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paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What is neonatology?

A

Speciality of new-born medical care

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2
Q

When does the CVS develop?

A
  • Begins to develop toward the end of the third week.
  • Heart starts to beat at the beginning of the fourth week.
  • The critical period of heart development is from day 20 to day 50 after fertilization.
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3
Q

Describe the circulation of the foetus.

A
  • Sats 60-70%
  • Oxygenated blood via umbilical vein through ductus venosus
  • Blood shunted through foramen ovale
  • Blood flow through ductus arteriors
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4
Q

What is the function of the ductus arteriosus?

A
  • Protects lungs against circulatory overload
  • Allows the right ventricle to strengthen
  • Carries low oxygen saturated blood
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5
Q

What is the function of the ductus venosus?

A
  • Foetal blood vessel connecting the umbilical vein to the IVC
  • Blood flow regulated via sphincter
  • Carries mostly oxygenated blood
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6
Q

What are the normal blood pressure or a new-born?

A

1 hour old

  • Systolic 70
  • Diastolic 44

1 day old

  • Systolic 70+/-9
  • Diastolic 42+/-12

3 days old

  • Systolic 77+/-12
  • Diastolic 49+-10
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7
Q

What is the usual respiratory rate of a new-born?

A
  • 30-60 per minute

- Periodical breathing pattern

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8
Q

What is considered normal HR in a new-born?

A

120-160bpm

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9
Q

What is considered tachycardia in a new-born?

A

> 160bpm

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10
Q

What is considered bradycardia in a new-born?

A

<100bpm

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11
Q

What does cold stress in new-borns lead to?

A

Lipolysis and heat production

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12
Q

What is brown fat innervated by?

A

Well innervated by sympathetic neurones

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13
Q

Why do new-borns need a metabolic production of heat?

A

They lack shivering thermogenesis

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14
Q

How do babies lose heat?

A

Radiation:
-Heat dissipated to colder objects.

Convection:
-Heat loss by moving air.

Evaporation:
-We are born in the water.

Conduction:
-Heat loss to surface on which baby lies

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15
Q

How can new-born breathing be assessed non-invasively?

A

Blood gas determination

  • PaCO2 5-6 kPa,
  • PaO2 8-12 kPa

Trans-cutaneous pCO2/O2 measurement

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16
Q

How can new-born breathing be assessed invasively?

A
  • Capnography
  • Tidal volume 4-6 ml/kg
  • Minute ventilation: (Tidal Volume ml/kg x respiratory rate)
  • Flow-volume loop.
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17
Q

When does physiological jaundice occur?

A
  • Appears on Day of life (DOL) 2-3.

- Disappears within 7-10 DOL in term infants and up to 21 DOL in premature infants.

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18
Q

What is the incidence of physiological jaundice?

A

Up to 60% of term babies and 80% of premature babies

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19
Q

What affect does blue light have on bilirubin/

A

Converts it to water soluble form and increases oxidation of bilitubin

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20
Q

How does kernicterus occur?

A
  • Unconjugated bilirubin is lipid soluble and can cross the BBB
  • At high concentrations it can cause irreversible brain changes
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21
Q

Why is 10% weight loss of a term baby normal?

A

Loss is due to natural

  • Shift in interstitial fluid to intravascular
  • Diuresis
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22
Q

When is it normal not to pass urine?

A

Term baby for the first 24 hours

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23
Q

Why is it difficult for a premature infant to maintain fluid balance?

A
  • Less fat in body composition
  • Increased loss through kidney
  • Increased insensible water loss
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24
Q

Why do premature infants lose more water through their kidneys?

A
  • Slower GFR
  • Reduced Na reabsorption
  • Decreased ability to concentrate or dilute urine
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25
Q

What insensible water loss do premature babies have?

A
  • Via immature skin and breathing

- Physiological IWL is 20-40 ml/kg/day but could be up to 82 ml/kg/day in 750-1000 g

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26
Q

What are the causes of anaemia of prematurity?

A
  • Reduced erythropoesis.
  • Infection
  • Blood letting – most important cause!
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27
Q

What physiological anaemia occurs in new-borns?

A
  • RBC production is 10% of in uterus DOL 7
  • Born with - Hb 15-20 g/l
  • Week 10 - Hb 11.4 g/l
  • Increase production of Erythropoetin
  • Week 20 - Hb 12.0 g/l
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28
Q

What is considered IUGR?

A

<10th centile

29
Q

What is considered severe IUGR?

A

<0.4th centile

30
Q

What are the categories of causes of babies being small for dates?

