Week 5 Flashcards
What are the 3 shunts found in foetal circulation?
What does this mean for oxygenation of blood?
Ductus venosus
Ductus arteriosus
Foramen ovale
These shunts mean that blood doesn’t travel to the lungs for oxygenation
At how many weeks gestation are the following lung developmental phases?
- pseudoglandular
- canalicular
- saccular
- alveolar
At what point does surfactant production begin?
Pseudoglandular - 3 weeks
Canalicular - 16 weeks
Saccular - 24 weeks
Alveolar - 36 weeks
Surfactant is produced from the saccular stage onwards (i.e. from 24 weeks)
What are some of the preparations made by the foetus in the 3rd trimester for delivery?
Production of surfactant
Accumulation of glycogen in the liver, muscles and heart
Accumulation of brown fat between the scapulae and around internal organs
Accumulation of subcutaneous fat
Swallowing of amniotic fluid
Describe what happens to a baby within the first few seconds of birth
Initially blue, then starts to breathe
Cries, which increases intrathoracic pressure and pushes fluid out of the air spaces in the lungs and into the interstitial tissues
Baby gradually goes pink as O2 sats go up to about 90% within the first 10 mins of life
Cord is then cut after 1-2 mins, too soon and the baby may become hypovolaemic/anaemic (more of a problem in pre-term babies)
What various changes occur in foetal circulation as it transitions to post-birth?
Pulmonary vascular resistance drops
Systemic vascular resistance rises
Oxygen tension rises
Circulating prostaglandins drop (due to removal of the placenta)
Ducts constrict and the foramen ovale closes
How is the ductus arteriosus closed at birth?
O2 is typically a potent vasodilator, however in the ducts it is a potent vasoconstrictor - as respiration begins this causes closure
Removal of the placenta (a v. low resistance organ) causes systemic resistance to rise, and blood to flow to the lungs where previously it hadn’t
The placenta also produces prostaglandins, specifically prostaglandin E2 to keep the DA open. Upon removal of the placenta, this removes the amounts of prostaglandins in the circulation and causes constriction of the ducts.
How can a patent ductus arteriosus be managed?
Conservative - watchful waiting to see if the duct closes itself
Medically - prostaglandin inhibitors may be given (either indomethacin or ibuprofen)
Surgically
What happens to the 3 shunts following changes in systemic circulation at birth?
Foramen ovale - closes, or remains patent in 10% of cases
Ductus arteriosus - becomes the ligamentum arteriosus, or may remain patent
Ductus venosus - becomes the ligamentum teres on the liver
What condition arises if normal circulatory transition fails?
What are the features of this condition?
Persistent pulmonary hypertension of the Newborn (PPHN)
Pulmonary hypertension, causing hypoxaemia (metabolic acidosis) secondary to a right-to-left shunting of blood at the foramen ovale and ductus arteriosus
How is PPHN managed?
Ventilation
Oxygen (babies tend to be resuscitated with normal air, not O2)
Nitric oxide (very potent vasodilator), works in a lot of babies, depending on the aetiology
Sedation
Inotropes - milrinone, vasodilator
Extra-corporeal life support (ECLS) - ECMO requires anticoagulants so has risks of clotting. This is a very specialised treatment
Why are newborn babies at risk of being too cold?
Large surface area in relation to their body weight + wet when born
Heat loss occurs by…
- babies being unable to shiver
- main source of heat production is non-shivering thermogenesis, which is inefficient in the first 12 hours of life
- peripheral vasoconstriction
Which babies are at greater risk of developing hypothermia?
How is this risk managed in post-natal care?
Small for dates/pre-term babies are at greater risk, but all babies need help to maintain their temperature
Smaller/pre-term babies have low stores of brown fat, little sub. cut. fat and a large surface area:volume
Hypothermia is managed with…
- drying the baby as soon as it is born
- dressing them in a hat and blanket/clothes
- skin-to-skin contact with mum as soon as possible
- heated mattresses
- incubators
How might a newborn baby develop hypoglycaemia?
