Neonatology Flashcards
(167 cards)
1
Q
What is the most common cause of neonatal jaundice?
A
Physiological jaundice
2
Q
When should we be concerned about neonatal jaundice?
A
If it appears within the first 24 hours of life, or if it persists past day 14.
Equally if it is over the threshold for treatment.
3
Q
How common is neonatal jaundice?
A
Very - 60% of neonates get it at some point.
4
Q
A neonate is 6 hours old and the mother notices she is jaundiced.
What are the differentials in this case?
A
- Haemolysis
- Infection
5
Q
What causes of haemolysis can cause jaundice in a neonate under 24 hours old?
A
- ABO incompatibility
- Rhesus disease of the newborn
- Hereditary spherocytosis
6
Q
What infections can cause jaundice in a neonate under 24 hours old?
What is the acronym to remember them?
A
TORCH: Toxoplasmosis Other Rubella CMV Hepatitis/Herpes
7
Q
What 4 things should we assess in the brand new new-born?
A
- Muscle tone
- Colour
- Breathing/Airway
- Heart rate
8
Q
A newborn is different from an adult how? (3)
A
It’s all wet (so its cold), it’s smaller so SA:V is higher so gets cold quicker, and…………………
9
Q
If a newborn has an obstructed airway, what might be in there?
A
- Meconium
- Blood
10
Q
How long can a newborn be blue for? Why?
A
Can be ok up to 10 minutes after birth as takes that much time to adjust to its own air supply to bring sats from ~60% up to “adult” saturations
11
Q
If a newborn looks like it needs resusitation, what method should we use?
A
ABC
12
Q
What is the A of newborn resus?
A
Airway!!
13
Q
What is the very first thing you do with a baby (while assessing tone/colour/breathing/HR)?
A
Warm it up!!
“You’re not dead until you’re warm and dead.”
14
Q
How do you assess tone in the newborn?
A
Are they floppy? That’s not good.
Are they moving their limbs? Or holding their arms and legs close to their body? That IS good.
15
Q
How do you assess breathing in the newborn?
A
Have they cried/screamed? That IS good.
Are they visibly breathing? Clearly, that would be good too.
Is their breathing easy? i.e. are they gasping/do they have a weak cry? Not good.
16
Q
How do you assess the colour of the newborn?
A
Pink? Great.
Pink body but blue extremities? Ok but keep an eye on it.
Blue or pale all over? May resolve in the first 10 minutes of life, but keep an eye on it.
17
Q
How do you assess the HR of the newborn?
A
Listen to the chest and count!
No heart beats? Thats bad.
HR less than 100 bpm? That’s also bad.
HR over 100 bpm? Grand.
18
Q
When assessing a newborns airway, what do you do?
A
- Put the child’s head in neutral position to open airway fully.
- Look in airway with laryngoscope (left hand, right hand open mouth with one finger in mouth to open from top).
- Apply some suction if something visible blocking airway.
19
Q
What is the B of newborn resus?
A
Breathing!!
You knew that. Easy win.
20
Q
What do we do for breathing in newborn resus?
A
- Check for chest movements
- If none, apply an ETT or laryngeal mask.
- Give some inflation breaths.
21
Q
What do we need to know for inflation breaths?
A
They help increase pressure in the lung to force fluid out of the air space.
In a term neonate, the air pressure should be 30cm of water.
Each breath should be given over 3 seconds.
5 breaths should be given over 30 seconds.
22
Q
If the term newborn doesn’t respond to inflation breaths, what is the next step?
A
Chest compressions and inflation breaths at a certain ratio.
23
Q
What ratio should chest compressions and inflation breaths be done at in the C part of newborn resus?
A
5 chest compressions to 2 breaths
24
Q
If the neonate doesn’t respond to chest compressions, what should we try next?
A
Drugs - IV adrenaline
25
How fast should chest compressions be done at for a newborn?
Roughly 100 bpm
| 1-2 beats per second, so 5 should take 3 seconds
26
How do you measure up an endotracheal tube for a newborn?
Length of tube should go from middle of mouth to angle of mandible/tragus of ear.
27
What can cause potentially 10% of newborns to have feeding difficulties?
Tongue tie
28
An infant presents to GP with feeding problems.
From this skint history, build a list of differentials.
```
GORD
Cow's milk allergy
Colic
Lactose intolerance
Overgrowth syndromes
URTI/blocked nose
Teething
Neurological (swallowing difficulties)
Overfeeding with bottle feeding
```
29
WRT nutrition, what is important to note about preterm babies?
