Paeds Neonatal medicine Flashcards
what are some causes of SGA?
- constitutional - small parents
- restricted foetal oxygen or glucose supple
- fetal abnormality
- maternal substance exposure
what are the complications of SGA?
increased risk of fetal death and asphyxia
hypoglycaemia
hypothermia
polycythaemia
NEC
thrombocytopenia/neutropenia/coagulopathy
meconium aspiration syndrome
what are the causes of LGA
most frequently constitutional - large parents mother has DM fetal hyperinsulinemia pancreatic islet cell hyperplasia hydrops fetalis Beckwith-Wiedemann syndrome
what are the complications of LGA?
perinatal asphyxia nerve palsies shoulder dystocia fractures hypoglycaemia
what are some predisposing factors for prematurity?
idiopathic previous preterm birth multiple pregnancy maternal illness PROM uterine malformation cervical incompetence placental disease
what are the problems associated with prematurity?
Resp problems : surfactant deficiency causing resp distress syndrome, apnoea of prematurity, chronic lung disease
CNS: intraventricular haemorrhage, periventricular leukomalacia , retinopathy of prematurity
GI: NEC, inability to suck, poor milk intolerance
Hypothermia, immuno-compromised, impaired fluid/electrolyte homeostasis, PDA, anaemia of prematurity, jaundice, perinatal hypoxia
why are steroids given to mother if prematurity is suspected?
what steroids should be given?
dexamethasone
reduces severity of respiratory distress syndrome, NEC and periventricular haemorrhage.
what are different types of birth trauma?
head: caput succedaneum (oedema presenting on the scalp), Cephalohematoma, Subaponeurotic haematoma
Skin: traumatic cyanosis, lacerations
Nevre palsies: brachial plexus (Erb’s palsy), facial nerve palsy
Fractures - clavicle, long bone, skull. treatment = analgesia, limb immobilisation
soft tissue trauma - sternocleidomastoid tumour - overstretching of the muscles leads to haematoma, fat necrosis
what are some causes of the non-specifically ill neonate?
infection hypothermia metabolic - inborn errors of metabolism cardiac GI CNS
how might the ill neonate present?
Skin: pallor, mottling, peripheral cyanosis, cool peripheries, cap refil>2seconds, rash, jaundice
Temp - up or down
CNS: lethargy, weak, unusual cry, hypotonia, irritability, jittery, seizures
Resp: apnoea, expiratory grunting, flaring nostrils, tachypnoea, intercostal or subcostal recession, tracheal tug
CVS: tachycardia, weak or absent pulses or hypotension should be considered late/pre-terminal signs
GI: vomiting, distended abdomen (ileus), diarrhoea, bloody stools, abdo tenderness, bilious vomit or aspirate
Metabolic - increased or decreased BG
how do you manage an non-specifically ill neonate?
assess ABC
secure airway - give O2 and provide ventilatory support if needed
transfer to neonatal unit
obtain vascular access and give bolus 0.9% saline 10-20mls/kg if circulatory compromise
monitor breathing
measure BP, blood glucose, U&E, FBC, blood gas
full septic screen (blood cultures, CXR/AXR, LP, C&S,
consider cranial USS if preterm/at risk
start a broad spectrum antibiotic (e.g. gentamycin)
if meningitis suspected give cefotaxime
if listeria infection give benzylpenicillin
what is physiological jaundice?
it is common and appear after 24 hours and peaks around day 3-4 and usually resolves by day 14
it is due to immaturity of hepatic bilirubin conjugation, but poor feeding can also contribute.
how do you treat elevated serum bilirubin above the gestation and age cut offs?
- you need to stop it rising to the level that might cause kernicterus
- treat the underlying cause
- start blue light phototherapy (makes it so bilirubin can be excreted in urine)
- use age/gestation charts to determine when to start phototherapy
- measure SBR frequently
- ensure adequate hydration
- cover eyes during phototherapy
- IVIG can be added
what is the presumption if jaundice occurs in the first 24 hours of life?
that it is pathological
what is considered prolonged jaundice
> 14 days in term infants
>21 days in preterm infants
what are some causes of prolonged jaundice
breastfeeding (usually resolves by 12 weeks) enclosed bleeding (cephalhaematoma) prematurity haemolysis sepsis hypothyroidism conjugated jaundice hepatic enzyme disorders
what initial investigations would you perform for prolonged jaundice?
SBR (total and conjugated) U&E FBC direct coombs test blood group TFTs LFTs
what is kernicterus?
Kernicterus is diagnosed pathologically by gross yellow staining and necroses of neurons in the basal ganglia, hippocampal area, and cerebellum. It occurs secondary to the entry of bilirubin into the brain, which causes a disruption of cellular energy metabolism in the basal ganglia, hippocampal area, and cerebellum.
if the neonate survives what are the clinical features of kernicterus?
Cerebral cortex is usually spared. If the neonate survives, the clinical features include chorio-athetoid cerebral palsy, paralysis of upward gaze, sensorineural hearing loss, dental dysplasia, and intellectual deficits (less often in the mental retardation range)
what are some causes of neonatal hypoglycaemia?
reduced glucose stores: preterm, UUGR, LBW, inborn errors of metabolism
Increased glucose consumption: sepsis, hypothermia, perinatal hypoxia, polycythaemia, haemolytic disease, seizures
hyperinsulinemia: maternal DM, BWS, pancreatic islet cell hyperplasia
maternal beta blockers, tissued or malfunctioning IV infuxion
other rare causes - fetal alcohol syndrome, pituitary insufficiency, adrenal insufficiency
how might neonatal hypoglycaemia present?
commonly asymptomatic jitteriness apnoea poor feeding drowsy seizures cerebral irritability hypotonia macrosomia
how do you manage severe/symptomatic hypoglycaemia in neonates?
IV bolus 3-5mL/kg of glucose 10%
follow with 10% glucose infusion IV (4-6mg/kg/min)
what are some causes of neonatal seizures?
brain injury
CNS infection
cerebral malformation
metabolic causes (hypoglycaemia, hypo/hypernatremia , hypocalcaemia, hypomagnesia)
neonatal withdrawal from maternal substance abuse
kernicterus
how should you manage neonatal seizures?
give oxygen, maintain airway, insert IV, treat underlying cause
first line anticonvulsant - IV phenobarbital, second line IV clonazepam
what is given to neonates to prevent haemorrhagic disease of the newborn??
vitamin K
what are the advantages of breast feeding?
decrease maternal post partum haemorrhage
mild maternal contraceptive effect
increased bonding decreased maternal breast cancer risk
cheap
decreased infant mortality
decreased GI and resp infection rate
dcreased later autoimmune disease incidence
