Neonatology Flashcards
(73 cards)
1
Q
What are the ways to get DNA from a baby?
A
- chorionic villus biopsy to get placenta
- amniocentesis to get skin/urine cells
2
Q
What does non-invasive prenatal testing include?
A
- sex determination
- trisomy testing
3
Q
How can trisomy 21 be detected non-invasively?
A
there will be an excess of chromosome 21 in the mother’s blood serum
4
Q
What is trisomy 18?
A
Edward’s syndrome
5
Q
What can be seen with invasive genetic testing?
A
- chromosome abnormality with chromosome microarray
- single gene changes by PCR and next gen. sequencing
6
Q
What are the + and - of chromosome microarray?
A
+ high resolution
+ easy
+ rapid
- may be incidental findings leading to ethical decisions about whether to tell parents or not
7
Q
What are the characteristics of a floppy baby?
A
- lack of head control
- increased ROM
- breathing difficulties
8
Q
What are the functions of the placenta?
A
- Fetal homeostasis
- Gas exchange
- Nutrient transport
- Waste product transport
- Acid base balance
- Hormone production
- Transport of IgG
9
Q
What are the main differences in the foetal circulation to an adult’s?
A
- ductus venosus
- foramen ovale
- ductus arteriosus
10
Q
What is the ductus venosus?
A
from placenta the ox blood goes through the liver through the ductus venosus into inferior vena cava
11
Q
What is the foramen ovale?
A
blood from the right atrium moves through this hole and into the aorta
12
Q
What is the ductus arteriosus?
A
- a small amount of blood enters the RV and goes into the lungs
- this is further reduced by the ductus arteriosus which moves blood back into the aorta
13
Q
How much of a foetus’ blood output goes to its lungs?
A
only 7% and this deoxygenated blood mixes in with the rest so the blood is very deoxygenated when it reaches the mother
14
Q
What are the main things that happen in the 3rd trimester to prepare the baby for birth?
A
- Surfactant production (from type 2 pneumocytes in the alveoli)
- Accumulation of glycogen in the liver, muscle and heart
- Accumulation of brown fat between the scapulae and around the internal organs (insulating fat)
- Accumulation of subcutaneous fat
- Babies inhale and swallow amniotic fluid to help the lungs to grow
15
Q
What happens biochemically at the onset of labour?
A
- increased catecholamines/cortisol
- synthesis of lung fluid stops
16
Q
How long after birth until the cord is clamped?
A
around 1 minute
17
Q
What are the changes that occur after the cord is clamped?
A
- pulmonary vascular resistance drops
- systemic vascular resistance rises
- oxygen tension rises
- circulating prostaglandins drop
- ducts constrict and foramen ovale closes
18
Q
What happens to the FO, DA and DV?
A
foramen ovale= shuts
DA= ligamentum arteriosus
DV= ligamentum teres
19
Q
How can persistent pulmonary hypertension of the newborn be tested for?
A
- pre and post ductal sats
- blood before DA will have a higher saturation
- sats monitors on hand and foot
- more than 3% different means a problem
20
Q
What is the management of PPHN?
A
ventilation oxygen nitric oxide sedation inotropes ECLS/ECMO
21
Q
What is the aims of management of PPHN?
A
vasodilate the pulmonary vasculature to reduce the pressure in the lungs
22
Q
What type of babies is transient tachypnoea common in?
A
large healthy babies that are born by section
23
Q
What is the ideal temperature for a baby?
A
36.5-37.4 degrees
24
Q
What is acrocyanosis?
A
this is longer term blueness of the hands and feet of a newborn which is normal
25
What biochemical levels may drop in a newborn baby?
- insulin as there is not much milk production in the mother until day 5
- there are ketones for backup
26
What are the babies that are most at risk of hypoglycaemia?
- increased energy demands due to sickness
- low glycogen stores due to prematurity
- inappropriate insulin to glucagon ratio due to GDM
27
What drug risks hypoglycaemia of the infant if the mother takes it during pregnancy?
beta blockers
28
What are the benefits of breastfeeding for the mother?
- reduced risk of breast cancer
| - prevention of post-natal depression
29
What is the affinity of foetal haemoglobin like?
high affinity for oxygen so grabs it well but doesn't let it go very well hence the need for adult haemoglobin (physiological anaemia in the gap between types)
30
What causes the shift in the curve for haemoglobin in babies?
an increase in 2,3 BPG which shifts the curve to the right
31
What are jaundice babies treated with?
phototherapy (blue light causes baby to pee out bilirubin) and very occasionally they need exchange transfusion
32
What is normal baby weight?
2.5-4kg
33
Why are babies given vitamin K?
they are given this IM to prevent haemorrhage disease of the newborn which is spontaneous bleeding
34
What are some tests that are done on newborns?
- TSH for thyroid function
- cystic fibrosis
- hip exam
35
What is looked for in the head, eyes and ears of babies?
- Head: circumference, cup succedaneum (more superficial), cephalhaematoma (deeper, stop at suture lines and are just above periosteum)
- Eyes: conjunctival haemorrhage, red reflex for cataracts and iris abnormality
- Ears: postion, ear canal, pits, Fhx of hearing loss
36
What is looked for in the mouth, rest and cardio systems of babies?