They have a very high nutritional requirement as growth and weight gain is the aim in the 3rd trimester.
30
When does a baby's suckling reflex kick in?
Around 34-36 weeks
31
How do we need to feed preterm infants who have not developed a suckling relfex yet?
NG tube or parenteral feeding
32
What is better for a baby - breast milk or formula milk?
Why?
Breast milk - breast feeding encourages bonding, helps build the child's immune system, reduces the risk of necrotising enterocolitis, and has a demand-lead pattern of feeding.
33
What can we do to breast milk for preterm infants to help it meet their requirements?
Use breast milk fortifier to increase calorie, protein, phosphate, and calcium intake.
34
How can we give parenteral nutrition to very immature or sick infants?
Central line (PIC) or vie an umbilical venous catheter.
35
What are the risks of parenteral feeding?
Infection
Extravasation
Skin damage/scarring
Necrotizing enterocolitis
36
What is necrotizing enterocolitis?
Ischaemic injury to or bacterial infection of the bowel in infants causing a portion of bowel to die.
37
What are the risk factors for necrotising enterocolitis?
```
Preterm birth
Cows-milk formula feeding
Ischaemic bowel injury
Bacterial bowel infection
Low birth weight
```
38
How does NEC present?
- Feed intolerance
- Tender abdomen
- Blood in stool
- Bilious vomiting
- Generally unwell (PEWSing)
- Abdo distension
- Collapse
- Shock
- Sepsis
39
How does NEC look on an abdo xray?
- Distended loops of bowel
- Intramural gas
- May be perforated (free gas under diaphragm/Rig;er's sign (double wall sign)/football sign)
40
How should NEC be managed?
- Stop oral feeds
- Broad spec abx
- Parenteral nutrition
- Cardio/resp support often needed
41
A newborn who is 10 hours old is jaundiced.
What investigations should be done?
- Bilirubin - get conjugated and unconjugated as separate levels.
- Blood film
- G6PD enzyme assay
- Coombs' test
42
When is knowing if jaundice is caused by conjugated or unconjugated bilirubin most important?
Why?
In prolonged jaundice (past 14 days of life)
Raised conjugated bilirubin suggests biliary atresia.
43
How do we decide how to manage neonatal jaundice?
Based on severity and rate of change - bilirubin levels plotted on a chart adjusted for gestational age.
44
How does jaundice spread?
From head to toes (so sclera should be a good place to look for it).
45
Why do we adjust for gestational age when deciding on jaundice treatment?
Preterm infants have a less well developed BBB so are at a higher risk of kernicterus compared to older/term babies.
46
What treatment can we do for neonatal jaundice?
- Supportive (hydration and nutrition)
- Phototherapy
- Exchange transfusion in severe cases
47
What are the main causes of prolonged/persistent neonatal jaundice?
- Biliary atresia
- Infection (often a UTI)
- Breast milk jaundice
- Congenital hypothyroidism
48
What are the 2 categories of neonatal infection?
Early-onset and late-onset sepsis
49
What is the cut off for early-onset sepsis?
Less than 48 hours after birth
50
What are the features of neonatal sepsis?
- Fever/hypothermia
- Poor feeding
- Vomiting
- Apnoea & bradycardia
- Jaundice
- Neutropenia
- Hypo/hyper-glycaemia
- Shock
- Seizures
- Lethargy/drowsiness/irritability
51
By what mechanism can early-onset sepsis occur in a neonate?
Bacteria ascend the birth canal and invade the amniotic fluid -> fluid into lungs -> pneumonia and secondary septicaemia.
52
When do most metabolic conditions get picked up?
At the blood spot/Guthrie test done on day 5-8 of life.
53
What conditions does the guthrie test look for?
```
PKU
HCU
Congenital Hypothyroidism
CF
MSUD
Sickle cell anaemia
Beta thalassaemia major
MCADD
Glutaric aciduria type 1
Isovaleric acidaemia
```
54
A child has a rare metabolic condition that isn't picked up at birth.
How might they present chronically?
- Failure to thrive
- Developmental delay
- Chronic episodic illness
- System specific, generalised symptoms e.g. cardiomyopathy, D&V, muscle weakness etc.
- Decompensation after minor illness
55
A child has a rare metabolic condition that isn't picked up at birth.
How might they present acutely?
