Neonate Flashcards
(49 cards)
Newborn life support!
At birth?
Meconium?
Lung Inflation?
At birth- delayed clamping of umbilical cord for at least 1 minute.
Menconium- vigorous Infant born through meconium stained should NOT be suctioned with on the perineum or the rescutirare.
Floppy, pale, respiration or bradycardia should be inspected- Oropharnyx (suction if present)
Tracheal incubation as well as suction should be performed if non vigorous infant.
Mask ventilation if there is persistent bradycardia.
Lung Inflation- given initially (21%)
3 seconds each breath, sets of 5
Once chest is moving. Ventilation breaths are given at 30-40min if required.
Neonatal Life Support!
1) What are the Airway man overs?
2) Chest Compressions?
3) Drugs that are given?
a) Airways manovers include
- Jaw thrust (2 person technique)
- Direct observation of the oropharynx and airway
- Guedel Airway
- Intubation (if competent)
b) Chest Compressions rate at 100/min using 2 thumb technique.
3 chest compression per lung Inflation (3:1 ratio.
Re asses infant after every 30 sec(15 cycles).
c) The drugs given through Umblicical Venous Catheter or IO( high dose).
B- bicarbonate
A- adrenaline
D- dextrose
Define Large for gestational age and Small for Gestational Age?
LGA- > 90 centile/ >4.2kg at birth
SGA- <10 centile/ <2.5kg at birth
What are the causes of Small gestational age?
- constitutional ( small parents) MOST COMMON
- placental dysfunction ( decrease O2 or glue code supply
-chromosomal disorders, congenital disorders and syndromes and Congenital infections
Maternal hypertension, multiple pregnancy, maternal infections.
- Maternal substance exposure ( smoking, alcohol and other drugs)
Complications of SGA?
- Increase risk of fetal death and asphyxia.
- Hypoglycemia due to reduced glycogen storage.
- Hypothermia
- polycythemia ( secondary to inuterine hypoxia?
- Necrotizing Encolitis
- Thrombocytopenia ( bone marrow and hepatic compromise)
- Menicoum Aspiration Syndrome
Management of SGA?
- Blood glucose monitoring and thermal care.
- Observe temperature, Pulse and respiration for at least the first 24hrs.
- Look for underlying cause and manage it.
- discharge only when infant suckling 3-4hrs, wait gain satisfactory 20-30g day.
- Body temp is at room temp & mother can care for infant
Causes of LGA?
- Constitutional (large parents)
- Infant of mother with diabetes
- Pancreatic Islet cell hyperplasia, fetal insulinism
- Hydrops fetalis
- Beckwith-Wiedemann Syndrome
Complications of LGA?
- Perinatal Asphaxia/ Shoulder Dystocia/ fractures
- Hypoglycemia ( especially in IDM)
- problems associated with underlying cause.
Management of LGA?
- Careful obesteritic examination to prevent obestetric complications.
- prevent hypoglycaemia
PROGNOSIS- Good unless hydrous fetalis
Pathophysiology of IDM?
-Pathophysiology
Maternal hyperglycaemia l i foetal glucose l i foetal insulin secretion (antenatally has growth hormone function) l macrosomia, organomega- ly, and polycythaemia. Rarely, maternal vascular disease results in foetal IUGR.
Associated complications of IDM?
-Associated complications
• 2–4 x risk of congenital abnormalities: caudal regression syndrome (sacral and femoral agenesis or hypoplasia); transient hypertrophic cardiomyopathy; small left colon syndrome; neural tube defects.
• Obstetric complications (see b Complications): increased risk of spontaneous miscarriage, intrauterine foetal death, and prematurity.
• Hypoglycaemia: generally resolves as serum insulin level falls.
• Respiratory disease: respiratory distress.
• Polycythaemia. Risk of secondary thrombosis (e.g. renal vein).
• Exaggerated physiological jaundice.
• Hypocalcaemia and hypomagnesaemia.
Prognosis of IDM?
• Normoglycaemia occurs within 48hr in vast majority.
• 7 x increased risk of diabetes mellitus in later life.
• Increased risk of later
Define prematurity.
Birth before 37 completed weeks gestation. 8% of all births. Most prob- lems seen in with infants born <32 completed weeks (72% of all births).
Predisposing factors of prematurity.
• Idiopathic (40%).
• Previous preterm birth.
• Multiple pregnancy.
• Maternal illness, e.g. chorioamnionitis, polyhydramnios, pre-eclampsia,
diabetes mellitus.
• Premature rupture of membranes.
• Uterine malformation or cervical incompetence.
• Placental disease, e.g. dysfunction, antepartum haemorrhage.
• Poor maternal health or socio-economic status.
What are the associated problems with prematurity?
Respiratory: surfactant deficiency causing respiratory distress syndrome, apnoea of prematurity ,chronic lung disease/bronchopulmonary dysplasia (CLD/BPD)
• CNS: intraventricular haemorrhage, periventricular leucomalacia; retinopathy of prematurity
• GI: necrotizing enterocolitis,inability to suck; and poor milk tolerance.