- Mouth: philtrum (smooth is alcohol), tongue tie, palate, teeth (need removed), Epstein's pearls and sucking reflex
- Resp: nasal flaring, grunting, should be <60 breaths per minute
- Cardio: sats, pulses, apex, thrills and heaves, heart sounds (eg murmur from pulmonary stenosis of Tetralogy of Fallot)
37
What is looked for in the abdominal, genitourinary, MSK and skin of babies?
- Abdo: distension, hernias, bile vomiting, anus and gastroschisis
- GU: undescended testes
- MSK: spine for spina bifida, hip exams for DDH
- Dermatology: strawberry birthmarks, Mongolian blue spots
38
What is included in the Apgar score?
-Appearance
-Pulse
-Grimace
-Activity
-Respiration
2 for each, 8 or over is normal
39
How much blood does a baby have?
300ml which is can of coke amount so hypovolaemia is common
40
What are the main bacteria that babies tend to be infected with?
- group B strep
- E.coli
- S.aureus
- S.epidermidis
41
What are the main viruses that babies tend to be infected with?
- enteroviruses
- paroviruses
- herpes
- cytomegalovirus
42
What are the main congenital respiratory conditions of newborns?
tracheo-oesophageal fistula and diaphragmatic hernia
43
What are the causes of HF in newborns?
HF with Hydrops fetalis can be caused by Rhesus disease (mother is anaemic) or chromosomal causes
44
What are the weeks for pre, post and term babies?
up to 37 weeks is preterm
37-42 weeks is term
above 42 weeks is post term
45
What are the levels of preterm?
extreme preterm is 23-27
very preterm is up to 32
preterm is up to 37
46
What are the risk factors for early death of a child?
- Preterm delivery
- Low birth weight
- Maternal age
- Smoking
- Postcode/poverty
47
What are the risk factors for preterm babies?
- Back to back pregnancies
- IVF
- Smoking, alcohol and drugs
- Poor nutrition
- Multiple preterm babies
48
Why do babies get hypothermic?
- low metabolic rate
- minimal muscular activity
- fat insulation is negligible
- high ratio of SA to mass
49
How is hypothermia treated in babies?
- cosy bags
- skin to skin
- transwarmer mattress
- prewarmed incubator
50
What are some common respiratory disease in preterm babies?
- respiratory distress syndrome
- apnoea of prematurity
- bronchopulmonary dysplasia
51
What is RDS and how does it present?
- RDS is lack of surfactant and undeveloped lungs
- symptoms are tachypnoea, increased RR, grunting, intercostal recession, nasal flaring, cyanosis
- this will worsen over minutes to hours
52
What is the treatment for RDS?
- maternal steroid
- surfactant
- ventilation
53
What is necrotising enterocolitis?
gut bacteria moves into the blood and can progress to sepsis
54
What can cause low baby birth weight?
- smoking (affects placental function)
- malnutrition
- valium
55
What is the best blood sugar for a baby?
above 2.6
56
What could cause low blood sugar in a baby?
- not being fed
- coldness
- mums with GDM
- mums that take beta blockers
- infection
57
What are the signs of hypoglycaemia in a baby?
```
Low temperature
Sleepiness
Seizures
Jitteriness
Poor feeding
```
58
What causes physiological jaundice in a newborn?
the old foetal haemoglobin is broken down and this makes bilirubin but the liver can't handle this so jaundice at 2-5 days
59
What are some other causes of jaundice in a newborn baby?
- infection
- blood group incompatibility
- placental insufficiency (baby makes more red cells so higher haemoglobin so more breakdown)
- trauma so bruising
- dehydration
- preterm
60
When would a baby get Hep B?
normally as part of injection regime but if there is IVDU in the family then this would happen earlier
61
What are the causes of tachypnoea in the newborn?
```
Infection
RDS
Withdrawal
Pneumothorax
Diaphragmatic hernia
NAS
Cardiac problems
Aspiration
```
62
Why is breastfeeding good for NAS babies?
it helps them to come down off the drug as there is some drug in the breastmilk
63
What are the treatments for babies with NAS?
- Cuddle them, give them a pacifier, put them in a rockable pram, play music
- oromorph or phenobarbital
64
What percentage of weight loss is ok for a baby?
up to 10%
65
What does the baby blood spot test screen for?
CF
Sickle cell
Congenital hyperthyroidism
66
What is prolonged jaundice in a baby?
beyond the first 14 days
67
What is a green tinged jaundice baby?
obstructive jaundice from TPN
68
What are the three ways that a baby can have an obstruction somewhere?
- something in the lumen
- something pushing from the outside
- something in the wall
69
What is a soap bubble sign on an XR?
obstruction in the lumen of the bowel
70
What can cystic fibrosis present as outside of the lungs?
a bowel problem which is quite common and can cause a meconium ileum in a neonate
71
What is an atresia?
a dead-end in the gut
72
What is laddering on an XR a sign of?
obstruction
73
What is the colour of bile stained vomiting and what could be causing it?
- mossy green like fairy liquid (not yellow like how it is in the liver)
- could be malrotation causing a volvulus with top left and bottom right of bowel
- needs an upper GI contrast fast or the bowel will infarct
