NICU cares Flashcards
What is surfactant?
A lipoprotein in the lungs which enables the alveoli to remain open by reducing surface tension allowing gas exchange.
What is asphyxia?
Oxygen deprivation - can occur in utero or after birth due to failure of respiration.
What are the 4 phases of asphyxia if hypoxia is prolonged?
- Hyperventilation
- Primary apnoea
- Deep irregular gasping respirations
- Terminal or secondary apnoea - baby is unresponsive to stimulation.
What causes asphyxia in the neonate?
Preterm birth Obstruction Some drugs/medications Congenital abnormalities (CDH or TOF) Cerebral damage Infection Haemorrhage Pneumothorax Pharyngeal suctioning
What are antenatal risk factors for asphyxia?
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
What are intrapartum risk factors for asphyxia?
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
When is meconium aspiration syndrome more common?
Near-term or term babies, or postdates. Rarely mec is passed in utero before 34 weeks gestation
What causes a fetus to pass mec in utero?
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.
What is the treatment for Mec Asp Syndrome?
Oxygen therapy and antibiotics to avoid pneumonia.
Surfactant therapy within 6 hours of birth may reduce severity.
What is transient tachypnoea of the newborn?
A temporary increase in respiratory effort after birth in otherwise health neonates.
What causes TTN?
Mild surfactant deficiency or inadequate absorption of fluid form the lungs after birth.
More likely in LSCS.
What are the symptoms of TTN?
Tachypnoea > 60 bpm up to 120 Nostril flaring Sternal recession Expiratory grunting Possible cyanosis
What is the management of TTN?
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
What is respiratory distress syndrome?
Respiratory problem causes by lack of surfactant, most common in preterm infants.
What are the symptoms of respiratory distress syndrom?
Nasal flaring
Grunting
Sternal and intercostal recession
Tachypnoea
What factors protect against RDS?
Chronic hypertension
maternal heroin addiction
Pre-eclampsia
growth retardation
What is the management of RDS?
Exclude infection - antibiotics, blood cultures/gases Surfactant therapy Ventilation support Observations Support parents
What is the definition of apnoea?
cessation of respiratory effort for 20 seconds or more.
When can apnoea occur?
Common in preterm infants - immature respiratory centre and chemoreceptor response to hypoxia and acidosis.
Can be first sign of infection
After maternal narcotic use
What is chronic lung disease and when is it seen?
Where oxygen therapy required after 36 weeks post conceptual age.
Preterm babies
intubation
High level ventilation
Oxygen toxicity
What is a pneumothorax?
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.
What is CDH?
Congenital diaphragmatic hernia - a defect in the diaphragm muscle with herniation of the abdominal contents into the thorax through the defect.
What is the treatment for CDH?
High mortality rates due to pulmonary hypertension and hypoplasia. Ventilation support, and if stablised, surgery - plication of the diaphragm.
78% of fetal loss 16-22 weeks was due to _______?
chorioamnionitis
What does TORCH stand for?
Toxoplasmosis, Other (syphilis, parvovirus), Rubella, Cytomegalovirus, Herpes
What is the pathogenesis of intrauterine infection?
- ascending infection from lower genital tract
- retrograde passage from peritoneal cavity
- maternal circulation
- invasive procedures such as amniocentesis
What are the risk factors for neonatal infection?
Maternal sepsis ROM > 18 hrs Labour > 12 hrs # of vaginal examinations Instrumental birth Fetal distress or birth asphyxia
What infection prevention measures should be taken?
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.
What is CONS?
Coagulase Negative Staphylococcus - most common infection in nurseries.
What is NEC?
Necrotising enterocolitis - inflammation of the gut wall as a result of infection
Symptoms - acute abdo pain, blood in stools, vomiting
What treatment reduces the incidence of NEC in preterm babies?
Probiotics!
What are the s/s of neonatal infection?
Lethargy Vomiting Diarrhoea Jaundice Mild respiratory difficulty Pyrexia Hypothermia/Hypotonia Irritability Poor feeding Weak cry Abdo distension Failure to thrive Rash
What does a raised CRP mean?
Increased C-Reactive protein in the blood is a marker of inflammation and indicates infection. It does not assist with diagnosis.
How is a neonatal infection diagnosed?
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.
How is GBS sepsis treated in the neonate?
Ventilation - CPAP with humidified oxygen therapy and continous sPo2 monitoring
Orogastric feeds to conserve energy
Antibiotics
