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Y3- TO LEARN > Neonates > Flashcards

Neonates Flashcards

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1
Q

Androgen insensitivity syndrome genotype and phenotype?

A

46XY

Female genitalia + undescended testes

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2
Q

What is cryptorchidism and what are the risks?

A

Undescended testes by adulthood

Risk of becoming testicular seminoma

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3
Q

How does the foetus prepare for birth in the 3rd trimester? (6)

A
  1. Surfactant production (25 wks)
  2. Inhibit lung fluid synthesis
  3. Accumulation of glycogen
  4. Accumulation of brown fat- thermoregulation
  5. Accumulation of subcut fat
  6. Swallowing amniotic fluid
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4
Q

What does the foetus release to induce labour?

A

Adrenaline and cortisol

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5
Q

What colour is a baby when first born, and why?

A

Blue

Due to utero being a hypoxic environment (baby sats=60-70%)

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6
Q

How does SVD encourage own breathing?

A

Squeeze chest

rub if C section

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7
Q

How does crying encourage breathing in newborns?

A

Creates negative intrathoracic pressure with closed glottis
Pressure pushes down into lungs
–>
ENCOURAGE REABSORPTION OF LUNG FLUID

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8
Q

Features of Transient Tachypnoea of Newborn?

A

Can’t clear fluid efficiently

Common in C-section- no preparation/cortisol released to stop fluid production

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9
Q

What causes meconium aspiration, and what are the signs?

A

Hypoxia in utero causing stressed baby to pass meconium

Reflex GASPING causes aspiration and irritates lungs

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10
Q

Where is the ductus venosus?

A

Liver

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11
Q

Where is the ductus arteriosus?

A

Between pulmonary artery and aorta

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12
Q

What happens to the foetal circulation to lungs when it is born?

A

O2 causes vasodilation- lower pulmonary vascular resistance= more blood to lungs!

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13
Q

What happens to the foetal circulation to body when it is born?

A

Placental cut-off (low resistance organ) and cause increase in systemic vascular resistance

Ducts close due to prostaglandins constricting smooth muscle

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14
Q

What does the ductus arteriosus become?

A

Ligamentum arteriosus

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15
Q

What does the ductus venosus become?

A

Ligamentum teres

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16
Q

How does Persistent Pulmonary Hypertension of Newborn occur?

A

Failure to transition to new circulation- leading to hypoxia

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17
Q

Management of Persistent Pulmonary Hypertension of Newborn? (5)

A 
O2
Sedation
Nitric oxide- pulmonary vasodilator
Inotropes
ECLS- heart-lung bypass
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18
Q

What happens to O2 sats in Persistent Pulmonary Hypertension of Newborn?

A

10-20% difference in sats from right hand to foot

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19
Q

What is most of the amniotic fluid made of?

A

Foetal urine

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20
Q

Why are newborns at high risk of heat loss?

A

Large surface area
Wet when born
No shivering
Do not break down brown fat in first 12 hours

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21
Q

How to prevent hypothermia in newborns?

A 
Dry with towel
Skin-to-skin
Hat + blanket
Heated mattress
Incubator
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22
Q

What happens to glucose homeostasis in newborn?

A

Drop in insulin
Increased glycogen
Gluconeogenesis occurs

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23
Q

Other than glucose, what else can babies use as brain fuel?

A

Ketones

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24
Q

What is a normal BG for newborns?

