Introduction to Neonatology Flashcards by Sarah McGuckin

What are the categories of term admissions to NNU?

Sepsis
Respiratory
Cardiac
Hypoglycaemia
Hypothermia
Jaundice
Birth asphyxia
Surgical problems

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What are the symptoms of neonatal sepsis?

Baby pyrexia or hypothermia
Poor feeding
Lethargy
Early jaundice
Hypoglycaemia/hyperglycaemia
Asymptomatic

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What are the risk factors for neonatal sepsis?

PROM
Maternal pyrexia
Maternal GBS carriage

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What is the management for presumed neonatal sepsis?

Admit NNU 
Partial septic screen and blood gas 
Consider CXR, LP 
IV penicillin and gentamicin 1st line 
2nd line vancomycin and gentamicin 
Add metronidazole if surgical/abdominal concerns 
Fluid management and treat acidosis 
Monitor vitals and support respiratory/cardio systems if required

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What are the commonest causes of neonatal sepsis?

Group B streptococcus 
E coli 
Listeria 
Coagulase negative staphylococci 
H influenzae

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What are the complications of GBS sepsis?

Meningitis 
DIC 
Pneumonia 
Respiratory collapse 
Hypotension 
Shock

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What are the most common congenital infections?

Toxoplasmosis
Rubella
CMV
Herpes

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What might congenital infections result in?

IUGR 
Brain calcifications 
Neurodevelopmental delay 
Visual impairment 
Recurrent infections

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What are the causes of respiratory problems?

Sepsis
Transient tachypnoea of the newborn (TTN)
Meconium aspiration

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What are the signs of TTN?

Grunting
Tachpnoea
Oxygen requirement
Normal gases

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How is TTN managed?

Supportive 
Antibiotics 
Fluids 
O2 
Airway support

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What is the pathophysiology of TTN?

Delay in clearance of foetal lung fluids

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What are the risk factors for meconium aspiration?

Post dates (aged placenta)
Maternal diabetes
Maternal hypertension
Difficult labour

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What are the symptoms of meconium aspiration?

Cyanosis 
Increased work of breathing 
Grunting 
Apnoea 
Floppiness

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What investigations are done for meconium aspiration?

Blood gas
Septic screen
CXR

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What is the treatment for meconium aspiration?

Suction below cord 
Airway support (intubation and ventilation) 
Fluids and IV antibiotics 
Surfactant 
NO or ECMO

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What investigations should be done for “blue baby” syndrome?

Examination and history 
Sepsis screen 
Blood gas and blood glucose 
CXR 
Pulse oximetry 
ECG 
Echo

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What s the differential diagnosis of “blue baby”?

TGA 
Tetralogy of Fallots
TAPVD
Hypoplastic left heart syndrome
Tricuspid atresia
Truncus arteriosus
Pulmonary atresia

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What is transposition of the great arteries?

2 separate circulations

Need to keep duct open

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What is the treatment for transposition of the great arteries?

Urgent septostomy

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What conditions are classified as tetralogy of fallouts?

Pulmonary stenosis
Thickened right ventricle
VSD
Overriding aorta

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What is total anomalous pulmonary venous drainage?

Pulmonary veins connected to one of the veins from the main circulation instead of left atrium
Oxygenated blood goes to the right side of the heart

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What are the features of a hypoplastic left heart?

Underdeveloped left heart
Poor oxygenation
Poor perfusion
Worse when duct shuts

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What is tricuspid atresia?

Absence of patent heart valve

Hypoplastic right ventricle

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What is truncus arteriosus?

Single blood vessel from left and right ventricles | Requires surgery to create 2 vessels

What is pulmonary atresia?

Abnormal pulmonary valve Obstructs blood from right ventricle to lungs Shunts and surgical repair

What is the treatment for a "blue baby"

``` ABC Inotropes as required Fluid resuscitation Respiratory support Prostin Nitric oxide Cardiology referral ```

How is neonatal hypoglycaemia managed?

``` Monitor blood glucose Start IV 10% glucose Increase fluids Increase glucose concentration Glucagon Hydrocortisone ```

How is hypothermia managed?

Admit and place in incubator Sepsis screen and antibiotics Consider checking thyroid function Monitor blood glucose

What is the management for neonatal jaundice?

