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Flashcards in Neonatology Deck (76):
1

What does the APGAR score include?

Appearance
Pulse
Grimace
Activity Respiration

2

In APGAR how is appearance assessed?

0: Blue/Pale all over
1: Blue at extremities but pink body
2: No cyanosis, body and extremities pink

3

In APGAR how is pulse assessed?

0: Absent
1: Less than 100
2: More than 100

4

In APGAR how is grimace assessed?

0: No grimace
1: Grimace or suction or aggressive stimulation
2: Cries

5

In APGAR how is activity assessed?

0: None
1: Some flexion
2: Flexed arms and legs that resist extension

6

In APGAR how is respiratory effort assessed?

0: Absent
1: Weak irregular gasping
2: Strong cry

7

What APGAR score is considered normal?

Above 7

8

In general, what causes symmetrical small growth in a fetus?

Chromosomal disorders, syndromes or congenital infections

9

In general, what causes non symmetrical small growth in a fetus?

Uteroplacental insufficiency

10

When do you do an APGAR score?

1 and 5 minutes of life

11

What can happen to neonates when there is a period of asphyxia during labour?

Hypoxic-ischaemic encephalopathy

12

Describe what happens in hypoxic ischaemic encephalopathy?

1. Significant hypoxic event immediately befor or during labour/delivery
2. Profound acidemia (pH less than 7)
3. Neurological manifestations
4. Multisystem organ dysfunction

13

What vitamin is given IM shortly after birth? Why?

Vitamin K. Prophylaxis against haemmorhagic disease of the newborn

14

What is tested for in the guthrie test?

1. PKU
2. Hypothyroid
3. Sickle cell disease
4. Thalassemia
5. MCAD
6. Cystic fibrosis

15

What is tetralogy of fallot?


Pulmonary stenosis
Ventricular septal defect (VSD)
Over-riding aorta
Right ventricular hypertrophy

16

How does maternal blood get into the fetus?

Umbilical vein

17

Describe the changes occur when a baby taken its first breath?

1. Ductus venosus sphincter contracts and blood is shunted to the liver
2. Massive drop in pulmonary resistance. Fluid pushed out of the lungs
3. Increased blood flow back to the left atrium meaning that the pressure here is greater than he right atrial pressure for the first time which causes closure of the foramen ovale.
4. Increases Oxygen decreases prostoglands which closes ductus arteriosum (few days later)

18

What does the umbilical vein become in adult life?

Ligamentum teres

19

What does the ductus venosus become in adult life?

Ligamentum venosum

20

What does the ductus arteriosum become in adult life?

Ligamentum arteriosum

21

What is in the lungs before birth?

Filled with amniotic fluid `

22

What does the ductus arteriosus do?

Connects the right ventricle to the descending aorta and so allows blood to bypass the lungs

23

What does the foramen ovale do?

Connects the left and right atria

24

What does the ductus venosus do?

Shunts the umbilical vein blood to the IVC, bypassing the liver

25

What is the definition of pre term?

Delivery before 37 weeks

26

What is meant by gestational correction?

Adjustement of the growth chart to account for the number of weeks early the baby was. This is calculated by 40 - number of weeks early

27

How long do you apply gestational correction to infant growth charts?

1 year for infants born 32 - 36 weeks
2 years for infants born before 32 weeks

28

What is the common cause of neonatal sepsis?

Group B Strep

29

A baby who was born at 36 weeks has grunting nasal flaring and is cyanosed.

Respiratory distress syndrome

30

What is the treatment for a baby with respiratory distress syndrome?

Surfactant
Ventilation

31

What two cardiovascular problems do you see in preterm infants?

Patent ductus arteriosus
Systemic hypotension

32

Premature babies may suffer from an intraventricular haemorrhage shortly after birth. Where does the bleeding usually begin?

The germinal matrix

33

What can you do to prevent an intraventricular haemmorhage in a premature infant?

1. Antenatal steroids
2. Resuscitation
3. Avoid haemodynamic instability

34

Describe the four grades of an intraventricular haemorrhage in a premature baby?

Grade I - bleeding occurs just in the germinal matrix
Grade II - bleeding also occurs inside the ventricles, but they are not enlarged
Grade III - ventricles are enlarged by the accumulated blood
Grade IV - bleeding extends into the brain tissue around the ventricles

35

When are premature babies most as risk of necrotizinf enterocolitis?

After recovering from respiratory distress syndrome

36

A premature baby at 2 days old has bloody stools, an unstable temperature and bradycardia. He also has bile stained vomit. What is the most likely diagnosis?

Necrotizing enterocolitis. Widespread necrosis in the small and large intestine

37

What drug can be used to close a patent ductus arteriosus in a premature baby?

Indomethacin

38

What imaging modality would you order if you suspected NEC in an infant?

