Peri and neonatal Medicine Flashcards
What can opioid analgesics use during labour do?
May suppress respiration at birth
Effect of epidural anaesthesia during labour?
Can cause maternal pyrexia which is often difficult to differentiate from fever caused by infection
What can oxytocin and prostaglandin use during labour do?
Can cause hyperstimulation of the uterus leading to fetal hypoxia
What is transient tachypnoea of the new born and when can it occur?
Rapid, laboured breathing for several hours after birth by c-section
Because lungs weren’t squeezed during delivery therefore fluid was not squeezed out and there is still fluid in lungs
What does Apgar score measure?
Used to measure babys condition 1 and 5 mins after delivery and then every 5 mins afterwards if condition remains poor
What measurements are included in Apgar score?
Heart Rate >100 bpm = good Respiratory effort Muscle tone (flexion good) Reflex irritability (grimace (1) or cry (2)) Colour (pink good)
When does passage of meconium become more common
Greater the infants gestational age, especially post-term
What can happen with passage of meconium?
If infants become acidotic from aspyhxia and try to breathe in utero then they can inhale thick meconium and develop meconium aspiration syndrome
Risk with aspiration of newborn and management
Can stimulate reflex bradycardia and cause newborn to be bradycardic
If regular breathing starts then nothing, if doesn’t - aspiration and if bradycardic then Post-pressure ventilation
Way to manage respiratory depression following maternal opiate use
Give Naloxone if respiration continues to be depressed following initial resuscitation
Phases of neonatal resus
Airway opening maneouvres Mask ventilation Two-person airway control Tracheal intubation Reintubate Chest compressions if HR
Resus of pre-term infants
Placed in a plastic bag or wrapped in plastic sheeting with exception of face
Use air/oxygen mixer to prevent excessive tissue oxygenation
What is erythema toxicum?
Neonatal urticaria
A common rash appearing at 2-3 days of age
Consisting of white pinpoint papules at the centre of an erythematous base
Fluid contains eosinophils
Mostly on the trunk - come and go at different sites
What is Mongolian blue spots
Blue/black macular discolouration at base of the spine and on buttocks
Usually but not invariably in Afro-Caribbean or Asian infants
Fade slowly over first few years
What is port-wine stain
Naevus flammeus
Due to vascular malformation of capillaries in dermis
Present from birth and usually grows with the infant
What can port-wine stain be associated with if in trigeminal nerve distribution?
Associated with intracranial vascular anomalies = Sturge-Weber syndrome
What are strawberry naevus?
Cavernous haemangioma
Not present at birth but appear in first month of life and may be multiple
More common in preterm
Development of strawberry naevus?
Increases in size until 3-15 months old
Then gradually regresses
Management of strawberry naevus
No treatment needed unless vision or airway are obstructed
Thrombocytopenia may occur with large lesions - therapy with systemic steroids or interferon-a may be required
Heart murmurs in newborn?
Most murmurs audible in first few days of life resolve shortly afterwards
Some are caused by congenital heart disease and if there is a significant murmur then investigation is needed
Vit K and newborn
Should be given to all newborns to prevent haemorrhagic disease of the newborn
At risk infants (mothers on anticonvulsant therapy) should be given IM
IM better than orally but controversial
What is screened for with the Guthrie test? x5
Phenylketonuria Hypothyroidism Haemoglobinopathies Cystic fibrosis MCAD deficiency
When is Guthrie done?
Day 5-9 of life when feeding has been established
How is cystic fibrosis detected?
Serum immunoreactive trypsin - raised if there is a pancreatic duct obstruction
What is hypoxic-ischaemic encephalopathy?
Brain damage following perinatal asphyxia and diminished brain tissue perfusion
Causes of hypoxic-ischaemic encephalopathy? x5
Failure of gas exchange across placenta
Interruption of umbilical blood flow (cord compression)
Inadequate maternal placental perfusion
Compromised fetus (anaemia, IUGR)
Failure of cardiorespiratory adaptation at birth
Clinical features of mild HIE x5
Irritable infant, responds excessively to stimulation
May have staring of eyes and hyperventilation
Impaired feeding
Moderate HIE features x3
Infant shows marked abnormalities of tone and movement
Cannot feed
May have seizures
Severe HIE features x4
No normal spontaneous movements or response to pain
Limb tone may fluctuate between hypotonia and hypertonia
Seizures prolonged and often refractory to treatment
Multi-organ failure
Management of HIE
Monitoring
Respiratory support
Electrolyte balance
Restrict fluids as transient renal impairment
Treat any seizures with anticonvulsants
(wrapping in cooling blanket may help reduce brain damage - induced mild hypothermia)
Prognosis of HIE
Mild can recovery completely
Moderate if recovery and neuro exam/feeding normal at 2 weeks then good prognosis, but if clinical abnormalities persist beyond 2 weeks - unlikely to improve
Severe = mortality of 30-40% and over 80% over survivors have neurodevelopmental disabilities
Severe consequence of HIE
Cerebral palsy
What is Chignon?
Oedema and bruising from Ventouse
What is Caput Succedaneum?
Birth injury causing bruising and oedema of presenting part extending beyond margins of skull bones
resolves in few days
What is Cephalhaematoma
Birth injury
Haematoma from bleeding below periosteum, confined within margins of skull sutures
Usually over parietal bone and centre feels soft
Resolves over several weeks
When do brachial nerve palsys occur in delivery
May occur at breech deliveries or with shoulder dystocia
Upper nerve root brachial plexus injury name and association
Erb Palsy
May also be associated with phrenic nerve injury causing elevated diaphragm
