Year 4 Neonatology Flashcards
when is term?
37 - 41 +6 weeks
what is pre-term?
before 36 weeks
when is there foetal loss?
under 22 weeks
when is post-term?
beyond 43 weeks
what is LBW?
<2500g
SGA <10th centile
what are all neonates given at birth?
vitamin K
iron + multivitamins
what does the heel prick test screen for?
9 congenital conditions:
- sickle cell disease
- CF
- congenital hypothyroidism
- phenylketonuria
- MCADD
- maple syrup disease
- IVA
- GA1
- homocystin
how long do the results for the heel prick test take to come back?
6-8 weeks
what can over-inflation of the lungs at birth lead to?
BPD
breathing support options
low flow nasal/ high flow CPAP BiPAP ventilation oscillation
how long should cord clamping be delayed?
at least 1 minute
how long is the neonatal period?
first 28 days of life
when should steroids be given to the mother?
two doses prior to delivery <36 weeks (either dex or betamethasone?)
what do steroids reduce the risk of?
RDS
sepsis
IVH
NEC
when should magnesium sulphate be given?
to the mother for delivery <34 weeks
why is caffeine given to neonates?
given to pre-terms to prevent apnoeic epsiodes and for neuroprotection
what is NEC?
widespread necrosis of the small and large intestine
when does NEC typically occur?
in the neonatal period after recovering from RDS
presentation of NEC
neonate with lethargy, bloody stools, bilious vomit, abdominal distension, apnoea, bradycardia
management of NEC
parenteral nutrition stop feeding
antibiotics (vanc + cefotaxime)
surgery if severe or perforation (bowel resection +/- stoma)
diagnosis of RDS
CXR and airbronchogram (ground glass appearance)
management of RDS
low level oxygen
natural surfactant within 6 hours of birth (curosurf)
what sats should be aimed for in RDS?
85-93% to prevent the development of ROP
what is surfactant?
phospholipid with apoproteins
what is interventricular haemorrhage?
bleeding into the germinal matrix
when do most IVHs occur?
first day of life
what is a RF for IVH?
RDS due to hypoxia, acidosis and hypotension making the cerebral circulation more unstable
management of IVH
steroids
graded 1-4
vit K deficiency
who is screened for ROP?
<1500g or <32 weeks
management of ROP
diode laser therapy
cryotherapy
intravitreal VEGF
what can cause neonatal abstinence syndrome?
opiates methadone BZDs cocaine amphetamines alcohol nicotine cannabis SSRIs
when do most NAS occur?
within 3-72 hours
presentation of NAS
irritability increased tone, tremors, seizures sweating pyrexia poor feeding loose stools
management of NAS
monitored with NAS chart for 3 days
if severe give magnesium sulphate in opiate withdrawal or phenobarbitone in non-opiate withdrawal
appearance of foetal alcohol syndrome
microephaly thin upper lip smooth flat philtrum short palpable fissure LD behaviour hearing vision problems cerebral palsy
when is jaundice pathological?
first 24 hours of life
prolonged >2 weeks
when does physiological/ breast feeding jaundice occur?
2-5 days
causes of jaundice in the first 24 hours?
sepsis ABO incompatibility RhD incompatibility congenital spherocytosis G6PD deficiency
unconjugated prolonged jaundice causes
physiological/breast feeding
hypothyroidism
galactosaemia
conjugated prolonged jaundice causes
biliary atresia
neonatal hepatitis
management of jaundice
plot bilirubin levels of threshold charts
phototherapy
exchange transfusions
how does phototherapy work?
converts unconjugated bilirubin into isomers
what is kernicterus?
accumulation of unconjugated bilirubin in basal ganglia (acute bilirubin encephalopathy)
choreoathetoid CP + SNHL
signs of BPD?
oxygen requirement beyond 36 weeks + evidence of pulmonary parenchymal disease on CXR
what is healing in BPD associated with?
continued lung growth over 2-3 years
often wheezy
what protection should babies with BPD be given?
monthly injections to protect against RSV
management of nappy rash
sudocream (+ clotrimazole if candida)
presentation of sepsis
resp distress apnoea jaundice temp poor feeding
management of febrile baby
cultures LP CXR urine microscopy septic screen
management of neonatal sepsis
gent + benzylpenicillin
what is a cephalohaemtoma?
subperiosteal bleed (collection of blood between the skull and periosteum)
does a cephalohaematoma cross suture lines?
no
management of cephalohaemtoma
resolves spontaneously
monitor for jaundice and anaemia
what is caput succedaenum?
oedema collection outside of the periosteum
does caput succedaneum cross suture lines?
yes
management of caput succedaneum
nothing
usually from traumatic delivery
what are milia?
white/cream papules on forehead, nose and cheeks
resolve spontaneously/ milk spots
CI to breastfeeding
HIV +ve mother
amiodarone
antithyroid (carbimazole)
opiates
neonatal screening questions?
has the baby passed meconium?
feeling okay?
FH of heart, eye or hip problems
