WH- Neonatology Flashcards
In newborn screening, what finding indicates PKU, what further Ix is required and what is the Mx?
- Increased phenylalanine
- Repeat phenylalanine assay
- Mx = low phenylalanine diet for life
In newborn screening, what finding indicates CF, what further Ix is required and what is the Mx?
- Increased serum immunoreactive trypsinogen
- Genetic testing for CF mutations
- Mx = lung and pancreatic Sx relief
In newborn screening, what finding indicates hypothyroidism, what further Ix is required and what is the Mx?
- Decreased TSH
- Full TFTs, thyroid scan and bone age
- Mx = T4 for life
On investigation, what findings confirm Rh haemolytic disease in the newborn?
- DCT strongly positive
- No spherocytes on blood film
On investigation, what findings confirm ABO haemolytic disease in the newborn?
- DCT weakly positive
- Numerous spherocytes on blood film
Outline the specific Mx of a SGA newborn
- Delivery and resuscitation
- Monitoring for and treatment of hypoglycaemia
- Hct for polycythaemia
- Assess for infection: mother’s TORCH serology, mother’s urine for CMV, US of brain for calcification (diagnostic)
- Chromosomal analysis
- Assess for hypocalcaemia (seizures) with serum Ca2+
What are the principles of neonatal resuscitation?
Airway: establish an airway, clear if necessary and place n neutral position
Breathing:
- PPV if not breathing (neopuff, air)
- Reassess at 1 minute, and ETT if fails
Circulation:
- Compression if HR
Causes of respiratory distress in a premature newborn?
- HMD (most common)
- Pneumonia (most dangerous)
- TTN
- MAS
What circulatory changes occur in the neonate at birth?
Fetal remnants close structurally, then functionally:
- DV, FO then DA all close
- DA closure is due to decreased blood flow, increased O2 saturation and decreased pulmonary resistance
- Functional closure of DA 24-96hrs, anatomical closure 2-4w
Cord is clamped and placenta removal –> UV and UA contraction
What are the causes of seizure in a neonate?
- Hypoxic-ischaemic encephalopathy (most)
- Cerebral infarction
- Cerebral trauma
- Infection
- Metabolic abnormalities: hypoglycaemia, low Ca2+, low Mg2+, high or low Na+
- Narcotic drug withdrawal
- Idiopathic
What are the principles of management for a neonatal seizure?
- EEG and imaging are required for diagnosis
- Bloods for reversible causes and treatment of these if present
- Anticonvulsant therapy acutely: phenobarbitol is first line
- Seizure recurs, commence on maintenance treatment (phenobarbitol for 6w)
Main causes of respiratory distress in a term infant
- Pneumonia
- TTN
- MAS
- HMD (uncommon)
- CHD
- Space occupying lesions
What factors are assessed in an Apgar score?
Appearance, pulse, grimace, activity, respiration
By which method is the most heat lost in a newborn?
Evaporation
What complication is more common in IUGR babies vs. premature babies?
Hypoglycaemia
