Neonatology Flashcards
(51 cards)
what is a neonate?
a baby up to 28 days of age
what is a term baby?
a baby born between 37-42 weeks gestation
what is a preterm baby?
a baby born before 36+6 weeks gestation
why do you give newborns vitamin K injections?
to prevent Vitamin K Deficiency Bleeding (VKDB)/haemorrhagic disease of the newborn (HDN) (same thing)
because they don’t have enough vit K in the blood
what can you do to prevent respiratory distress syndrome in preterm babies?
give maternal steroids pre-birth
what are defined as high risk deliveries?
- pre-term (<36 weeks)
- multiple births
- crash/emergency c sections (metals distress, undiagnosed breech)
- meconium stained liquor
- instrumental deliveries
- expected problems; abnormal scans etc
what is meconium stained liquor?
when meconium is passed when the baby is still in the womb, staining the amniotic fluid because there is bile salts and enzymes, if inhaled by the foetus = MAS meconium aspiration syndrome
what is sturge weber syndrome?
and what symptoms/signs are associated with it?
what is the pathology of this?
rare congenital neurological and skin disorder (neurocutaneous syndrome)
-port wine stains esp in the ophthalmic distribution, glaucoma, seizures, mental retardation
proliferation of arteries in the brain
in what populations might you see only a single palmar crease?
trisomy 21 - downs syndrome
fetal alcohol syndrome
other chromosomal abnormalities
when performing the red light reflex, what is the most likely diagnosis for….
Bilateral lack of RLR ?
unilateral lack of RLR ?
bilateral - congenital cataracts (if untreated can lead to a lazy eye)
unilateral - retinoblastoma
name the two tests performed when examining for hip dysplasia in a newborn and what they are doing?
Barlaw - pushing the hip joint downwards to try and displace it
Ortolani - pushing in and upwards to try and relocate it
what is talipes equinovarus and explain the two types and their prognosis
‘club foot’
positional - occurs due to positioning in the uterus, generally correctable with passive dorsiflexion of the foot
congenital - can be idiopathic or due to genetic syndromes, teratological anomalies, neuro disorders or myopathies, generally harder to treat
what are risk factors for infection in a term baby?
- PROM (prolonged rupture of membranes)
- mum GBS (group B strep) carrier
- not receiving maternal antibiotics in labour
normal temperature range is?
36.5 C - 37.5 C (rough)
what things should you think about in an unwell term baby?
- sepsis (group B strep, e.coli, listeria)
- hypoglycaemia (ABC - DEFG - don’t ever forget glucose)
- congenital cardiac abnormality
- metabolic problem
- others: transient tachypnoea of newborn, anaemia/hemolysis, birth asphyxia, seizures
percentage of pregnant women in the UK are group B strep carriers and what does this mean for their baby and how can you prevent this?
1/4 of pregnant women carry GBS
babies can get sepsis from it - septicaemia with possible pneumonia/meningitis, although most aren’t
maternal antibiotics in labour = 90% RR for early (within 1st week) GBS sepsis
how do you manage GBS sepsis in a unwell term baby?
what antibiotics are used?
ABC - DEFG
airway
breathing - oxygen, CPAP, ventilation
circulation - fluids and inotropes
DEFG - always check glucose
treat with abx - ben pen and gent until microbiology comes back
what do the following antibiotics cover for?
ben pen
gent
amox
benzyl penicillin = GBS, strep, staphs
gentamicin = gram neg and ecoli
amox = listeria
what does the coombs test (DAT - direct anti globulin test) look at?
ABO or Rhesus incompatibility
what do you separate the causes of neonatal jaundice in to and name some cases under each category?
unconjugated and conjugated
unconjugated can be further split into onset <24 hours and consent >24 hours
<24 hours - sepsis, autoimmune hemolysis (ABO incompatibility and rhesus disease), congenital infections
onset >24 hours - sepsis, homeless, congenital infections (i.e. TORCH), hypothyroidism (slow liver enzymes), metabolic disorders
OR physiological jaundice, breast milk jaundice (non pathological and diagnosis of exclusion)
conjugated bilirubin = biliary atresia, choledochal cyst, liver disease
how do you treat neonatal jaundice?
No treatment — this may be appropriate for well neonates with physiological or breastmilk jaundice and a bilirubin level below the treatment threshold. - adequate hydration through good feeding and mothers continue to breast feed
Treatment of any underlying illness (such as infection).
Phototherapy — absorption of light through the skin converts unconjugated bilirubin into products that are more easily excretable in the stool and urine.
Exchange transfusion — indicated if the baby has signs of bilirubin encephalopathy and considered if the risk of kernicterus is high or jaundice is not responding to phototherapy.
Early surgical treatment — required for conditions such as biliary atresia.
when should you do an emergency/urgent admission in neonatal jaudice?
jaundice appears <24 hours of life
jaundice with features of bilirubin encephalopathy (atypical sleepiness, poor feeding, irritability)
jaundice appears > 7 days of life, appears unwell, was preterm, prolonged jaundice (2-3 weeks), pale stools/dark urine, poor feeding/concerns about weight
what should you ask when taking a history about neonatal jaundice?
Obstetric history (including the mother’s Rhesus status and blood group if known) and the baby’s gestational age at birth.
Age at onset and duration of jaundice.
Feeding history (type of feeding and whether there have been any problems with adequate intake).
Number of wet or dirty nappies in a day (to assess the state of hydration).
Also specifically ask about the presence of dark urine and/or pale stools.
Signs of illness (for example lethargy, fever, vomiting, significant weight loss, irritability).
Family history of relevant conditions — for example significant haemolysis (including glucose-6-phosphate-dehydrogenase deficiency).
Ask whether any siblings or close family members have required hospital treatment such as phototherapy or exchange blood transfusion for neonatal jaundice.
Examine the neonate to assess for:
Any signs of illness, including fever.
Appropriate weight gain (compared with previous measurements if available).
Evidence of bruising (for example cephalhaematoma following ventouse delivery).
What tests are done when a baby presents with neonatal jaundice?
serum bilirubin levels are usually measured in order to confirm the diagnosis and guide treatment.
Full blood count and blood film — a high or low white blood cell count or thrombocytopaenia can suggest sepsis; a haematocrit of less than 45% can suggest haemolytic anaemia; an increased reticulocyte count suggests haemolysis; a peripheral blood film may show evidence of haemolysis.
Blood group (mother and baby) — ABO incompatibility is suggested by a mother with blood group O and a baby with group A or B. Rhesus incompatibility is suggested if the mother is Rhesus negative and her baby is Rhesus positive.
DAT (direct anti globulin test - Coombs’ test) — used to diagnose ABO or Rhesus isoimmunisation.
Liver function tests — in congenital infection, liver enzymes may be increased.
Blood glucose-6-phosphate-dehydrogenase (G6PD) levels, taking into account ethnic origin — to check for G6PD deficiency.
Microbiological cultures of blood, urine, and/or cerebrospinal fluid (if infection is suspected) — to look for a source of sepsis.