Increased energy demands
- if unwell
- hypothermia
Low glycogen stores
- small
- premature
Inappopriate insulin:glucagon ratios
- maternal diabetes
- hyperinsulinism
Some drugs
- e.g. labetalol (used to treat high maternal blood pressure)
If left untreated, how might hypoglycaemia affect a newborn? How is this avoided/treated?
Inappropriately high insulin shuts off ketone production, which can result in brain damage in babies
Managed by…
- identifying high risk babies
- feeding effectively
- keeping babies warm
- monitoring carefully
How does a baby’s sucking affect the mother’s hypothalamus?
Creates a positive feedback loop
Post. pituitary releases oxytocin which causes milk ejection
Ant. pituitary releases prolactin which causes milk production
Describe the change in haemoglobin from neonate to adult. How might this lead to anaemia?
What chromosome is responsible for the different subunits of Hb?
Foetal haemoglobin is made up of alpha and gamma subunits
Adult haemoglobin is made up of alpha and beta subunits
At birth, synthesis of foetal haemoglobin ceases, however adult haemoglobin is made slower than foetal haemoglobin is broken down, which can result in physiological anaemia as well as physiological jaundice
Beta and gamma subunits are synthesised on chromosome 11
For how long should folic acid be taken at pregnancy?
400 micrograms daily for 3 months prior to conception, and also the first 3 months of pregnancy
What point of a pregnancy is there the greatest amount of teratogenic risk?
1st trimester, especially weeks 4-11
1st trimester is when organogenesis takes place, and if possible all drugs should be avoided unless maternal benefit outweighs the risk
Name some known teratogenic drugs. How do they affect the foetus?
ACE inhibitors/ARBs - cause renal hypoplasia
Androgens - can cause virilisation of female foetus
Antiepileptics - can cause cardiac, facial, limb and neural tube defects
Cyotoxics (e.g. chemo) - multiple defects, abortions
Lithium - cardiovascular defects
Methotrexate - skeletal defects
Retinoids (used for acne, similar to Vit. A) - ear, cardiovascular and skeletal defects
Warfarin - limb and facial defects
How might some drugs affect outcomes around term? Examples (think labour and baby after delivery)?
Adverse effects on labour
- adaptation of foetal circulation may be affected by NSAIDs resulting in premature closure of ducts
- suppression of foetal systems e.g. opiates causing respiratory depression
- bleeding e.g. caused by warfarin
Adverse effects on baby after delivery
- withdrawal symptoms e.g. caused by SSRIs and opiates
- sedation
What drug, when taken by mothers to prevent recurrent miscarriage (didn’t work), resulted in their children developing urogenital malignancies?
Diethylstilbestrol a.k.a. desplex
What antiepileptic drugs should be avoided in pregnancy?
Is it worth treating epileptic women while pregnant?
Avoid phenytoin and valproate
YES! Benefits of treating outweigh the risks in most cases, there is a 20-30% risk of congenital malformations if on 4 drugs, so monotherapy is preferred and be sure to give folic acid as well
Which antihypertensive agents are used in pregnancy?
Which ones should be avoided?
Older antihypertensives, as more is known about their effect in pregnancy
Labetalol
Methyldopa
(Nifedipine - not ideal, reserve for patients that don’t tolerate the above)
Avoid ACE inhibitors, ARBs and antidiuretics. Beta blockers may also inhibit foetal growth in late pregnancy
What medications should be used for the following acute problems?
- nausea and vomiting
- UTI
- Pain
- Heartburn
N+V - Cyclizine is safest
UTI - nitrofurantoin, cefalexin, or if 3rd trimester use trimethoprim
Pain - paracetamol
Heartburn - antacids
In breast milk, foremilk is higher in ____, while hindmilk is higher in ____
Foremilk is higher in protein
Hindmilk has a higher fat content
What drugs might be unsafe in breastfeeding?
