Neonatology Flashcards
(38 cards)
What are some causes of hypoxic ischaemic encephalopathy?
Asphyxia:
- Maternal shock
- Intrapartum haemorrhage
- Prolapsed cord = cord compression
- Nuchal cord = cord stranguling baby
What are the different grades for HIE?
Sarnat staging:
Mild - poor feeding, irritable, hyper alert, resolves w/i 24 hours, normal prognosis
Mod - poor feeding, lethargic, hypotonic, seizures, can take weeks to resolve, ~40% = CP
Severe - reduced conc, apnoea, flaccid, reduced or absent reflexes, ~50% die, 90% CP
What is the management of HIE?
Supportive - neonatal resus, ventilation, circ support, nutrition, acid base balance, treat seizures
Therapeutic hypothermia - helps to protect brain from hypoxic injury
What is therapeutic hypothremia?
Cooling baby’s core body temp in NICU w cooling blankets and a cooling hat - 33-34 degrees is the target. Measure using rectal probe. Do this for 72 hours and then warm to normal temp over 6 hours.
Reduce inflam and neurone loss after acute hypoxic injury
What are some organisms that cause neonatal sepsis?
GBS
E.coli
Listeria
Klebsiella
S.aureus
What are the RF of neonatal sepsis?
Vaginal GBS colonisation or GBS sepsis in prev baby
Maternal sepsis, chorioamnionitis or fever >38 degrees
Prematurity <37 weeks
PPROM - preterm rupture mem
PROM - prolonged rupture mem
What are the CF of neonatal sepsis?
- Fever
- Reduced tone and activity
- Poor feeding
- Resp distress or apnoea
- Vom
- Tachy or brady
- Hypoxia
- Jaundice
- Seizures
- Hypoglycaemia
What are the red flags of neonatal sepsis?
Confirmed sepsis in mother
Signs of shock
Seizures
Term baby needing invasive ventilation
Resp distress >4 hours after birth
Presumed sepsis in another baby in multiple preg
What are the guidelines for presumed sepsis?
- If there is one RF or CF - monitor for 12 hours
- 2+ RF or CF - start abx
- If one red flag - start abx
- Give abx w/i 1 hour of deciding to start them
- Take blood cultures before giving abx, check FBC and CRP
- Perform LP if suspect meningitis
Abx - benzylpenicillin and gentamycin but check local guidelines
What is the ongoing management of presumed sepsis?
- Check CRP again at 24 hours
- Check blood culture results again at 36 hours
- Stop abx if baby clincally well, blood cultures -ve and CRP <10
- Check CRP again at 5 days if still on treatment
- Stop abx if baby clinically well, LP and blood cultures -ve and CRP normal by 5 days
- If CRP >10 do LP
What is neonatal jaundice?
Jaundice in preterm or term babies w/i first month of life. Affects ~60% of term babies at birth, is more common in pre term babies.
What are the CF of physiological jaundice?
- Harmless w no underlying cause
- Breastfed babies more commonly have physiological jaundice
- RBC have shorter lifespan so higher turnover and slower excretion = more bilirubin
What are some causes of pathological jaundice?
- Haemolysis - newborn haemolytic anaemia, G6PD
- Errors of metabolism - Gilbert syndrome, Crigler Najjar syndrome = disorder of biliary conjugation
- Biliary atresia
- Sepsis, bruising
What is Kernicterus?
Unconjugated bilirubin = toxic to neural tissue in newborns and can cross the blood brain barrier. Is yellow staining of the cerebral tissue due to bilirubin deposition - acute or chronic bilirubin encephalopathy but is v rare
What are the features of acute bilirubin encephalopathy?
- Lethargy
- Irritability
- Abnormal muscle tone/posture
- Aponea episodes
- Convulsions
What are the features of chronic bilirubin encephalopathy?
- CP
- Sensorineural hearing loss
- Gaze palsy
- Dental dysplasia
What are the ix into acute neonatal jaundice?
Serum bilirubin to confirm jaundice
Blood packed cell vol
Blood group of mother and baby
Direct antiglobulin test - look for ab mediated RBC destruction/direct Coombs test
FBC, blood film, LFTs, G6P levels, cultures, TFTs
What are the ix into prolonged jaundice?
> 14 days in term, >21 days in preterm
- Assess for features of obstructive jaundice - pale stools, dark urine
- Conjugated bilirubin levels
- LFTs, FBC
- Urine culture
- Metabolic screen
What is the management of neonatal jaundice?
Plot total bilirubin levels on treatment threshold charts that are age specific.
- Phototherapy - converts unconjugated bilirubin into water soluble molecules that can be excreted
- Emergency exchange transfusion if vvv high bilirubin - remove blood from neonate and replace w donor blood
What are the CF of neonatal resp distress?
- Cyanosis
- Stridor, grunting
- Head bob, flared nostrils
- Recessions
- <32 weeks gestation when lungs don’t have enough surfactant to keep alveoli open
- CXR = ground glass appearance
What is the management of neonatal resp distress?
- Dex to mothers w preterm labour to increase surfactant production
- Severe resp distress = intubation and ventilation
- Can give endotracheal surfactant via endotracheal tube
- CPAP via nasal mask w supplementary O2 - 91-95% is the aim in preterm neonates
What are the short term complications of neonatal resp distress?
Pneumothorax
Infection
Apnoea
IV haemorrhage
Pulm haemorrhage
Necrotising enterocolitis
What are the long term complications of resp distress?
- CLD of prematurity - ARDS >28 days
- Retinopathy of prematurity
- Neuro, hearing and visual impairment
What are the principles of neonatal resus?
Warm the baby - vigorous drying, heat lamp, <28 weeks = plastic bag while wet and heat lamp
APGAR score to indicate progress, done at 1, 5 and 10 mins
Stim breathing - dry vigorously, neutral position, check for meconium in airway
