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Reproduction & Sexual Health > Newborn > Flashcards

Newborn Flashcards

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1
Q

Define a ‘term’baby

A

After 37 weeks completed gestation

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2
Q

What is normal weight for a term infant?

A

2.5 - 4kg

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3
Q

How much weight is put on each day by the baby during the third trimester?

A

24g

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4
Q

In addition to weight gain what happens in the 3rd trimester?

A

Transplacental transfer of;

  • iron
  • vitamins
  • calcium
  • phosphate
  • antibiotics
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5
Q

What four route tasks are carried out on a newborn?

A 
Vitamin K 
Maternal Infection History 
Snuggle bundle 
Maternal vaccination 
Screening tests
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6
Q

Why are newborn babies given vitamin K?

A

To prevent haemorrhage disease of the newborn - clotting disorder which results in spontaneous bleeding - GI, CNS, lungs

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7
Q

How is Vit K administered?

A

Intramuscularly or orally - also present in formula milk

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8
Q

What are the key infections to find out about in maternal history?

A 
Hep B 
Hep C
HIV
Syphilis 
TB 
Group B Strep
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9
Q

What should be done if the baby is at risk of hep B?

A

Very high risk - mother has active disease - immunoglobulin
High risk - baby given immunisation in hospital
Low risk - wait until normal immunisation given

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10
Q

What should be done if the mother has HIV/HCV?

A

RNA/viral load tested, two negatives mean the load is undetectable and the baby is at very low risk

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11
Q

If a baby is at risk of TB what should they be given?

A

BCG

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12
Q

What can cause sepsis in babies?

A

Group B strep from maternal carriage

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13
Q

Describe a snuggle bundle

A

Paper booklet helps mums and dads to care for their babies and educates them on when to get help with common risk factors

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14
Q

What two vaccinations are given to pregnant women?

A

Pertussis (whooping cough)

Influenza

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15
Q

What screening tests are done on new born babies?

A

head to toe examination
hearing screening
hip screening
new born screening card

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16
Q

What is tested for on a newborn screening card?

A

Cystic fibrosis, congenital hypothyroidism, haemoglobinopathies (sickle cell anaemia), metabolic diseases

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17
Q

What should you look for on the head of a newborn?

A 
Overlapping sutures
Fontanelles 
Ventouse/forceps marks 
Mousing 
Cephalhaematoma 
Caput succedaneum 
Measure circumference
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18
Q

What is cephalhaematoma?

A

Brusing/bleeding between the periosteum and epicranial aponeurosis - suture line is not crossed

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19
Q

What is caput succedaneum?

A

Soft tissue swelling - reduces in 12 hours

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20
Q

What do you look for in the eyes of a newborn?

A

Size, distance apart, red reflex, conjunctival haemorrhage, squints, iris abnormality

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21
Q

What is lack of red reflex a sign of?

A

Congenital cataract - serious risk of loss of vision

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22
Q

What do you look for when examining the ears of a newborn?

A

Position, external auditory canal, tags/pits, folding, family history

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23
Q

What do you look for in the mouth of a neonate?

A

Shape, philitrum, tongue tie, palate, neonatal teeth (need removed by dentist), sucking reflex, ebsteins pearls

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24
Q

What is the purpose of looking at the philitrum?

A

Bit between upper lip and nose if its large and smooth it is a sign of foetal alcohol syndrome