Phenobarbitone - causes suckling difficulties
Amiodarone - can cause neonatal hypothyroidism
Cytotoxics - causes bone marrow suppression
BZDs - causes drowsiness
Bromocriptine - suppresses lactation
This drug causes teeth staining in children
Tetracyclines
This drug can cause spina bifida and anencephaly
Sodium valproate
This drug can cause cleft palates/lips
Phenytoin
What is considered a normal weight range for a newborn baby?
‘Normal’ = 2.5 - 4kg
Over 4kg = large for gestational age (LGA)
Under 2.5kg = small for gestational age (SMA)
What is the Apgar score? What score is considered normal?
Used post-birth as an objective measure of perinatal adaptation
Score is given out of 10 in the categories of… (0, 1 or 2)
- Heart rate
- Resp rate
- Responsiveness
- Tone
- Colour
Normal = 8 or more
What infections might a newborn be at risk of, based on maternal history?
Hepatitis B
Hepatitis C
HIV
Syphilis
TB
Group B Strep
What vitamin deficiency is the cause for Haemorrhagic Disease of the Newborn? (and subsequently, replacement is the treatment)
Vitamin K
Name some conditions that are screened for in newborn babies
How is this done?
Newborn examination checks immediately after birth
Universal hearing screening
Hip screening - both clinical and USS
Guthrie blood-spotting card
- CF
- Haemoglobinopathies
- Hypothyroidism
- Various metabolic diseases (PKU, maple syrup urine disease, isovaleric acidaemia etc.)
Define the terms “term” and “post-term”
Term - after 37 weeks of gestation are complete
Post-term - after 41 weeks of gestation are complete
What tissue type is largely accumulated in the 3rd trimester that aids the neonate immediately after birth?
How does this differ at a) 28 weeks and b) at term?
Fat is accumulated in the third trimester, with a gain of approximately 7g of fat in the final 4 weeks of gestation
At 28 weeks, an average male will have a body fat % of 3.5%
At term, an average male will have a body fat % of 15%
This is relevent in the case of pre-term infants
T/F - a baby must be regularly fed within the first 24 hours after birth
False - allow babies to feed when they want, they will use brown fat as their main energy source initially
How might a mother become infected with hepatitis B? How can transmission to her baby be prevented?
Hepatitis B infection via blood transfusions, IVDU or sex
Transmission can be prevented via immediate vaccination after birth (if mother is infected, otherwise vaccine is typically done at 2 months), or via immunoglobulins
Name some swellings that may develop in a baby’s head as a result of Ventouse/forceps delivery
Cephalhaematoma - well demarcated swelling (blood) between the epicranial aponeurosis and the periosteum. Spread is stopped by suture lines. May cause anaemia (left image)
Caput Succedaneum - more diffuse swelling (right image)
When screening the neonate, what features are inspected for in the eyes?
Size
Presence of red reflex (absence could indicate retinoblastoma)
Conjunctival haemorrhage
Squints (common, tend not to require intervention)
Iris abnormalities
When screening the neonate, what features are inspected for in the ears?
Position
Is there an external auditory canal present?
Tags/pits
Folding
Is there a family history of hearing loss?
When screening the neonate, what features are inspected for in the mouth?
Shape
Philtrum
Palate
Tongue tie
Neonatal teeth
Sucking reflex
When screening the neonate, what is looked for when assessing respiratory and cardiovascular functions?
Respiratory
- Chest shape
- Nasal flaring
- Sternal/Interncostal recessions
- Tracheal tug
- Grunting
- Tachynpnoea
- Breath sounds
Cardiovascular
- Colour of the baby
- O2 saturations
- Palpation of the femoral pulse - irregularities could indicate coarctation of the aorta
- Palpation of the apex beats and heaves/thrills
- Heart sounds
When screening the neonate, what is looked for when assessing the abdomen?
Does it move with respiration?
Is there distension?
Presence of hernias?
Assess the umbilicus
Has there been bile-stained vomit?
Has there been passage of meconium?
Assess the anus
When screening the neonate, what is looked for when assessing the genitourinary system?
Normal passage of urine?
Normal external genitalia?
Are there undescended testes?
Is there evidence of hypospadias?
When screening the neonate, what is looked for when assessing the muskuloskeletal system?
