Paeds: Neonatology Flashcards
(199 cards)
1
Q
Neonatal Jaundice
what is jaundice
A
the condition of abnormally high levels of bilirubin in the blood
2
Q
Neonatal Jaundice
describe the excretion of biliruibin
A
broken down RBCs release unconjugated bilirubin into the blood
unconjugated bilirubin is conjugated in the liver
conjugated bilirubin is excreted in 2 ways: via the biliary system into the GI tract or via the urine
3
Q
Neonatal Jaundice
why does physiological jaundice occur
A
fetal RBCs break down more rapidly, releasing lots of bilirubin which is usually excreted by the placenta
this leads to a normal rise in bilirubin after birth
4
Q
Neonatal Jaundice
how long does physiological jaundice usually last
A
mild yellowing of skin + sclera from 2-7d of age
usually resolves completely by 10d
5
Q
Neonatal Jaundice
how can the causes of neonatal jaundice be split into
A
- increased production
- decreased clearance
6
Q
Neonatal Jaundice
causes due to increased production of biliruibin
A
- haemolytic disease of the newborn
- ABO incompatibility
- haemorrhage
- intraventricular haemorrhage
- cephalo-haematoma
- polycythaemia
- sepsis + DIC
- G6PD deficiency
7
Q
Neonatal Jaundice
causes due to decreased clearance of bilruibin
A
- prematurity
- breast milk jaundice
- neonatal cholestasis
- extrahepatic biliary atresia
- endocrine disorders (hypothyroid + hypopituitary)
- Gilbert syndrome
8
Q
Neonatal Jaundice
what is a common cause of jaundice in the first 24h of life
A
neonatal sepsis
needs urgent inx and mnx
9
Q
Neonatal Jaundice
why is physiological jaundice exaggerated in premature babies
A
due to the immature liver
10
Q
Neonatal Jaundice
why are breastfed babies more likely to have neonatal jaundice
A
- components of breast milk inhibit the ability of the liver to process the bilirubin
- inadequate dehydrated breastfed babies: slow passage of stools, increasing absorption of bilirubin in the intestines
11
Q
Neonatal Jaundice
what causes haemolytic disease of the newborn
A
incompatibility between the rhesus antigens on the surface of the RBCs of the mother and fetus
12
Q
Neonatal Jaundice
pathophysiology of haemolytic disease of the newborn
A
pregnant rhesus D -ve woman and rhesus D +ve child
mother’s immune system recognises this rhesus D antigen as foreign and produce antibodies to the rhesus D antigen. Mother has become sensitised
subsequent pregnancy, the mother’s anti-D antibodies can cross the placenta and attach to RBCs of the rhesus D +ve fetus and cause the immune system of the fetus to attack their own RBCs
this leads to haemolysis, causing anaemia and high biliruibin levels –> haemolytic disease of the newborn
13
Q
Neonatal Jaundice
what does rhesus D negative mean?
A
does not have the rhesus D antigen
14
Q
Neonatal Jaundice
what does rhesus D positive mean
A
does have the rhesus D antigen
15
Q
Neonatal Jaundice
what is prolonged jaundice
A
jaundice that lasts:
>14d in full term babies
>21d in premature babies
16
Q
Neonatal Jaundice
inx
A
- FBC + blood film: polycythaemia or anaemia
- conjugated biliruibin
- blood test typing for ABO or rhesus incompatibility
- Direct Coombs Test
- Thyroid function
- Blood + urine cultures
- G6PD levels
17
Q
Neonatal Jaundice
what do elevated conjugated bilirubin levels indicate
A
a hepatobiliary cause
18
Q
Neonatal Jaundice
what are treatment threshold charts
A
in jaundiced neonates, total bilirubin levels are monitored and plotted on it
if the total bilirubin reaches the threshold on the chart, they need to be commenced on trx
19
Q
Neonatal Jaundice
treatment threshold chart: what is plotted on the x axis
A
age of baby
20
Q
Neonatal Jaundice
treatment threshold chart: what is plotted on the y axis
A
total bilirubin level
21
Q
Neonatal Jaundice
mnx
A
phototherapy
if extremely high: exchange transfusion
22
Q
Neonatal Jaundice
what does phototherapy do?