- Metabolic acidosis
- Hypoglycaemia
- Non-specific symptoms e.g. hypotonia, seizures, lethargy, poor sucking reflex, respiratory distress
56
What inheritance pattern do most inherited metabolic disorders demonstrate?
Autosommal recessive
57
What inheritance pattern do mitochondrial disorders demonstrate?
Maternal inheritance
58
What is the most common cause of early-onset severe infection in the neonatal period?
Group B Strep
59
When might a neonate be exposed to Group B strep?
During labour as many mothers are carriers in their bowel flora.
60
Which neonates are at increased risk of Group B strep infections?
- Premature infants
- Prolonged labour/rupture of membranes
- Previous sibling GBS infection
- Maternal pyrexia
61
What are the main culprits in congenital cyanotic heart disease?
```
Tetralogy of Fallot
Transposition of the great arteries
Coarctation of the aorta
Pulmonary atresia
Pulmonary stenosis
```
62
When might cyanosis worsen, and why?
Day 1-2 as the PDA closes so there is no blood mixing/flow from left to right.
63
How would coarctation of the aorta present O/E?
Upper limb hypertension
Weak/absent femoral pulses
Cyanosis after day 2/3
64
How is congenital heart disease detected?
Antenatal scans
NIPE
Presentation with heart murmur, heart failure, or cyanosis.
65
How do we diagnose congenital heart disease?
Echocardiography
66
How do we manage cyanotic congenital heart disease?
Keep the PDA open with prostaglandins as immediate management, along with airway stabilisation and A to E assessment.
Definitive Rx is usually surgery.
67
When can a neonate contract an infection?
At any time - in utero, during delivery, or post-natally.
68
When is early onset neonatal sepsis defined as?
Sepsis occuring within the first 48-72 hours of life.
69
What is important once early onset neonatal sepsis is identified?
Starting treatment immediately! Reduces risk of death :)
70
What is the most common cause of EONS? (Organism)
Group B Streptococcus
71
Other than group B strep, what organisms are often responsible for EONS?
E. coli
Coagulase negative staph
H. influenzae
Listeria monocytogenes
72
How do neonatal infections that lead to EONS present?
Respiratory distress
Pneumonia
Septicaemia
73
What are the factors that predispose neonates to EONS?
Previous baby or current pregnancy having invasive GBS
Prelabour rupture of membranes
Preterm birth
Infrapartum fever
74
What are the RED FLAGS for EONS?
Respiratory distress starting more than 4 hours after birth
Seizure
Signs of shock
Need for mechanical ventilation in a term baby
Suspected/confirmed infection in a co-twin
75
What differentials can there be for respiratory distress in a neonate?
```
Early onset neonatal sepsis
Transient tachypnoea of the newborn
IRDS
Meconium aspiration
Haemolytic disease of the newborn
```
76
What antibiotics do we use for EONS?
IV benzylpenicillin and Gentamicin
Unless micro say use something else, or local guidelines say something else.
77
What is the overall mortality rate for sepsis in late-preterm/term neonates?
2-4%
78
A newborn has respiratory distress. During the birth, the amniotic fluid was stained with meconium, and the mother bled heavily (but she’s ok now, dw).
What might be causing the respiratory distress in this case?
Aspiration of meconium or blood would be my top 2 differentials.
79
What are the 3 main risk factors for meconium aspiration?
Post-term infant
Thick meconium at birth
Birth asphyxia
80
What are the main effects that meconium has once it has been aspirated?
- Degree of airway obstruction
- Foetal hypoxia
- Pulmonary inflammation
- Infection
- Surfactant inactivation
- Persistent pulmonary hypertension
81
How is meconium aspiration diagnosed?
Clinically:
- Tachypnoea/cardia
- Cyanosis
- Grunting/nasal flaring/recessions
82
What investigations would support a diagnosis of meconium aspiration syndorme?
Chest x-ray
Infection markers
ABG
83
A child has meconium aspiration syndrome. You think the degree of hypoxia could have been severe. What extra scans might you want to order?
Cranial ultrasound - assess for hypoxic damage to the brain
84
How should a newborn with meconium aspiration syndrome be managed?
```
Observation of vitals
Routine care (incubator, continuous obs, assess haem, nutritional support)
Ventilation/Oxygen
Antibiotics
Surfactant
Inhaled nitric oxide
```
85
Why would we use inhaled nitric oxide as a therapy in meconium aspiration syndrome?