Movement and posture
Limbs and digits
Spine and hip examination (may indicate, for example, spina bifida or need for a Pavlik harness)
When screening the neonate, what is looked for when assessing the neurological system? (inlcuding primitive reflexes, 5)
Is the baby alert and responsive?
Do they cry?
Is there tone?
Posture and movement
Primitive Reflexes
- Moro (startle) reflex
- Sucking
- Rooting
- Asymmetric Tonic Neck Reflex (ATNR) a.k.a. fencing reflex
- Stepping
- Grasp
Name some skin conditions that may be seen in the neonate, including one that may point to an underlying condition
Erythema toxicum neonatum - benign
Mongolian blue spot - benign melanocytic naevus that is often mistaken for bruising
Strawberry haemangioma (naevus) - benign, gets bigger before disappearing
Haemangioma on the face, “port wine stain” - may indicate underlying Sturge-Weber Syndrome
How long is the neonate period?
0-27 days
How is a sick neonate initially managed?
ABC approach
Check and manage temperature
Airway and breathing - do they require oxygen?
Circulation - do they require fluids or inotropes?
Metabolic balances - do they require glucose management or acid-base correction?
Antibiotics
What pathogen causes most perinatal infections in the neonate?
What other bacteria cause problems in the neonate?
Group B Strep
E. coli
Listeria monocytogenes
Staph aureus
Staph epidermidis (NB - remember this is coagulase negative, and is associated with babies that have lines in)
What viruses cause problems in the neonate?
CMV
Parvovirus
Herpes viruses
Enteroviruses
Toxoplasma
HIV
Hepatitis
Rubella
What mode of delivery is more likely to result in development of Transient Tachypnoea of the Newborn (TTN)?
C-section
What cardiac conditions might present in the neonate that are related to pregnancy/birth specifically?
Heart failure as a result of Hydrops faetalis (fluid where there shouldn’t be fluid e.g. around the heart, in the lungs etc.). Caused by Rhesus, parvovirus, chromosomal factors etc.
Persistent Pulmonary Hypertension in the Newborn - caused because pressure in the lungs is too high and blood cannot flow into them
Name some congenital cardiac abnormalities
Tetralogy of Fallot
Atrial/Ventricular septal defects
Transposition of the great arteries
Coarctation of the aorta
Total Anomylous Pulmonary Venous Drainage (TAPVD)
What are the 4 components of Tetralogy of Fallot?
Pulmonary stenosis
Right ventricular hypertrophy
Ventricular septal defect
Overriding aorta
What is “pre-term” defined as?
Birth occurring before 37 weeks of gestation have been completed
What public health intervention saw premature births fall by 10%?
The smoking ban
Globally, the number of pre-term babies being born is rising/declining
Why is this the case?
Rising
Increased maternal age
Increase in pregnancy-related complications
Greater use of infertility treatments
More c-section deliveries before term
What are some of the risk factors for pre-term birth?
Interval of less than 6 months between pregnancies
Conceiving through IVF
Smoking, drinking alcohol, illicit drugs
Poor nutrition
Some chronic conditions
Mutliple miscarriages/abortions
What are some common conditions affecting premature babies?
Temperature control issues
Feeding/nutrition issues
Sepsis
System immaturities and dysafunctions e.g. respiratory distress, PDA, intraventricular haemorrhage, NEC
What is necrotising enterocolitis (NEC)? What are the main features?
Seen in pre-term/unwell infants (7% of preterm infants develop NEC), a portion of the bowel dies.
Symptoms - poor feeding, bloating, decreased activity, blood in the stool, vomiting bile
Treatment - bowel rest, orogastric tube, IV fluids and antibiotics
If free air is seen in the abdomen, surgery is required
Among those affected, approx 25% die
Why is thermal regulation inefficient in a pre-term baby?
They have low basal metabolic rates
There is minimal muscular activity (can’t shiver)
Subcutaneous fat insulation is markedly reduced compared to a term baby
There is a high ratio of surface area to body weight
How is growth/nutrition impaired in pre-term babies?
