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Paeds > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What is neonatology?

A

The medical care of newborn infants, especially the ill or premature

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2
Q

What do neonatologists deal with?

A 
Prematurity
Low birth weight 
IUGR
Congenital malformations 
Infection 
Birth asphyxia
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3
Q

When does the CVS begin to develop?

A

Towards the end of the 3rd week

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4
Q

When does the heart start to beat?

A

Beginning of 4th week

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5
Q

When is the critical period of heart development?

A

Day 20 to day 50 after fertilisation

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6
Q

Foetal body saturations

A

60-70%

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7
Q

What is the biggest organ of the baby when it is born and what is the significance of this?

A

Liver

Gets most of the oxygenated blood

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8
Q

What are the functions of the Ductus Arteriosus?

A

Protects lungs against circulatory overload - safety valve
Allows the right ventricle to strengthen
Carries low oxygen saturated blood

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9
Q

What does the ductus venosus do?

A

Connects the umbilical vein to the IVC

Carries mostly oxygenated blood

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10
Q

What is ductus venosus blood regulated by?

A

Sphincter

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11
Q

What happens with the first breath?

A

Breathe with the fluids
Start moving the fluids out
Normal labour forces cause stress and mechanical squeeze
First breath opens the arteries in the lungs - so instead of blood on bypass, it is getting great oxygenation and circulation
Ductus arteriosus, ductus venosus, umbilical veins and arteries become ligaments
Foramen ovale closes and leaves a depression

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12
Q

Normal BP for a 1 hr old newborn

A

70/44

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13
Q

Normal BP for a 3 day old newborn

A

77 +/- 12 / 49 +/- 10

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14
Q

RR for full term newborn

A

30 - 60 / min

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15
Q

What is a feature of breathing of a full term newborn?

A

Periodical breathing

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16
Q

Normal HR for a full term newborn

A

120 - 160 b / min

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17
Q

Tachycardia value for a newborn

A

> 160 b / min

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18
Q

Bradycardia value for a newborn

A

< 100 b / min

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19
Q

How is thermoregulation done in the foetus?

A

Maternal thermoregulation in the womb
Metabolic production of heat due to lack of shivering
Brown fat well innervated by sympathetic neurones
Cold stress leads to lipolysis and heat production

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20
Q

Loss of heat occurs by….

A

Radiation - heat dissipated to colder objects
Convection - heat loss by moving air
Evaporation
Conduction - heat loss to surface on which the baby lies

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21
Q

How is breathing measured in newborns?

A 
Non invasive
- Blood gas
- Trans cutaneous pCO2 / O2 measurement 
Invasive
- capnography 
- tidal volume 4-6ml / kg 
- minute ventilation TV x RR
- flow volume loop
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22
Q

What is normal values of PaCO2 and PaO2 in newborns?

A 
PaCO2 = 5-6kPa
PaO2 = 8-12 kPa
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23
Q

When does physiological jaundice appear?

A

DOL 2-3

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24
Q

What does DOL stand for?

A

Day of life

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25
Q

When does physiological jaundice disappear?

A

7-10 DOL

up to 21 DOL in premature infants

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26
Q

What % of babies develop visible jaundice?

A

60% terms

80% premature

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27
Q

How much bilirubin comes from haemoglobin?

A

75%

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28
Q

What does bilirubin cause at high concentrations?

A

Irreversible changes in the brain - kernicterus

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29
Q

What does blue light do to jaundice?

A

Converts bilirubin to water soluble form and increases oxidation of bilirubin

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30
Q

Loss of fluid in the full term newborn is due to what?

A

Shift of interstitial fluid to intravascular

Diuresis

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31
Q

Loss of fluid in the premature infant is due to what?

A 
Less fat in body composition 
Increased loss through kidney 
- slower GFR
- reduced Na reabsorption 
- decreased ability to concentrate or dilute urine
Increased insensible water loss (IWL)
- immature skin 
- breathing
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32
Q

How much insensible water loss is normal to lose?

