the newborn Flashcards
what are some signs of respiratory distress in a newborn?
tachypnoea >60breaths per minute
central cyanosis - babies should be PINK not BLUE
increased WOB
noisy breathing
what are some causes of respiratory distress in a TERM newborn?
- pneumonia (most severe)
- wet lung/ transient tachypnoea of newborn
- meconium aspiration
- chronic heart disease
- space occupying lesions
when should we expect a newborn to pass urine/meconium post birth?
All newborn infants should pass urine within 24 hours and meconium within 48 hours.
what is the main role of the guthrie heel prick test and when is it performed?
To pick up congenital metabolic disorders
such as CF, PKU and congenital hypothyroidism (TSH)
performed usually from day 3-5 post birth
what is the point of doing an agpar score and when do we do it? what score is normal?
Seeing how well the newborn adapts to extrauterine environment.
performed at 1min and 5min post delivery. Agpar score of 8-10 is normal.
why do we give newborns vitamin K injection?
Without enough vitamin K a baby is at risk of developing a rare disorder called Vitamin K Deficiency Bleeding or VKDB, which can cause them to bleed into their brain. This condition can also lead to death.
when do we do a full newborn exam?
day 3 post delivery
what is the medical name for tongue tie?
ankyloglossia
what imaging might we need to ix neonatal encephalopathy?
cranial ultrasound, MRI and EEG.
what are common causes of hypoxic ischaemic encephalopathy of the newborn?
cord prolapse
placental abruption
what is the mainstay treatment of hypoxic ischaemic encephalopathy of the newborn?
Whole body hypothermia (33 to 34°C) for up to 72 hours is used in the neonatal intensive care setting as a key treatment of moderate or severe HIE. The time-critical period to commence treatment is in the first 6 hours, hence recognition (and if not already, transfer to a tertiary setting) is important.
what are some causes of seizures in the newborn?
Hypoxic-ischaemic encephalopathy Metabolic imbalance: hypoglycaemia, hypocalcaemia, hyponatraemia, hypomagnesaemia Infection: meningitis and encephalitis Anatomical brain abnormalities Intracranial haemorrhage Inherited metabolic disorders Neonatal drug withdrawal
tell me about breastfeeding jaundice?
Breast milk jaundice is a prolonged unconjugated hyperbilirubinaemia common in breastfed babies.
The jaundice peaks in the second week but resolves only very slowly and may last up to 3 months
The infant is healthy and thriving.
Breast milk jaundice is thought to be due to factors in breast milk that cause increased enteric absorption of bilirubin.
what do you think if you see a newborn with persistent drooling after birth?
oesophageal atresia
how might we manage neonates at risk of hypoglycaemia? when do they go to the special care nursery?
Admit to special care nursery if born from a mother with poorly controlled diabetes, birthweight less than 2500 or macrosomia or signs of illness (e.g. resp distress)
feed within 1 hr post delivery and monitor BSLs.
feed every 4 hourly
BSL less than 2.6= hypoglycaemia
Other options include administering buccal glucose gel if hypoglycaemia present or IV dextrose
what might you think if a newborn suddenly vomits red blood?
usually the blood is actually maternal blood swallowed during delivery
what are the four criteria for ordering a follow up u/s at 6 weeks post birth to check for DDH?
oligohydramnios
breech
FMH of DDH
multiples/packaging issues during pregnancy
what is the risk of deep suction in managing meconium aspiration syndrome?
can cause bradycardia because of increased vagal tone –> airway obstruction
during neonatal resuscitation, what is the HR we are aiming for?
> 100bpm
what are some causes of neonatal seizures?
neonatal stroke
hypoxic ischaemic encephalopathy secondary to metabolic/apnoea etc
what are some causes for prolonged jaundice in newborn?
biliary atresia
breastmilk jaundice, sepsis, dehydration
describe the process and principles of neonatal resuscitation
- Start the clock. Is the baby term or preterm? What is its Apgar score? Is it breathing/crying/has good tone? –> if yes then dry and thermoregulate–> hand to the mother
- If no, dry and stimulate the baby and open the airway. Assess the HR. Is it below 100bpm?
- If HR is less than 100bpm, commence saturation O2 monitoring and positive pressure ventilation or CPAP. Ensure good seal.
- Is the HR still less than 100bpm? If so reduce leaks, consider 2 person ventilation +/- increase O2 concentration +/- intubation
- Is the HR below 60bpm? Commence 3 chest compressions (3:1) to 1 breath. Gain venous access.
- Is the HR still below 60bpm? Consider using adrenaline +/- O neg blood or fluids for volume expansion
IV adrenaline should be used if HR is less than 60bpm and has failed adequate ventilation and chest compression
how might we assess whether the ventilation is adequate during neonatal resuscitation?
• Improvement in HR
• Chest wall movement
Improvement in O2 sats
what are some practice points of suctioning a neonate post delivery?
- If there is evidence of meconium stained liquor, consider suction
- Suctioning is never routine however
- Suctioning should only be used if the baby shows signs of obstruction.
Suctioning especially deep suction past the vocal cords can only be performed by a trained and experienced neonatalogist.
what is the antibiotic treatment of early onset sepsis in a newborn?
benzylpenicillin
gentamicin
what is the antibiotic treatment of necrotising enterocolitis?
amoxicillin, gentamicin, metronidazole
what are the causes of gastrointestinal obstruction causing bilious vomiting in a newborn?
malrotation and volvulus duodenal atresia (if obstruction distal to Ampulla of Vater 80 per cent of cases) jejunoileal atresia meconium ileus meconium plug syndrome (18 per cent) Hirschsprung’s disease (8 per cent).
