Peershare Flashcards
neonatal resus
- warm baby under lamp
- dry as quickly as possible (helps stimulate breathing)
- calculate APGAR score
- delayed umbilical cord clamping
paeds life support
- look, listen, feel
- shout for help
- open airway
- 5 rescue breaths
- check for circulation (infants = brachial/femoral pulse, children = femoral pulse)
- 15:2 chest compressions to rescue breaths
* chest compressions 100-120/min
* 1/3 of AP dimension of chest - infants = two thumb encircling technqiue
* children - compress lower 1/2 sternum
APGAR
assessed at 1, 5 and 10 mins
* appearance (skin colour) 0 = blue, 1 = peripheries blue, 2 = pink
* pulse 0 = absent, 1 = <100bpm, 1 = >100bpm
* grimace (response to stimulation) 0 = no response 1 = little response/aggressive stimulation for cry, 2 = strong response/crying
* activity (tone 0 = absent/floppy, 1 = flexed arms/legs, 2 = active/flexes and rists extension
* respiratory effort 0 = absent, 1 = slow/irregular/gasping, 2 = strong, regular, crying
def: caput succedaneum v caphalohaematoma
caput - crosses suture lines, collecting on scalp outside periosteum
caused by traumatic/prolonged/instrumental delivery
ablle to cross suture lines
no treatment - resolves in few days
cephalohaematoma - bloo dbetween skull and periosteu,
does not cross suture lines
traumatic subperiostel haematoma
resolves in few months with no treatment
risk of anaemia/jaundice should be monitored until resolves
causes: hypoglycaemia neonates
- preterm <37 weeks
- IUGR
- GDM
- maternal diabetes
- hypothermia
- neonatal spesis
- inborn errors metabolism
- nesidioblastosis
- Beckwith-Wiedemann syndrome
def: nesidioblastosis
nesidioblastosis and insulinoma are disorders of the endocrine pancreas causing endogenous hyperinsulinemic hypoglycemia
def: Beckwith-Weidemann syndrome
condition that affects many parts of the body
classified as an overgrowth syndrome
affected infants are larger than normal (macrosomia)
some may be taller than their peers during childhood
BWS has various signs and symptoms, including a large body size at birth and taller-than-average height during childhood, a large tongue, and hypoglycemia (low blood sugar). In some children with BWS, parts of the body, such as the ears, may grow abnormally large, leading to an asymmetric or uneven appearance
def: hypoglycaemia neonates
?<2.6mmol/L
common even in term babies - can be hypoglycaemic for first 24 hrs but no sequelae
presentation: hypoglycaemia neonates
autonomic: hitteriness/irritable/tachypnoea/pallor
neuroglycopenic: poor feeding/sucking, weak cry, drowsy, hypotonic, seizures
other fx: apnoea, hypothermia
rx: hypoglycaemia neonates
asymptomatic = wncourage feeding and monitor
symptomatic/v low = admit to NICU and 10% dextrose IV
causes: IUGR
- smoking, alcohol, or illicit drug use
- infection: cytomegalovirus, German measles (rubella), toxoplasmosis, or syphilis
- some seizure treatment
- lupus, anemia, or clotting problems
- hypertension
problems: preterm birth
- RoP
- necrotising enterocolitis
- RDS
pathophys: NEC
part of bowel = necrotic
presentation: NEC
- intolerance to feeds
- vomiting (green bile)
- unwell
- distended tender abdomen
- absent bowel sounds
- blood in stool
ix: NEC
bloods - FBC for WCC< CRP, blod gas = metabolic acidosis) and blood culture ?sepsis
AXR - dilated loops of bowel, bowel wall oedema (thickened walls), pneumatosis intestinalis (gas in bowel wall), pneumoperitoneum and gas in portal veins
rx: NEC
- NBM
- IV fluids
- TPN
- NG tube - drip and suck
- Abx
surgical emergency - may require temporary stoma
complications: NEC
- perforation
- peritonitis
- shock
pahtophys: RoP
- retinopathy of prematurity
- abnormal development of blood vessels in retina
- normal development stimulated by hypoxia - triggered by supplemental O2
ix: RoP
screen premature babies
rx: RoP
stop new vessel growth
1st line = transpupillary laser photocoagulation to halt and reverse neovascularisation
cryotherapy ot intravitreal VEGF inhibitors
surgery if retinal detachment
complications: RoP
scarring
retinal detachment
blindness
pathophys: RDS
commonly occurs before 32 weeks when lungs start to produce lung surfactant
* inadequate surfactant
* high surface tension with alveoli
* atelectasis (lung collapse) since more difficult for alveoli and lungs to expand
* inadequate gas exchange
* hypoxia and hypercapnia causing respiratory distress
ix: RDS
CXR = ground glass appearance
rx: RDS
antenatal maternal steroids (dexamethasone) with ? premature labour
- intubation and ventilation if severe
- endotracheal surfactant via endotracheal tube
- CPAP via nasal mask
- supplementary O2 to maintain 91-95% sats