Neonatology 2 Flashcards
(47 cards)
1
Q
What are the dates for a term baby?
A
37-42 weeks
2
Q
What are the symptoms of sepsis in a newborn?
A
- Baby pyrexia or hypothermia
- Poor feeding
- Lethargy or irritable
- Early jaundice
- Tachypnoea (RR>60)
- Hypo or hyperglycaemia
- Floppy
- Asymptomatic
3
Q
What are the risk factors for a term baby developing sepsis?
A
- PROM (prolonged ruptured membrane: >18 hours of labour)
- Maternal pyrexia
- Maternal GBS (group B strep) carriage
4
Q
How is presumed sepsis managed in newborns?
A
- Admit NNU
- Partial septic screen (FBC, CRP, blood cultures) and blood gas
- Consider CXR, LP
- IV penicillin and gentamicin 1st line
- 2nd line iv vancomycin and gentamicin
- Add metronidazole if surgical/abdominal concerns
- Fluid management and treat acidosis
- Monitor vital signs and support respiratory and cardiovascular systems as required
5
Q
What are the commonest causes of neonatal sepsis?
A
- *Group B strep* □ Early onset: birth to 1 week □ Late onset or recurrence: up to 3 months □ Symptoms: may be non-specific □ May have no risk factors □ Complications ® Meningitis, DIC, pneumonia and respiratory collapse, hypotension and shock □ Prognosis – 4 to 30% mortality - *E. Coli* - Listeria - Coagulase-negative staph. - Haemophilus Influenzae
6
Q
What are the congenital infections in newborns?
A
- ToRCH □ Toxoplasmosis (and other including syphilis) □ Rubella □ CMV □ Herpes
7
Q
What might congenital infections in newborns result in?
A
□ IUGR (intrauterine growth restriction) □ Brain calcifications □ Neurodevelopmental delay □ Visual impairment □ Recurrent infections
8
Q
What are the causes of respiratory distress syndrome?
A
- Sepsis
- TTN – transient tachypnoea of the new-born
- Meconium aspiration
9
Q
Talk about transient tachypnoea of the new-born
A
- Self-limiting and common
- Presents within 1st few hours of life
- Clinically
□ Grunting, tachypnoea, oxygen requirement, normal gases - Pathophysiology
□ Delay in clearance of foetal lung fluids - Management
□ Supportive, antibiotics, fluids, O2, airway support
10
Q
What are the risk factors of meconium aspiration?
A
□ Postdates (aged placenta)
□ Maternal diabetes
□ Maternal hypertension
□ Difficult labour
11
Q
What are the symptoms of meuconium aspiration?
A
□ Cyanosis □ Increased work of breathing □ Grunting □ Apnoea □ Floppiness
12
Q
What investigations are done for meuconium aspiration?
A
□ Blood gas
□ Septic screen
□ CXR
13
Q
What is the treatment for meuconium aspiration?
A
□ Suction below cords □ Airway support- intubation and ventilation □ Fluids and antibiotics □ Surfactant □ NO or ECMO
14
Q
What is the prognosis of meuconium aspiration?
A
□ Most do well
□ Some develop Persistent pulmonary hypertension of the new-born
□ There is an associated mortality
15
Q
What investigations are done on the “blue baby”?
A
- Examination and history
- Sepsis screen
- Blood gas and blood glucose
- CXR
- Pulse oximetry
- ECG
- Echo
- (Hypoxia test)
16
Q
What aree the diferentials for the “blue baby”?
A
- (1) truncus arteriosus
- (2) TGA
- (3) tricuspid atria
- (4) tetralogy of Fallot’s
- (5) TAPVD
- Hypoplastic left heart syndrome
- Pulmonary atresia
17
Q
Talk about hypoglycaemia and the new-born
A
○ If requires admission to NNU may still manage with enteral feeds
○ Monitor blood glucose
○ Start iv 10% glucose
○ Increase fluids
○ Increase glucose concentration (central iv access)
○ Glucagon
○ Hydrocortisone
18
Q
Talk about hypothermia and the newborn
A
○ If unable to maintain temperature on PNW admit and place in incubator
○ Sepsis screen and antibiotics
○ Consider checking thyroid function
○ Monitor blood glucose
19
Q
Talk about jaundice and the newborn
A
○ In severe jaundice may require admission for intensive phototherapy and/or exchange transfusion
○ Incubator and IV fluids may be required
20
Q
What are the causes of birth asphyxia?