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25
What are ebsteins pearls?
Small white cysts (made up of skin cells) found on top of the babies mouth, gums and can be on the tip of the penis
26
What side of the face is affected by a fascial palsy?
The side that looks normal - cannot move
27
How is the newborns heart checked?
``` Pulses (femoral pulse) Apex beat Heaves/thrills Heart sounds Colour (saturation if CHD screening) ```
28
How are the newborns lungs checked?
``` Chest shape Nasal flaring Grunting Tachypnoea In-drawing Breath sounds ```
29
What do you feel/look for in the abdomen of a newborn?
Movement with respiration, distention, hernia, umbilicus, bile strained vomit, passage of meconium, anus (fissure)
30
Describe the genitourinary examination of the newborn
Passage of urine, normal genitalia, undescended testes, hypospadius
31
What is hypospadius?
Urethra is on the underside of the penis
32
Describe the MSK examination of the newborn
Movement, posture, tone, spine, limbs, digits | Hips - barlow and ortolani
33
Name four primitive reflexes
Suck Rooting Moro ATNR (turn baby and it will stick its opposite arm out)
34
Name the common skin condition >50% of babies get after birth
Erythema toxicum
35
What is looked for on a newborns skin?
Birth marks, 'port wine stain' - abnormality of blood vessels, mongolian blue spot (common in darker skin)
36
How is central access achieved in neonates?
Umbilical route
37
What is the neonate period?
Birth to 28 days
38
What score is used to assess the health of neonates?
Apgar
39
Describe the Apgar score
``` Appearance Pulse Grimace Activity Respiration ```
40
State the normal neonatal heart rate
120-140/160
41
State the normal neonatal temperature
36.5-37.4
42
State the normal neonatal heart rate
40-60
43
What should neonatal oxygen sats be?
>95%
44
What should neonatal cap refill be?
2-3 seconds
45
What is the effect on the lungs if a baby gets cold?
Surfactant doesn't work
46
Name the three conditions in a neonate that are all linked
- hypothermia - hypoxia - hypoglycaemia
47
What should be done in babies with neurological ischaemia?
Therapeutic cooling, stops cerebral palsy in 1 baby in 8
48
What types of infection are associated with each of the 'natal' phases?
Antenatal - bacterial Perinatal - viral Postnatal - fungal
49
What is the risk factor for perinatal infections?
Ruptured membranes
50
Name the common sites of infection in neonates
Blood stream CNS - meningitis Respiratory - pneumonia GU - UTI
51
Name the organisms which often cause bacterial infections
Group B Strep E.coli Listeria myocyotgenes Staph aureus/epidermidis
52
What are the common viral infections that present in neonates?
``` Cytomegalovirus Parvovirus Herpes Enteroviruses HIV/Syphilis ```
53
What is given to babies with herpes virus?
Aciclovir
54
Describe hypoxic ischaemic encephalopathy
Perinatal asphyxia leads to multi organ damage, baby will have poor apgar score and active resuscitation is required
55
Where is hypoxic ischaemia encephalopathy more common?
Developing countries - less advanced resuscitation equipment
56
Name four respiratory diseases that can present in term infants
Transient tachypnoea - fluid in the lungs Pneumothorax (spontaneous or due to resus) Respiratory distress syndrome Pneumonia
57
What cardiovascular disease can present in term infants?
Heart failure - hydrops | Persistent pulmonary hypertension of the newborn - Failure to adapt
58
What is hydrops fetalis?
Accumulation of fluid leads to oedema
59
What causes hydrops fetalis?
anaemia, chromosomal defect, idiopathic, rhesus disease
60
Name five congenital cardiac diseases
``` Tetralogy of fallot Transposition of the great arteries Coarctation of the aorta Total anomylous Pulmonary Venous Drainage Hypo plastic heart ```
61
Name two congenital respiratory diseases how will they present?
Tracheo-oesphageal fistula Diaphragmatic hernia Pulmonary hypertension and RDS
62
State two neurological congenital disorders
Microcephaly | Spina bifida
63
Describe one renal congenital syndrome
Potters - renal agenesis - no urnine/amniotic fluid leads to lung problems - pulmonary hypoplasia
64
Define preterm
Birth occurs before 37 completed weeks of gestation
65
Define term
Birth occurs between 37 and 42 weeks of completed gestation
66
Define post term
Birth occurs after 42 completed weeks of gestation
67
What is the difference between extreme and very preterm?
extreme - <27 weeks | very - <32 weeks
68
What are the risk factors for a preterm infant?
- complications in pregnancy - twins - maternal age - smoking/drinking/drugs - ethnicity - IVF - poor nutrition/miscarriages/abortions - <6 months between pregnancies - abnormally shaped uterus - >2 preterm deliveries increases risk of another
69
What causes hypothermia in preterm infants?
Low admission temperature (ambulance), low BMR, stressful birth, minimal muscular activity, no subcutaneous fat, large surface area: body mass
70
Why do preterm babies have increased risk of nutritional compromise?
Limited nutrient reserves, gut immaturity, immature metabolic pathways, increased nutrient demands
71
How are preterm babies fed?
Breast milk, donor breast milk (prescription only), total parental nutrition may be required, formula
72
What is the difference between early and late onset neonatal sepsis?
Early - bacteria acquired before/during delivery | Late - bacteria acquired after delivery (nosocomial/community sources)
73
Which organisms often cause EOS?
Group B strep, gram negatives (e.coli)
74
Which organisms often cause LOS?
Coagulase -ve staph, gram negatives, staph aureus
75
Why are preterm babies at increased risk of neonatal sepsis?
Immature immune system, intensive care environment - tubes and lines
76
How is neonatal sepsis managed?
Prevention, hand washing, vigilant infection screening, supportive measures, judicious use of antibiotics
77
What antibiotics are used in neonatal sepsis?
Benzylpenicillin and gentamicin until cultures obtained
78
What is respiratory distress syndrome?
Lack of surfactant causes immature lung due to hyaline membrane disease
79
How can RDS arise?
Primary - surfactant deficiency/structural immaturity | Secondary - intubation/ventilation can cause damage meaning the baby cannot clear secretions
80
What are the clinical features of RDS?
Tachypnoea (grunting, nasal flaring, cyanosis) | Respiratory distress
81
How is RDS managed?
Maternal steroids Surfactant Ventilation
82
Describe patent ductus arteriosus
No mechanism to close if baby is born preterm leads to a higher burden on the heart and inadequate oxygenation
83
How does a intraventricular haemorrhage arise?
Blood vessels in a preterm baby are fragile and break easily leading to bleeding in the brain which can cause nerve damage
84
How is an intraventricular haemorrhage diagnosed?
Anterior fontanelle ultrasound
85
Describe the different types of intraventricular haemorrhage
Grade 1 and 2 - neurodevelopmental delay up to 20%, mortality 10% Grade 3 and 4 - neurodevelopmental delay up to 80%, mortality 50%
86
What can prevent intraventricular haemorrhage?
Anti-natal steroids
87
What is a serious gut pathology that can occur in preterm infants?
Necrotising Enterocolitis
88
Describe Necrotising Enterocolitis
Immature gut meconium is only passed after birth - in extreme preterm babies the gut cannot handle the milk so the bacteria translocated across the lumen into the blood leading to a sepsis like picture
89
What may happen in Necrotising Enterocolitis ?
Gut may rupture and require surgery

Reproduction & Sexual Health (36 decks)

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