Prematurity/Neonate Flashcards
When is baby prem?
Born before 37weeks gestation
Definition of chronic lung disease of prematurity
Need oxygen at 36weeks gestation.
Persistent hypoxia.
Also known as bronchopulmonary dysplasia.
Apnoea of prematurity
Unmyelinated brainstem before 34weeks gestations.
Often bradycardic too.
Rx = caffeine, NCPAP
Prevent with maternal antenatal corticosteroids.
APGAR score
Assessed at 1, 5 and 10mins of age.
Looks at baby heart rate, resp rate, muscle tone, colour, irritability reflex (cry).
Intraventricular haemorrhage
Preterms have unsupported blood vessels in subependymal germinal matrix = instability when blood pressure changes.
S+S = seizure, bulging fontanelle.
Can lead to cerebral palsy.
Retinopathy of prematurity
Retinal detachment and vision loss due to hyperoxia.
Abnormal fibrovascular and vascular proliferation.
Higher risk if supplement O2 causing fluctuating SpO2.
Screening!!
Rx = diode laser therapy.
Management of neonate sepsis
More common in preterms as less IgG transfer from placenta.
ABCDE
Blood culture
CXR
LP
Broad spec ABx e.g. Benzylpenicillin + gentamicin.
X-ray for NEC
Dilated bowel loops
Bowel wall oedema
Pneumatosis intestinalis
Riger sign = air inside and outwide bowel wall.
Air outlining falciform ligament (football)
portal venous gas
Pneumoperitonemum from perforation
Diseases associated with oesophageal atresia
Congenital malformations in VACTREL = Verebral, anorectal, cardiac, tracheo-oesophageal, renal and radial Limb.
Micronathia, displacement of tongue (posteriorly) and midline cleft in soft palate
Pierre Robin Sequence.
Hypoxic-ischaemic encephalopathy
- Brain injury secondary to low cerebral oxygen.
- Encephalopathy develops within 24hrs of birth.
- Causes can be antenatal intrapartum or postpartum (placenta abruption, cord prolapse, IUGR).
- Rx = resus due to resp distress, prevent Hyperthermia, treat seizures.
- Prognosis = if severe can have cerebral palsy, death, if mild complete recovery.
Clinical features of a septic preterm neonate
Labile temperature Poor feeding Respiratory distress Seizures Lethargy/drowsy Vomiting Abdo distension
Common organisms for neonate sepsis
GBS, Listeria, E.coli. if late consider S.aureus.
Hydrops fetalis
Can occur n rhesus haemolytic disease
Fluid collection in numerous compartments of fetus.
Perinatal HF
Causes of respiratory distress syndrome in preterms
Deficiency of surfactant
Clinical features of preterm resp distress syndrome
Tachypnoea over 60breaths/min
Increased work of breathing - chest wall recessions, nasal flaring.
Grunting
Cyanosis
CXR of preterm resp distress syndrome
Diffuse granulomar pattern (ground glass) +/- air bronchogram
Management of preterm resp distress syndrome
Oxygen May need to intubate Consider surfactant therapy Keep warm Fluids
Non-worrying low O2 sats
In first 5-10mins of life can have 85% O2 if active baby
What to check if continuing deterioration of preterm resp
DOPE Displaced ET tube Obstruction to airflow Pneumothorax Equipment failure
Periventricular leukomalacia pathophys
Injury to white matter surrounding ventricles leading to softening, necrosis and scarring.
Mostly due to intraventricular haemorrhage.
Can lead to cerebral palsy, learning difficulties, seizures.
Clinical features of a baby with rhesus haemolytic disease
Jaundice CCF = oedema Hypoalbuminaemia Anaemia Bleeding Yellow vernix Hepatospenomegaly Hydrops fetalis = sever oedema!
Maternal physiology in rhesus disease
Mother is RhD-ve. Maternal production of anti-D IgG antibodies on exposure to RhD +ve cross placenta(previous preg, miscarriage, amniocentesis).
Jaundice, yellow urine, pale stools. hepatosplenomegaly.
Biliary tree occlusion e.g biliary atresia.
Why are babies more susceptible to jaundice
RBC life span is short (70days) so more breakdown products.
High Hb at birth leads to physiological release of haemoglobin
Inefficient hepatic bilirubin conjugation in first few days of life.
Causes of jaundice if <24hrs old
ALWAYS ABNORMAL!!!!
Haemolytic disease (RhD, G6PD deficiency)
Congenital infection
Causes of jaundice if 24hrs-2weeks of age
Mostly normal = Breast milk jaundice
Infection (UTI)
Bruising (NAI)
Haemolysis (causes as for <24hrs)
Causes of jaundice if over 2 weeks of age
UNCONJUGATION = Hypothyroid Pyloric stenosis (GI obstruction) Haemolytic anaemia CONJUGATED = Bile duct obstruction NEC Hepatitis if over 3 weeks INVESTIGATE!
Rx for unconjugated
Phototherapy, exchange transfusion
Which is more worrying high conjugated or unconjugated
Unconjugated as can lead to kernicterus
Kernicterus
Acute bilirubin encephalopathy Lethargy Poor feeding Hypertonia Shrill cry Arch back = opisthotonus Seizures Yellow bilirubin staining in brain
Differentials for seriously unwell neonate
THE MISFITS T = Trauma/NAI (image brain) H = Heart disease E = Endocrine (CAH) M = Metabolic (DM, NA) I = Inborn error of metabolism S = Sepsis (GBS benpen + gentamicin) F = Formula mishaps I = Intestinal (NEC, malrotation) T = Toxin S = Seizure/CNS
Testing for autoimmune haemolytic diseases e.g. RhD
Direct Coombs test - look at RBC
Prenatal testing for risk fo RhD
Indirect Coombs test - IgG antibodies in plasma
Biliary atresia
Inflammation of biliary tree.
Hepatomegaly, pale stools, prolonged jaundice
High conjugated bilirubin
Surgical Rx
Reasons for biliary obstruction causing pale stools and jaundice
Conjugated bilirubin is soluble = travels out in urine making it dark but can’t be excreted in faeces making that pale.
General pathway of bilirubin metabolism
Haem form RBC haemoglobin forms unconjugated bilirubin in blood.
UCBili heads to liver with carrier protein where it is conjugated to make it water soluble.
Excretion via urine as urobilinogen or stools as stercobilinogen.
