Week 5- the normal neonate and the sick neonate Flashcards
When is term?
37-41 weeks
What weight is considered normal for term babies?
2.5-4kg.
When is a baby considered small for gestational age at term?
Under 2.5kg
When is a baby considered large for gestational age at term?
Over 4.0kg.
What environment is created for the baby during contractions in labour? How has the baby adapted to this?
Hypoxic- so very stressful
Fetal haemoglobin allows release of oxygen easier at low partial pressures.
What does the hypoxic environment during labour cause the baby to produce?
Cortisol and adrenaline- which enhance adaption.
What does the first breath or cry cause in the baby?
Alveolar expansion
Increasing paO2.
What is an APGAR score?
What is a normal score?
Objective measure of perinatal adaption. Each thing is scored out of two -colour -tone -resp rate -heart rate -responsiveness Normal score>8
Why is it so important for the baby to be in close contact with its mum asap after delivery?
Allows attachment to form. Attachment decreases neglect in children and also decreases risk of long term illnesses etc.
What causes haemorrhagic disease of the newborn? How can you stop this?
Vitamin K deficiency.
All babies are offered IM (or oral but this is worse) vitamin K immediately after delivery
What other vaccinations/treatment of infections might you consider when the baby is born?
Hepatitis B- if the mother has a history of it. Give it within 24 hours.
Syphillis- mother normally has screening during pregnancy but if not give penicillin.
Prophylactic antibiotics if there is history of group B strep
Hep C- no vaccination/treatment. Check if mother is IV drug user.
In what scenario might you give the BCG vaccine?
If the baby is at risk of TB. Give in the first month.
What screening tests must be performed on the baby before leaving hospital?
Heel prick test- tests for metabolic diseases, cystic fibrosis etc
Developmental hip dysplagia.
When is the full neonatal examination carried out?
In the first 24 hours.
In the neonate, what things in the head do you examine?
Inspect the fontanelles for bulges or sinking.
Ventuse/forceps marks
Moulding- bones sliding over one another.
Cephalhaematoma- bleeding below the surface of the bones of the head.
Caput succedaneum- fluid collection.
How can you differ between cephal haematoma and ventuse extraction caput?
Cephal haematoma will be bounded by suture lines whereas ventuse extraction will have more generalised caput.
On neonatal examination, what are you looking for in the eyes?
Shape, size and symmetry Red reflex- for congenital cataracts. Conjunctival haemorrhage Squints Iris abnormalities
On neonatal examination, what are you looking for in the ears?
Shape, size, symmetry
Position- low lying could be Edwards or treacher collins
Tags/pits (major accessory tags can be associated with renal anomalies)
Folding
Family history of hearing loss.
On neonatal examination, what are you looking for in the mouth?
Shape Philtrum Tongue tie- not usually a problem unless it interferes with feeding Look at hard palate and feel it. Look for neonatal teeth Assess sucking and rooting reflex.
On neonatal examination, what are you looking for in the face?
Any obvious abnormalities e.g. trisomy 21
Facial palsy’s
On chest examination of the neonate, what are you looking out for?
Chest shape
Any grunting, nasal flaring/signs of increased effort
Any undrawing or tachypnoea
Normal vesicular sounds
On cardiovascular examination of the neonate, what are you looking out for?
Colour/oxygen saturations Pulses- femoral Apex beat Thrills and heaves Heart sounds in 5 areas- aortic, pulmonary, bicuspid, tricuspid and mid scapular.
On abdominal examination of the neonate, what are you looking out for?
Abdomen moves with respiration Any distension? Hernias Passage of meconium Anus
On examination of the genitals of the neonate, what should you look for?
Normal urethra position i.e. at the end of the penis.
Undescended testes
Hypospadius (opening of urethra on underside of penis)
On musculoskeletal examination of the newborn, what are you assessing?
Movement and posture
Limbs and digits
The spine- for signs of spina bifida
Hip examination
What harness is used to treat developmental dysplasia of the hip?
