Flashcards in Neonatal Medicine Deck (58):
Give an example of a live, attenuated vaccine.
Give an example of an inactivated vaccine.
Name 5 vaccine preventable diseases.
3. Whooping cough.
Give 3 signs of immune deficiency.
1. Frequent infections.
2. Infection with unusual organisms.
3. Severe infections.
4. Failure to thrive.
How much should you feed to a neonate?
(Day 1: 60ml/kg/day Day 2: 90ml/kg/day Day 3: 120ml/kg/day Day 4: 150ml/kg/day)
When are fluids indicated in a neonate?
- If they are premature.
- If they have respiratory distress.
- If they are NBM.
What fluid would you give to a neonate?
How do you calculate the rate at which to give maintenance fluids to a child?
100ml/Kg/day for first 10Kg.
50ml/Kg/day for the next 10Kg.
20ml/Kg/day for every Kg after that.
Radiology: give 5 ways in which imaging a child differs to imaging an adult.
2. Growth plates.
3. Skull sutures.
5. Congenital problems e.g. dextrocardia and osteogenesis imperfecta.
A baby makes many adaptations to ex-utero life. Give 4 CV adaptations.
1. Closure of foetal shunts e.g. foramen ovale and ductus arteriosus.
2. Perfusion of lungs.
3. Fall in pulmonary artery pressure and increase in systemic blood pressure.
4. Increase in CO.
A baby makes many adaptations to ex-utero life. Give 4 respiratory adaptations.
1. Foetal lung fluid removed.
2. Surfactant released.
3. Gaseous exchange.
A baby makes many adaptations to ex-utero life. Aside from CV and respiratory give 4 other adaptations.
1. Control of own movements.
2. Independent hormonal responses.
Give 3 functions of surfactant.
1. Reduces surface tension.
2. Prevents alveoli collapse.
3. Allows homogenous aeration.
When is surfactant produced?
From 34 weeks gestation. Production increases rapidly 2-weeks before birth.
Where is surfactant produced?
Surfactant is produced by type II pneumocytes.
What can mothers be given antenatally to prevent surfactant deficiency?
Steroids can be given to the mother to encourage foetal surfactant release.
Premature babies may have surfactant deficiency. Give 3 consequences of this.
1. Respiratory distress syndrome.
2. Chronic lung disease of prematurity.
3. Non-compliant lungs.
4. Unequal aeration.
5. Reduced lung volume.
Briefly describe the pathophysiology of chronic lung disease of prematurity.
There is reduced lung volume and reduced alveolar surface area -> diffusion defect. This often leads to recurrent hospital admissions and increased mortality.
Give 3 reasons why pre-term infants are particularly vulnerable to hypothermia.
1. Large SA relative to mass.
2. Thin and heat permeable skin.
3. Little fat for insulation. Temperatures can be maintained using incubators.
The brain stem is not fully myelinated until 32/34w. What problem can this cause in preterm infants?
They are at risk of apnoea of prematurity. They have no respiratory drive due to the lack of myelination and so 'forget to breathe'. It is often associated with bradycardia.
Describe the treatment for apnoea of prematurity.
1. Nasal CPAP.
2. Stimulation - caffeine.
Why are high levels of unconjugated bilirubin concerning in a neonate?
Unconjugated bilirubin is fat soluble and can diffuse into brain tissue. High levels of unconjugated bilirubin can lead to kernicterus and then cerebral palsy.
What is kernicterus?
Brain damage due to high levels of bilirubin.
Give 3 causes of high levels of unconjugated bilirubin.
5. Metabolic disease.
How can you treat high levels of unconjugated bilirubin in a neonate?
Why are pre-term babies at increased risk of infection?
Active IgG transfer happens in the last 3 months of pregnancy therefore pre term babies are at increased risk of infection; particularly with organisms that are not normally pathogenic.
Give 3 reasons why newborns become jaundiced.
1. Marked physiological release of Hb from RBC breakdown.
2. RBC lifespan is shorter (70 days)
3. Hepatic bilirubin metabolism is less efficient.
What is the likely cause of jaundice in a neonate who is <24h old?
Rhesus haemolytic disease, ABO incompatibility, heriditary spherocytosis, GP6D deficiency.
Why is it important to identify a neonate with a haemolytic cause of their jaundice?
