Neonataology Flashcards
1
Q
Define preterm
A
<37 weeks
2
Q
define very preterm
A
<32 weeks
3
Q
define extremely preterm
A
<28 weeks
4
Q
define term
A
37-42 weeks
5
Q
define post term
A
> 42 weeks
6
Q
define foetal loss
A
<23 weeks
7
Q
define low birth weight
A
<2.5kg
8
Q
define very low birth weight
A
<1.5kg
9
Q
define extremely low birth weight
A
<1kg
10
Q
define small for gestational age
A
<10th centile in weight for expected gestation
11
Q
define appropriate for gestational age
A
10-90th centile in weight for gestation
12
Q
define large for gestational age
A
> 90th centile in weight expected for gestation
13
Q
RF for preterm births
A
multiple pregnancy uterine/cervical pathology chronic health conditions in mother e.g. BP, DM, clotting infections in pregnancy smoking, alcohol, illicit drugs idiopathic
14
Q
most preterm babies <28wk will need help with transitioning to air breathing, this is called resuscitation, true or false
A
false, not resuscitation
15
Q
what is the difference between preterm and term babies when they are born
A
preterm: get colder faster more fragile lungs dont breathe effectively fewer reserves
16
Q
why is cord clamping delayed for a minute in premature babies
A
to allow placental transfusion
‘optimal cord clamping’
17
Q
how can you keep the preterm baby warm during cord clamping
A
place them in a plastic bag while still wet under a radiant heater
reduces heat loss from convection and evaporation
18
Q
how do you manage the airway in a premature newborn
A
neutral head positioning - over extension will block the airway
jaw thrust
suction, gentle and only if secretions are present
19
Q
what can happen if the premature newborns lungs are overinflated
A
damage leading to inflammation and long term morbidity (broncho pulmonary dysplasia)
20
Q
common concerns in the preterm infant
A
temp control feeding and nutrition - late sucking reflex sepsis system immaturity - RDS - PDA - IVH - NEC Metabolic ROP
21
Q
hypothermia in a preterm infant increases severity of all preterm morbidities, true or false
A
true
22
Q
why is thermal regulation in preterm babies ineffective
A
low BMR
minimal muscular activity
SC fat negligible
high SA:bodymass ratio
23
Q
methods of warming a preterm baby
A
skin to skin
plastic bag / wrap
transwarmer mattress
prewarmed incubator
24
Q
why are preterm babies at risk of nutritional compromise
A
lower reserves
immature metabolic pathways
increased nutritional demands
25
what is gestational correction
adjusts the measurements to account for the number of weeks a baby was born early
26
how do calculate gestational age for a preterm baby
corrected age = chronological age - weeks of prematurity
| where weeks of prematurity = 40-gestational age at birth
27
which gestation do you correct gestational age
<37 weeks
28
how long to do you continue to correct gestational age
1 year for 32-36/40wk
| 2 years for <32/40wk
29
causes of infections in premature babies
```
septicaemia
meningitis
resp infections
diarrhoea
neonatal tetanus
line infections
```
30
how can neonatal sepsis be classified
early onset - bacteria acquired before/during delivery
| late onset - after delivery
31
organisms causing neonatal sepsis
GBS
Gram negatives: klebsiella, E coli, pseudomonas, salmonella
Gram positives: coag - Staph (especially with lines/plastic), staph A, strep pneumoniae, strep pyogenes
32
Incubators Increase Infection, true or false
true!
33
respiratory complications of prematurity
resp distress syndrome
apnoea of prematurity
bronchopulmonary dysplasia
34
what is resp distress syndrome/hyalline membrane disease
alveoli are immature and dont produce surfactant, this and structural immaturity resulting in alveolar damage, exudate, inflammation and resulting in fibrosis
35
clinical features of RDS
```
tachypnoea
grunting
intercostal recession
nasal flaring
cyanosis
worsens over min-hours
```
36
management of RDS
maternal steroids
surfactant
ventilation - invasive/noninvasive
37
there is a hazy appearance of the lungs in RDS CXR, true or false
true
due to poor aeration of alveoli = ground glass appearance
also, presence of bronchograms
38
CVS concerns in a preterm infant
PDA
| systemic hypotension
39
features of intraventricular haemorrhage
begins with bleeding in the germinal matrix
| most occur in the first day of life
40
how can you investigate an intraventricular haemorrhage
USS through the fontanelle
41
what are the major RF for intraventricular haemorrhage
prematurity
| RDS - hypoxia, unstable cerebral circulation
42
clinical presentation of intraventricular haemorrhage
clinically silent
intermittent deterioration: hypoxia, pallor, hypotension, irritable, apnoea
CVS collpase
43
preventing intraventricular haemorrhage
```
antenatal steroids
prompt resus
avoid:
hypoxia
hypercapnia
hyperoxia
hypocarbia
swinging BP
```
44
what is NEC
necrotising enterocolitis is the most common neonatal surgical emergency
widespread necrosis in small and large intestines
45
clinical presentation of NEC
usually recovering from RDS
lethargy, distended abdomen
bloody stools, temp instability, apnoea, bradycardia
46
when is retinopathy of prematurity evident
after 6-8 weeks
| from too much oxygen therapy
47
what are early and late metabolic complications of prematurity
early - hypoglycaemia, hyponatraemia
| late - osteopaenia of prematurity
48
when is a newborn examination carried out
between 6-24 hours of life
| before 72 hours
49
reasons for carrying out the newborn examination
screen for problems
alleviate concerns
health promotion
continuity of care record
50
overview of the newborn exam
resp and heart - when baby is settled
head to toes
front and back
hips and moro reflexes last
51
important aspects of the history to ask about before carrying out a neonatal examination
```
gestation, weight, height, head circumference and centiles
FH - hips, heart, eyes, ears...
