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Sugar & Safe care Flashcards

1
Q

What method to work out cm do you secure at?

A

Add 6 to the infant’s weight in kg

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2
Q

Do we give oral or enteral feeds to sick infants? Why / Why not (4)

A

No. Increased risk of aspiration. 4 main reasons not to feed >

  1. Pre-term infants with laboured resp. have poor coordination and sucking / swallowing/breathing
  2. Illness including infection - can lead to abdominal distention and delayed gastric emptying
  3. When an infant has low oxygen levels or low BP > intestinal blood flow may be reduced and this can make the intestines susceptible to ischemic injury (bowel needs time)
  4. Bowel obstruction - then becomes a high risk for aspiration. need to decompress first
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3
Q

Causes of bowel obstructions (3)

A
  1. Atresis (narrowing) ANYWHERE in the gastro. tract
  2. Malrotation with volvulus (twisting of the stomach)
  3. Function causes e.g. hirschsprugs disease, mec. plug or meconium ileus
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4
Q

What is Hirschsprugs disease?

A

Connected to nerve function of the rectum and being underdeveloped = can cause bowel blockage

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5
Q

What should we be worried about if the mother has polyhydramnios?

A

(excess amniotic fluid in the sac) = can cause bowel obstruction

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6
Q

What might be wrong if the infant is coughing / choking with feeds/drooling>?

A

esophageal atresia or tracheoesophageal fistula (TEF)

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7
Q

Explain why a malrotation with a midgut volvulus might occur.

A

In early fetal life 6-12 weeks gest. the elongating intestine rotates and returns to the abdominal cavity. Sometimes this can fail causing a malrotation. This cuts off the mesenteric artery blood supply.

  • common in first few week of life
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8
Q

What is bilious emesis

A

Green-coloured vomit - a sign of bowel obstruction

Tests - bloods , abdo x-ray

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9
Q

Best IV sites?

A

Peripheral hand, foot or scalp

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10
Q

UVC uses

A

IV fluids and meds - up to 1 week post birth

  • low lying can be used for emergency glucose infusion + fluids
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11
Q

Glucose supply to the organs in neonates

A

Need to stabilise sick infants with IVF with Glucose

> The liver, skeletal, muscle and heart can store glucose. BUT the BRAIN can not !

The brain can not store adequate amounts of glucose in the form of glycogen and thus needs a steady supply of glucose to function normally

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12
Q

Main reasons (6) infants are at an increased risk of hypoglycemia

A
  1. less than 37 w
  2. SGA
  3. LGA
  4. Diabetic mother
  5. stressed
  6. sick
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13
Q

Medication for mothers that affect - hypoglycemia in the neonate

A

Beta-sympathomimetics (pre-term labour)
Sulfonylureas (T2DM)
Beta Blockers
Thiazide diuretic
Antidepressants Tricyclic

  • material hyperglycemia leads to fetal pancreatic beta cell stimulation and increased insulin secretion
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14
Q

The impact of giving material dex IV in labour on the neonate

A

Glucose crosses the placenta and causes increased fetal insulin secretion

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15
Q

Extrauterine life and the glucose stability of the neonate - pathophys.

A

The fetus stores glucose in the form of glycogen. The fetus cannot convert glycogen to glucose and relies primarily on a placental transfer of glucose and amino acids to meet energy demands.

When the cord is cut the infant no longer receives glucose from the mother.

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16
Q

3 main factors that negatively impact blood glucose after birth

A
  1. Inadequate glycogen stores and decreased glucose production
  2. Hyperinsulinemia, which suppresses glucose production and increases glucose utilization
  3. Increased glucose utilization
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17
Q

In pre-term infants where is glycogen stored?

A

In the liver/heart/lugs and skeletal muscle

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18
Q

What gest. is considered metabolically and physiologically immature

A

before 37 weeks

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19
Q

Small gestational age infants (SGA) definition

A

Birth weight below the 10th percentile for their GA

20
Q

“Fetal” - small gestational age risk factors

A
  • Genetic abnormalities
  • Chromosomal abnormalities
  • Syndromes
  • Metabolic disorders
  • Intrauterine viral infections e.g cytomegalovirus, rubella, syphilis, varicella
  • Multiple gest.
21
Q

“Material” - small gestational age risk factors

A
  • Poor nutritional status
  • Drugs
  • Chronic illness
  • Prescription meds.
  • Genetic factors
22
Q

