Neonatal and Newborn 2 Flashcards

Question

Why do premature babies have problems regulating temperature? (3)

Answer 1

1) Increased SA:V leads to loss of heat 2) Immature skin cannot retain heat and fluid efficiently 3) Reduced SC fat reduces insulation

Answer 2

1) Hypoglycaemia is common: - Symptomatic hypoglycaemia must be treated promptly - Blood glucose should be maintained >2.6mmol/L 2) Hypocalcaemia 3) Electrolyte imbalance 4) Osteopenia of prematurity with risk of fractures

Answer 3

1) Increased risk of sepsis - esp group B strep and coliforms 2) Pneumonia is common 3) Infection is a common complication of central venous lines required for feeding

Answer 4

May require parenteral nutrition NG feeds until sucking reflex develops at 32-34wks NB it is difficult to achieve in utero-growth rates

Answer 5

1) Anaemia of prematurity | 2) Neonatal jaundice

Answer 6

1) Extremely preterm = <28wks 2) Very preterm = 28-32wks 3) Moderate to late preterm = 32-37wks

Answer 7

1) Chronic lung disease = bronchopulmonary dysplasia - Results from disrupted lung development - May require long-term oxygen treatment for months / years 2) Neurological sequelae - Significant risk of hydrocephalus developing secondary to an intraventricular haemorrhage - Shunt may need to be inserted to relieve pressure - Hypotension may be sustained which can lead to periventricular leucomalacia. This carries risk of cerebral palsy (esp diplegic type) 3) Blindness 4) Poor growth - Esp if catch up growth is not achieved

Answer 8

White-matter brain injury, characterised by necrosis of white matter near the lateral ventricles Premature infants are at greatest risk Leads to problems with motor control and developmental delay, often developing CP or epilepsy later in life

Answer 9

IM corticosteroids to women expecting delivery <34wks 2 doses, 12-24hrs apart Betamethasone or dexamethasone

Answer 10

Most require stabilisation and support (not resuscitation) <28 weeks need senior paediatrician Delay cord clamping for 1 min if infant not compromised Keep warm Provide resp support if needed: - Positive end experiratoy pressure = PEEP (CPAP) - Consider intubation Monitor and maintain blood glucose Encourage mother to express breast milk If ?infection - start broad spectrum abx

Answer 11

1) Surfactant deficiency = by far most common 2) Pneumonia 3) Pneumothorax 4) Cardiac failure 5) Congenital lung malformation

Answer 12

* Premature birth - main risk factor * Genetic predisposition * Elective C-section - uterine contractions during normal labour increase levels of glucocorticoids that aid lung maturation * Maternal diabetes - insulin inhibits surfactant synthesis - main cause of RDS in term babies * Hydrops fetalis * Multiple pregnancy

