Week 5 part 1 Flashcards
What does the avergae male weigh at term?
3550g, 15% fat
Normal weght of baby born?
2.5kg - 4kg
What is a normal apgar score?
Greater than 8/10
5 aspects of apgar score?
- HR
- Resp
- Responsiveness
- Tone
- Colour
What is important for establishing breast feeding?
Skin to skin contact
What are the three shunts present in the foetus prior to borth?
`1. Ductus Venosus
- Foramen Ovale
- Ductus Arteriosis
What shunt in foetal circulation: crosses through the liver to the IVC?
Ductus venosus
What shunt in foetal circulation: is kept open by pressure being higher in right atrium, allowing blood to cross to left side of heart and supply brain?
Foramen Ovale
What shunt in foetal circulation: has blood pass through it to go out of right side of heart to systemic circulation?
Ductus arteriosis
How does the baby prepare for labour in 3rd trimester?
Stores oxygen in liver, muscle, and heart to withstand hypoxic phase of labour.
During delivery of baby what occurs in lung aeration?
Pulls lung fluid from alveolar to interstitial tissue back into lymphatics as babies take deep breath
When baby takes deep breath, lungs open up, vessels have no more room to expand and P02 increases. 100% of CO now goes to lungs. As pulmonary vascular resistancen decreases, systemic vascular resistance increases to allow left side pressure to be greater than right - thus closing off …
Foramen ovale
What becomes ligamentum arteriosis?
Ductus arteriosus
What does ductus venosis become?
Ligamentum teres
Main cause of sepsis in neborn?
Group B strep
How is PPHN treated in newborn?qN
NO gas, inotropes, keep warm
How do babies keep warm in first few hours if they cannot shiver?
Breakdown of adipose tissue in response to catecholamines
Labetalol is used to treat pregnancy in hypertension - what might it induce?
Neonatal hypoglycaemia
Is losing 10% of birth weight during first 5 days normal for baby?
Yes due to high proportion of fluid in body - if more than 10% then admit for hyponatraemia
Why is it normal for babies to be a bit anaemic at 8-10 weeks?
Lack of time between foetal and adult HB synthesis - babies have higher haematocrit in utero
Name a physiological cause of neonatal jaundice?
Rhesus or ABO incompatibility
Is jaundice in newborn less than 24 hours bad?
Always pathalogical
Is conjugated hyperbilirubinaemia normal in newborn?
Always abnormal - hepatitis, biliary atresia
What is meconium ileus a sign of?
probably been born with CF
ABDOMINAL distension and bile stained vomit?
Malrotation until proven otherwise
Biggest bacterial infection affecting neonates?
Strep Group B
Name two pregnancy/birth related respiratory problems?
- Transient tachypnoea of the newborn (TTN)
2. Pneumothorax
In baby: swollen liver, severe abdominal swelling?
Hydrops fetalis
Tetralogy of Fallot?
- Pulmonary stenosis
- Right ventricular hypertrophy
- Over-riding aorta
- Ventricular septal defect
Name two congenital respiratory disease of sick term infant?
- Tracheooesophageal fistula
2. Diohragmatic hernia
What is normal resp rate of newborn?
40-60 - periodic breathing normal
What is normal newborn heart rate?
120-140
a birth that occurs after 42 completed weeks of gestation?
post term
extremely preterm weeks?
Less than 27
Very preterm weeks?
Less than 31 weeks
What is the biggest cuase of preterm birth?
Spontaneous preterm labour
Greater than how many preterm deliveries increase the risk of another preterm baby by 70%?
2
By how muich does an abnormally shaped uterus increase risk of giving birth early?
19%
wHAT MAKES women 9 times more likely to give birth early?
If have multiple pregnancy
An interval of less than how many motnsh between pregnancies increases preterm risk?
6 months
Is preterm risk increased with conceiving throgh in vitro fertilisation?
Yes
In relation to preterm babies and cord clamping: if baby is ok and can be kept warm what should you do?
Pause for at least one montie to allow placental transfusion
What might damage from overinflation of preterm lungs predispose to?
Inflammatory cascade leading to bronchiopulmonary dysplasia
What four systemic immaturities/dysfunctions are common concerns in preterm infants?
- Respiratory discress syndrome
- Patent ductus arteriosus
- Intraventricular haemorrhage
- Necrotsiing enterocolitis
give four reasons thermal regulastion is ineffective in preterm infants?
- Low BMR
- Minimal muscular activity
- Subcut fat insulation negligible
- High ratio of surface area to body mass
Name organisms likely to cause late onset neonatal sepsis?
Gram positive - staph auireus, stpah epidermidis, strep pneumoniae, strep pyogenes
Name organisms likely to cause early onset neonatal sepsis?
Group B strep
gram neg - klebsiellam, e.coli, pseudomonas,
What increases infection which is used for preterm infants?
