11. diseases of the newborn. Clinical and morphological assessment of the newborn.

Question 1

what are the main diseases of new borns ?

Answer 1

asphyxia
hypoglycaemia
hyperbilirubinemia

CNS
seizures

malformation : 
choanal atresia
herniation of diaphragm
oesophageal atresia 
omphalocele
gastrochisis
heart anomalies

Question 2

there are three types of asphyxias what are they ?

Answer 2

prepartum -

intrauterine

during labour
postnatally

Question 3

what causes prepartum intrauterine asphyxia ?

Answer 3

placental abnormalities placental abruption

maternal diseases like diabetes
drop in blood pressure
anemia ,

foetus has the umbilical cord wrapped around the neck
knotting of umbilical cord

Question 4

what causes asphyxia during labour ?

Answer 4

due to umbilical cord compression

umbilical cord prolapse

Question 5

what causes asphyxia postnatally

Answer 5

respiratory distress -
RDS / hyaline membrane disease

meconium aspiration

amniotic aspiration

=====
this can cause respiratory distress: 
metabolic acidosis 
hypothermia 
hypoglycaemia

Question 6

what is the most severe outcome of asphyxia

Answer 6

hypoxic -ischemic encephalopathy - leads to irreversible neurological damage
manifested as intellectual disability
developmental delay
spasticity

or multiple organ failure

Question 7

how is intrauterine asphyxia diagnosed

Answer 7

done through blood being drawn from the umbilical cord and running blood gas analysis on it
Profound metabolic acidosis

fetal distress
Tachycardia : > 160 beats / min. due to sympathetic stimulation caused by mild
hypoxia.

ii) Bradycardia: < 100 beats / min due to vagal stimulation caused by moderate hypoxia.
iii) Cardiac arrhythmia (irregular FHR) : due to severe hypoxia. It is the most dangerous one.
iv) Late deceleration.

Question 8

signs and symptoms for respiratory distress syndrome/

Answer 8

tachypnea > 60 breaths per min (30-60 is normal)

nasal flaring

expiratory grunting

Rib retraction

Question 9

diagnosis of respiratory distress syndrome ?

Answer 9

low apgar score
in auscultation decreased breath sounds

blood gas analysis of fetes -
for respiratory distress syndrome - respiratory and metabolic acidosis
pco2 80 mmhg in severe cases

chest x ray - fine reticular granular lung opacities

Question 10

what is the treatmnet for respiratory distress syndrome ?

Answer 10

CPAP with with Positive end expiratory pressure of 3-8cm h20

start intubation with mechanical ventiation if Respiratory acidosis with a PaCO2 > 50 mm Hg, a PaO2 < 50 mm Hg or O2 saturation <90% persists

Acidosis should be corrected by intravenous administration of sodium bicarbonate

endotracheal administration of exogenous surfactant within 2 hours postpartum

Question 11

what is a big complication of respiratory distress syndrome ?

Answer 11

bronchopulmonary dysplasia chronic lung disease primarily found in premature infants exposed to prolonged mechanical ventilation and oxygen therapy for neonatal RDS

increased chance in neonates treated with more than 21% oxygen for at least 28 days

Diagnostics
Chest x-ray: diffuse, fine, granular densities,
areas of atelectasis interspersed with areas of hyperinflation

Therapy: controlled oxygenation, bronchodilators diuretics, possibly glucocorticoids

Question 12

what are other complication of HMD?

Answer 12

infection and pneumothorax

Question 13

to whom does meconium aspiration syndrome occur ?

Answer 13

term or post-term babies who are small for gestational age (IUGR)

Question 14

diagnosis of meconium aspiration ?

Answer 14

Aspiration of meconium from the trachea at birth
or visualised in vocal cords

meconium in amniotic fluid

in auscultation - rales and rhonchi

Radiologically hyperinflated lung fields, flattened diaphragm with coarse and patchy infiltration

blood gas - hypoxemia and hypercapnia

Question 15

management of meconium aspiration syndrome ?

Answer 15

Airway and oral suctioning may be needed

Liberal oxygen supply

Mechanical ventilation is required where PO2 is less than 50 mm Hg and PCO2 is above 50 mm of Hg.

Antibiotic coverage

Question 16

there are 5 different types of post natal icterus what are they ?

