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Neonatal Flashcards

(55 cards)

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1
Q

3 definitions of a premature baby

A

Small for Gestational Age
Intrauterine Growth Restriction
Hypotrophy

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2
Q

2 types of hypotrophy in premature babies

A

Symmetric- all values the same

Asymmetric

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3
Q

Causes of prematurity

A

Maternal - smoking, pre-eclampsia/toxaemia
Foetal - Chromosomal (Edward’s), Infection (CMV)
Placental
Twin pregnancy
- Recipient and donor - receipient has circulation overload

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4
Q

Common problems in premature babies

A 
Perinatal hypoxia
Hypoglycaemia
Hypothermia
Polycythaemia
Thrombocytopenia
Gastrointestinal (feed, NEC)
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5
Q

Why is the gut more susceptible to ischaemia in premature babies?

A

Sympathetic compensation to vital organs

Blood flow to skin, gut and muscle implicated

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6
Q

What can happen if the gut wall becomes ischaemic in premature babies?

A

Perforation

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7
Q

Long term issues for premature babies

A

Hypertension
Reduced growth
Obesity
Ischaemic Heart Disease

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8
Q

What causes respiratory distress syndrome in the newborn>

A

Not enough surfactant

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9
Q

At what stage does a baby begin producing surfactant?

A

24-28 weeks of pregnancy

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10
Q

When might respiratory distress syndrome occur in babies who were delivered at term?

A

Mother is diabetic
Baby is underweight
Lungs not developed

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11
Q

Symptoms of Newborn Respiratory Distress Syndrome?

A

Cyanosed - blue lips, fingers, toes
Rapid, shallow breathing
Flaring nostrils
runting when breathing

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12
Q

Investigations for Newborn Respiratory Distress Syndrome

A

Physical examination
Bloods - exclude infection
Pulse oximetry
Chest x-ray

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13
Q

How will lungs of a premature baby with NRDS appear on x-ray?

A

Cloudy

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14
Q

Treatment for Newborn Respiratory Distress Syndrome

A

Surfactant
Early extubation
Non-invasive support
Minimal ventilation (low tidal, good inflation)

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15
Q

Complications of Newborn Respiratory Distress Syndrome

A

Pneumothorax
Bleeding
Developmental issues due to hypoxia - learning diffculties, difficulty with hearing, vision, movement problems
Bronchopulmonary dysplasia

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16
Q

Aetiology of bronchopulmonary dysplasia

A

Volume trauma in lungs leads to inflammatory changes
Scarring occurs from tissue repair
Scarring occurs from surfactant or steroids to treat NRDS
Causing atelectasis

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17
Q

What is atelectasis?

A

Loss of lung volume, failed expansion, (collapse)

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18
Q

Treatment of bronchopulmonary dysplasia?

A

Patience
Nutrients
Steroids

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19
Q

Treatment for apnoea/irregular breathing/desaturations?

A

Caffeine

N-CPAP

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20
Q

How is intraventricular haemorrhage prevented in premature babies?

A

Antenatal steroids

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21
Q

Treatment of intraventricular haemorrhage

A

Symptomatic

Drainage

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22
Q

What changes are seen at Day Of Life 7 in periventricular leukomalacia? (PVL)

A

Cystic changes

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23
Q

What DOL will show significant changes from DOL7 in periventricular leukomalacia (PVL)?

Study These Flashcards
A

DOL21 -significantly worse changes

24
Q

Cause of oedema in lungs in premature baby?

Study These Flashcards
A

Patent Ductus Arteriosus

25
How can a patent ductus arteriosus give rise to fluid in the lungs?
Additional pulmonary circulation, over perfusion of lungs
26
Other complications of a patent ductus arteriosus
Reduced systemic circulation due to overperfusion of lungs leads to ischaemia Worsening respiratory problems Fluid retention ( low renal perfusion) GI symptoms
27
How does necrotising enterocolitis occur (NEC)?
Inflammatory and ischaemic changes lead to a necrotic bowel leading to perforation
28
Treatment of necrotising enterocolitis?
Surgery Antibiotics Parenteral nutrition (through vein)
29
Definition of premature baby
Delivered before 37 weeks gestation
30
Outcomes of premature babies
1/3 will die 1/3 normal to mild disability 1/3 moderate to severe disability
31
At what week does the cardiovascular system develop in the foetus?
Towards end of 3rd week
32
At what week is a heartbeat present in the foetus?
4th week
33
Which days after fertilisation are critical for development of the foetus?
Days 20-50 after fertilisation
34
Through which vessel does the foetus receive oxygenated blood?
Umbilical vein - Ductus venosus
35
How does blood enter the Aorta in the foetus>
Foramen ovale to left atrium, to left ventricle to aorta
36
How does blood enter the pulmonary artery in the foetus?
Right ventricle, to pulmonary artery, via patent ductus arteriosus to aorta
37
What is the SaO2 in a foetal body?
60-70%
38
What is the function of the ductus arteriosus?
Protects lungs from circulatory overload Allows the right ventricle to strengthen Carries low oxygen saturated blood
39
Function of the ductus venosus?
Foetal blood vessel connecting umbilical vein to IVC | Carrie oxygenated blood
40
How is the blood flow regulated in the ductus venosus?
Via sphincter
41
What is the normal heart rate of a full term newborn?
120-160 beats per minute Tachycardic > 160 Bradycardic <100
42
What is the normal respiratory rate of a full term newborn?
30-60 per min | Periodical breathing
43
What is the normal blood pressure of a full term newborn?
At 1 hour 70/44 At day One : 70 +/-9 over 42+/- 12 diastolic Day Three : 77+/- 12, over 49 +/- 10 diastolic
44
Around which days are signs of physiological jaundice common?
DOL 2-3, disappear DOL 7-10 up to DOL 21 in preterm infants
45
What percentage of babies develop visible jaundice?
60% term | 80% preterm
46
What is kernicterus?
High levels of bilirubin | Can cross BBB leading to irreversible changes
47
Treatment for physiological jaundice
Blue light | converts bilirubin to water soluble form - increasing bilirubin oxidation
48
3 features of increased fluid loss in the kidney in premature infants
Slower GFR Reduced Na absorption Decreased ability to concentrate/dilute urine
49
Reason for increased insensible water loss in premature infants
Immature skin | Breathing
50
At DOL 7, what percentage of previous production in the uterus is the production of red blood cells in the infant?
10%
51
What is the haemoglobin level normally at birth?
12-20 g/l
52
What is the haemoglobin by week 11 in the infant?
11.4 g/l
53
What is increasingly produced between week 10 and week 20 in the infant?
Erythropoeitin
54
What is the haemoglobin level by week 20?
12 g/l
55
3 causes of anaemia in prematurity
Reduced erythropoiesis Infection Blood letting

Paediatrics (10 decks)

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