Neonatal medicine Flashcards
(27 cards)
outline the parameters by which low birth weight is classified
- low birth weight - <2500g
- very low birth weight - <1500g
- extremely low birth weight - <1000g
aetiology?
placental insufficiency leading to IUGR
- Pregnancy induced HT
- smoking /alcohol
- maternal systemic disease
- diabetes
- twin pregnancy
differentiate between symmetrical & asymmetrical low birth weight
- symmetrical- proportionate ie both head & body small
- 1st trimester insult: DNA insult (congenital/chromosomal anomalies)
- permanent damage; bad prognosis
- asymmetrical- head normal growth, body small
- 3rd trimester insult
- will feed them and they’ll grow ; better prognosis
what is the pathology of hypoxic-ischaemic encephalopathy?
brain injury resulting from a hypoxic-ischaemic insult
- abruption
- cord prolapse
- any cause of maternal hypoxia
- inadequate post natal circulation
presentation of HIE?
- poor APGAR scores
- metabolic acidosis
- abnormal CTG before birth
signs / symptoms of HIE?
- milld
- hyperalert, hypotonia, poor feeding
- severe
- comatose
- severe hypotonia
- seizures
Ix of HIE?
- EEG
- marked voltage suppression
Mx of HIE?
- supportive
- cooling (therapeutic hypothermia)
- only to >35 weeks
complications of HIE
- cerebral palsy
- epilepsy
- learning difficulties
- hearing & visual impairment
Prognosis of HIE
- mild- majority no sequelae
- moderate - 40% serious long term complications
- severe- 30% mortality , 50% severe disability
what APGAR score indicates a poor outcome?
< 3 at 10 minutes
outline the causes of respiratory distress in term infants
- meconium aspiration syndrome
- pneumonia
- pneumothorax
- Transient Tachypnoea of Newborn (TTPN)
- Persistent Pulmonary HT of Newborn (PPHN)
- diaphragatic hernia
- HF
signs / symptoms of respiratory distress in newborn
- tachypnoea
- tachycardia
- hypoxia –> acidosis
- cyanosis
- grunting
- nasal flaring / head bobbing
- intercostal recession
Ix of any neonate that present with respiratory distress?
- CXR
- Echo if cardiac cause / PPHN suspected
Mx of respiratory distress in term infants? before you know cause
ventilation - oxygen, CPAP, invasive ventilation
pathology of meconium aspiration syndrome
when meconium is passed in utero due to foetal distress, and is then aspirated during delivery causing pneumonitis
what is seen on CXR in MAS?
patchy infiltrates
Rx of MAS
- surfactant
- oxygen
- ventilation
- Abx
prevention of MAS?
if presence of meconium stained liquor (amniotic fluid), deliver ASAP
pathology of PPHN
failure of pulmonary vascular resistance to reduce after birth
aetiology of PPHN
- primary
- disease of pul vasculature
- secondary
- lung parenchymal disease ie pneumonia
- birth issues ie asphyxia
signs of PPHN?
- R–> L shunt
- increase in pul arterial pressure
Rx of PPHN?
- Nitric oxide
- Oxygen
- ECMO if severe
Aetiology of Pneumothorax in newborn?
often iatrogenic via CPAP