A

20 - 40 ml / kg / day

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33
Q

Anaemia of prematurity

A

Reduced erythropoiesis
Infection
Blood letting

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34
Q

Most important cause of anaemia of prematurity

A

Blood letting

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35
Q

Types of small babies

A

Small for gestational age (SGA)
IUGR
Hypotrophy
- symmetric / asymmetric

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36
Q

What centile is IUGR?

A

< 10th centile

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37
Q

What centile is severe IUGR?

A

< 0.4th centile

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38
Q

Causes of small for dates babies

A 
Maternal 
- smoking
- alcohol 
- PET 
Foetal chromosomal e.g. Edwards syndrome
Infection e.g. CMV, syphilis 
Placental 
- insuffiency 
- abruption 
Twins - TTN
Normal 
Mixed
39
Q

Common problems in small for dates babies

A 
Perinatal hypoxia 
Hypoglycaemia
Hypothermia
Polycythaemia 
Thrombocytopenia
Hypoglycaemia 
GI problems (feeds, NEC)
RDS (less surfactant)
Infection
40
Q

Long term problems for small for dates babies

A 
HTN
Reduced growth 
- first 2 - 3 yrs remain small 
Obesity 
Ischaemic Heart disease
41
Q

What gestational age is a baby preterm?

A

< 37 weeks

42
Q

What gestational age is a baby extremely preterm?

A

< 28 weeks

43
Q

What is considered a low birth weight?

A

< 2500g

44
Q

What is considered an extremely low birth weight?

A

< 1000g

45
Q

Incidence of prematurity

A

5 - 12%

46
Q

What is RDS?

A

Respiratory distress syndrome

47
Q

What is IVH?

A

Intraventricular haemorrhage

48
Q

What is PVL?

A

Peri-ventricular leuomalacia

49
Q

What is NEC?

A

Necrotising entero-colitis

50
Q

What is PDA?

A

Patent ductus arteriosus

51
Q

What is BPD?

A

Broncho-pulmonary dysplasia

52
Q

What is ROP?

A

Retinopathy of prematurity

53
Q

What is PHH?

A

Post haemorrhagic hydrocephalus

54
Q

What is NAS?

A

Neonatal abstinence syndrome

55
Q

What is HIE?

A

Hypoxic - ischaemic encephalopathy

56
Q

Pathology of RDS

A

Alveoli collapse
Become hypercapnic even though have good perfusion
Less surfactant

57
Q

Prevention of RDS

A

Antenatal steroids

58
Q

Treatment of RDS

A

Early - surfactant
Early extubating
Non invasive support (N-CPAP)
Minimal ventilation (low tidal volume and good inflation)

59
Q

Pathology of BPD

A 
Overstretch by volubaro trauma
Atelectasis 
infection via ETT
O2 toxicity 
Inflammatory changes 
tissue repair - scarring
60
Q

Treatment of BPD

A

Patience
NUTRITION AND GROWTH
steroids

61
Q

Minor respiratory problems include

A

Apnoea
Irregular breathing
Desaturations
Sometimes forget to breathe

62
Q

Treatment of minor resp problems

A

Caffeine

N-CPAP

63
Q

Prevention of IVH

A

Antenatal steriods

64
Q

Treatment of IVH

A

NO TREATMENT

Drainage

65
Q

Pathology of PVL

A

white matter surrounding ventricles deprived of O2 and blood leading to malacia (softening) - leading to holes in the brain and abscess

66
Q

What % of PVL have adverse outcomes?

A

95%

67
Q

Pathology of PDA

A

Over perfusion of lungs - Lung odema
Lung oedema steals from systemic circulation leading to
Systemic ischaemia

68
Q

Consequences of PDA

A

Worsening of resp symptoms
Retention of fluids (low renal perfusion)
GI problems (GI ischaemia)

69
Q

What does NEC involve?

A

Ischaemic and inflammatory changes

Necrosis of bowel

70
Q

Treatment of NEC

A

Surgical often required
Antibiotics
Parental nutrition

71
Q

Prognosis of prematurity

A

1 / 3 die
1 / 3 normal life or mild disability
1 / 3 have moderate or severe disability for lifetime
1 in 6 entirely normal at 6 y/o

72
Q

Treatment of PVL

A

No treatment

73
Q

What can IVH lead to?