A
converts unconjugated bilirubin into isomers
that can be excreted in the bile and urine without requiring conjugation in the liver
23
Q
Neonatal Jaundice
what light in phototherapy is used
A
blue light is the best at breaking down biliruibin
24
Q
Neonatal Jaundice
what is double phototherapy
A
2 light boxes shining blue light on the baby’s skin
25
Neonatal Jaundice
once phototherapy is complete, what should be measured
a rebound bilirubin 12-18h after stopping phototherapy
26
Neonatal Jaundice
why do we treat neonatal jaundice
to prevent kernicterus
27
Neonatal Jaundice
what is kernicterus
a type of brain damage caused by excessive bilirubin levels causing direct damage to the CNS
as bilirubin can cross the blood-brain barrier
28
Neonatal Jaundice
how does kernicterus present
a less responsive. flopping, drowsy baby with poor feeding
damage to the CNS is permanent: Cerebral palsy, learning disability + deafness
29
Hypoxic-Ischaemic Encephalopathy (HIE)
meaning
hypoxia: lack of oxygen
ischaemia: restriction in blood flow to the brain
encephalopathy: malfunctioning of the brain
30
Hypoxic-Ischaemic Encephalopathy (HIE)
what can prolonged or severe hypoxia lead to
permanent damage to the brain causing cerebral palsy
severe HIE can result in death
31
Hypoxic-Ischaemic Encephalopathy (HIE)
when should you suspect HIE
when there are events that could lead to hypoxia during the perinatal or intrapartum period
acidosis (pH<7) on the umbilical artery blood gas
poor Apgar scores
features of HIE
evidence of multi organ failure
32
Hypoxic-Ischaemic Encephalopathy (HIE)
causes
anything that leads to asphyxia (deprivation of O2) to the brain:
- maternal shock
- intrapartum haemorrhage
- prolapsed cord: causing compression of the cord during birth
- nuchal cord: wrapped around neck of baby
33
Hypoxic-Ischaemic Encephalopathy (HIE)
grades (Sarnat Staging): Mild
- poor feeding, generally irritability + hyper-alert
- resolves within 24h
- normal prognosis
34
Hypoxic-Ischaemic Encephalopathy (HIE)
grades (Sarnat Staging): Moderate
- poor feeding, lethargic, hypotonic + seizures
- can take weeks to resolve
- up to 40% develop cerebral palsy
35
Hypoxic-Ischaemic Encephalopathy (HIE)
grades (Sarnat Staging): Severe
- reduced consciousness, apnoeas, flaccid + reduced or absent reflexes
- up to 50% mortality
- up to 90% develop cerebral palsy
36
Hypoxic-Ischaemic Encephalopathy (HIE)
mnx
neonatal specialist supportive care:
- neonatal resus + ongoing optimal ventilation
- circulatory support
- nutrition
- acid base balance
- trx of seizures
- therapeutic hypothermia
- follow up by MDT to assess development and support any lasting disability
37
Hypoxic-Ischaemic Encephalopathy (HIE)
what is therapeutic hypothermia
- actively cooling the core temp of the baby according to a strict protocol
- transferred to neonatal ICU using cooling blankets + cooling hat
38
Hypoxic-Ischaemic Encephalopathy (HIE)
therapeutic hypothermia: what is the target temp
33 and 34 degrees measured using a rectal probe
39
Hypoxic-Ischaemic Encephalopathy (HIE)
therapeutic hypothermia: how long is the cooling done for
72h
then baby gradually warmed to a normal temp over 6h
40
Hypoxic-Ischaemic Encephalopathy (HIE)
how does therapeutic hypothermia work
reduces inflammation and neurone loss after the acute hypoxic injury
41
Hypoxic-Ischaemic Encephalopathy (HIE)
what does therapeutic hypothermia reduce the risk of
- cerebral palsy
- development delay
- learning disability
- blindness
- death
42
Prematurity
definition
birth before 37 weeks gestation
43
Prematurity