Limited reserve of nutrients
Potential gut immaturity
Potentially immature metabolic pathways
Increased nutrient demands
What are the two categories of neonatal sepsis, and what are the most common causative organisms of each?
Early onset - mainly due to bacteria acquired before and during delivery
- Group B strep
- Gram negatives
Late onset - acquired after delivery (nosocomial/community sources)
- Coagulase negative staphylococci (e.g. Staph epidermidis)
- Gram negatives
- Staph aureus
What are some of the respiratory complications of prematurity?
Respiratory Distress Syndrome (RDS)
Apnoea of prematurity
Bronchopulmonary dysplasia
What are some of the primary and secondary causes of Respiratory Distress Syndrome in neonates?
How common is this condition?
Primary
- surfactant deficiency
- structural immaturity
Secondary
- alveolar damage
- formation of exudate from leaky capillaries
- inflammation
- repair
This condition is common in premature babies - experienced by 75% of infants born before week 29, and 10% of infants born after week 32
Respiratory Distress Syndrome - signs/symptoms and treatment
Signs and Symptoms
- tachypnoea
- grunting
- intercostal/sternal recessions
- nasal flaring and tracheal tugging
- cyanosis
- worsens over minutes to hours, reaching its worst between 2-4 days, then gradually getting better
Treatment
- maternal steroids
- surfactant
- ventilation (either invasive or non-invasive)
How are intraventricular haemorrhages classified? What is associated with the grades?
Graded I-IV
Grades I and II - neurodevelopmental delay in up to 20% of infants, and mortality of 10%
Grades III and IV - neurodevelopmental delay in up to 80% of infants and mortality of 50%
What does restricted foetal growth indicate if it is a) symmetrical and b) asymmetrical?
a) symmetrical growth restriction indicates that a genetic cause is more likely
b) asymmetrical growth indicates placental failure/malnutrition, as cranial growth will be prioritised
What easy, non-invasive test can be done to establish the sex of a foetus in utero?
Testing maternal blood for foetal DNA
What would the following drugs cause if used during pregnancy?
- ACE inhibitors/ARBs
- Androgens
- Anti-epileptics
ACEI/ARBs - renal hypoplasia of foetus
Androgens - virilisation of female foetus
Anti-epileptics - cardiac, facial, limb, neural tube defects
What would the following drugs cause if used during pregnancy?
- Lithium
- Methotrexate
- Warfarin
Lithium - cardiovascular defects
Methotrexate - skeletal defects
Warfarin - limb and facial defects
What cautions should be taken when prescribing any drug during pregnancy?
Consider non-drug alternatives
Only prescribe if benefits outweigh the risks
Use the lowest effective dose for the shortest duration possible
Discuss the risks and benefits, and document this
Use older drugs with established safety records
Most drugs do/do not cross the placenta
What is the exception?
Most drugs DO cross the placenta
Exception - large molecular weight drugs, such as heparin
How might the pharmacokinetics of a drug (the absorption, distribution, metabolism and excretion) be affected by pregnancy?
Absorption - may be affected by morning sickness
Distribution - increased body fat stores meaning Vd increasess
Metabolism - increased liver metabolism of some drugs e.g. Phenytoin
Excretion - increased GFR means renally excreted drugs are eliminated more quickly
Which part of pregnancy is the period with the greatest risk of teratogenicity?
Why?
The 1st trimester (4th-11th week) - organogenesis occurs
There is also a risk of early miscarriage
If possible, all medications should be avoided at this time, unless maternal benefit outweighs the risk to the foetus
How might drugs given in the second and third trimester affect the foetus adversely?
Affect growth
Affect functional development - intellectual impairment and behavioural abnormalities
Toxic effects on foetal tissues
Around term, what might the following drugs cause if used?
- NSAIDs
- Opiates
- SSRIs
- Warfarin
NSAIDs - may cause a premature closure of the ductus arteriosus, disrupting the adaptation of the foetal circulation
Opiates - respiratory depression in the foetus, as well as withdrawal syndrome
SSRIs - withdrawal syndrome in the foetus
- Warfarin - excessive bleeding around term
What drug was given to pregnant women in the past in an attempt to prevent recurrent miscarriage (unsuccessfully), and resulted in vaginal adenocarcinoma in female children and urological malignancy in male children?