A

PHH

74
Q

What is a risk factor for NEC?

A

Formula feeding

75
Q

What is protective of NEC?

A

Breastfeeding

76
Q

What is the first step in neonatal resuscitation?

A

Dry the neonate

77
Q

Neonatal resus guidelines

A
  1. Dry the neonate, remove any wet towels and start the clock / note the time
  2. within 30 seconds; assess tone, breathing and HR
  3. within 60 seconds; if gasping or not breathing; open airway and give 5 inflation breaths
  4. Re-asses; if no increase in HR, look for chest movement
  5. if chest not moving; recheck head position, consider 2 person airway control and other airway manouvres, repeat inflation breaths and look for a response
  6. If no increase in HR, look for chest movement
  7. When the chest is moving, if the HR is not detectable or slow (<60bpm) start chest compressions 3 compressions to each breath
  8. Reassess HR every 30 seconds. If HR not detectable or slow consider venous access and drugs
78
Q

What is used to assess the health of a newborn baby?

A

APGAR score

79
Q

What is looked at in the APGAR score?

A 
Pulse
Resp effort
Colour 
Muscle tone
Reflex irritability
80
Q

What parts of the APGAR score get a score of 2?

A 
Pulse > 100
Resp effort - strong, crying 
Pink in colour
Muscle tone - active movement
Reflex irritability - Cries on stimulation/sneezes, coughs
81
Q

What parts of the APGAR score get a score of 1?

A 
Pulse < 100
Resp effort is weak and irregular
Body pink but extremities blue
Muscle tone - limb flexion 
Reflex irritability - grimace
82
Q

What parts of the APGAR score gets a score of 0?

A 
Pulse absent
Resp effort nil 
Blue all over
Muscle tone - flaccid
No reflex irritability
83
Q

Interpretation of APGAR scores

A

0 - 3 very low score
4 - 6 moderate low
7 - 10 baby in good state

84
Q

When is a childs hearing first assessed and how?

A

Newborn

Otoacoustic emissions test

85
Q

In the first 10 mins of life, what can be expected of O2 sats of neonates?

A

They may be suboptimal

86
Q

What are the greater risks associated with neonatal meningitis?

A 
LBW
Prematurity
Traumatic delivery 
Foetal hypoxia
Maternal peripartum infection
87
Q

If a baby has a heel prick test done, and it is found to have raised immunoreactive trypsinogen (IRT), what is the next most appropriate test for the baby? What are they looking for?

A

Sweat test

Tests for CF

88
Q

Presentation of NEC

A 
Feeding intolerance
Abdominal distension 
Bloody stools
Can quickly progress to 
- abdominal discolouration 
- perforation 
- peritonitis
89
Q

What is the investigation for NEC and what does it show?

A

AXR

  • Dilated bowel loops (often asymmetrical in distribution)
  • Bowel wall oedema
  • Pneumatosis intesinosis (intestinal gas)
  • portal venous gas
  • pneumoperitoneum resulting from perforation
  • Air both inside and outside of the bowel (rigler sign)
  • air outlining the falciform ligament (football sign)
90
Q

If a baby has an abnormal hearing test at birth, what test are they offered?

A

Auditory brainstem response test

91
Q

What is the compression to ventilation ratio in neonates?

A

3:1

92
Q

All breech babies at or after 36 weeks gestation require what?

A

USS for DDH at 6 weeks regardless of mode of delivery

93
Q

Risk factors for surfactant deficient lung disease of the newborn

A 
Decreasing gestation 
Male
Maternal DM
C section 
Second born of prem twins
94
Q

Presentation of surfactant deficient lung disease of the newborn

A 
Resp distress of the newborn 
- tachypnoea
- intercostal recession 
- expiratory grunting
- cyanosis 
CXR
- 'Ground glass' appearance with an indistinct heart border

Paeds (28 decks)

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