Plain adominal X ray

39

On a plain abdominal X ray of a baby you see bowel wall oedema with thumb printing and dilated bowel loops. What is the most likely diagnosis?

NEC

40

What is the definition of a neonate?

Birth until 28 days

41

When does physiological jaundice arise?

After 24 hours

42

What are the causes of jaundice that occurs before 24 hours?

Usually haematological causes: Rhesus, ABO incompatibility, G6PD deficiency

43

What are the causes of jaundice due to conjugated bilirubin in a baby over 2 weeks old?

Sepsis
CF
Bile dict obstruction
Hepatitis

44

What is the cause of physiological jaundice?

Immaturity of hepatic bilirubin conjugation

45

When would you have to intervene in physiological jaundice?

If serum bilirubin in over 260mmol/litre

46

Is dark urine and pale stools seen in conjugated or unconjugated jaundice?

Conjugated

47

What is the most common treatment of neonatal jaundice?

Phototherapy

48

What is normal weight loss after birth?

10%

49

How do you calculate % weight loss in an infant?

Weight change/Birth weight x 100

50

What day is the guthrie test performed?

Day 5

51

What is the most common cause of pathological jaundice occurring before 24 hours?

Haemolysis causing excessive production of bilirubin. The haemolysis could be caused by ABO incompatibilty, Rh immunisation or sepsis

52

What should you do to investigate neonatal jaundice?

1. Total and serum bilirubin concentration
2. Maternal blood group and antibody titres
3. Baby's blood group, direct coombs test
4. FBC
5. CRP

53

What are the causes of persistent unconjugated hyperbilirubinaemia?

Breast milk jaundice
Haemolysis
Infection (especially UTI)
Hypothyroid

54

What are causes of consistent conjugated hyperbilirubinaemia?

(ALWAYS ABNORMAL)
Hepatitis
Biliary Atresia

55

What is kernicterus?

Bilirubin induced brain dysfunction. Unconjugated bilirubin is toxic to the brain and can cause the death of brain cells and yellow staining in the brains grey matter.

56

When would you give IV immunoglobulin in an infant with jaundice?

Infants with isoimmune haemolytic disease and rising bilirubin despite intensive phototherapy.

57

What % of term infants get jaundice in the first week of life?

60%

58

When does physiological jaundice resolve by?

Day 10 - 14

59

What antibiotics would you give in neonatal sepsis?

Benzylpenicillin
Gentamicin

60

When is the newborn examination carried out?

Within 72 hours

61

In the newborn examination: What are you looking for in the general observation?

Overall appearance
General tone
Proportions
Jaundice
Birthmarks and other skin abnormalities
Cry
Weigh baby and plot on growth chart

62

In the newborn examination: What are you looking for in the examination of the head?

Shape
Fontanelles (Sunken? Bulging?)
Measure head circumference
Asymmetry or abnormality of facial characteristics

63

In the newborn examination: What are you looking for in the eyes?

Shape and appearance
Red reflex
Cataracts

64

In the newborn examination: What are you looking for in the ears?

Shape and size
Normal or low set
Patency of external auditory meatus

65

In the newborn examination: what are you looking for in the mouth?

Mucous membranes
Suckling reflex (insert little finger into babies mouth)

66

In the newborn examination: what are you looking for in the arms and hands?

Shape and movement
Traction birth injury eg Erbs Palsy
Number of fingers
Palmar creases (Single palmar crease seen in downs syndrome)

67

In the newborn examination: What are you looking for when examining the heart and peripheral pulses?

Brachial, radial and femoral pulses for rate rhythm and volume
Cardiac position by palpation
Heave/Thrill
Murmurs

68

What would you suspect if you heard a hyperdynamic pulse in a newborn?

Patent ductus arteriosus

69

What would you suspect if you felt a weak pulse in a newborn?

Cardiac anaomoly

70

In the newborn examination: What are you looking for on examination of the respiratory system?

Respiratory pattern, rate and depth
Intercostal recession
Stridor
Auscultate lung fields

71

In the newborn examination: What are you looking for on examination of the abdomen?

Girth and shape
Umbilical stump for infection or hernia
Organs, masses and hernia
Liver and Spleen (Normal in healthy babies to feel these!)
External genitalia
Palpation of testes
Inspect anus

72

In the newborn examination: what are you looking for on examination of the back?

Skin (Hair tufts, sinus, dimples may be signs of spina bifida)

73

In the newborn examination: What are you looking for on hip examination?

Congenital hip dysplasi (Barlow and Ortoloni's test)

74

In the newborn examination: What are you looking for on examination of the legs?

Movements at each joint

75

In the newborn examination: What are you assessing in examination of the nervous system?

Tone
Behaviour
Movements
Posture

76

After initial newborn examination when is the next neonatal screening?

6 - 8 weeks