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A3 ME3034 SPECIALTIES > W08 - PAEDS: Neonatology; Common Postnatal Issues & NNU > Flashcards

W08 - PAEDS: Neonatology; Common Postnatal Issues & NNU Flashcards

1
Q

Growth Related Problems in Utero

A

<2500g born too small
- small for gestational age
- intra-uterine growth restriction
- hypotrophy
- symmetric & asymmetric hypotrophy

<1500g = very low b/w
<1000g = extremely low b/w

<37w = preterm
<28w = extremely preterm

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2
Q

Reasons and Outcomes of being born small

A

Maternal:
- maternal pre-eclamptic toxemia => small for dates

Foetal:
- chromosmal: edward’s syndrome
- infection: CMV
- placental
- twin pregn.

  • USS OF BRAIN BY END OF 1ST W.
  • deterioration cognitive and behavioural between 2yo and 6yo
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3
Q

Learn about common problems of prematurity

A
  • perinatal hypoxia
  • hypos. glyc., therm.
  • polycythaemia
  • thrombocytoponeia
  • GI problems: feeds

LT:
- HT, reduced growth, obesity, ischemic heart disease

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4
Q

Respiratory Preterm Complications

A

1) RDS

> antenatal steroids
surfactant = wean off

> early. extubation
non-invasive support = N-CPAP
minimal ventilation

2) Bronchopulmonary dysplasia
> patience; nutrition & growth
> steroids

3) Apnoea / irreg. breathing / desats
> caffeine
> n-cpap

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5
Q

Neurological Preterm Complications

A

1) IVH = Intraventricular Hemorrhage in Premature Infants
* common limiting factor for good prognosis

gradeIV = 75% adverse outcome, intraparenchymal extension

> AN steroids
drainage

2) PVL = Periventricular leukomalacia
- cerebral palsy, 1-2yo presentation

> supportive, physio

3) posthemorrhagic hydrocephalus from prematurity

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6
Q

CVS Preterm Complication

A

1) PDA = LtoR shunt
- over-perfusion of lungs, lung edema. + systemic ischemia
=> retention and low renal perfusion, GI ischemia
acyanotic defect

> IE risk reduction
Cardiac catheterisation
NSAID = closure

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7
Q

GI Preterm Complication

A

1) Necrotising entero-colitis
ischemic, inflamm., necrosis of bowel
> abx and parenteral nutrition
>sx

2) NUTRITION
- patients triple in size during hospital stay with enormous nutritional input

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8
Q

CVS Development

A
  • development at the end of 3rd w
  • heart starts to beat at the beginning of the 4w
  • critical period of heart development is 20 to 50
  • ductus venosus =oxygenated blood
  • LV Ao = blood via the foramen ovale
  • pulm. artery - PDA
  • saturations in foetal body 60-70%
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9
Q

Normal vital signs of Full Term newborn

A

BP 70/44 - first hour
BP 70/42 - 1st d
BP 77/49 - 3rd day

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10
Q

Role of thermoregulation

A
  • Maternal in womb
  • Newborns lack shivering thermogenesis = metaabolic prod of heat
  • Brown fat innerv. sympathetic neurons
  • Cold stress = lipolysis and heat production
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11
Q

Assessing newborn breathing

A

Non invasive:
Blood gas determination
PaCO2 5-6 kPa, PaO2 8-12 kPa
Trans-cutaneous pCO2/O2 measurement

Invasive:
Capnography
Tidal volume 4-6 ml/kg
Minute ventilation:
Tidal Volume ml/kg x respiratory rate
Flow-volume loop.

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12
Q

Physiological Jaundice

A

Present from day2/3 will resolve
- risk of irreversible KERNICTERUS

> blue light therapy
exchange transfusion

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13
Q

Fluid Loss in premature infants

A
  • Increased Insensible Water Loss (IWL)
    Via immature skin and breathing
    Physiological IWL is 20-40 ml/kg/day but could be up to 82 ml/kg/day in 750-1000 g
  • Increased loss through kidney:
  • slower GFR
  • reduced Na reabs.
  • decreased ability to concentrate or dilute urine
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14
Q

Physiological anemia of newborn

A

By week 10, dropin Hb
* stimulate increased prod of EPO

  • may have reduced erythporesis dt premarutiy
  • infection
  • blood letting
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15
Q

Causes of neonatal jaundice and mgmt

A

1) 24hr
- hemolytic dt rh incompatibility, ab, hereditary anemias

2) 2nd day to 3rdw
- physiological
- dehydration
- breast milk
- sepsis
- polycythemia
- bruising
- hemolytic
- crigler najjar syndrome

3) Prolonged jaundice: 2w+
- breastmilk

> hydrate
phototherapy
exchange transfusion
immunoglobulin

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16
Q

Postnatal Skin Presentations

A

1) ERYTHEMA TOXICUM
- maculo-papular rash
- 30-70% of normal term
* self-resolves, no Rx.