A

> 2.6

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25
How can hypoglycaemia occur in a newborn?
Increased energy demands Decreased glycogen stores Maternal diabetes Labetalol
26
What is a normal amount of weight loss in the first few days?
10%
27
How does physiological anaemia occur in newborn?
Switch to adult Hb Adult Hb produced more slowly that foetal Hb is broken down
28
How does physiological jaundice occur in newborn, and how long does it last?
Due to breakdown of foetal Hb- immature liver causes high levels of unconjugated bilirubin 24 hours - 2 weeks
29
When might a liver be visible on X ray of newborn?
In pneumoperitoneum- air surrounding liver that has leaked from a perforated bowel
30
10 days old baby presents with distension, tenderness and rectal mucous/blood- what's the diagnosis?
``` Necrotising enterocolitis (NEC) Bowel bacterial (aerobic) infection producing air- necrotic and abscesses in severe ```
31
How is NEC diagnosed?
X ray with contract
32
Treatment of NEC?
Stop oral feeding Antibiotics Surgery
33
3 general causes of obstruction?
1. stuck in lumen (intralumenal) 2. Compression from outside 3. Something in wall
34
What is meconium ileus?
Meconium gets stuck (more common in CF)
35
Symptoms of meconium ileus?
No bowel movements Vomiting in first 2 days Distention Meconium mass
36
Investigation of meconium ileus?
X ray with contrast
37
Symptoms of obstruction due to something 'in the wall'?
Keen to feed Vomiting after first feed Distention
38
Common cause of 'in the wall' obstruction?
Jejunal atresia
39
What sign on X ray suggests obstruction in small bowel?
Dilated bowel will line up like rungs of a ladder Less rungs= higher obstruction
40
Common cause of external compression obstruction?
Hernia
41
What is malrotation?
Twisted mesentery during development of the bowel
42
Symptoms of malrotation + volvulus?
Vomiting bile
43
Investigation of malrotation + volvulus?
Upper GI contrast X ray with FOLLOW THROUGH TO BOWEL
44
Why is surgery for malrotation + volvulus an emergency?
Prevent bowel ischaemia + necrosis
45
What is a normal birth weight?
2.5-4kg
46
What is APGAR score a measure of, and what are the components?
Measure of perinatal adaptation ``` Appearance-colour Pulse- HR Grimace- responsiveness Activity- tone Respiration- RR ```
47
When is APGAR measured, and how is it scored?
Measured at 1, 5 + 10 mins 0-2 points for each component >8= normal
48
Which screening tests are carried out on newborns? (5)
1. Baby checks 2. Hearing 3. Hip exam 4. Guthrie test (day 5) 5. Newborn EWS chart
49
When is a newborn examination carried out and what does it involve?
24 hours of age ``` Measure head + inspect Red reflex Ear inspection Mouth inspection + tongue tie + palate Reflexes Respiration assessment Pulses + precordial exam Abdo inspection Examine genitalia Hip exam Tone ```
50
What is erythema toxicum?
'Baby acne'
51
What is a mangolian spot?
Benign black spot at sacrum | document!- not bruise!
52
What should the RR of a newborn be?
40-60 / minute
53
What should the HR of a newborn be?
120-140 bpm
54
Features of hypoglycaemia in newborns?
``` Hypothermia Jittery/seizure activity Poor feeding Floppy Lethargy Apnoea ```
55
Most common antenatal infection of baby?
CMV
56
Most common perinatal infection of baby?
Group B strep
57
When is Hep B vaccine given to a newborn?
If going home to high risk environment e.g. PWIDs around
58
What is hypoxic ischaemic encephalopathy?
Multi-organ damage due to tissue hypoxia
59
Management of hypoxic ischaemic encephalopathy?
Cooling mat may reduce adverse neurological outcomes
60
What is hydrops foetalis?
Accumulation of fluid in lungs, heart, or abdomen, or under the skin (ascites, pleural effusion, pericardial effusion)
61
What is Tetralogy of Fallot?
Pulmonary Stenosis Ventricular Septal Defect RV hypertrophy Overriding aorta
62
What is Potter's Syndrome?
Kidneys can't produce amniotic fluid (therefore no lung fluid) No movement in-utero--> ALL IUD
63
Feature of myotonic dystrophy?
Breathing difficulties | Improves with time
64
What does the Guthrie Test screen for?
CF Sickle cell disorders Congenital hypothyroidism Inherited metabolic conditions (PKU, MCADD, maple syrup urine disease etc.)
65