Diethylstilbestrol (DesPlex)
Should epileptic pregnant women continue to take their anti-epileptic medications?
Yes
Incidence of congenital malformations is higher in untreated women with epilepsy than in women without epilepsy
Seizures also increase in 10% of women during pregnancy (related to non-compliance and changes in plasma conc of drug)
Frequent seizures in pregnancy are associated with lower verbal IQs, hypoxia, bradycardia, antenatal death and maternal death
How should epilepsy during pregnancy be managed?
Monotherapy preferred - lamotrigine, topiramate etc.
AVOID Na valproate and Phenytoin
Also give folic acid 5mg daily
How is Diabetes managed during pregnancy?
Insulin is thought to be safe, Sulphonylureas are NOT safe
Requirements change during pregnancy. If poorly controlled, risk of congenital malformations and intrauterine death
What changes occur to maternal blood pressure during pregnancy?
If it needs to be managed pharmacologically, what medications should be used?
BP falls during the second trimester so hypertension may not be as severe
If needed to treat, use either labetalol or methyl-dopa as they are older and more is known about their safety
AVOID ACE inhibitors/ARBs (foetal renal hypoplasia) and beta-blockers (inhibit foetal growth in late pregnancy)
Nausea and vomiting is common during pregnancy - what medication is safest to give to manage this?
Cyclizine (anticholinergic and antihistamine)
UTIs are a common acute problem during pregnancy - what medication(s) are given?
Nitrofurantoin
Cefalexin (in the first/second trimester), Trimethoprim (in the third trimester)
What painkiller is generally the best option when prescribing in pregnancy?
Paracetamol
The risk of what vascular pathology is greatly increased during pregnancy?
How is this managed?
Risk of venous thromboembolism is increased 10-fold during pregnancy and is a leading cause of maternal death during pregnancy
All pregnant women are assessed for VTE risk, and those with significant risk factors are prescribed LMWH as thromboprophylaxis
(Avoid Warfarin in both early and late pregnancy as it is teratogenic and may cause excess bleeding during delivery)
How do foremilk and hindmilk differ in terms of content?
Foremilk - protein rich
Hindmilk - higher fat content (meaning it is more likely to contain any fat-soluble drugs that the mother may be taking, however few are in sufficient quantities to cause problems)
Which drugs cause problems during breastfeeding?
Phenobarbitone - causes suckling difficulties
Amiodarone - may cause neonatal hypothyroidism (amiodarone is an iodine-rich drug)
Cytotoxics e.g. chemo - cause bone marrow suppression in neonate
Benzodiazepines - cause drowsiness
Bromocriptine (dopamine agonist used to treat pituitary tumours, Parkinson’s etc.) - suppresses lactation
What foetal defects does Phenytoin cause?
How about Sodium valproate?
Phenytoin - cleft lip and palate
Sodium valproate - spina bifida and anencephaly
What is the normal weight range for a newborn baby?
2.5 - 4kg
Under 2.5 = small for gestational age
Over 4 = large for gestational age
What is the APGAR score?
Objective measure of perinatal adaptation, scored out of 10, with ‘normal’ being 8 and above
- Heart rate
- Respiratory rate
- Responsiveness
- Tone
- Colour
How does the risk of breast cancer change in relation to bodyweight?
5% increase with every 2kg/m2 of bodyweight
What are some of the criteria that have to be met for a woman to be accepted for IVF?
BMI must be between 18.5 and 30
Non smokers (both) for >3months
No illegal substance abuse
Both must be methadone free for at least 1 year
Neither partner should drink alcohol
Neither partner should have undergone voluntary sterilisation, even if reversed
What are some common MSK-related pregnancy problems?
Back pain
Pelvic girdle pain
Diastasis or Rectus Abdominis Muscle (DRAM) - gap developing between rectus abdominis muscle
Carpal tunnel syndrome
What MSK observations can be carried out for a pregnant woman?
