Neonates Flashcards
(54 cards)
Who gets neonatal jaundice?
50% of term babies, 80% of preterm babies
Usually 2-4days after birth
Explain physiological jaundice of the neonate
Normal transition of fetal to adult haemaglobin-> increased haemolysis-> increased bilirubin
Reduced hepatic excretion due to immature liver
Less conjugation due to less UDPGT (uridine diphosphate glucuronlytransferase) enzyme. Unconjugated bilirubin is fat soluble-> skin, eyes, brain
Neonatal gut motility is slow, increased enterohepatic circulation of bili-> less is excreted
What is the risk of hyperbilirubinaemia?
Neurotoxic
Death via kerniterus
Name 11 causes of pathological neonatal jaundice (6 categories)
- Haemolytic (haemolytic anaemia, blood group incompatibilities, G6DP deficiency)
- Polycythaemia (delayed cord clamping)
- Congenital infection (cytomegalovirus, toxoplasmosis)
- Obstruction (cholestasis, biliary obstruction, congenital abnormality of bile duct/pancreas)
- Drugs bind and compete for albumin, more free bilirubin
- Gilbert’s syndrome
In biliary atresia, what needs to be given?
Fat soluble vitamins
A, D, E, K
Treatment of neonatal jaundice
Phototherapy (isomerisation, isomers are less neurotoxic) IV immunoglobulins (blood group incompatibilities) Exchange transfusion (3rd line)
What does a neonate’s fluid requirement depend on?
Gestation, day of life, weight, blood glucose and electrolytes
What fluid are neonates usually given?
0.9% saline with 10% glucose
Electrolytes given according to levels
Na 2-6mmol/kg/day
K 1-3mmol/kg/day
In a term, well, neonate on 1st day of life, how much fluid would you give?
50-60ml/kg over 24hrs
Days 5-28 of life, term well neonate, how much fluid?
120-150ml/kg/day
What does APGAR stand for?
Appearance Pulse Grimace Activity Respiration (assessment at delivery, 1 min, 5 mins and 10 mins)
What scores can be given in an APGAR for appearance?
0=blue all over
1= blue at extremities
2= No blue colouration
What scores can be given in an APGAR for pulse?
0=no pulse
1=<100bpm
2=>100bpm
What scores can be given in an APGAR for grimace?
0= no response to stimulation 1= grimace of feeble cry when stimulated 2= sneezing, coughing or pulling away when stimulated
What scores can be given in an APGAR for activity?
0= no movement 1= some movement 2= active movement
What scores can be given in an APGAR for respiration?
0= no breathing 1= weak, slow or irregular breathing 2= strong cry
Why is an APGAR score relevant?
A score of 0-3 at 1 min indicated immediate resuscitation is needed
What is done is a NIPE shows clunking hips?
Referred to a specialist
USS at 6 weeks
Treatment is usually multiple nappies
What is the Guthrie/blood spot test?
Heel prick test onto filter paper
Done on day 5-8
Screening
What is screened for in the heel prick test of the newborn? 9 things
- Congenital hypothyroidism (TSH tested)
- Sickle cell disorders (SCD)
- Cystic fibrosis (CF)
- Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
- Phenylketonuria (PKU)
- Maple syrup urine disease (MSUD)
- Isovaleric acidaemia (IVA)
- Glutaric aciduria type 1 (GA1)
- Homocystinuria (HCU)
What makes a baby more mucusy as a neonate?
C section (mucus not squeezed out, natural steroids not initiated by stress) Water birth
Name 8 common neonatal abnormalities
Mucusy baby Problems latching/feeding Heart murmurs Dislocated hips Delayed passage of meconium Neonatal jaundice Strawberry naevus Umbilical cord stump infection
What is IUGR?
When a fetus is unable to reach its genetically determined potential size
Name 3 categories of causes of IUGR?
Maternal causes
Placental causes
Umbilical cord causes
