Paeds inherited conditions and neonates (ILA 6) Flashcards
(110 cards)
Outline the steps in neonatal life support
- dry the baby
- assess tone, breathing and circulation
- if not breathing -> open airway, 5 inhalation breaths, consider oxygen
- re-assess
- if chest not moving -> recheck head position, 2 person airway control,repeat breaths, look for response
- when chest is moving, ventilate for 30 secs and start chest compressions
- re-assess every 30 sec
- update patients
What is given to the newborn if heart rate low (<60bpm)?
adrenaline
What is used to treat lactic acidosis in the newborn?
sodium bicarbonate
What is used to treat hypoglycaemia in the newborn?
dextrose
Define a preterm baby
<34 weeks of gestation
What is the viability threshold of a pregnancy and the age when to start treating in the uK?
24 weeks gestation
List the steps in stabilising the preterm/ sick infant
- assess airway, circulation, tone
- manage as required
- monitor - O2, RR, HR, BP, temp, glucose, blood gases, weight
- temp control
- venous and arterial lines established
- Chest x-ray
- investigations
- minimal handling and parents!!!
Outline the steps in maintaining temperature control in the preterm infant
place in plastic bag
stabilisation under a radiant warmer
add a heated mattress or humidified incubator
Which venous/arterial lines should be established in the sick child?
- peripheral intravenous line
- umbilical venous catheter
- arterial line
- PIC line
Which investigations would you do for a sick newborn?
FBC urea and creatinine electrolytes blood cultures CRP coagulation screen blood glucose
List the problems affecting a premature baby…
lung problems due to lack of surfactant heart defect -PDA nutrition and feeding problems nectrotising enterocolitis jaundice hypoglycaemia temperature control - hyperthermia haemorrhage retinopathy anaemia sepsis
How is respiratory distress syndrome caused?
it is due to a lack of surfactant
lack of surfactant increases surface tension
leads to widespread alveolar damage and insufficient gaseous exchange
Where is surfactant excreted from?
excreted from the type 2 pneumocytes of the alveolar epithelium from 24 weeks gestation
When does respiratory distress syndrome present?
within 4 hours of birth
Outline the symptoms and signs of respiratory distress syndrome
within 4 hours of birth, baby shows signs of respiratory distress…
tachypnoea nasal flaring expiratory grunting chest recession laboured breathing cyanosis
What are the signs of respiratory distress syndrome on a chest x-ray?
ground glass appearance
How is respiratory distress syndrome managed?
- ambient oxygen therapy - nasal canulae, CPAP
- surfactant therapy
- glucocorticoids - given to mother to stimulate surfactant production if preterm baby expected
What is the risk with excess oxygen therapy?
damages the retina
What is bronchopulmonary dysplasia?
also termed “chronic lung disease of prematurity”
= officially needing oxygen at 28 days or 36 weeks post menstrual age
How does bronchopulmonary dysplasia occur?
it is due to abnormal development of the lung causing…
- reduced lung volume
- reduced alveolar surface
- cysts
- diffusion defect
How is chronic lung disease of prematurity managed?
- antibiotics for infections
- Pavlivuzumab - vaccination against RSV
- NICU
What are the possible respiratory complications a premature baby can develop?
- respiratory distress syndorme
- bronchopulmonary dysplasia
- pneumothorax
- apnoea
- bradycardia, desaturations
Outline the circulatory problems preterm infants encounter?
Hypotension
Patent ductus arteriosus
Anaemia
How should nutrition of a preterm baby be managed?
- nasogastric tube feeding until 36 weeks
- parenteral nutrition required via PIC line or umbilical venous catheter
- breast milk supplemented with calories, vitamins, calcium, phosphates