For pulmonary hypertension as it is a vasodilator
86
A newborn with meconium aspiration syndrome gets a chest xray. On it you notice a pneumothorax.
How might this have happened?
Meconium -> obstruction of airway outflow -> alveolar hyperinflation -> air leak into pleural space, or into mediastinum -> pneumomediastinum.
87
A newborn with meconium aspiration syndrome has been ventilated with CPAP, then with intubation as he didn’t respond to CPAP.
Despite intubation, he is still in respiratory failure. What else can we try?
ECMO
88
A newborn with meconium aspiration syndrome has been ventilated with CPAP, then with intubation as he didn’t respond to CPAP. You are fortunate because the Glenfield can take him for ECMO.
How do you explain to parents what ECMO is?
It is a way of oxygenating the blood without using the lungs.
Insert a tube into a vein, which takes blood out into a machine that pumps oxygen into it. The blood is then returned to the body ready for tissues to use.
This allows the lungs to rest and recover. Not a long term solution.
89
What are the risks associated with ECMO? How do we manage them?
Risks - bleeding (blood products, care of any wounds, monitor), clots (heparin), infection (antibiotics), neurological damage (regular checks), renal damage (monitor, dialysis), failure to recover.
90
What does ECMO stand for?
Extracorporeal membrane oxygenation
91
What are the acyanotic congenital heart problems?
```
VSD
ASD
PDA
Aortic stenosis
Pulmonary stenosis
Coarctation of the aorta (initially)
Atrioventricular canal defect
```
92
How common are congenital heart defects?
8.2 per thousand live births in Europe.
Accounts for 1/3 all major congenital anomalies.
93
What are the risk factors for congenital heart disease?
- 1st degree relative with congenital her disease
- Consanguineous union of parents
- Infection during pregnancy
- Drugs/alcohol during pregnancy
- Genetic conditions
- Maternal Diabetes mellitus
94
In which group of newborns might we particularly see transient congenital heart defects?
Premature babies
95
How are the majority of congenital heart defects diagnosed in the UK?
Detailed antenatal scans.
If not them, picked up during the NIPE
96
How might a baby present with a significant L->R shunt if it is not picked up on antenatal screening or the NIPE?
Signs of heart failure and faltering growth early in infancy.
97
What hx do we need to take when an infant/child present with a heart murmur?
- Full SQITARS esp. are they symptomatic with it?
- Developmental hx
- Hx of pregnancy
- Mothers health in pregnancy inc. infections
- Drug/alcohol/medication use in pregnancy
- FHx
98
What is the first line investigation for heart murmurs in secondary care?
Echocardiography
99
Some children with congenital heart disease may not require any specific treatments, but may need something else. What is this "something else"?
Prevention for infective endocarditis
100
What can we give to neonates with ducuts-dependant congenital heart defects?
Prostaglandin infusion to keep the ductus arteriosus open.
101
What tends to be the definitive treatment for congenital heart defects?
Surgery
102
What are the complications associated with congenital heart defects?
- Risk of infective endocarditis
- Failure to thrive
- Paradoxical embolism -> systemic embolism.
- Pulmonary hypertension
- Cyanosis -> polycythaemia
103
What is IUGR?
A condition where a baby's growth slows or ceases when it is in the uterus. It is part of a wider group called small for gestational age foetuses.
104
What maternal factors can cause IUGR?
- Age of mother (under 16, over 35)
- Inter-pregnancy interval being less than 6 or more than 120 months
- Maternal illhealth
- Maternal lifestyle (smoking, alcohol, substance abuse)
- Maternal infections
- Placental dysfunction or abruption
105
What foetal factors can cause IUGR?
- Chromosomal abnormalities
- Genetic syndromes
- Major congenital anomalies
- Multiple gestation
- Congenital infections
- Metabolic disorders
106
What are the 3 types of IUGR and what are they caused by?
Symmetrical (i.e. all proportions reduced) - early onset, hypoplasia.
Asymmetrical (abdo circ reduced, other measurements normal) - malnourishment.
Mixed - early IUGR augmented by placental causes later in pregnancy.
107
What are the short term complications of IUGR?
Neonates are more prone to asphyxia, meconium aspiration, persistent pulmonary HTN, hypothermia, hypo/hyperglycaemia, hypocalcaemia, jaundice, feeding problems, NEC, late onset sepsis...
It's just not good.
108
What are the long term complications of IUGR?
- Lower scores on cognitive testing.