The bilirubin is unconjugated and if allowed to reach high levels could cause kernicterus.
Describe the treatment for haemolytic jaundice.
2. Exchange transfusion.
How does phototherapy work in treating jaundice?
Light converts unconjugated bilirubin into a harmless water soluble pigment excreted predominantly in the urine
When might exchange transfusion be used in the treatment of jaundice?
If bilirubin rises to potentially dangerous levels and phototherapy alone is not effective.
What must you rule out as a cause of hyperbilirubinaemia in a child >2 weeks old who has jaundice?
Give 3 causes of jaundice from 2 days to 2 weeks of age.
1. Physiological jaundice.
2. Breast milk jaundice.
4. Congenital hypothyroidism.
5. Haemolytic cause.
Give 2 causes of conjugated hyperbilirubinaemia.
1. Biliary atresia (bile duct obstruction).
2. Neonatal hepatitis.
What is biliary atresia?
When there is progressive fibrosis and obliteration of the extra-hepatic and intra-hepatic biliary tree. Chronic liver failure and death can occur within 2 years.
What investigations might you do to determine whether a child has biliary atresia?
1. Measure transcutaneous bilirubin - conjugated bilirubin would be raised.
2. LFT's would be abnormal.
3. ERCP imaging would fail to outline a normal biliary tree.
What is the treatment for biliary atresia?
Surgery to bypass fibrotic ducts.
Nutrition and vitamin supplementation.
Give 5 signs of hepatic dysfunction in children.
6. Spider naevi.
8. Palmar erythema.
10. Malnutrition and faltering growth.
How would you manage respiratory distress in a neonate?
3. CO2 monitoring.
4. Surfactant therapy.
5. Nasal CPAP and mechanical ventilation.
6. Fluids if indicated.
What antibiotics would you prescribe empirically to reduce the risk of neonatal infections in a pre-term baby?
Benzylpenicillin (50mg/kg BD).
Gentamicin (5mg/Kg OD).
How would you feed a baby born at 27 weeks?
NG tube feeds. At 35 weeks you can start breast/bottle feeding as this is when suckling reflex develops.
What long term problems can a pre-term baby develop?
1. Retinopathy of prematurity.
2. Bronchopulmonary dysplasia
3. Osteopenic bones.
4. Neurodevelopmental delays.
What is the Moro reflex?
The Moro (startle) reflex is a primitive reflex that is a response due to a sudden loss of support. Sudden extension of the head causes symmetrical extension then flexion of the arms.
What conditions does the new born blood spot (Guthrie test) screen for?
2. Congenital hypothyroidism.
3. Sickle cell disease, thalassaemia
4. metabolic diseases e.g. MCADD, phenylketonuria and maple syrup disease etc.
Give 4 risk factors of respiratory distress syndrome.
1. male sex
2. diabetic mothers
3. Caesarean section
4. second born of premature twins
What do you see on CXR of respiratory distress syndrome?
Chest x-ray characteristically shows 'ground-glass' appearance with an indistinct heart border
What is the mx of respiratory distress syndrome?
1. prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation
3. assisted ventilation
4. exogenous surfactant given via endotracheal tube
List 6 ix which are carried out in a baby with prolonged jaundice.
1. conjugated and unconjugated bilirubin: the most important test as a raised conjugated bilirubin could indicate biliary atresia which requires urgent surgical intervention
2. direct antiglobulin test (Coombs' test)
4. FBC and blood film
5. urine for MC&S and reducing sugars
6. U&Es and LFTs
List 6 causes of prolonged jaundice.
1. biliary atresia
4. urinary tract infection
5. breast milk jaundice
6. congenital infections e.g. CMV, toxoplasmosis
Define neonatal death.
Death in the first 28 days of life.
Death in utero before 24 weeks of gestation
Define puerperal death.
Maternal death within the puerperal period (first 6 weeks after birth).
Define perinatal death.
A term sometimes used to classify deaths that are a result of obstetric events, the term encompasses stillbirths and deaths within the first week of life.
Define early and late neonatal death.
An early neonatal death refers to a death within the first week of life.
A late neonatal death refers to death after 7 days of life, but before 28 days.
Give 6 causes of neonatal hypoglycaemia.
1. maternal diabetes mellitus
5. neonatal sepsis
6. inborn errors of metabolism
occipital-frontal circumference < 2nd centile