2) MONGOLIAN BLUE SPOTS
* pigmentations: lower-back and buttocks

3) STORK MARKS / NAEVUS SIMPLEX: cap. vascular malformations
* back of neck or midline of face
* fades

4) PORT WINE STAIN / NAEVUS FLAMMEUS
flat or slightly raised, do not regress.

5) STRAWBERRY NAEVUS
*cluster of dilated capillaries

17
Q

Common Postnatal Issues

A

1) HYPOTHERMIA
> resus. and cold stress

2) HYPOGLC.
* jitters, temp instab.,lethargy, hypotonia, apnoea, poor feeding, vom., high pitched/weak cry, seizures

3) BILOUS VOMITING

4) RESP DISTRESS.
- grunting, retracts, nasal flaring = red flags for. resp distress
* sepsis
* TTN
* meconium aspiration

5) ABSENT FEMORAL PULSES = COARCTATION of AO

6) CLEFT LIP
* adjustment for feeding
* airway problems
+hearing screen, cardiac ECHO, trisomies

7) ABSENT RED REFLEX (EYES): lens opacification or retinoblastoma

18
Q

Spinal Dimples

A

dimples commonly found during newborn examination
* SPINA BIFIDA
+ hairy tuft

*SPINAL IMAGING

19
Q

Blood in nappy

A

normal
1) pseudomenstruation: from vagina d2-10
*drop off of oestrogen from birth

2). URATE CRYSTALS: behind on fluids

20
Q

CEPHALOHAEMATOMA

A

local. swelling of head, soft non-transluscent
* limits parietal bone
* haemorrage beneath pericranium

±hemolysis = neonatal jaundice

> SELF-RESOLVE 3-4w.

21
Q

TALIPES

A

medial varus
lateral. valgus
= deviation of foot

> physio
fixed manipulation, strapping, casting, or possible sx.

22
Q

DDH

A
  • barlow test, ortolani test

> relocate head offemur to acetabulum to ensure normal development
pavlik harness
sx reduction

23
Q

Trisomy 21

A

*dysmorphism
* hypotonia

*cardiac defects = ECHO screening
* thryoid = annual check
* haematological
* learning difficulties

24
Q

Mgmt of Sepsis in Neonate/Postnatal for Admission

A

Partial septic screen (FBC, CRP, blood cultures) and blood gas

Consider CXR, LP

IV penicillin and gentamicin 1st line
2nd line IV vancomycin and gentamicin
+ Add metronidazole if surgical/abdominal concerns

Fluid management and treat acidosis

Monitor vital signs and support respiratory and cardiovascular systems as required

25
Q

Commonest cause of neonatal sepsis

A

group b strep

e. coli

listeria

coag. neg staph

h. influenza

26
Q

Congenital Infection

A

TORCH
- toxoplasmosis
- other
- rubella
- CMV
- Herpes simplex virus

=> IUGR, brain calcifications, neurodevelopmental delay, visual impairment, recurrent infections

  • Maternal risk factors include lapsed immunizations, sexually transmitted infections, and animal exposures during pregnancy.
27
Q

TTN

A

transient tachypnoea of newborn
- self limiting, 1st few hours of life
- grunting, tachy.opnea, o2 req.

  • delay in clearance of fetal lung fluids

> supportive
abx
fluids
O2 support, airway support

28
Q

Cardiac Causes for Admission to NNU

A
  • cyanotic baby
    + sepsis
  • ?non-innocent humour

1) truncus art.
2) TGA
3) tricuspid atresia
4) ToFallot
5) TAPVD

29
Q

Admission of hypoglc. and mgmt in NNU

A

> IV glc.
central IV access

> fluids
glucagon
hydrocortisone

30
Q

Hypothermia mgmt in NNU

A

> place in incubator

> sepsis screen + abx

> thryoid funct?

> monitor blood glc.

31
Q

Approach to Birth Asphyxia

A

> Therapeutic hypothermia via cooling

> Treat seizures

> Fluid restriction to prevent oedema (encephalopathy)

  • risk of Hypoxic Ischaemic encephalopathy
32
Q

Failure to. pass stool

A
  • meconium-caused
  • plug
  • meconium ileus = ?CF
  • large bowel atresia
  • imperforate anys ±fistula
33
Q

Neonatal Abstinence Syndrome

A

Withdrawal from physically addictive substances taken by the mother in pregnancy

  • finnegans score
  • urine toxicology

> comfort
morphine
phenobarbitone

A3 ME3034 SPECIALTIES (27 decks)

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