Answer 16

icterus neonatal simplex 
icterus praecox
icterus gravis
kernicterus 
prolonged icterus

Question 17

describe icterus neonatal simplex / physiological

Answer 17

starts at 2/3rd day of birth and not before - reaches peak at 5th day - vanishes in two weeks

physiological icterus from the not fully functioning liver
the levels of indirect bilirubin should not exceed 15mg/d

usually 12mg/dl in term
premature <15mg/dl

Question 18

describe icterus praecox

Answer 18

mild jaundice presents first day of birth

it usually clears rapidly and spontaneously

Question 19

what causes icterus praecox ?

Answer 19

due to RH ABO blood group incompatibility ( mother and fetus has different blood group and mother’s immune system may attack it causing hemolytic anemia

cephalohematoma (hemorrhage between skull and periosteum) or other traumas during birth
occasionally resulting in haemolytic disease but it quickly clears

intraventricular hemorrhage

neonatal - eccoli infection

USUALY NOT TREATMENT REQUIRED

Question 20

what is icterus gravis

Answer 20

bilirubin is higher than 16mg/dl

DEVELOPS JAUNDICE WITHIN 24 HOURS

Question 21

what causes icterus gravis ?

Answer 21

often the cause erythroblastosis fetalis - haemolytic anemia caused by transplacental transmission of maternal antibodies to red blood cells of fetus often due to the RhD antigens

defect in conjugation of bilirubin
Crigler-Najjar syndrome (autosomalrecessive), Gilbert syndrome(autosomaldominant),

Preterm babies with impaired liver function

Question 22

describe kernicterus ?

Answer 22

higher than critical level of 20mg/dl where indirect bilirubin starts to deposit in the basal ganglia - leads to brain damage and retardation

CONJUGATED BILIRUBIN CANNOT CAUSE KERNICTERUS

Question 23

what causes kernicterus ?

Answer 23

again due to haemolytic anemia - erythroblasts fetalis ,

liver enzymes present but not active

administration of aspirin - displaced bilirubin attached to albums

Question 24

signs and symptoms of kernicterus ?

Answer 24

lethargy, hypotonia, poor feeding

severe illness is manifested by prostration, respiratory distress and finally opisthotonos, hyperpyrexia, convulsions, enlarged liver, spleen

Question 25

quick diagnosis of kernicterus is ?

Answer 25

diagnosis is through - assymetrical moro reflex (spreading out arms , pulling arms in , crying) asymmetrical moro reflex - (spreading out of arms , pulling arms in and crying - rapidly lowering the infant while supported to a sudden stop and pinching the skin of the abdomen or head is tilted suddenly a few cm lower

Question 26

every icterus except prolonged icterus can be treated with ?

Answer 26

treatments is introduced when bilirubin above 13mg/dl in term 11mg/dl in preterm Adequate hydration - put phototherapy (double from above and below ) using blue light rays convert the unconjugated bilirubin to conjugates Phenobarbital therapy induces hepatic microsomal enzymes and increases bilirubin conjugation and excretion Metalloporphyrins decreases bilirubin production by inhibiting heme oxygenase. Tin and zinc metalloporphyrins a

Question 27

diagnosis of neonatal hyperbilirubinemia ?

Answer 27

clinical dermal zone 1 - face and neck = 5mg/dl dermal zone 2 - chest and back - 10mg/dl dermal zone 3 - abdomen and below umbilicus to knees - 12mg/dl dermal zone 4 - arms ad legs below knees- 15mg/dl dermal zone 5 - feet and have - >15mg/dl ====== serum bilirubin level and total blood test blood group status of mother and child antibody screening of mother direct coombs test for rh incompatibility

Question 28

what is breast milk jaundice ?

Answer 28

The activity of the enzyme-glucuronyl transferase is inhibited by a specific steroids fatty acids of breast milk. level rises from the 7th day after birth to max by 14th day. but less than 15mg/dl rarely causes kernicterus. no treatment. If the bilirubin level is high temporary withdrawal of breastfeeding cures.

Question 29

what causes CNS seizures ?

Answer 29

traumatic hypoxic ischemicncephalopathy neonatal asphyxia intra cranial hemorrhage metabolic hypoglycemia kernicterus hypo/hypercalcemia infective -high fever , cns strep b ore coli iatrogenic - narcotic withdrawl premature and low birth weight

Question 30

how do we treate sezuires in new borns ?

Answer 30

control convulsion :phenobarbitural but be ready to intubate the newborn

Question 31

what empirical treatment for neonatal sepsis

Answer 31

ampicillin and gentamicin

Question 32

what are the causes for neonatal sepsis

Answer 32

Early-onset neonatal sepsis (within 1 week of birth) is typically caused by vertical or perinatal transmission to the fetus most commonly caused by group b strep and ecoli hsv

Question 33

who are at high risk for neonatal sepsis ?