Answer 13

``` Tachypnoea - RR > 60 Nasal flaring Intercostal recession Cyanosis Expiratory 'grunting' ```

Answer 14

'Ground glass' appearance due to alveolar collapse with an air-bronchogram = bilateral and relatively symmetric diffuse ground glass lungs with low volumes and a bell-shaped thorax Generalised atelactasis = complete of partial collapse of a lung or lobe of the lung

Answer 15

A phospholipid which reduces alveolar surface tension to prevent them from collapsing Produced by lamellar bodies of type II alveolar cells

Answer 16

Surfactant production occurs at 20 weeks' gestation but distribution throughout the lungs begins around 28-32 weeks and reaches sufficient concentration at 35 weeks However, the stress of labour usually stimulates production, and thus RDS is usually self-limiting, lasting 5-7 days

Answer 17

24mg IM betamethasone (2 doses of 12mg 24h apart) to stimulate surfactant production 1-7 days before birth

Answer 18

They are physiologically 'stressed' and thus tend to get less severe RDS due to endogenous corticosteroid release

Answer 19

Optimising oxygenation and supporting respiration - either with CPAP via nasal prongs, or by mechanical ventilation Surfactant can be administered via an endotracheal tube Abx - penicillin or gentamycin until congenital pneumonia has been excluded (can mimic or coexist with RDS) Nutrition - IV fluids until stable, then start NG tube feeds

Answer 20

20% develop chronic lung disease of prematurity = bronchopulmonary dysplasia If severe may require home oxygen therapy Generally good prognosis, 5-10% mortality

Answer 21

Life-threatening complication in which there is impaired blood flow to the bowel Mucosal ischaemia allows gut microorgnaisms to penetrate the bowel wall causing severe hemorrhagic colitis

Answer 22

Breast milk = protective But increasing milk feeds (esp formula feeds) too quickly is a risk factor for NEC Prematurity

Answer 23

Acute collapse Abdo distension Bilious vomiting Fresh red blood in stools

Answer 24

Supine position Lateral position Lateral decubitus position Distended loops of bowel with thickening of bowel wall Gas in bowel wall = pneumatosis intestinalis Possible pneumoperitoneum if perforation has occurred

Answer 25

Gut rest - nil by mouth with IV fluids and TPN and NG tube Broad spectrum antibiotics - 10 days metronidazole Laparotomy - surgical emergency - Resection of dead bowel tissue - Temporary stoma if significant bowel removed

Answer 26

Erythromycin

Answer 27

Most cases require no treatment but causes blindness in 1% Laser ablation to prevent risk of retinal detachment and blindness

Answer 28

Proliferation of new blood vessels in an area of relative ischaemia in the developing retina Oxygen toxicity and genetic predisposition are two causes - at risk infants should be screened by an opthalmologist

Answer 29

A haemorrhage develops in the floor of the lateral ventricle and ruptures into the ventricle In a small minority the haemorrhage involves the white matter around the ventricle by a process of obstructive venous infarction = high risk of hemiplegic cerebral palsy Can be asymptomatic and diagnosed by asymptomatic USS Occurs in 30% of very low birth weight babies

Answer 30

Posthaemorrhagic hydrocephalus Occurs in 15% of severe IVH

Answer 31

Progressive dilation of the ventricular system

Answer 32

May require insertion of a ventriculo-peritoneal shunt

Answer 33

Less common than IVH but is the most common cause of cerebral palsy in surviving infants

Answer 34

Chorioamnionitis Severe hypotension Monozygotic twins

Answer 35

Cystic change = 80% develop CP

Answer 36

``` Toxoplasmosis Other = syphilis Rubella CMV Hepatitis and HIV ```

Answer 37

Excessive weight gain can lead to HTN, IHD and DM later in life

Answer 38

Tallipes equinovarus

Answer 39

Males 2 x more likely

Answer 40

Talipes equinovarus = club foot - feet are hyper-inverted and plantar-flexed Talipes calcaneovalgus = ankles are hyperflexed

Answer 41

1. Equinus foot position - short Achilles tendon fixes the foot in plantar flexion so dorsiflexion beyond 90 degrees is not possible 2. Varus position - supination of calcaneus 3. Adductus - medial deviation of the toes 4. Supinatus - inversion of forefoot 5. Distinct arching of foot

Answer 42

1) Oligohydraminous 2) Uterine anomalies 3) Multiple surgeries = restrictive uterine environment

Answer 43

The foot cannot be passively everted and dorsiflexed through the normal range

Answer 44

Ponseti-method - manual correction with serial casting that should be initiated within 24 hours of birth Foot is manipulated and placed in a long leg plaster cast on repeat occasions - important that the deformity correction is gradual If this does not work, operations on soft tissues and/or bones may be carried out later (from 2yrs)

Answer 45

* IUGR * Sensorineural deafness * Bilateral cataracts * Microcephaly * PDA

Answer 46

* IUGR * Periventricular calcifications * Pin point petechial 'blueberry muffin' skin lesions remember CMV infection would have been asymptomatic in the mother so no history of maternal illness

Answer 47

Classic triad: 1. Chorioretinitis 2. Hydrocephalus 3. Diffuse intracranial calcifications

Neonatal and Newborn 2 Flashcards

(72 cards)