The Neonate Flashcards
1
Q
How do you recognise the sick neonate?
A
- poor feeding
- dry nappies
- not passed mec
- appears jaundiced
- temp lower than 36 degrees
- temp higher than 37.5 degrees
- high resp rate/grunting when breathing
- high or low HR
- low o2 sats
- less active, less responsive or more irritable than usual
- bulging or depressed fontanelle
2
Q
How is temperature regulated in the neonate?
A
- temperature control is emulated by the hypothalamus, it is matured by 35 wks
- normal core temp of 36.5 degrees is the temperature where heat production and loss should be balanced
- babies have a large surface area to body area through which to lose heat -> this can be compounded by thin skin and a lack of brown adipose tissue (especially in pre term infants)
3
Q
Why is thermoregulation more important in the pre term neonate?
A
- they have immature/absent thermoregulatory mechanisms
- larger surface to body area
- immature thin skin
- reduced/absent brown adipose tissue
- limited ability to move and shiver to preserve heat
4
Q
How is heat lost in the neonate?
A
- hyperthermia is defined as a temp below 36.5 degrees
- conduction -> direct heat loss to solid surfaces
- convection -> heat loss to currents of air
- evaporation -> heat lose when water evaporates from the skin
- radiation -> heat loss via electro magnetic waves from skin to surrounding surfaces
5
Q
What are some of the effects of hypothermia?
A
- increased energy expenditure - if prolonged can lead to hypoglycaemia and slow weight gain
- reduced surfactant production and increased oxygen consumption exacerbating any existing respiratory distress
- babies may subsequently develop pulmonary hypertension and metabolic acidosis
- the risk of these are increased in the sick neonate
6
Q
How can hypothermia be prevented?
A
- maintain a thermo-neutral environment
- skin to skin contact
- hot cots/radiant warmers
7
Q
How is glucose metabolised in the neonate?
A
- glucose provides about 80% of the energy available to the fetus before birth, diffuses across placenta from mother
- glycogen stored in the liver during pregnancy provides glucose during labour and early postnatal period
8
Q
What is hypoglycaemia?
A
- for symptomatic babies blood glucose should be maintained >2.5mmol/l
- for babies deemed ‘at risk’ but asymptomatic blood glucose should be actively managed if <2 mmol/l
- blood glucose levels fall immediately after delivery and are at the lowest approx 1 hour after delivery
- after 2-3 hours levels begin to rise and usually stabilises by about 24 hours of age
- blood glucose levels after this time are generally dependent on feeding
9
Q
What are some of the risk factors for hypoglycaemia?
A
- sepsis
- hypothermia
- prematurity
- IUGR
- SGA
- LGA
- maternal diabetes
- maternal medication such as beta blockers
- hypoxic ischaemic encephalopathy
10
Q
What are some of the symptoms of hypoglycaemia?
A
- jitteriness
- high pitched cry
- seizures - extreme
- poor feeding
- drowsiness
- lethargy
- apnoea - extreme
- however, most will be asymptomatic
11
Q
How can hypoglycaemia be prevented?
A
- skin to skin
- early feeding
- monitoring blood glucose
12
Q
What is neonatal jaundice?
A
- jaundice is the yellow colouration of the skin and sclera resulting in an accumulation of bilirubin in the blood
- in most infants this is part of normal transition to ex utero life but in some infants the rise is excessive and can be harmful
- very high levels of jaundice can be neurotoxic, leading to death or long term disability
- prolonged jaundice can be an indication of underlying pathology and requires investigation
13
Q
How is bilirubin metabolised in the neonate?
A
- it is produced during the normal breakdown of red blood cells
- neonates have more red blood cells in their bodies and the cell life span is shorter therefore they produce more bilirubin
- neonates liver is immature and so not able to break down all the bilirubin and so levels in the blood rises
- as the liver matures it becomes better able to break down bilirubin so that it can be excreted from the body
14
Q
What are the two different types of jaundice?
A
- physiological
—> usually occurs >24 hours age typically around 3 days
—> often doesn’t require treatment
—> should resolve within 2 weeks
—> not normally associated with underlying disease - pathological
—> usually presents within 24 hours of age
—> persists beyond 2 weeks of age
—> pale stools/dark urine
—> often associated with underlying disease
15
Q
What are some of the causes and risk factors of neonatal jaundice?
A
- breastfeeding - in the first few days of life whilst mothers’ milk supply becomes established
- previous sibling with jaundice requiring phototherapy
- significant bruising
- East Asian ethnicity
- prematurity
- infection
- ABO or other blood incompatibilities
- Rhesus iso-immunisation
- liver abnormalities
- red cell abnormalities resulting in blood cells breaking down more quickly/more red blood cells