BONUS Q - which gluteal is most likely to fail during pregnancy?
Observation - gait, posture, build and bump
Bony landmarks
Muscle activity (strength or weakness, wasting or overactivity)
Neural assessment if deemed necessary
Glut medius is known to fail during pregnancy
How might pelvic floor dysfunction present?
Incontinence (urine or faeces)
Difficulty with defaecation (issues with control and relaxation)
Pain
Prolapse
What grading system is used to assess pelvic floor strength?
Modified Oxford Scale
Grade 0 - no discernable contraction
Grade 1 - flicker
Grade 2 - weak contraction
Grade 3 - moderate contraction
Grade 4 - good contraction
Grade 5 - strong contraction against maximal resistance
How is pelvic floor dysfunction managed?
Lifestyle - smoking cessation, healthy BMI, moderating ADLs/doing appropriate exercises
Bladder symptom management - caffeine reduction, bladder training/drill, voiding techniques, pelvic floor exercises +/- biofeedback training, core stability exercises
How are pelvic floor exercises delivered?
Structured programme ensuring correct technique
Individualised to account for slow and fast twicth muscle fibres
Learning to engage pelvic floor prior to increases in intra-abdominal pressure
Exercises are performed until muscle fatigue several times a day
What is vuvlodynia and how is it best managed?
Chronic pain around the vagina with no obvious identifiable cause
Physio exercises have been seen to be the most effective management
A new mother with hepatitis C and currently on methadone is wondering if she can breastfeed - what do you say?
Hep C - okay
Methadone - okay, minimal exposure to baby
What is considered a normal temperature for a newborn baby?
Why might newborn babies be cold?
36.5 degrees upwards
Babies are born wet, and have an increased surface area to bodyweight
What are some of the risk factors for a newborn baby becoming hypoglycaemic?
Low birth weight (less resources)
Maternal/Gestational DM
Blood pressure medications in the mother, especially Labetolol
Low temperature
Being pre-term
Which of the following times after birth would it be abnormal for a baby to be jaundiced?
- 0-24 hours
- 2-3 days
- 14+ days
What potentially serious complication could result from early neonatal jaundice?
0-24 hours - abnormal
2-3 days - normal
14+ days - abnormal, suggests liver pathology/biliary atresia
If a baby is significantly jaundiced following birth (<24 hours), they could develop kernicterus which could result in impaired neural development
How is kernicterus managed?
Kernicterus risk if hyperbilirubinaemia <24 hours after birth
Manage with immediate exchange transfusion, phototherapy (first line for neonatal jaundice in general, do this first and see effect to determine if exchange transfusion is required), hydration and IV immunoglobulin
How is phototherapy used to treat hyperbilirubinaemia?
Isomerises bilirubin, making it water soluble and able to be passed more easily
In a neonate expressing methadone withdrawal symptoms, what can the mother do that might help?
Express milk - may contain a small amount of methadone to help the baby with withdrawal symptoms
What is a NAS score? What parameters are measured?
Neonatal Abstinence Syndrome
- sweating
- diarrhoea and vomiting
- nappy rash
- tachypnoea
- irritability and tremors
- uncoordinated feeding
- seizures if extreme
What is a Guthrie card and what is it used for?
Blood spotting card, ideally used when baby is 5 days old, screens for a variety of infections
- Sickle cell disease
- Cystic Fibrosis
- Inherited Metabolic Diseases (PKU, maple syrup urine disease etc.)
- Congenital hypothyroidism
How is Neonatal Abstinence Syndrome managed pharmacologically?
If there are 2 consecutive raised NAS scores, oramorph can be given
Weaning can take weeks
It is normal/abnormal for babies to lose weight initially after birth
Normal - babies lose weight through fluid loss, using reserves etc.
Up to 10% bodyweight loss initially is acceptable
What is the definition of ‘prolonged neonatal jaundice’ in…
- pre-term babies
- term babies
Pre-term - +21 days
Term - +14 days
