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week 5 part 2 Flashcards

1
Q

What is Perinatal asphyxia (PA) characterised by?

A

Impairment of exchange of respiratory gases (oxygen and carbon dioxide)

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2
Q

What does PA result in?

A

Hypoxia

Hypercapnia

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3
Q

What is the incidence of PA?

A

1 to 6 per 1,000 live full-term births

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4
Q

What plays a role in the way in which the baby positions themselves to come out in the best way?

A
  1. Condition of the uterus

2. Condition of the mother

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5
Q

Define Hypoxia

A

Diminished amount of oxygen in the blood supply

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6
Q

Define cerebral ischemia

A

Diminished amount of blood perfusing the brain

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7
Q

What is HIE?

A

Encephalopathy due to hypoxia and cerebral ischaemia

Resulting in death or subsequent cerebral palsy

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8
Q

What are babies able to sustain?

A

withstand stress of labour

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9
Q

When can you only call those who have hypoxic ischaemic Encephalopathy?

A
  • Diminished amount of oxygen
  • Have evidence of being affected by lack of perfusion
  • The baby should have encephalopathy because it has both hypoxia and cerebral ischemia
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10
Q

What are the History/Etiology/Risk Factors of PA?

A
  1. Pre-conceptual
  2. Antepartum
  3. Intra partum
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11
Q

What is example of Pre-conceptual?

A
  1. IDDM
  2. Maternal medical illness
  3. Sepsis
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12
Q

What is Antepartum?

A
  1. Infection
  2. IUGR
  3. Pre-eclampsia
  4. APH
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13
Q

What is an example of Intra-partum?

A
  1. Breech
  2. Shoulder dystocia
  3. cord prolapse
  4. Cord around the neck
  5. Uterine rupture
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14
Q

what is the consequence of cord tighten around the neck?

A

Interrupts blood flow and therefore get acidosis with hypoxia or hypercapnia

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15
Q

What is HIE?

A

major cause of death and disability in a well grown term baby

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16
Q

Where is HIE seen?

A

around 2-3 per 1000 live births in developed countries

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17
Q

What does HIE account for?

A

6% neonatal deaths and a combined mortality/morbidity of around 23% developed countries

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18
Q

What is the criteria for HIE?

A
  1. Need for prolonged resuscitation beyond 10 minutes after birth
  2. Perinatal acidosis in a blood gas in the first hour with PH < 7.0

Base deficit > 16mmol/L

  1. High lactate
  2. APGAR score of < 5 at 10 mins
  3. Abnormal neurological examination or presence of seizures
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19
Q

What is the APGAR score?

A

Devised by DR Virginia Apgar in 1952 and comprises 5 components

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20
Q

What are the 5 components of APGAR score?

A
  1. Appearance
  2. Pulse rate
  3. Grimace or reflexes
  4. Activity or muscle tone
  5. Respiration
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21
Q

What will recover with normal neurological examination?

A

APGAR score of > 7 at 5 minutes

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22
Q

What do babies with very poor score of 0-3 at 5 minutes have?

