Problems in the neonate Flashcards
Meconium aspiration - X ray feature
Patchy lung fields
PPHN - definition
Persistent foetal circulation after birth
- the baby continues to shunt blood from RA -> LA
- blood crosses from the pulmonary artery -> descending part of the aortic arch via persistent patent ductus arteriosus
PPHN - the majority of the blood in the systemic circulation is OXYGENATED. True or false?
False
- de-oxygenated
PPHN - clinical features
Decreased O2 sats
- O2 sats of foot will be lower than O2 sats in baby hand
PPHN - management
Ventilation Oxygen Nitric oxide - vasodilator Sedation Inotropes - force more blood to circulate to the lungs
Patent ductus arteriosus - definition
When the ductus arteriosus persists. It should close within 2 hours post delivery due to the drop in pulmonary arterial pressure after birth (meaning its easier for blood to move into the pulmonary circulation).
What happens to the circulation if there is a patent ductus arteriosus after birth?
`the pulmonary pressure will stay high ad blood will bypass the pulmonary circulation
Hypothermia - who is at highest risk
Pre term babies
- low brown fat and subcutaneous fat stores
Hypothermia - management
Put a hat on baby Skin to skin contact Blanket/clothes Transwarmer mattress Prewarmed incubator Put baby in a bag
Early onset sepsis - causative organisms
Group B strep
Gram -ves
Late onset sepsis - causative organisms
Coagulase -ve staph
Gram -ves
Staph aureus
Physiological jaundice - definition
Breakdown of foetal haemoglobin
Normal from day 2-14
Pathological jaundice
Jaundice that occurs before day 2 or after day 14
Management of pathological jaundice ?
Blue light therapy
Respiratory distress syndrome - clinical features
Tachypnoea Grunting Intercostal recession Nasal flaring Cyanosis
Respiratory distress syndrome - investigations
CXR - ground glass appearance
Respiratory distress syndrome - management
Maternal steroids - increases surfactant production
Foetal alcohol syndrome - clinical features
Small eye openings Flat mid face Upturned nose Smooth philtrum Thin upper lip
Which babies tend to get a retinopathy?
Premature babies
Most common antenatal infection
CMV
Most common perinatal infection
Group B strep
Post natal infection causes
Could be anything in the external environment
How long does the neonatal phase last?
First 4 weeks of life
Necrotising enterocolitis (NEC) - definition
Sick gut
Where tissues in the intestine become inflamed and start to die. This can lead to a hole developing which allows the contents of the intestine to leak out to the abdomen, causing dangerous infection
NEC - who gets it
Premature baby
NEC - clinical features
Swollen/tender abdomen
General signs of illness
Problems with feeding/vomiting
NEC - investigations
Abdo XR
- bowel wall gets leaky and gas starts to move out to the bowel wall
- wrigglers sign
NEC - management
NG tube insertion to drain contents from stomach
Must have surgery if perforation occurs
What are the 3 ways of an obstruction occurring?
Something gets stuck in the lumen
Something on the outside of the lumen pushing in
Something in the bowel wall
What type of obstruction is meconium ileus?
Intraluminal obstruction
2 day old baby who is feeding ok but vomiting. The baby has not yet pooed. On examination there is a distended abdomen which feels doughy. What is the likely diagnosis?
Meconium ileus
Which condition is meconium ileus associated with?
Cystic fibrosis
Malrotation - definition
The gut is sitting in the wrong orientation
Volvulus - definition
The gut twists around on itself and this cuts off the blood supply
Malroatation - clinical features
Baby vomiting green bile
Malrotation - investigations
Upper GI water soluble x-ray
Malrotation - management
Emergency surgery
If there is a high obstruction there will be lots/little laddering?
little
If there is a low obstruction, there will be lots/little laddering?
Lots
Tetralogy of fallot commonly presents within the first few days of life. True or false?
False
- usually infant hood or even adulthood
Tetralogy of fallot - which murmur is it associated with?
Pulmonary stenosis
Transposition of the great arteries - where does the aorta and pulmonary artery come off?
Aorta - comes off right ventricle
Pulmonary artery - comes off left ventricle
When does transposition of the great arteries present?
Around 48 hours after birth
- when the ductus arteriosus closes