What does HbA1C show

A

Overall glucose control

23
Q

What happens when a fetus is stressed re-glucose

A

It may use most, if not all the stores of the placentally transferred glucose for growth and survival

> then limits its ability to store or make glycogen after birth

24
Q

% risk of IUGR Babies being hypoglycemic

A

Term infants - 25% chance
Pre term - “higher”

25
Symmetric growth restriction (Symmetric SGR)
LOWER weight, length and head circumference for their gestational age Caused by - intrauterine viral infection in early gestation, a long-standing material disease with placental growth restriction through mots of pregnancy or genetic causes
26
Intrauterine Growth Restriction (IUGR)
Infants who have altered fetal growth, especially in the third trimester when lipid accumulation is greatest and growth is rapid. - Can see on second-semester U/S
27
IUGR vs SGA
NOT the same thing IUGR > asymmetric growth restriction. There weight will be low for GA and some impact on length But not head / brain like SGA
28
Glucose and insulin transfer during pregnancy * Infant of an IDM mum
The only source of glucose available to the fetus is transferred from the placenta. This is typically 70-80 % of the mother's glucose level, as some is used in the placenta itself. > However insulin does not cross the placenta! Thus, when the cord is cut the insulin levels can remain high (can take several days to come down) = hypoglycemia May need IV dex to maintain blood sugars
29
LGA babies - define
Greater than 90% percentile. causes - ethnic, genetic, high BGl during preg, PCOS
30
Hyperinsulinemia
If the infant is a LGA and hyperinsulinemic the BGL may fall rapidly when the umbi cord is cut. > BGL 1-2 hours post birth, then 1-3 hours until settled * indeal prior to feed
31
What is considered macrosomic
over 4 kg Birth complications > shoulder dystocia, brachial plexus injury, fractures
32
VBG of an anaerobic metabolism
Metabolic acidosis Low bicarb Worsening base deficit
33
Aerobic and Anaerobic link to glucose
Under aerobic conditions the oxygen in the blood is sufficient to satisfy the tissue needs, glucose is then metabolised into energy. However when infants are hypoxic - rely on anaerobic glycolysis for energy production. WHICH is very inefficient. > large quantities of glucose are consumed for low yield of study. usually only minutes of energy to sustain cellular function
34
Glucose monitoring in infants
"gold standard" is the plasma glucose level (sent to lab) Bed side glucose may also be 10-18% lower then plasma
35
Signs and symptoms of a hypoglycemic infant General / Neurologic / Cardioresp.
General - Abnormal cry (high pitched) - Poor feeding - hypothermic - Diaphoresis Neologic signs - Tremors - jitters - irritable - hypotonic - lethergy - seziures Cardioresp. - Tachypnea - Apnea - cyanosis
36
Recommended BGL
2.8 - 6.1 mmol/L
37
What is carbs for babies
BF, Formula > IV dex if can not feed
38
Initial IVF and Rate in a sick infant
10% dec without electrolytes @ 80 ml / kg / day - this matches the liver glucose production rate in healthy newborns * if over 24 hours , my need electrolytes
39
IVF Bolous for a sick neonate, what would you give ??
Dex 10% 2 ml / kg Infusion @ 1 ml per minute This should be given if the BGL is less then 2.8
40
Evaluate the BGL within 15-30 minutes of >
Commencing a bolus Starting an infusion An infant with a low BGL
41
What is the highest level of peripheral IV dex that can be given
D12.5 W Then may need a central line
42
Heparin dose of UVC, UAC
0.5 - 1 unit of heparin per ml of fluid
43
High blood sugar > what does this mean
Above 6.9 and not decreasing may be secondary to glucose intolerance or as a stress response. - immature endocrine system - need review - could try IVF high rate with decreased dex
44
What size IO
18G , can give bloods, meds, fluids
45
UVC - indications ?
rapid access, more than one IV line is needed, emergency fluids/meds, if need to give over 12.5% dex * can also be used for exchange transfusion + vasopressors
46
What to watch for in ART lines
Arterial spasms or development of emboli from clots. > Signs of impaired perfusion; white / blue / black discolouration on the skin , back, feet or toes, abdomen or back Radial > same changes in hands / fingers + skin temp
47
How much blood should you need from an ART line draw?
1-3 mls

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