- Learning difficulties
- Cerebral palsy, gross motor and minor neurological dysfunction.
- Behavioural problems
- Poor perceptual performance, poor visuo-motor perception.
They are also more susceptible to develop adult-onset diseases in their infancy and adolescence - eg, diabetes, hypertension, obesity, metabolic syndrome, coronary heart disease.
109
How can we try and prevent IUGR/SGA foetuses?
- Give antiplatelet therapy to mother if at risk of pre-eclampsia
- Smoking cessation
110
At what gestational age is a baby defined as being premature?
Before 37 weeks.
111
What affects prognosis when it comes to premature babies?
Birth weight as well as gestational age at birth.
112
Why is a premature baby at increased risk of hypothermia?
They have little subcutaneous fat, they are less able to shiver, and less able to maintain homeostasis.
113
Which metabolic abnormalities are premature babies at risk of, and what can that predispose them to?
Hypoglycaemia and hypocalcaemia.
This predisposes them to convulsions -> long term brain damage.
114
What respiratory problem are premature babies at risk of, and why?
Respiratory distress syndrome.
Surfactant production from type 2 pneumocytes may not have started/be sufficient and the lungs may not be structurally mature.
115
Which GI disorders are premature babies more at risk of developing?
Jaundice
| NEC
116
Which neurological and sensory disorders are premature babies more at risk of developing?
Kernicterus (due to jaundice)
Intraventricular brain haemorrhage
Retinopathy of prematurity
Hearing impairment
117
Other than neonatal sepsis, what neonatal infections can occur?
Meningitis
Pneumonia
UTI
118
If menningitis is suspected in a noentae, what should the first Ix be?
Lumbar puncture
119
Which organisms are implicated in neonatal meningitis?
Group B strep. and E. coli are responible 2/3 of the time.
120
What is neonatal pneumonia thought to be due to?
Aspiration of micro-organisms during delivery
121
What can neonatal pneumonia be similar to in presentation?
IRDS
122
What is the pathophysiology of pneumonia in a neonate?
Infection -> pulmonary changes with infiltration and bronchopulomnary tissue destruction.
Pulmonary surfactant function is inhibited.
123
How should a neonatal UTI be managed?
Treat immediately in the ill child. Use IV cefotaxime or an aminoglycoside with careful monitoring.
124
What might a neonatal UTI suggest?
Congenital structural abnormality.
125
What is the most common organism in neonatal skin infections?
Staph. aureus
126
Where on the skin is a neonatal skin inection most concerning?
Periumbilical
127
Why is a periumbilical skin infection in neonates worrying?
There is a possibility of bacteria passing up umbilical vein -> thrombophlebitis/hepatic abscess.
128
How can oral thrush in a baby be distinguished from milk curds?
If scraped with a tongue spatula, the milk curds will move but thrush will be adherent.
129
How does a neonatal oral thrush infection present?
- D+V
- Firmly adherent small white plaques
- Sore mouth -> feeding difficulties
130
How should neonatal oral thrush infection be managed?
Topical antifungal like miconazole
131
How might a neonatal TB infection present?
```
At around 6 weeks of life (if acquired at birth).
Unwilling to feed
Excessive weight loss
Slight fever
Hepatosplenomegaly
```
132
How should neonatal TB be investigated?
CXR
133
How is neonatal TB treated?
If FHx of TB in prev. 6 months, BCG is given at 3 days.
| Rx is with standard antituberculous drugs.
134
What is conjunctivitis within the first 28 days of life called?
Ophthalmia neonatorum
135
What used to be the most common cause of neonatal conjunctivitis?
Neisseria gonorrhoeae, then Chlamydia thrachomatis overtook it.
Neither of them are the most common any more.
136
What organisms cause most cases of neonatal conjunctivitis?
Non-sexually transmitted bacteria like S. aureus, Strep. pneumonia, Pseudomonas, and Haemophilus species.
137
Is neonatal conjunctivitis usually severe or mild?
Mild
138
Is neonatal conjunctivitis a notifiable condition?
Not any more
139
How does neonatal conunctivitis present?
Sticky eyes i.e. purulent, mucopurulent, or mucoid discharge from one or both eyes.
Conjunctiva are typcally injected and lid is swollen.
140
A neonate has a crusty, sticky eye. What are the differentials?
- Ophthalmia neonatorum
| - Blocked nasolacrimal duct
141
How does presentation of blocked nasolacrimal duct differ to neonatal conjunctivitis?