A
- Placental problem
- Long, difficult delivery
- Umbilical cord prolapse
- Infection
- Neonatal airway problems
- Neonatal anaemia
21
Q
What are the stages of birth asphyxia?
A
- First □ Within minutes without O2 □ Cell damage occurs with lack of blood flow and O2 - Second □ Reperfusion injury □ Can last days or weeks □ Toxins are released from damaged cells
22
Q
What is the management of birth asphyxia?
A
- Supportive
- Therapeutic hypothermia (cooling) – improves outcome especially in moderate group
- Fluid restriction (avoid cerebral oedema)
- Monitor for renal and liver failure
- Respiratory support
- Cardiac support
- Treat seizures
23
Q
List some surgical problems newborns might have
A
- Oesophageal atresia/ fistula
- Duodenal atresia and other GI atresia
- Causes of failure to pass stool
□ Constipation
□ Large bowel atresia
□ Imperforate anus
® +/- fistula
□ Hirschsprung’s disease
® When you don’t have the normal amount of nerves that are at the end of the bowel
® It means that the normal motility is not there
□ Meconium ileus
® think cystic fibrosis - Abdominal wall defects
□ Exomphalos
□ Gastroschisis - Diaphragmatic hernia
24
Q
Talk about diagphragmatic hernias in newborns
A
□ 1 in 2500 births □ 90% on left □ Male > female □ Can be syndromic □ Usually pulmonary hypoplasia □ Intubation at birth □ Respiratory support □ Surgery □ (ECMO)
25
What is neonatal abstinance syndrome?
○ Withdrawal from physically addictive substances taken by the mother in pregnancy
- Opioids (methadone, heroin)
- Benzodiazepines
- Cocaine
- Amphetamines
26
How is neonatal asbstinance syndrome diagnosed?
- Finnegan Scores
| - Urine toxicology
27
How is neonatal abstinance syndrome managed?
○ Maternal co-morbidity (smoking, alcohol, blood born viruses, ill health)
○ Social & discharge planning
○ Treatment:
- Comfort (e.g. swaddling)
- Morphine
- Phenobarbitone
○ Main aim of the treatment is to comfort the baby, enable them to grow and feed and to prevent seizures which is on the extreme end
28
What type of rashes might a postnatal infant get?
- Benign
- Milia
- Malaria
- Erythema toxicum neonatorum
• maculo-papular rash
□ Red background with small red papules
□ 30 – 70% of normal term neonates.
□ very rare in the pre-term.
□ rash fades by end of 1st week
□ no Rx is required.
- Infections
- Sebaceous nevus
29
What birthmarks might a postnatal baby get?
- Capillary haemangiomas (Strawberry naevus)
- Mongolian blue spots
- Port wine stains (Capillary vascular malformations)
- Stork marks (Capillary vascular malformations)
- Giant melanocytic naevi
- Café au lait spots
30
What is a capillary haemangioma?
□ A cluster of dilated capillaries which appears within the first month after birth.
□ Raised and bright red, with discrete edges, occurring in any part of the body.
□ Usually regresses after one year of age
31
What is a mongolian blue spot?
```
□ Blue-grey pigmentations
□ Often : lower back + buttocks
□ Accumulation of melanocytes
□ Very common : races with pigmented skin
□ Less obvious as skin darkens
```
32
What is a port wine stain?
□ Naevus flammeus
□ Present at birth, flat or slightly raised.
□ Caused by dilated, mature capillaries in the superficial dermis.
□ These do not regress.
□ Associations:
® Sturge Weber
® Klippel-Trenaunay
33
What are stork marks?
```
□ Nevus simplex
□ light colour capillary dilatation
□ commonly at back of neck.
□ Maybe along midline of face.
□ Gradually fades
□ within the 1st 2 years
```
34
What is the energy triangle?