A

High chance of death/disability

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23
Q

20% of those with an APGAR score of 0 at 10 minutes

A

still survive with no disability at 6-7 years

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24
Q

What are the 5 characteristic of APGAR score

A
  1. Appearance
  2. Pulse
  3. Grimace
  4. Activity
  5. Respiration
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25
When is the score done?
At first minute, 5 minutes and 10 minutes of life during resuscitations
26
Good score
the baby didn’t need any help and therefore had a normal delivery and normal pregnancy
27
What happens when there is an insult?
there is a lack of blood supply, lack of oxygen, and therefore lack of ATP production provided by the mitochondria
28
What is the cellular level changes in HIE?
Disruption in the ATP=dependent pathway
29
What are the neurological examination?
1. state of mind/consciousness 2. Movement - Eyes, limbs 3. Tone 4. Posture 5. Reflexes 6. Presence or absence of abnormal movement or seizures
30
What is Sarnat & Sarnat Grading of HIE?
is a classification scale for hypoxic-ischaemic encephalopathy of the newborn (HIE), a syndrome caused by a lack of adequate oxygenation around the time of birth which manifests as altered consciousness, altered muscle tone, and seizures
31
Baby on the ventilator
it is having nitric oxide because of pulmonary hypertension
32
What are the Multi-organ involvement in HIE?
1. Heart 2. lungs 3. Renal 4. Liver 5. GI 6. Hematologic
33
Heat
Myocardial contractility severe hypotension passive cardiac dilatation tricuspid regurgitation
34
Lungs
Severe pulmonary hypertension requiring assisted ventilation
35
Renal
Renal failure presenting as oliguria
36
Liver
Elevated liver function tests and coagulopathy
37
GI
poor peristalsis and delayed gastric emptying rarely necrotising enterocoloitis
38
Hematologic
``` Increased nucleated RBC neutropenia Neutrophilia Thrombocytopenia Coagulopathy ```
39
What are the other factors that baby can have?
- Birth trauma, maternal drug toxins, infections/sepsis, meningitis and loads of other neurological and neuromuscular problems
40
What are DD's for HIE?
1. Metabolic encephalopathy 2. Neuromuscular disorders including neonatal myopathies 3. Congenital brain disorders 4. Infections 5. Truma 6. Toxins (Maternal drug use)
41
What is the specific scan for brains?
Cranial ultrasound scan
42
What is aEEG?
this is the bedside cerebral function monitor – it gives you a pattern recognition to know if it is a normal pattern or more relatively suppressed abnormal pattern and the last one is no activity in the brain
43
What is currently the best available biomarker for HIE?
MRI
44
When is MRI done?
around 7-10 days of age
45
What are the pattern of injury score?
1. posterior limb of the internal capsule (PLIC) 2. Basal ganglia and thalamic (BGT) score 3. White matter (WM) score 4. Cortical involvement
46
What are the supportive treatment?
1. Manage ventilation 2. Multi-organ support: Inotropes, fluid management, feeding, coagulopathy 3. Avoidance of hypoglycaemia, hypocarbia 4. Seizure management
47
What is the only definitive treatment currently available for hypoxic ischemic encephalopathy?
Total body cooling
48
When should you start the treatment?
treatment during re-perfusion window to try and avoid damage from subsequent on-going injury
49
total forest plot favoured hypothermia
∆ CoolCap was done in Australia and NIHCD was done in America and Toby was done in Europe by putting them together
50
What is one of the biggest landmarks in neonatal world
hypothermia therapy
51
What is the Therapeutic Hypothermia?
Total body hypothermia for term infants initiate as early as possible within 6 hours 33.5 to 34.5 degrees - active cooling, rectal temperature Duration - 72 hours Gradual rewarming period for 14 hours only in level 3 neonatal intensive care units can be initiated while transfer to NICU using mobile cooling equipment
52
What are the novel adjunct therapies?
1. Xenon/Argon 2. Melatonin 3. Erythropoietin
53
What is Xenon/Argon?
1. Toby-Xe - feasible and safe, but is unlikely to enhance the neuroprotective effect of cooling 2. inhibitor of NMDA glutamate receptors 3. Reduces apoptosis by activation of anti-apoptotic factors
54
What is melatonin?
1. anti-inflammatory, anti-apoptotic, and antioxidant processes through nuclear and cell membrane receptors 2. Boosts glial and neuronal development
55
What is Erythropoietin?
1. Reduces apoptosis due to less NO/glutamate toxicity, anti-inflammatory, anti-oxidative role 2. Modulates NO synthase and improves perfusion - Erythropoiesis, Neurogenesis and Angiogenesis
56
What is poor prognosis?
1. Lack of spontaneous respiration within 20-30 mins ago age 2. Presence of seizures 3. Abnormal clinical examination beyond 7-10 days 4. Absence of suck by 7-10 days 5. Poor head growth during post natal and first year of life
57
What is the follow up care?
1. Monitoring as out-patient for development, head growth - regularly until 2 years of age 2. 18 months to 2 years - detailed developmental assessment to quantify long term disability 3. Support from community services - Sppech and language, physiotherapist, occupational therapist and community paediatrician 4. portage services - home visiting educational service for pre-school children with SEND and their families
58
What are the various scales to develop a neurological outcomes at 2 years?
1. Denver Scale 2. Schedule of growing skills 3. Griffiths mental developmental scales 4. Bayley Scales of Infant and Toddler Development, Third edition (Bayley-III)
59
What are the 5 domains of Bayley III?
1. Cognitive 2. Receptive language 3. Expressive language 4. Fine motor 5. Gross motor
60
What does Bayley III separate?
1. separates cognitive and language | 2. widely used
61
What is the availavle Biomarker for HIE - Injury/prognosis
1. Clinical examination - Evolves with time - birth until 2 year corrected age for developmental check 2. MRI imaging at 7-14 days

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