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.