Answer 33

for preterm and low birth weight neonates , | PROM

Question 34

what are the symptoms for neonatal sepsis ?

Answer 34

symptoms - fluctuations in temp respiratory abnormalities decreased milk drinking diarrhea and decreased bowl movements

Question 35

what is choanal atresia ?

Answer 35

back of nasal passage blocked usually by bony tissue or soft tissue due to failed recanalisation of the nasal fossa during fetal development

Question 36

what are the signs and symptoms of choanal atresia

Answer 36

bilateral - cyanosis the baby through feeding continuous stream of mucus draining from one or both noses

Question 37

what is the treatment for choanal atresia ?

Answer 37

endotracheal tubing extracorporeal membrane oxygenation if bone obstruction then its drilled through drilled through and stent is placed

Question 38

how is hernia of diaphragm diagnosed

Answer 38

routine ultrasound | Otherwise, it is diagnosed soon after birth when a baby shows signs of breathing difficulties

Question 39

clinical management f herniation of diaphragm ?

Answer 39

nano gastric tube inserted - release any excess air in stomach and intestine which relives pressure on lungs ventilator f respiration problems , extracorporeal membrane oxygenation if severe then operation when everything is stable

Question 40

what is omphalocele ?

Answer 40

abdominal wall defect in which intestines , lover and other abdominal organ may be outside in sac , failure of them going back into the abdominal cavity during 9th week of of gestation

Question 41

what is the diagnosis of omphalocele ?

Answer 41

fetal ultrasond , elevated AFP

Question 42

what is the treatment of omphalocele ?

Answer 42

Immediately after birth a nasogastric tube is required to decompress the intestines and an endotracheal intubation is needed to support respiration. The exomphalos sac is kept warm and covered with a moist saline gauze and plastic transparent bowel bag to prevent fluid loss. surgery required

Question 43

what is gastroschisis ?

Answer 43

baby's intestines extend outside of the abdomen through a hole next to the belly button. in gastroschisis the umbilical cord is not involved and the intestinal protrusion is usually to the right of the midline. Parts of organs may be free in the amniotic fluid and not enclosed in a membranous (peritoneal) sac

Question 44

what is the diagnosis of gastroschisis ?

Answer 44

ultrasound and raised AFP

Question 45

what is the clinical management of gastroschisis ?

Answer 45

same as omphalocele

Question 46

heart defects which are cyanotic ?

Answer 46

tricuspid atresia tetralogy of fallout - ventricular septal defect pulmonary valve stenosis right ventricular hypertrophy overriding aota transposition of great arteries truncus arteriosus - the pulmonary arteries and aorta do not separate - one trunk arising from the heart with mixed blood supplied to coronary artery , lungs , and rest of body (perisirant - cyanotic)

Question 47

what is a long term complication of hypoglycaemia ?

Answer 47

mental retardation seizures development delay

Question 48

why is there physiological hypoglycaemia in new born ?

Answer 48

glucose is transferred from the mothers placenta but not insulin , the continuous glucose supply stops once after delivery during last trimester glucose is stores in liver , heart and skeletal muscles all new born experience glucose decline 2-3 hours after birth then maintained through regular feedings

Question 49

how is hypoglycaemia defined ?

Answer 49

below 30mg/dl first 24 hours then glucose levels are below 45mg/dl

Question 50

what are symptoms of hypoglycaemia ?

Answer 50

``` can show no symptoms hypothermia tremor hypotonia if severe seizures ```

Question 51

what are the risk factors for hypoglycaemic baby ?

Answer 51

premature hypotrophic - not enough glycogen stores hyperinuslinemic hypoglycaemia gestational diabetes type 1 diabetes in of mother high level of glucose in fetes , thus high levels of insulin - when the umbilical cord gets cut the source of glucose is gone however the insulin levels are still high and need some time to decrease decreased gluconeogensisis - adrenal insuffieicneecy , errors of metabolism , glycogen storage disease increased glucose use - hyperthermia , polycethmia , spespsis, hypoxia

Question 52

how is hypoglycaemia diagnosed ?

Answer 52

heel prick and blood analysis

Question 53

what is the clinical management go hypoglycaemia ?

Answer 53

dextrose gel applied directly to infant’s mouth / intravenous infusion of glucose less severe - beast feeding regularly

Question 54

Jaundice presenting in the first 24 hours of life is more likely to have a serious underlying cause such as ?

Answer 54

infection, haemolytic disease or metabolic disorder