Why is a IM vitamin K infection given to all newborns?
To prevent haemorrhagic disease of newborn (due to lack of vit K as newborn)
66
Symptoms associated with jaundice?
``` Yellow skin Sleepiness Poor feeding Weight loss Pale stool Dark urine ```
67
What increased the risk of physiological jaundice?
Forceps delivery--> bruising broken down into bilirubin
68
Features of early jaundice?
<24 hours Usually due to haemolysis (also polycythaemia, infection)
69
Causes of haemolysis in newborns?
``` ABO incompatibility Rhesus disease Sepsis Poor feeding Intestinal obstruction (e.g. pyloric stenosis) ```
70
Investigation of early jaundice in newborns?
Total + conjugated serum bilirubin Blood group + antibodies Coombs test (direct) Urine/stool culture
71
What is breast feeding jaundice?
Insufficient milk supply causing jaundice
72
What is persistent jaundice and how is classified?
Term >14 days Preterm >21 days Can be mostly conjugated or unconjugated
73
Causes of persistent unconjugated jaundice?
Breast milk jaundice Haemolysis Infection Hypothyroidism
74
Causes of persistent conjugated jaundice?
``` ALWAYS ABNORMAL Hepatitis Biliry atresia CF Down's Syndrome etc. ```
75
Treatments of jaundice?
Phototherapy- blue light box (add O2 + bilirubin- water soluble= out in bile + urine) Treat cause Hydrate Exchange transfusion (IV immunoglobulins)
76
What can unconjugated bilirubin lead to?
Kernicterus (bilirubin encephalopathy) unconjugated toxic to brain
77
Symptoms of kernictus?
``` High pitched cry Spasticity Muscle spasms Seizures Hypotonia- floppy Temperature instability Lethargy Irritability Poor feeding ```
78
What can kernictus lead to?
``` Cerebral palsy Learning disability Hearing loss Twitching Eye movement disorders Poor teeth development ```
79
What is NAS?
Neonatal Abstinence Syndrome | - exposure to drugs in-utero
80
Management of NAS?
Hydrate + feed (NG tube) Decrease loud noises + lights ORAMORPH 40mg/kg every 4 hours
81
Causes of preterm birth?
``` Spontaneous Multiple pregnancy Premature ROM Hypertension Antepartum haemorrhage ```
82
What is normal temperature for neonates?
36.5-37.4
83
Why is preterm baby more at risk of hypothermia?
Lack of muscle activity | Lack of subcut/brown fat
84
Why is preterm baby more at risk of nutritional compromise?
Lack of nutrient reserves Gut immaturity Increased demands
85
How is nutritional compromise managed in preterm babies?
100-140kcal/kg Breastfeeding, formula or IV vitamin therapy (yellow infusion)
86
What is early onset neonatal sepsis and typical pathogens?
Acquired before/during delivery e.g. premature ROM Group B strep/ gram -ves
87
What is late onset neonatal sepsis and typical pathogens?
Community sources Gram -ves, staph aureus, coagulase negative staph
88
Risk factors for neonatal sepsis?
Group B strep colonisation Premature ROM Maternal temp >38 Chorioamnionitis
89
Symptoms of neonatal sepsis?
``` Respiratory distress (grunting, cyanosis) Pallor (hypotension, hypoxia) Lethargy Poor feeding Tachycardia ```
90
Treatment of neonatal sepsis?
Early- benzylpenicillin + gentamicin | Late- vancomycin/flucloxacillin
91
What is respiratory distress syndrome (RDS) due to?
Surfactant deficiency (<25 weeks) or structural immaturity
92
Other causes of breathlessness in preterm babies?
``` TTN Infection/sepsis Pneumothorax Pneumonia Polycythaemia Cardiac cause ```
93
How does RDS appear on CXR?
Hazy throughout
94
Treatment of RDS?
Suction Surfactant Steroids Ventilation
95
Preterm baby with cyanosis, tired, sweating, heavy breathing etc.?
Patent ductus arteriosus
96
How does intraventricular haemorrhage occur in preterms, and how is it diagnosed?
Due to limited control of BP between body and brain Diagnosed on USS
97
Treatment of intraventricular haemorrhage?
Magnesium sulphate to mother for neuroprotection
98
How can the eyes be affected by preterm delivery?
Retinopathy- neovascularisation
99
What is SUDI and what increases high?
Sudden Unexpected Death in Infancy (cot death) | Increased in prematurity, multiple babies, babies with chronic conditions, parents of previous SUDI etc.
100
How to identify a dilated bowel on X ray?
If bowel diameter is more than diameter of vertebral bodies

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