A
  • Maternal
  • Foetal
  • Placental
  • Other
  • Normal
  • MIxed
31
Q

What maternal causes of small for dates are there?

A
  • Alcohol
  • Smoking
  • Pre-eclamptic toxaemia
32
Q

What foetal causes of small for dates are there?

A

-Chromosomal (Edwards’ syndrome)-Infection (CMV)

33
Q

What placental causes of small for date are there?

A
  • Placental abruption

- Anything that affects placental perfusion

34
Q

Why can small for dates occur with twins?

A

Twin to twin transfusion syndrome

35
Q

What are some common problems experienced by small for date babies?

A
  • Perinatal Hypoxia
  • Hypoglycaemia
  • Hypothermia
  • Polycythaemia
  • Thrombocytopenia
  • Hypoglycaemia
  • Gastrointestinal problems (feeds, NEC)
  • RDS, Infection
36
Q

What long term problems can babies that are small for dates experience?

A
  • Hypertension
  • Reduced growth
  • Obesity
  • Ischaemic heart disease
37
Q

Premature

A

Baby delivered <37 weeks

38
Q

Extremely preterm

A

Baby delivered <28 weeks

39
Q

Low birth weight

A

<2500g

40
Q

Very low birth weight

A

<1500g

41
Q

Extremely low birth weight

A

<1000g

42
Q

What is the incidence of prematurity?

A

5-12%

43
Q

What systems can be affected in preterm babies?

A

Any system

  • Respiratory
  • Circulation
  • Metabolic / Nutrition
  • Immune / Infection
  • Brain
  • Gastrointestinal
  • Haematology
  • Renal
  • Skin
44
Q

What does RDS stand for?

A

Respiratory distress syndrome

45
Q

What does IVH stand for?

A

Inter-ventricular haemorrhage

46
Q

What does PVL stand for?

A

Peri-ventircular leucomalacia

47
Q

What does NEC stand for?

A

Necrotising entero-colitis

48
Q

What does PDA stand for?

A

Patent ductus arteriosus

49
Q

What does BPD stand for?

A

Broncho pulmonary dysplasia

50
Q

What does ROP stand for?

A

Retinopathy of prematurity

51
Q

What does PHH stand for?

A

Post haemorrhagic hydrocephalus

52
Q

What does NAS stand for?

A

Neonatal abstinence syndrome

53
Q

What does HIE stand for?

A

Hypoxic-ischaemic encephalopathy

54
Q

How is RDS prevented?

A

Antenatal steroids

55
Q

What early treatment is there for RDS?

A
  • Surfactant
  • Early extubation
  • N-CPAP
  • Minimal ventilation
56
Q

What can cause BPD?

A
  • Overstretch by volu-baro-trauma
  • Atelectasis
  • Infection via ETT
  • O2 toxicity
  • Inflammatory changes
  • Tissue repair - scarring
57
Q

How is BPD treated?

A
  • Patience
  • Nutrition and growth
  • Steroids ?
58
Q

What minor respiratory problems can premature babies face?

A
  • Apnoea
  • Irregular breathing
  • Desaturations
59
Q

How can minor respiratory problems be managed in premature babies?

A
  • Caffeine

- NCPAP

60
Q

What is the most common limiting factor for good prognosis for premature babies?

A

IVH

61
Q

How is IVH graded/

A

I-IV

-Grad IV has a 75% adverse outcome

62
Q

How can IVH be prevented?

A

Antenatal steroids

63
Q

How can IVH be treated?

A
  • Symptomatic

- Drainage

64
Q

What is the pathophysiology of PDA

A
  • Pressure of aorta> PA leading to LR shunt
  • Additional blood to pulmonary circulation leads to over-perfusion of lungs and lung oedema
  • Steal from systemic circulation leads to systemic ischaemia
65
Q

What are the consequences of PDA?

A
  • Worsening of respiratory symptoms
  • Retention of fluids (poor renal perfusion)
  • GI problems (ischaemia)
66
Q

What is NEC?

A

-Ischaemic and inflammatory changes leading to necrosis of the bowel

67
Q

How is NEC managed?

A
  • Surgical intervention is often required

- Conservative management is sometimes possible by antibiotics and parenteral nutrition

68
Q

What are the outcomes of extreme prematurity?

A
  • Unpredictable at birth
  • US of brain by day 7
  • Can deteriorate even on discharge (up to age 6)
  • May be some unexpected improvements
  • I/3 die
  • 1/3 have normal life/mild disability
  • 1/3 have moderate/severe disability

paediatrics (37 decks)

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