Pavlock harness.
What neurological responses do you look for in examination of the new born?
Is the baby alert/responsive is it crying Tone Posture Movement Primitive reflexes.
When is the neonatal period?
0-28 days.
When might a neonate become unwell?
At delivery
First few hours of life
Up to 28 days.
Describe the appearance category and how it is marked in the APGAR score?
Appearance = skin colour
Blue or pale- 0
Blue in extremities but the body is pink-1
No cyanosis- 2
Describe how pulse is scored on the APGAR score?
No pulse- 0
<100- 1
>100 = 2
What is grimace? How is it scored on APGAR system?
Unpleasant reaction to stimulus
No response- 0
Grimace/feeble cry when stimulated- 1
Cry or pull away when stimulated- 2
Describe how muscle tone (activity) is scored on the APGAR score?
None- 0
Some flexion- 1
Flexed arms and legs that resist extension- 2
Describe how respiration is assessed in the APGAR score?
Absent-0
Weak, irregular, gasping- 1
Strong cry-2
What maternal history might be important in a neonatal clinical assessment?
PMH, pregnancy issues, drugs, any infection risks
What respiratory rate should a newborn have?
40-60
What heart rate should a newborn have?
100-160
What cap refill should a newborn have?
2-3 seconds
What oxygen saturations should a newborn have?
SaO2 of 95%
What four broad categories can cause a newborn to be sick?
Congenital abnormalities
Pregnancy/birthing issues
Metabolic causes
Infectious causes
What common sites of infection can newborns have?
Blood borne- bacteraemia/septicaemia Respiratory- pneumonia GU- UTI CNS- meningitis GI- necrotising enterocolitis
Which bacterial infectious agents are likely to infect a newborn?
Group B streptococcus E coli Listeria myocytogenes Staph aureus Staph epidermis
What viral infectious agents are likely to infect a newborn?
Cytomegalovirus
Parvovirus
Herpes viruses
Enteroviruses
NOTE- others (not necessarily viral include)- syphilis, toxoplasma gondii, HIV, TORCH
What is hypoxic ischaemic encephalopathy? How can you recognise it in a newborn?
Multi-organ damage due to tissue hypoxia.
Can be recognised by low APGAR scores- needs active resuscitation.
What is hydrous feotalis? Why does it occur?
Accumulation of fluid in atleast two of the body compartments.
Its a complication of severe Rh incompatibility
What is meant by rhesus incompatibility?
Rhesus is an antibody coating on RBC’s. If the mother has rhesus negative antibodies and the baby has rhesus positive antibodies, the blood will recognise any of the babies blood as being foreign. So if there is any mixing of maternal and foetal blood, the mother will create antibodies that attack the babies blood if encountered again.
What is persistent pulmonary hypertension of the newborn?
When the ductus arteriosus and the foramen ovale don’t close meaning there is a right to left shunt of blood in the heart. This means that the lungs get very little blood and the body gets deoxygenated blood.
What congenital cardiac abnormalities can affect the newborn?
Tetralogy of Fallot Transposition of great arteries Coarctation of the aorta TAPVD Hypoplastic heart
What is tetralogy of fallot?
Characterised by 4 heart defects
- a large ventricular septal defect
- Pulmonary stenosis
- Right ventricular hypertrophy
- An overriding aorta
What is transposition of great arteries?
The aorta and pulmonary artery switch sides.
How does tetralogy of fallot present?
Transient cyanosis (baby goes blue at times)
Heart murmur
Difficulty breathing
May become limp or lose consciousness
What is co-arctation of the aorta? How does it present
Narrowing of the aorta. Pulses may be reduced and differ in timing between upper and lower limbs.
What is hypo plastic heart?
the left side of the heart is drastically underdeveloped.
What is TAPVD?
Stands for total anomalous pulmonary venous drainage- this means the pulmonary veins are not connected to the left atrium.
What is a tracheoesophageal fistula?
Abnormal connections between the oesophagus and the trachea.
