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Complex Care 2 > NICU cares > Flashcards

NICU cares Flashcards

1
Q

What is surfactant?

A

A lipoprotein in the lungs which enables the alveoli to remain open by reducing surface tension allowing gas exchange.

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2
Q

What is asphyxia?

A

Oxygen deprivation - can occur in utero or after birth due to failure of respiration.

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3
Q

What are the 4 phases of asphyxia if hypoxia is prolonged?

A
  1. Hyperventilation
  2. Primary apnoea
  3. Deep irregular gasping respirations
  4. Terminal or secondary apnoea - baby is unresponsive to stimulation.
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4
Q

What causes asphyxia in the neonate?

A 
Preterm birth
Obstruction
Some drugs/medications
Congenital abnormalities (CDH or TOF)
Cerebral damage
Infection
Haemorrhage
Pneumothorax
Pharyngeal suctioning
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5
Q

What are antenatal risk factors for asphyxia?

A 
Diabetes
Pre-eclampsia
Anaemia or isoimmunisation
Hx of previous fetal or neonatal death
Maternal infection
Poly/Oligo hydramnios
PROM/PPROM
APH
Post dates
Multiple gestation
IUGR/SGA
Maternal drug abuse
Known congenital abnormalities
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6
Q

What are intrapartum risk factors for asphyxia?

A 
LSCS
Breech or malpresentation
Prem labour
Prolonged ROM
Precipitous or prolonged labour
Prolonged 2nd stage
Non-reassurring FHR
General anaesthesia
Narcotics within 4 hrs of birth
MSL
Cord prolapse
Abruption or praevia
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7
Q

When is meconium aspiration syndrome more common?

A

Near-term or term babies, or postdates. Rarely mec is passed in utero before 34 weeks gestation

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8
Q

What causes a fetus to pass mec in utero?

A

Fetal hypoxia causes gut paralysis to increase and sphincter relaxes releasing mec.

Distress causes cortisol levels to rise resulting in fetal gasping, bringing mec into the airways allowing air in, but not out.

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9
Q

What is the treatment for Mec Asp Syndrome?

A

Oxygen therapy and antibiotics to avoid pneumonia.

Surfactant therapy within 6 hours of birth may reduce severity.

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10
Q

What is transient tachypnoea of the newborn?

A

A temporary increase in respiratory effort after birth in otherwise health neonates.

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11
Q

What causes TTN?

A

Mild surfactant deficiency or inadequate absorption of fluid form the lungs after birth.

More likely in LSCS.

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12
Q

What are the symptoms of TTN?

A 
Tachypnoea > 60 bpm up to 120
Nostril flaring
Sternal recession
Expiratory grunting
Possible cyanosis
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13
Q

What is the management of TTN?

A

Observations every 15 minutes:

  • colour
  • resp rate
  • muscle tone
  • HR normal and not increasing.

Paed review
Rule out infection - chest x-ray, blood gases and cultures
Possibly SCN admission for oxygen and observation

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14
Q

What is respiratory distress syndrome?

A

Respiratory problem causes by lack of surfactant, most common in preterm infants.

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15
Q

What are the symptoms of respiratory distress syndrom?

A

Nasal flaring
Grunting
Sternal and intercostal recession
Tachypnoea

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16
Q

What factors protect against RDS?

A

Chronic hypertension
maternal heroin addiction
Pre-eclampsia
growth retardation

17
Q

What is the management of RDS?

A 
Exclude infection - antibiotics, blood cultures/gases
Surfactant therapy
Ventilation support
Observations
Support parents
18
Q

What is the definition of apnoea?

A

cessation of respiratory effort for 20 seconds or more.

19
Q

When can apnoea occur?

A

Common in preterm infants - immature respiratory centre and chemoreceptor response to hypoxia and acidosis.
Can be first sign of infection
After maternal narcotic use

20
Q

What is chronic lung disease and when is it seen?

A

Where oxygen therapy required after 36 weeks post conceptual age.

Preterm babies
intubation
High level ventilation
Oxygen toxicity

21
Q

What is a pneumothorax?

A

Where alveoli rupture allowing air into the pleural cavity. Also known as “air leak syndrome”.

It can be spontaneous at birth or induced by high ventilator pressure.

22
Q

What is CDH?

A

Congenital diaphragmatic hernia - a defect in the diaphragm muscle with herniation of the abdominal contents into the thorax through the defect.

23
Q

What is the treatment for CDH?

A

High mortality rates due to pulmonary hypertension and hypoplasia. Ventilation support, and if stablised, surgery - plication of the diaphragm.

24
Q

78% of fetal loss 16-22 weeks was due to _______?

A

chorioamnionitis

25
Q

What does TORCH stand for?

A

Toxoplasmosis, Other (syphilis, parvovirus), Rubella, Cytomegalovirus, Herpes

26
Q

What is the pathogenesis of intrauterine infection?

A
  • ascending infection from lower genital tract
  • retrograde passage from peritoneal cavity
  • maternal circulation
  • invasive procedures such as amniocentesis
27
Q

What are the risk factors for neonatal infection?

A 
Maternal sepsis
ROM > 18 hrs
Labour > 12 hrs
# of vaginal examinations
Instrumental birth
Fetal distress or birth asphyxia
28
Q

What infection prevention measures should be taken?

A

Inutero - flu vax, screen for risk factors, health education for mum
Handwashing for professionals and visitors
Equipment - not shared between babies
Environment - babies room in or if not possible, adequate spacing of babies
minimise invasive procedures and use asceptic technique
Limit exposure through visitors and other children.

29
Q

What is CONS?

A

Coagulase Negative Staphylococcus - most common infection in nurseries.

30
Q

What is NEC?

A

Necrotising enterocolitis - inflammation of the gut wall as a result of infection

Symptoms - acute abdo pain, blood in stools, vomiting

31
Q

What treatment reduces the incidence of NEC in preterm babies?

A

Probiotics!

32
Q

What are the s/s of neonatal infection?

A 
Lethargy
Vomiting
Diarrhoea
Jaundice
Mild respiratory difficulty
Pyrexia
Hypothermia/Hypotonia
Irritability
Poor feeding
Weak cry
Abdo distension
Failure to thrive
Rash
33
Q

What does a raised CRP mean?

A

Increased C-Reactive protein in the blood is a marker of inflammation and indicates infection. It does not assist with diagnosis.

34
Q

How is a neonatal infection diagnosed?

A 
FBC and blood gases
Blood culture
Urine culture
Swabs of any area that may be infected
Lumbar puncture and CSF culture
Chest x-ray, CT, MRI
Culture of AF, placental tissue, cord blood.
35
Q

How is GBS sepsis treated in the neonate?

A

Ventilation - CPAP with humidified oxygen therapy and continous sPo2 monitoring
Orogastric feeds to conserve energy
Antibiotics

Complex Care 2 (15 decks)

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