PAEDS 2: Neonates and Development Flashcards
What is the criteria for the APGAR score?
Appearance (0 = blue/pale, 1=blue extremities, 2= no cyanosis)
Pulse rate (0 = <60, 1 = 60-100, 2 = >100)
Grimace (0 = no response, 1 = aggressive stimulation needed for cry, 2 = cries on stimulation)
Activity (0 = absent/floppy, 1 = some flexion, 2 = flexes + resists extension)
Respiratory effort (0 = absent, 1 = weak/gasping, 2 = strong cry)
How often is APGAR done and what are the threshold levels?
Done at 1 and 5 minutes post-birth and continued if score under 7.
Totals:
7+ = normal
4-6 = low
3 or less = critically low
(resuscitation should begin before 1 minute score if critically unwell)
Outline neonatal life support for a term baby
- dry/wrap, stimulate, keep warm, delay cord clamping if possible
- assess APGAR
- ensure open airway (if preterm consider CPAP)
- if gasping/not breathing give 5 inflations in air, apply PEEP, SpO2 and ECG if possible
- reassess
- if chest not moving, check positions, 2 person support, consider sunction and laryngeal mask, repeat inflation breaths
- reassess
- if HR not detectable or <60bpm after 30 secs of ventilation do 3:1 chest compression to ventilation, increase O2 to 100% and consider intubation
- reassess and if still no recovery gain vascular access and administer drugs
Outline neonatal life support for a preterm baby <32 weeks
place undried in plastic wrap + radiant heat
inspired oxygen of 21-30% if 28-31 weeks gestation or 30% if <28 weeks gestation
if giving inflations start with 25cm H2O
How do you assess neonatal cyanosis (blue baby)?
Hyperoxia test - give 100% O2 for 10 mins then do ABG and assess PaO2
What does a PaO2 >15kPa on the hyperoxia test suggest?
Respiratory cause of neonatal cyanosis e.g. NRDS, transient tachypnoea, meconium aspiration
What does a PaO2 <15kPa on the hyperoxia test suggest?
Cardiac cause of neonatal cyanosis e.g. tetralogy of fallot, transposition of great arteries, tricuspid atresia, ebstein’s anomaly
What would imaging and treatment be for NRDS?
CXR = ground-glass lung apperance
RF = prematurity
Mx = surfactant therapy
What would imaging and treatment be for transient tachypnoea of the newborn?
CXR = fluid on horizontal fissure
Mx = resolves spontaneously
What would imaging and treatment be for meconium aspiration?
CXR = lung overinflation, patches of collapse and consolidation
RF = macroscomia
Mx = IV Abx
What would investigations show for tetralogy of fallot?
CXR = boot shaped heart
Cyanosis in days, on exertion (tet spells)
ESM
What would investigations show for transposition of great arteries?
CXR = round heart
Cyanosis in hours
Loud S2, no murmur
What would investigations show for tricuspid atresia?
CXR = prominent aortic root
Cyanosis upon minutes
ESM
How are cardiac causes of neonatal cyanosis managed?
Prostaglandin infusion + delayed surgery
What are the steps of NIPE (newborn infant physical examination)?
- General measurements (height, weight, head circumference, abdominal circumference etc.)
- General inspection (tone, look at spine, moles, skin abnormalities, looking at feet and hands etc., primitive reflexes)
- Eyes (red reflex on both eyes, absent red light reflex = sign of congenital cataracts)
- Heart (murmurs, pulses esp. femoral, if absent or asymmetrical may indicate narrowing of aorta)
- Hips (DDH tests)
- External genitalia
What primitive reflexes are tested in the NIPE?
Placing reflex - when dorsum of foot touches surface, steps onto it (lasts 3/12)
Palmar grasp - lasts 3/12
Rooting reflex - turns head if touched near mouth
Sucking reflex - sucks nipple or teat placed in mouth
Asymmetric tonic neck reflex (ATNR) - fencing posture on turning head to one side (lasts 5/12)
Moro reflex - symmetrical abduction and extension followed by flexion and adduction of arms on sudden head extension (lasts 3/12)
What does an absence of the red light reflex in a newborn signify?
Congenital cataracts (may be secondary to TORCH infection, genetic syndromes e.g LHON etc.)
How can neonatal murmurs be classified?
Cyanotic
Non-cyanotic
Innocent
How does a cyanotic murmur present?
Right to left shunt (more life threatening than left to right)
ESM (except for TGA)
What congenital heart defects cause non-cyanotic murmurs?
1) Left to right shunts: PDA, ASD, VSD
2) Outflow obstructions: valve stenosis, coarctation of aorta
How does a PDA present?
Gibson murmur - continuous machine like murmur
How does an ASD present?
ESM + fixed S2 splitting
Primary = foramen ovale
Secondary = defect of atrial septum
How does VSD present?
If large = soft PSM + apical MDM + loud P2
If small = loud PSM + quiet P2
How does valve stenosis present?
ESM + ejection click + quiet A2/P2