antenatal complications
delivery mode - resus?
presentation
feeding
urine and bowels
```
52
normal APGAR score
>=8/10
53
assistance vs resuscitation in premature babies
assistance to help transition to air breathing
| resuscitation is more aggressive and uses drugs etc
54
neonatal life support algorithm
```
ABCDE
Allow delayed cord clamping
Keep baby warm
Airway - they have small floppy airways
Breathing - lungs are fragile, CPAP
```
55
what is the triad of hypothermia
hypothermia can lead to hypoglycaemia and hypoxia
| hypoglycaemia exacerbates hypoxia
56
nutritional options for preterm babies
```
breast milk (mothers ideally, donor milk is available also)
parenteral nutrition (TPN) - IV feed
preterm formula
```
57
what do you do if there is abdominal concern in a newborn
stop feeding/putting things into tummy
examination - tense, tender
vomit? stool?
58
AXR features of NEC
air within the bowel wall
thickened loops of bowel
if severe: it can rupture and perforate - free air in abdomen (football sign)
59
risk of RDS
pneumothorax
60
complication of IVH
hydrocephalus
blood tries to break down and is taken up by CSF, but it is full of protein and so clogs up the CSF drainage leading to hydrocephalus
also, cerebral palsy
61
what is grunting
sign of resp distress
| expiration against a closed glottis
62
2 doses of maternal steroids
RDS
sepsis
haemorrhage
NEC
63
Magnesium sulphate
neuroprotection
64
normal HR in newborn
>100
65
first thing to do in a newborn resuscitation
dry them / rubbing
66
what do you do first in newborn resuscitation, compressions or breaths
breaths
67
RDS RF
```
male
Maternal DM and HTN
IUGR <29weeks
Sepsis
Hypothermia
C-section delivery
Second twin
```
68
treatment for RDS
surfactant ideally within 6 hours of birth
69
when is surfactant produced
naturally produced from 24 weeks but only produced in sufficient amounts by 34 weeks
70
what drugs are given to all preterm babies
Vit K - to prevent haemorrhagic disease of the newborn, IVH
Caffeine - preventing apnoeic episodes and neuroprotective
ABIDEC - multivitamin
Sytron - iron
71
features of NEC
bilious vomiting
bloody stool
abdominal distension
72
RF for NEC
prematurity
IUGR
formula feeding
umbilical arterial lines
73
what is grunting
breathing against a closed glottis giving themselves CPAP
74
what is surfactant
```
a molecule (phospholipid and apoprotein) that helps to reduce surface tension
helps to keep lungs open
```
75
what gestation do babies make surfactant
around 30-32 weeks
76
management of pneumothorax
aspirate
| chest drain
77
what is chronic lung disease/BPD
oxygen requirement beyond 36 weeks corrected gestation plus evidence of pulmonary parenchymal disease on CXR
78
what is synergis
MAB IgG against RSV in at risk babies
79
at what gestation do premature babies learn to suck e.g. from a bottle
~32 weeks
80
what is term
37-41 weeks
81
when babies are born, what do they breathe through, their mouth or nose?
they are obligate nose breathers
| therefore have to take care with NG tube (can do an OG tube)
82
trophic feed
minimal enteral nutrition
| tiny amount of breast feed to stimulate the gut
83
baby acne
present on baby's cheek / face
mix of black comedones, pustules and papules
harmless, goes away and doesnt scar
(erythema toxicum is all over)
84
physiological jaundice is un/conjugated
unconjugated
| water insoluble
85
breastfed babies are commonly jaundiced, true or false
true
86
Is UV light used in phototherapy for jaundice
no
it is coloured light
light therapy NOT UV therapy resulting in photoisomerisation ie breaking down bilirubin to a soluble molecule to be peed out
87
consequences of raised bilirubin
encepahlopathy
kernicterus
CP
88
waiters tip posture
erbs palsy
| C5-6