Intensive phototherapy or exchange transfusion | Incubator and IV fluids may be required

What are the causes of birth asphyxia?

``` Placental problem Long, difficult delivery Umbilical cord prolapse Infection Neonatal airway problem Neonatal anaemia ```

What is the 1st stage of birth asphyxia?

Within minutes without O2 | Cell damage occurs with lack of blood flow and O2

What is the 2nd stage of birth asphyxia?

Reperfusion injury Can last days or weeks Toxins are released from damaged cells

What are the symptoms of mild hypoxic-ischaemic encephalopathy?

``` Slightly increased muscle tone Brisk deep tendon reflexes Poor feeding Irritability Excessive crying or sleepiness ```

What are the symptoms of moderate hypoxic-ischaemic encephalopathy?

``` Lethargic Hypotonia Diminished deep tendon reflexes Grasping and sucking reflexes sluggish or absent Apnoea Seizures ```

What are the symptoms of severe hypoxic-ischaemic encephalopathy?

Seizures

What is the management fro hypoxic-iscahemic encephalopathy?

``` Supportive Fluid restriction Monitor for renal and liver failure Respiratory support Cardiac support Treat seizures Therapeutic hypothermia ```

What is the cooling criteria for hypoxic-ischaemic encephalopathy?

Infants >/= 36 weeks with at least 1 of (Apgar score of <=5 at 10 minutes Continued need for resuscitation > 10 minutes, acidosis within 1st hour (pH <7), base deficit >= 16 within 1 hour) Seizures At least 30 minutes of abnormal electrical activity

What is the management for therapeutic hypothermia?

``` Baby cooled to 33C for 72 hours Rewarmed slowly over 12 hours Sedated for cooling Monitored for CFAM Cranial ultrasounds MRI at 7-10 days Neurodevelopmental follow up ```

What are the different types of oesophageal atresia/fistula?

``` Atresia with distal fistula Atresia with proximal fistula Atresia Atresia with double fistula Fistula ```

What is the treatment for oesophageal atresia/fistula?

IV fluids and suction | Surgical repair

What are the causes of failure to pass stool?

``` Constipation Large bowel atresia Imperforate anus Hirschsprungs disease Meconium ileus ```

How is a diaphragmatic hernia managed?

Intubation at birth Respiratory support Surgery ECMO

What are some examples of abdominal wall defects?

Exomphalos | Gastroschisis

What is IUGR?

Intrauterine growth restriction

What is SGA?

Small fro gestational age

What are the causes of SGA?

Maternal Foetal Placental Twin pregnancy

What are the common problems associated with SGA?

``` Perinatal hypoxia Hypoglycaemia Hypothermia Polycythaemia Thrombocytopenia GI problems ```

What are the long term problems associated with SGA?

Hypertension Obesity Reduced growth Ischaemic heart disease

What is pre term?

<37 weeks | <28 weeks (extremely pre term)

How can respiratory distress syndrome be prevented?

Antenatal steroids

How can respiratory distress syndrome be prevented?

Early surfactant treatment Early extubation Non invasive support (NCPAP) Minimal ventilation

What is the treatment for broncho-pulmonary dysplasia?

Nutrition and growth | Steroids

How can intraventricular haemorrhage be prevented?

Antenatal steroids

What is the pathophysiology of pulmonary ductus arteriosus?

``` Additional blood to circulation Over perfusion of lungs Lung oedema Steal from systemic circulation Systemic ischaemia ```

What are the consequences of pulmonary ductus arteriosus?

Worsening of respiratory symptoms Retention of fluids GI problems

When is the critical period of heart development?

Days 20-50

Where does a foetus receive circulation via?

Umbilical vein Foramen vale (LA, LV) Patent ductus arteriosus (RV, PA)

What is the function of the ductus arteriosus in the foetus?

Protects lungs against circulatory overload | Allows the right ventricle to strengthen

What is the ductus venosus?

Blood vessel that connects the umbilical vein to the IVC

How can a newborn's breathing be assessed?

``` Blood gases Transcutaneous pCO2 Capnography Tidal volume Minute ventilation ```

What happens when the foetus takes it's first breath?

Ductus arteriosus, venosus and umbilical veins and arteries become ligaments Foramen ovale close, leaving a depression

What is the normal heart rate range for neonates?

120-160bpm

How do neonates thermoregulate?

Maternal thermoregulation in womb | Brown fat due to lack of shivering

When will physiological neonatal jaundice appear?

Day of life 2-3

Introduction to Neonatology Flashcards

(65 cards)