wide calibre feeding tube passed and check Xray to see if it reaches the stomach
presentation of oesophageal atresia + tracheooesophageal fistula
persistent salivation and drooling from the mouth after birth. Infant will cough and choke when fed, and have cyanotic episodes.
50% will have other congenital malformations (VACTERL)
mx of Tracheooesophageal fistula
continuous suction passed into oesophageal pouch to reduce aspiration of saliva and secretions whilst waiting transfer to neonatal surgical unit
mx of meconium ileus
gastrografin contrast medium to diagnose and dislodge
what to avoid in diaphragmatic hernia?
bag and mask ventilation
- may cause swallowing of air, expansion of the bowel and further respiratory compromise
causes of unexpected resp distress in term newborn
TTTN, pneumothorax, congenital pneumonia/ sepsis, lung malformations, congenital diaphragmatic hernia, choanal atresia/ upper airway malformations, congenital heart disease, cerebral haemorrhage, oesophageal atresia/ TOF
swelling in head several hours after birth, does not cross suture lines, can take several months to resolve
cephalohaematoma.
A cephalohaematoma is seen as a swelling on the newborns head. It typically develops several hours after delivery and is due to bleeding between the periosteum and skull. The most common site affected is the parietal region
jaundice may develop.
mx of haemophilia influenza meningitis in child > 1month
IV cefotaxime/ ceftriaxone
+ IV dexamethasone
if neonatal meningitis mx? <3 months old
IV cefotaxime + amoxicillin
if meningitis in >3 month old?
IV cefotaxime
abx prophylaxis of contacts? for bacterial meningitis
ciprofloxacin
prognosis of Congenital diaphragmatic hernia dependnent on which 2 factors?
- liver -> if herniated into chest, more severe and lower chance of survival.
- Lung to head ratio. (ratio >1.0 reflects a better outcome.
by what age does child’s visual acuity match that of an adult?
2 years of age.
what age does child fix and follow to 90 degrees
6 weeks
what age does child fix and follow to 180 degrees
3 months
mx of idiopathic constipation if movicol paediatric plain does not lead to disimpaction after 2 wks?
add stimulant laxative e.g. senna
