Care of the newborn Flashcards
(35 cards)
Risk factors for preterm birth
High or low BMI Previous preterm birth Maternal comorbidities Cone biopsy, cervical trauma Smoking, alcohol, drugs Maternal infection: sepsis, cervicitis, STI, UTI, BV Short pregnancy interval Uterine abnormalities Domestic violence
What gestational age do foetus’ begin producing surfactant
36 weeks
Role of maternal steroids in preterm labour
Promote foetal lung maturity
What is a tocolytic drug and examples
Drugs to reduce contractions
Atosiban, nifedipine
Role of magnesium sulphate in preterm labour
Foetal neuroprotection
Imaging modalities useful for preterm infants
CXR Cerebral ultrasound (IVH)
Source of bleeding in premature neonatal intraventricular haemorrhage
Germinal matrix
Gives origin to cerebral neuroblasts and glia therefore is highly cellular and vascularised
Neurological complications of neonatal intraventricular haemorrhage
Seizures Developmental delay Cerebral palsy (40%)
Grades of IVH
Grade I - bleed occupies <10% of ventricle
Grade II - bleed occupies 10-50% of ventricle
Grade III - bleed occupies >50% of ventricle
Grade IV - parenchymal involvement (periventricular venous infarction)
Risk factors for neonatal intraventricular haemorrhage
Prematurity (<32 weeks especially) Low birth weight RDS Hypoxia Sepsis Hypotension, hypertension Hypovolaemia Altered cerebral blood flow
Investigations for IVH
ABG - metabolic acidosis FBC - low Hb doesn't improve with transfusion Transfontanelle USS (gold-standard) MRI to assess brain injury
Surgical management of IVH
Ventriculoperitoneal and ventriculosubgaleal shunts for post-haemorrhagic hydrocephalus
Pharmacological management of IVH
Anticonvulsants for seizures
Acetazolamide to decrease CSF production to limit hydrocephalus
Common causes of neonatal meningitis
Bacteria
Group B Strep, E. coli, Listeria monocytogenes
Complications of neonatal meningitis
Sensorineural hearing loss Memory difficulties Brain damage Gait problems Kidney failure Decreased visual acuity Reduced growth Cerebral palsy Global developmental delay Death
Treatment of neonatal bacterial meningitis when organism is unknown
IV amoxicillin and cefotaxime
Role of dopamine infusion in preterm infants
Iatrogenic - increases myocardial contractility to correct haemodynamic imbalance
2 main complications of oxygen toxicity in preterm babies
Bronchopulmonary dysplasia
Retinopathy of prematurity
Definition of bronchopulmonary dysplasia
Oxygen dependence at 36 weeks postmenstrual age
Common presentation of BPD
Preterm infant with respiratory distress who responds well to initial surfactant and ventilation treatment but then increases need for oxygen/ventilation over first 2 weeks of life
Prenatal risk factors for BPD
Foetal inflammatory response
Amnion infection
Growth restriction
Postnatal risk factors for BPD
Congenital and nosocomial infections Oxygen toxicity Mechanical ventilation Malnutrition Persistent ductus arteriosus Fluid overload Hormonal deficiency
Signs of BPD on CXR
Diffuse haziness and coarse interstitial pattern
Pharmacological management of BPD
Dexamethasone Furosemide Inhaled bronchodilators Caffeine Nitric oxide (?)
