Flashcards in Neonatal Problems Deck (32):
What is kernicterus?
Bilirubin-induced brain dysfunction. (Bilirubin can cross the blood brain barrier in neonates). Prevention through phototherapy or exchange transfusion.
Bill of >360umol/L =increased risk
Neonatal jaundice is common (60%) but what are you worried about if there is jaundice within 24 hours of birth?
Within 24 hours is abnormal. Can indicated: sepsis or haemolytic disease e.g. Rheus, ABO in compatibility, red cell abnormalities (congenital spherocytosis, G6PD definciency)
Test: fbc, blood group, Coombs test and blood film.
What can cause physiological hyperbilirubinamia?
Hyperbilirubinamia >200umol/L after 24hrs of life.
1) ⬆️bil production due to faster rbc turnover in neonates
2) ⬇️ conjugation - hepatic immaturity
3) ⬇️ gut flora ⬇️ bile elimination
4) exclusive breast feeding
What is the Kasai procedure used for?
Kasai procedure is used in biliary atresia. Also called hepatoportoenterostomy. Surgery exposes the porta hepatis and attaches small bowel to the exposed surface to allow bile drainage into the gut.
Op is 60% successful in first 60days of life. Less so after 100days and infant may need liver transplant within 1year.
Which neonatal emergency presents is early life with abdo distension, no bowel sounds, soap-bubble appearance on x-ray and bilious vomiting and bloody diarrhoea?
NEC - necrotising entrocolitus - necrosis of usually the distsl ileum or proximal colon
RFs: prematurity and low birth weight
Rx nasogastric tube - drip and suck
? Surgical resection
What structures are present in the foetus which close in the neonate?
Ductus venousus (Umbilical vein from the placenta which bypasses most of the liver via the DV) closes after 2-3weeks. To form ligamentum venosum.
Foramen ovale (septum secondum) R-L shunt (low pressure on left) therefore bypassing the lungs into systemic circulation. At birth the pressure decreases on right and increases on the left reversing the shunt which closes the FO. Takes a few months to fully close.
Ductus arteriosus (high resistance in lung forces blood from the truncus pulmonalis into the aorta. Connects after the supply of well oxygenated blood goes to the brain) blood then goes to the lungs at birth and DA closes quickly. Anatomical closure about 2 months.
Where is surfactant produced?
Type 2 pneumocystis
Why is vitamin K given to almost all babies at birth?
To prevent haemolytic disease of the newborn
Which 5 diseases are screened for at birth by the heel prick test?
What is the most common cause of neonatal encephalopathy?
Birth asphyxia (perinatal hypoxia)
Best outcomes come from whole body cooling of the infant to 33.5'c for 72 hours, then a gradual re-warming
Does the majority of perinatal asphyxiation happen before, during or after birth?
Before- 70% of insults occur Antenatally e.g. Placental abruption, maternal cardiac arrest...
What is the apperance of respiratory distress syndrome of a newborn on a CXR?
Diffuse granular or 'ground glass' appearance and air bronchgram of the large airways.
Caused by surfactant deficiency in premature infants. Also known as hyaline membrane disease because hyaline membranes line the collapsed alveoli.
Glucocorticoids (steroids) are given antenatally to stimulate surfactant production in expected preterm births.
What causes TTN (transient tachypneoa of the newborn)?
Delay in absorption of feral lung fluid (usually in c-section babies). On CXR see prominent pulmonary vasculature and fluid in horizontal fissure
How does a diaphragmatic hernia cause respiratory distress?
Hole in diaphragm usually on th left (80%) allows bowel contents to herniated into chest.
Many are picked up antenatally
Which group of babies is meconium aspiration rare?
Causes of prolonged jaundice? Unconguagated and conjugated
Unconjugated - g6pd, hypothyroid, breast milk
Conjugated - CF, hypothyriodism, alpha 1 antitrypsin def, viral hepatitis, biliary atresia
What eye problem are premature babies at risk from? When are they screened?
Retinopathy of premAturity
Oxygen is also a risk factor
If⬇️27weeks screen at 30/31weeks post menstral age
If 27-32 weeks screen at 28/35 days of life
What abx do you give in early-onset neonatal infection?
Benzylpenicillin and gentamicin
(If meningitis expected give cefotaxime)
(If listeria give ampicillin/amoxicillin)
What abx do you give for late-onset neonatal infection?
Flucloxacillin and gentamicin
If a neonatal seizure is prolonged (>3/5mins) or recurrent, what is the first line anticonvulsant treatment?
Pneumatosis intestinalis on X-ray is pathognomonic of which neonatal condition?
It is gas in the gut wall, indicative of NEC (necrotising enterocolitis)
When would you consider treating strawberry naevus?
If covering eye or joint, can give propranolol
What two antenatal signs may suggest oespageal atresia?
What type of milk is more likely to give NEC?
Formula milk (try to express breast milk)
When would you worry about jaundice?
And after 14days
Where does kernicterus effect in the brain?
- sensory neural deafness
What is galactosemia?
Rare cause of hyperbilirubinamia
Signs of congjugated bilirubin
What happens to the lungs in diaphragmatic hernia?
Why give abx in RDS?
Ground glass - RDS
Same appearance as pneumonia (give abx incase)
Why do babies grunt?
Create Positive end expiratory pressure