define extreme preterm
under 28w
44
Prematurity
define very preterm
28-32w
45
Prematurity
define moderate to late preterm
32-37w
46
Prematurity
when should you consider resuscitation
babies <500g or <24w gestation
as outcomes are likely to be very poor
47
Prematurity
associations
- social deprivation
- smoking
- alcohol
- drugs
- overweight or underweight mothers
- maternal co-morbidities
- twins
- personal or FH of prematurity
48
Prematurity
what are the 2 options of trying to delay birth in:
- women with a hx of preterm birth
- cervical length of ≤25mm before 24w
- prophylactic vaginal progesterone
| - prophylactic cervical cerclage
49
Prematurity
what is cervical cerclage
putting a suture in the cervix to hold it closed
50
Prematurity
what are the options to improve outcomes where preterm labour is suspected or confirmed
- tocolysis with nifedipine
- maternal corticosteroids
- IV MgSO4
- delayed cord clamping or cord milking
51
Prematurity
what is nifedipine
a CCB that supresses labour
52
Prematurity
what does IV MgSO4 do
offered before 24w gestation and helps protect the baby's brain
53
Prematurity
how does delayed cord clamping or cord milking help
can increase the circulating blood volume and haemoglobin in the baby
54
Prematurity
issues in early life
- resp distress syndrome
- hypothermia
- hypoglycaemia
- poor feeding
- apnoea + bradycardia
- neonatal jaundice
- intraventricular haemorrhage
- retinopathy of prematurity
- necrotising enterocolitis
- immature immune system and infection
55
Prematurity
long term effects
- chronic lung disease of prematurity
- learning + behavioural difficulties
- susceptibility to infections, esp resp
- hearing + visual impairment
- cerebral palsy
56
Apnoea of Prematurity
definition of apnoea
periods where breathing stops spontaneously for >20s
or shorter periods with O2 desaturation or bradycardia
57
Apnoea of Prematurity
apnoea is very common in ____
premature neonates
occur in almost all babies <28w
58
Apnoea of Prematurity
what does apnoea in term infant usually indicate
underlying pathology
59
Apnoea of Prematurity
cause
immaturity of the autonomic nervous system that controls respiration and heart rate
60
Apnoea of Prematurity
what developing illnesses is apnoea often a sign of?
- infection
- anaemia
- airway obstruction (may be positional)
- CNS pathology: seizures, haemorrhage
- GOR
- neonatal abstinence syndrome
61
Apnoea of Prematurity
mnx
- attach apnoea monitors to premature babies: make a sound when apnoea is occurring
- Tactile stimulation: prompts baby to restart breathing
- IV caffeine: prevents apnoea + bradycardia in babies with recurrent episodes
62
Apnoea of Prematurity
prognosis
episodes will settle as the baby grows and develops
63
Retinopathy of Prematurity
what is it
abnormal development of the blood vessels in the retina can lead to scarring, retinal detachment and blindness
typically affects babies before 32w
64
Retinopathy of Prematurity
pathophysiology
retinal blood vessels develop at 16w and is complete by 37-40w
vessel formation is stimulated by hypoxia (which is normal)
when retina is exposed to higher O2 concs in a preterm (supplementary O2), the stimulant for normal blood vessel development is removed
when the hypoxic environment recurs, the retina responds by producing XS blood vessels (neovascularisation) + scar tissue
these abnormal blood vessels may regress and leave the retina without a blood supply
the scar tissue may cause retinal detachment
65
Retinopathy of Prematurity
what are the zones that the retina is divided into?
