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Paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

List 5 features that increase the risk of neonatal birth injury

A
  1. Macrosomia
  2. Cephalo-pelvic dysjunction (CPD)
  3. Breech position
  4. Instrumental delivery
  5. Shoulder dystocia
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2
Q

What are the layers of the scalp - working outside - inside (7 items)

A
  1. Skin
  2. Subcutaneous connective tissue
  3. Galea aponeurotic layer
  4. Periosteum
  5. Bone
  6. Periosteum
  7. Dura
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3
Q

What is the galea aponeurotica?

A

Scalp Anatomy: A layer of fibrous connective tissue that forms the middle (third) layer of the scalp. Deep to this, but above the periosteum, is the sub-galeal space. Blood vessels within the galea aponeurosis communicate with scalp layers above and below.

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4
Q

What is a subgaleal haemorrhage?

A

Bleeding into the space below the galea apnoenurosis and above the periosteum

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5
Q

Define the margins of the sub-galeal space (3 items)

A
  1. Orbital ridge
  2. Nape of the neck
  3. Top margin of the ears
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6
Q

How might a sub-galeal haemorrhage be identified on examination of a newborn? (5 items)

A
  1. Pallor (anaemia)
  2. Resting tachycardia (early shock)
  3. Diffuse swelling not confined by suture lines
  4. Moves like water beneath the fingers
  5. Pooling at the nape of the neck
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7
Q

List 4 PREVENTATIVE aspects of routine care for all neonates (in a low resource context)

Source: MSF Neonatal Guidelines

A
  1. Cord care - Disinfect
  2. Eye drops
  3. Vitamins (Vit K inj/Vitamin D)
  4. Vaccines (BCG/Polio/Hep B)
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8
Q

Aside from prophylactic treatments - what other support should all mothers and babies receive? (3 items)

A
  1. Breastfeeding support
  2. Thermoregulation (hat/skin-skin/wrap)
  3. Infant screening examination (top-toe)
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9
Q

What solutions can be used for cord disinfection? (2 items)

Source: MSF Neonatal guidelines

A
  1. 7.1% chlorhexidine digluconate gel (4% Chlorhexidine content) - usually comes in a 3g sachet. Apply the full contents to the tip, stump and base of the cord.

For a home birth give 7 day supply of day to the mother - apply once daily

  1. 10% Povidone solution - applied with a sterile compress
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10
Q

What eye ointment can be used for the prevention of gonococcal eye disease in newborns?

Source: MSF Neonatal guidelines

A

1% Tetracycline ointment - Single application to both eyes as soon as possible after birth

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11
Q

What is the standard dose of IM Vitamin K for a neonate who is <1500grams?

A

0.05mL of 2mg/0.2ml vial

Dose of 0.5mg

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12
Q

What is the standard dose of IM Vitamin K for a neonate who is >1500grams?

A

0.1mL of 2mg/0.2ml vial

Dose of 1mg

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13
Q

Can Vitamin K be given intravenously instead?

A

Yes, at the same does - for sick neonates who already have an IV cannula for another reason.

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14
Q

How long should infants receive Vitamin D supplementation?

A

From 0-6 months of age

Prophylactic dosing

Oral supplements (liquid)

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15
Q

What is the dose of Cholecalciferol (Vitamin D3) for infants GA of 37 weeks or above (term)?

A

400-800IU/day

Check how many IU per drop for your choice/concentration of choice has

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16
Q

What is the dose of cholecalciferol (Vitamin D3) for infants < 37 weeks GA OR living in high-risk areas?

A

600-1200IU/day

Check how many IU per drop for your choice/concentration of choice has

17
Q

If you wish to give a mother sufficient Cholecalciferol (Vit D3) to give her infant for 0-6 months, how might you achieve this?

Source: MSF Neonatal Guidelines

A

Cholecalciferol (Vitamin D3 liquid) 10ML bottle
Concentration 10,000 IU/Ml
2 bottles for 6 months supply

18
Q

What is the recommended sunlight exposure for a breastfeeding neonate to prevent Vitamin D deficiency?

A

Approx 30 minutes of afternoon sun per week, with 40% body exposed - can keep nappy on.

19
Q

How many doses of oral polio vaccine are required?

A

4 total

Dose 0 occurs at birth

1-3 as part of the Expanded Immunisation Program (EPI) in childhood.

20
Q

When should the Hep B vaccine be given to a neonate?

A

Ideally in the delivery room

At least within the first 24 hours

Prevention of mother-child transmission

At least 2 other doses are required to complete the primary series. Some countries give 3 as part of a combined vaccine.

21
Q

What is a ‘late birth dose’ of Hep B vaccine?

A

A dose given after the first 24 hours of life - anytime up to the first 6 weeks post partum.

Effectiveness for prevention of horizontal transmission declines over time - but some vaccine has a benefit over none if given within the 6-week window.

22
Q

Why should the BCG ideally be given 2-3 days prior to discharge?

Source: MSF Neonatal Guidelines

A

To monitor for apnoea - a rare side effect of this vaccine

23
Q

What is the dose of the Hep B vaccine for a neonate?

A

Single-dose

Monovalent vaccine

10micrograms IM

24
Q

What is the dose of the Oral Polio Vaccine (OPV) for a neonate?

A

Dose 0

Bivalent vaccine (type 1+3)

0.1ml (2 drops)

25
Q

What is the dose for the neonatal BCG vaccine?

A

Single-dose

0.05mL

Intra-dermal injection - deltoid region

26
Q

What are the contraindications to giving a neonatal BCG vaccine?

A
  1. Clinically suspected HIV infection
  2. Confirmed HIV infection
  3. Maternal active TB
  4. Sick neonate - sepsis/congenital infection - delay dose

Paediatrics (10 decks)

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