Block nasolacrimal duct will not cause red conjunctiva or swollen eyelids, and the dischareg may be intermittent.
142
If a neonate is taken to the GP with red and sticky eyes, what should happen?
They should be referred, always.
143
What is erythema toxicum?
A common benign rash in neonates characterised by blotchy erythematous papules with pustules and vesicles.
144
Is the cause of erythema toxicum known?
No, although it is thought to be an immune reaction due to high levels of eosinophils within the lesions.
145
How common is erythema toxicum?
Very, especially in caucasian neonates.
146
When does erythema toxicum typically present?
3 days to 2 weeks
147
What is the characteristic behaviour of erythema toxicum lesions?
They appear and disappear within minutes to hours.
148
Does ?erythema toxicum need to be investigated?
If the hx is clear, then no. If the picture is atypical, swab a pustule for infection.
If sepsis suspected, manage accordingly.
149
Does erythema toxicum need treatment?
No it is self-limiting
150
Are there any complications associated ith erythema toxicum?
Nope, not even an increased risk of atopy. Full resolution occurs within 2 weeks.
151
What is haemolytic disease of the newborn?
A condition which results from transplacental passage of maternal antibodies which cause immune haemolysis of fetal/neonatal red blood cells.
152
Which pathogenesis for haemolytic disease of the newborn is most commonly recongised?
Rhesus D alloimmunisation
153
What iatrogenic causes are there for foetal-maternal transfusion which can precipitate haemolytic disease of the newborn?
Amniocentesis, chorionic villus sampling, cordocentesis.
154
What blood groups do the parents need to be in order for rhesus snsitisation to occur?
Mother need to be rhesus negative, and father resus positive.
155
What has reduced the incidence of haemolytic disease of the newborn in the estern world?
Use of Anti-D (rhesus D immunoglobulin administration to 1) Rh-neg pregnant women and 2) Rh-neg women post-natally from Rh-pos baby.
156
Does rhesus alloimmunisation cause more serious issues during the primary exposure, or subsequent pregnancies?
Subsequent pregnancies because arge amounts of maternal anti-D antibodies are produced.
157
How does rhesus alloimmunisation cause haemolytic disease of the newborn?
After a sensitising event, maternal anti-D antibodies cross the placenta and bind to foetal red cell. These are then recognised as "foreign" by the foetal immune system which subsequently recruits macrophages and lymphocytes to destroy its own red cells.
158
How can haemolytic disease of foetus cause hydrops fetalis?
Rate of red cell destruction is greater than production, causing foetal anaemia, which leads to foetal heart failure, fluid retention, and swelling, causing foetal death.
159
Why is moderate haemolytic disease of the newborn not a problem for the foetal liver?
RBC breakdown produces bilirubin which is cleared by the placenta when the foetus is in-utero.
160
Why do newborns become jaundiced after birth due to haemolytic disease of the newborn?
Bilirubin is no longer cleared by placenta, and neonate liver is not capable of handling this amount of bilirubin, so unconjugated bilirubin enters circulation and causes jaundice.
161
How do we screen to prevent haemolytic disease of the newborn?
Indirect Coomb's test on mother at first antenatal booking for all rhesus negative women. Routine scans to pick up hydrops or foetal anaemia.
162
How is foetal anaemia picked up antenatally?
Doppler scan of MCA vessel blood flow increased as metabolic demand of growing brain is not met. Performed if blood flow is abnormal or signs of heart failure (secondary to aneamia)
163
When is a Direct Coomb's test done?
Immediately after any birth to a rhesus negative mother - blood taken from cord or baby, as well as tested for blood groups, and Hb and bilirubin at baseline.
164
How does management of haemolytic disease of the foetus differ from haemolytic disease of the newborn?
HDoF should be traeted with blood transfusion to foetus as soon as anaemia is confirmed, usually at 18 weeks. HDoN usually means there was no sensitisation until birth, management in-utero is not normally needed.
165
What are the complications of haemolytic disease of foetus and newborn?
Kernicterus late onset anaemia, other concurrent metabolic disorders, hydrops.
166
When is anti-D prophylaxis given?
Either 2 dose at 28 and 34 weeks, or one larger dose at 28 weeks.
167
Under what circumstances is anti-d prophylaxis given?
All rh-neg women who have not been sensitised, and following abortion/miscarriage/amniocentesis/ectopic pregnancy/bdominal trauma.