• Hypothermia.
• Immuno-compromise resulting in i risk and severity of infection.
• Impaired fluid/electrolyte homeostasis (i transepidermal skin water
loss, poor renal function).
• Patent ductus arteriosus
• Anaemia of prematurity
• Jaundice (liver enzyme immaturity;
• Birth trauma
• Perinatal hypoxia
• Later: increased risk of adverse neurodevelopmental outcome,
behavioural problems, sudden infant death syndrome (SIDS), non- accidental injury (NAI), and/or parental marriage break up (due to impaired infant–maternal bonding, stress of long-term complications, etc.).
What are the steps to postnatal management of a premature infant?
Most preterm infants require stabilization and support in transition– not resuscitation.
• Senior paediatrician should be present at birth if very preterm, e.g. <28wks.
• Delay cord clamping for 1min if infant not compromised.
• Immediately after birth, place in food grade plastic bag and under
radiant heater.
• Provide respiratory support as required:
• use positive end-expiratory pressure (PEEP) (5cmH2O);
• start with lower peak inspiratory pressure or proximal (PIP)
(20cmH2O);
• consider elective intubation and ETT surfactant if <27/40;
• may be possible to stabilize with PEEP/nasal continuous positive
airway pressure (CPAP) only.
• Monitor oxygen saturation levels if available (right wrist = pre-ductal),
and target oxygen therapy appropriately:
• must be familiar with normal values;
• approx 10% well preterm infants will have SpO2 <70% at 5min;
• H ‘correct’ starting dose of O2 unclear, therefore, can start in air; • easy to hyperoxygenate if start in high FiO2.
• Once stable, well infants >1800g, and >35/40 may be transferred to a suitable postnatal ward if midwifery staffing and expertise exists for the required additional care. Otherwise admit to a neonatal unit.
• Measure weight and temperature on admission and monitor closely: • <1000g 37–37.5C;
• >1000g 36.5–37C;
• nurse in 80% humidity for first 7 days if <30/40.
• Monitor and maintain blood glucose with enteral feeds (expressed breast milk), total parenteral nutrition (TPN) or 10% glucose as appropriate. Encourage ALL mothers to express breast milk from day 1.
• Start broad spectrum antibiotics if any possibility of infection, e.g. benzylpenicillin, and gentamicin.
• Start specific treatment for associated diseases and complications of prematurity, e.g. surfactant for RDS.
• Aim for minimal handling of infant with appropriate levels of noise and cycled lighting in the nursery.
• Support parents.
Risk factor for birth trauma?
- LGA, cephalic–pelvic disproportion
- malpresentation
- precipitate delivery
- instrumental delivery
- shoulder dystocia
- prematurity.
Define Caput succedaneum?
- Oedema of the presenting scalp. Can be particularly large following ventouse delivery (chignon).
Rapidly resolves.
What is a Cephalhaematoma?
- Common fluctuant swelling(s) due to subperiostial bleed(s). Most often occur over parietal bones. Swelling limited by suture lines. Resolves over weeks.
What is a Subaponeurotic haematoma?
It is rare; bleeding not confined by skull periostium, so can be large and life-threatening. Presents as fluctuant scalp swelling, not limited by suture lines.
What is the most common Brachial Plexus?
- commonest is Erb’s palsy (C5–C6 nerve routes).
May result from difficult assisted delivery (e.g. shoulder dystocia); the arm is flaccid with pronated forearm and flexed wrist (waiter’s tip position). Complete recovery occurs within 6wks in two-thirds of cases. X-ray clavicle to exclude fractures. Refer to physiotherapy for assessment and follow-up.
Explain facial never palsy in birth trauma’s.
Facial nerve palsy: follows pressure on face from either maternal ischial spine or forceps. Presents as facial asymmetry that is worse on crying (affected side shows lack of eye closure and lower facial movement; mouth is drawn to normal side). Majority recover in 1–2wks. May require eye care with methylcellulose and specialist referral.
Types of Fractures in Birth Trauma.
Fractures
• Clavicle (commonest).
• Long bone fractures: usually lower avulsion fractures of the femoral or
tibial epiphyses, or mid-shaft fractures of the femur or humerus. Infant presents as unsettled, with affected limb pseudo-paralysis, or obvious deformity or swelling. Confirm by X-ray.
• Skull fracture: associated with forceps delivery and usually require no treatment unless depressed in which case neurosurgical referral is required.
• Treatment: analgesia; limb immobilization (arm inside baby-grow), often do not require orthopaedic intervention, healed in a few weeks. Rapid healing and remodelling usually occur.
What is a Sternoclediomastoid tumour?
overstretching of muscle leads to haematoma. Subsequent contraction of muscle results in non-tender ‘tumour’ and torticollis (head turns away from affected muscle). Physiotherapy almost always curative (see also b p.883). Possible indication of malposition in-utero—consider increased risk of developmental dysplasia of the hip (D