Incubators
Name three respiratory complicatoins of prematurity?
- Resp distress syndrome
- Apnoea of prematurity
- Bronchopulmonary dysplasia
What si the primary pathology of respiratory distress syndrome?
- Surfactant deficiency
2. Structural immaturity
Tachypnoea Grunting Intercostal recessions Nasal flaring Cyanosis?
Respiratory distress syndrome of newborn
Management of respiratory distress of newborn?
- Maternal steroid
- Surfactant
- Ventilation
Name a complication of respiratory disress syndrome of newborn?
tension penumothorax
Why are premature infants at risk of patnet ductus arteriosus?
Duct not responding to close signals that occur in labour
What does intraventricular haemorrhage begin with bleeding into?
Germinal matrix
What are the two major risk factors for intraventricular haemorrhage in newbonr?
Prematuriry
Resp distress syndrome
When do most intraventricular haemorrhages of newbirn occur?
In first day of life - usually present within 72 hours
How do you prevent intraventricular haemorrhage?
Antenatal steroids
Prompt and appropriate resuscitation
Inrelation to intraventricular haemorrhage: what is grade 1 and 2 classification and outcome?
Neurodevelopmental delay up to 20%
Mortality 10%
In relation to intraventricular haemorrhage: what is grade 3 and 4 classification and outcome?
Neurodevelopmental delay up to 80%
Mortality 50%
wHAT is the most common neonatal surgical emergency?
Necrotising enterocolitis NEC
Usually after RDS recovery
Early signs: lethargy and gastric residuals
Blood stool, temp instability, apnoea and bradycardia?
NEC
Name a large molecular weight drug which doesnt cross placenta?
Heparin
What pharmacokinetics might be disrupted by morning sickness?
Volume of distribution increases - increased plasma volume and fat stores
Increased free drug (decreased protein binding)
Increased liver metabolism e.g. phenytoin
What abnormality does lithium cause in pregnancy?
Ebsteins anomaly
In what stage of pregnancy might hypertensive patients be more susceptible to drugs?
2nd trimester - BP naturally falls
Pre-conception, what should women take?
Folic acid 400mg daily for 3 months prior and into
In pregnancy when is greatest teratogenic risk?
4th to 11th weeks
Teratogenic effects of: ACE/ARBs?
Renal hypoplasia
Teratogenic effects of: androgens
virulisation of female foetus
Teratogenic effects of: antiepileptics
Cardiac, faical, limb, neural tube defects
Teratogenic effects of: cytotoxics
multiple defects, abortion
Teratogenic effects of: lithium
Cardiovascular defects
Teratogenic effects of: methotrexate?
Skeletal defects
Teratogenic effects of: retinoids
ear, cardiovascular, skeletal defects
Teratogenic effects of: warfarin
Limb and facial defects
wHAT CAuses finger hypoplasia?
Carbamazepine in pregnancy
What can cause abnormal closure of ductus arteriosus ?
NSAIDs taken by mother in opregnancy
What drugs in pregnancy can cause respiratory depression in newborns?
Opiates
What drug can lead to vaginal adenocarcinoma in female children aged 15-20 years ?
Diethylstilbestrol
What are frequent seizurse during pregnancy associated with?
Lower verbal IQ in child, hypoxia, bradycardia, antenatal death, maternal death
What two antiepileptic drugs should be carefully AVOIDED in pregnancy?
Phenytoin and valproate
What diabetic drugs are not safe in pregnancy?
Sulfonylureas
Significant side effect of methyldopa?
Depression
Is cylizine fine to take in pregnancy if mother has nausea and vomiting?
Yes
Pregnant women with significant risk factors for VTE shpuld receive what?
Thromboprophylaxis with LMWH
Name some risk factors for VTE?
Obesity Over 35 Smoking para more than 3 Previous DVT cs delivery
What is foremilk rich in?
Protein
What is hindmilk rich in?
Higher fat content
Name a drug that is actively concentrated in breast milk and leads to suckling difficulties?
Phenobarbitone
When breastfeeding, what can occur if taking amiodarone?
Neonatal hypothyroidism
When breastfeeding, what can occur if taking cytotoxics
bone marrow suppression
When breastfeeding, what can occur if taking benzodiazepines
drowsiness
When breastfeeding, what can occur if taking bromocroptine
suppresses lactation
Which antibiotic given during pregnancy or in early childhood can cause this appearance of staining bones and teeth?
Tetracycline
Which drug taken in excess in early pregnancy causes short palpable fissures, flat mid face, short nose, idistinct philtrum, thin upper lip, low nasal bridge and a small chin?
Alcohol
Which antiepileptic drug is particularly associated with cleft lip and palate?
Phenytoin
Which drug taken during pregnancy can cause this problem in female offspring - adenocarcinoma vaginal?
Stilbestrol
Which antiepiletpic drug is particulalry associated with spina bifida and anencephaly?
Valproate
