Neonatology Flashcards
(168 cards)
What is Jaundice?
Condition of abnormal high levels of bilirubin in the blood.
What is physiological jaundice in the newborn?
There is a high concentration of red blood cells in the neonate and foetus. The red blood cells are more fragile than normal red blood cells and the foetus and neonate also have less developed liver function. Fetal red blood cells break down more rapidly than normal red blood cells and release lots of bilirubin, normally this bilirubin is excreted by the placenta, however at birth the foetus no longer has access to a placenta to excrete bilirubin, this leads to a normal rise in bilirubin shortly after birth which causes a mild yellowing of skin and sclera from 2-7 days of age. Usually it will resolve completely by ten days.
What are the causes of jaundice in the first 24 hours?
Jaundice in the first 24 hours is always pathological Rhesus haemolytic disease ABO haemolytic disease Hereditary spherocytosis Glucose 6 phosphodehydrogenase
If the baby is less than 24hrs and is jaundice, what should you do?
They are at high risk of developing severe hyper bilirubin anemia and therefore must have their serum bilirubin urgently (within 2 hours)
What investigations should you do if there are still signs of jaundice after 14 days?
A jaundice screen is performed, this includes…
Conjugated and unconjugated bilirubin (raised conjugated bilirubin could indicate biliary atresia which requires urgent surgical intervention).
. Direct antiglobulin test (Coombs)
. TFTS
. FBC and blood film
. Urine for MC&S and reducing sugars
. U and Es and LFTS
What are the causes of prolonged jaundic3?
Biliary atresia Hypothyroidism Galactosaemia UTI Breast milk jaundice Congenital infections-CMV, toxoplasmosis
What are the circulation changes during birth?
Removal of placenta
Reduced pulmonary vascular resistance
Onset of breathing
Closure of the shunts (ductus venosus, ductus arteriosus, Foramen ovale)
What does the heel prick (Guthrie) check for?
This on the 5th day of life
It screens got common illnesses (sickle cell anaemia, cystic fibrosis, congenital hypothyroidism, common metabolic defects)
What clinical features are assessed in a newborn examination (within 24 hours of life)?
Head- red pupil reflex, hard and soft palate, fontanelle, facial dysmorphism, tongue/lip cyanosis.
Breathing- rate, rythm, resp distress?
CVS- rate, murmurs, check femoral pulses (coarctation of aorta)
Neuro- tone, reflexes, baby should be in flexed position, check spine and back for dimples, marks and spina bifida.
Hands and feet- check for palmar crease, talipes, extra digits
Abdomen- palpate for masses, check umbilical cord
Hips- check for developmental dysplasia of the hip
Genitalia
Hearing
Eyes- looking for retinoblastomas (very malignant and can spread to brain) and for cataracts (peripheral blindness within 6 weeks if not treats).
Give brief overview of the newborn examination…
. Document any birthmarks
. Plot newborn on growth chart
. Get senior input if you Are unsure of any findings
. Ask mum how she is feeling and if she has any concerns.
What would be contraindications to vaccinations?
Anaphylaxis to previous vaccine or vaccine component
Anaphylaxis to egg (yellow fever and influenza)
Immunocompromised (live attenuated)
What is the difference between perinatal and neonatal mortality rate?
Perinatal= number of stillbirths and neonatal deaths within the first week of life per 1000 live births
Neonatal= number of deaths per 1000 live births in the first 28 days
What are the two types of IUGR and what is meant by them?
Symmetrical IUGR= this is where there is a proportionally small head, length and weight
Asymmetrical IUGR= there is a small length and weight but the head circumference is preserved
What is the usual causes of symmetrical IUGR?
Intrauterine infections and chromosomal abnormalities
What are the causes of asymmetrical IUGR?
Placental insufficiency/ pre eclampsia
What investigations would you do at birth for IUGR?
Blood gas is typical on delivery to get a baseline on how unwell the infant is
What are the risk factors for prematurity/ IUGR?
Multiple pregnancy Maternal illness Placental insufficiency In utero infection Genetic disorder
What is meant by prematurity?
Any birth before 37/40 weeks gestation.
What is meant by IUGR?
Failure of the foetus to achieve genetic growth potential.
What is meant by SGA?
A newborn below a certain centile for that particular gestation, usually the 10th centile.
What is LBW?
Newborn weighing less than 2500g
What is VLBW?
Newborn weighing less than 1500g
What is a stillbirth?
Foetus born after 24/40 that never shows any signs of life.
What is neonatal death?
Death of a newborn within 28 days of delivery