```
○ Pink
- Hypoxia/ anoxia
○ Warm
- Hypothermia
○ Sweet
- Hypoglycaemia
○ If you have a baby with any one of these you need to monitor the others
```
35
What babies are at risk of hypoglycaemia?
```
- Limited glucose supply
□ Premature babies
□ Perinatal stress
- Hyperinsulinism
□ Infants of diabetic mothers
- Increased glucose use
□ Hypothermia
□ Sepsis
```
36
How is hypoglycaemia diagnosed in postnatal babies?
- Hypoglycaemia= blood sugar<2.0mmol/l
- Bedside testing can be inaccurate
□ At low or high levels
□ When there is poor prefusion
□ When there is polycythaemia
-Check a lab sample if there are any concerns
37
What are the symptoms of hypoglycaemia in postnatal babies?
- Jitteriness
- Temperature instability
- Lethargy
- Hypotonia
- Apnoea, irregular respirations
- Poor suck / feeding
- Vomiting
- High pitched or weak cry
- Seizures
- Asymptomatic
38
What should be done in resusitation and cold stress?
- Dry quickly
- Remove wet linens
- Use warm towels/blankets
- Provide radiant warmer heat
- Use heated/humidified oxygen
39
What are the advantages of breast feeding?
- Reduces risk of allergic and inflammatory disorders
- Protects against infection
- Reduces risk of SIDS
- Promotes mother and baby bonding
- Reduces babies risk of obesity, cardiovascular disease and leukaemia
40
What should be done for tonfue ties?
- Short +/- thickened frenulum
- Attached anteriorly
base of the tongue
- Mostly: no treatment necessary
- Restriction of tongue protrusion beyond the alveolar margins AND feeding is affected
frenotomy
41
What GI problems can present in the postnatal period?
```
○ Vomiting
○ Posseting
○ Mucous vomits
○ Gastro-oesophageal reflux
○ Cow's milk protein intolerance
○ Bilious vomiting
○ Failure to pass meconium
○ Bloody stools
○ Blood in vomit
```
42
Talk about cleft lip in infants
○ 70% of cases also have cleft palate.
○ Can be incomplete (small gap in lip) or complete (continue into the nose)
○ Can be unilateral (left sided unilateral is most common) or bilateral (85% have palatal involvement)
○ Maxillary and medial nasal processes fail to merge, usually around 5 weeks gestation
43
What issues are infants with cleft lip faced with?
```
- Feeding issues
□ Special bottles and teats
□ Can still attempt breast feeding
- Airway problems
- Associated anomalies
□ Need hearing screen
□ Need cardiac echo
□ Remember trisomies
```
44
What opthamology problems can present in the postnatal period?
○ Always check red reflexes
○ Cataracts
- lens opacification
- If undetected early could lead to blindness
- May require no treatment
- May require lens removal and artificial lens
○ Retinoblastoma
- Rare eye cancer which can be successfully treated if picked up early
- Laser therapy, chemo, surgical removal of eye
45
What are spinal dimples?
○ Can reveal a more serious abnormality involving the spine and/or spinal cord, such as spina bifida occulta which is the least serious form of spina bifida +/- tethered cord
○ If the dimple is large, off midline, high or with other cutaneous maker (e.g. hairy tuft) → spinal imaging
46
Talk about cephalohaematomas in the postnatal period
○ Localised swelling over one or both sides of the head
○ Becomes maximal in size by the 3rd to 4th day of life
○ Soft, non-translucent swelling
○ Limits are those of one of the cranial bones – usually parietal bone
○ Haemorrhage is beneath the pericranium
○ No treatment is required and resolution occurs in 3-4 weeks
○ Occasionally, if the haematoma is very large, the increased haemolysis results in increased or prolonged neonatal jaundice
○ No association with intracranial bleeding
47
What is talipes?
○ Medial (varus) or lateral (valgus) deviation of the foot is often positional and requires no treatment other than physiotherapy
○ Fixed talipes requires more vigorous manipulation, strapping, casting or possibly surgery
○ Babies with significant talipes may also have developmental dysplasia of the hips