Zone 1, 2 and 3
66
Retinopathy of Prematurity
retina: what is included in zone 1
optic nerve and macula
67
Retinopathy of Prematurity
retina: where is zone 2
from the edge of zone 1 to the ora serrata, the pigmented border between the retina and ciliary body
68
Retinopathy of Prematurity
retina: where is zone 3
outside the ora serrata
69
Retinopathy of Prematurity
how are the retinal areas described as
a clock face e.g. there is disease from 3 to 5 o'clock
70
Retinopathy of Prematurity
how are the areas of disease described as
from stage 1 (slightly abnormal vessel growth)
to stage 5 (complete retinal detachment)
71
Retinopathy of Prematurity
what does 'plus disease' describe
additional findings such as tortuous vessels and hazy vitreous humour
72
Retinopathy of Prematurity
who should be screened for RoP
babies born before 32w or under 1.5kg by an ophthalmologist
73
Retinopathy of Prematurity
at what age should screening start?
30-31w gestational age in babies born before 27w
4-5w of age in babies born after 27w
74
Retinopathy of Prematurity
how often should screening happen and when to cease?
at least every 2w
cease once the retinal vessels enter zone 3, usually at around 26w gestation
75
Retinopathy of Prematurity
what is involved in screening
all retinal areas need to be visualised
screening involves monitoring the retinal vessels as they develop
and looking for plus disease
76
Retinopathy of Prematurity
what is the aim of trx
systemically targeting areas of the retina to stop new blood vessels developing
77
Retinopathy of Prematurity
1st line trx
transpupillary laser photocoagulation
to halt and reverse neovascularisation
78
Retinopathy of Prematurity
other trx options apart from transpupillary laser photocoagulation
- cryotherapy
- injections of intravitreal VEGF inhibitors
- surgery if retinal detachment occurs
79
Respiratory Distress Syndrome
pathophysiology
affects premature neonates, born before the lungs start producing adequate surfactant
inadequate surfactant --> high surface tension within alveoli -->atelectasis --> inadequate gas exchange --> hypoxia, hypercapnia + resp distress
80
Respiratory Distress Syndrome
what is atelectasis
lung collapse
81
Respiratory Distress Syndrome
why does atelectasis occur
high surface tension within alveoli make it more difficult for the alveoli and lungs to expand
82
Respiratory Distress Syndrome
what does the CXR show
ground glass appearance
83
Respiratory Distress Syndrome
mnx
antenatal steroids eg dexamethasone given to mothers with suspected or confirmed preterm labour
84
Respiratory Distress Syndrome
what does antenatal steroids do
increase the production of surfactant and reduces the incidence and severity of resp distress syndrome
85
Respiratory Distress Syndrome
what may premature neonates need and why
- intubation + ventilation: to fully assist breathing
- endotracheal surfactant: artificial surfactant delivered via endotracheal tube
- CPAP: via nasal mask to help keep lungs inflated
- supplementary O2: to maintain O2 sats between 91-95%
86
Respiratory Distress Syndrome
short term complications (6)
- pneumothorax
- infection
- apnoea
- intraventricular haemorrhage
- pulmonary haemorrhage
- necrotising enterocolitis
87
Respiratory Distress Syndrome
long term complications (3)
- chronic lung disease of prematurity
- retinopathy of prematurity
- neuro, hearing and visual impairment
88
Necrotising Enterocolitis
what is it
a disorder affecting premature neonates
where part of the bowel becomes necrotic
cause is unclear
life threatening emergency
89
Necrotising Enterocolitis
what can a necrotic bowel lead to
bowel perforation --> peritonitis --> shock
90
Necrotising Enterocolitis
RFs (5)
- v low birth weight or v premature
- formula feeds
- resp distress + assisted ventilation
- sepsis
- patent ductus arteriosus + other congenital heart disease
91
Necrotising Enterocolitis
presentation
- intolerance to feeds
- vomiting, esp with green bile
- generally unwell
- distended, tender abdomen
- absent bowel sounds
- blood in stools
- perforation: peritonitis + shock, severely unwell
92
Necrotising Enterocolitis
blood tests
- FBC: thrombocytopenia, neutropenia
- CRP: inflammation
- Capillary blood gas: metabolic acidosis
- Blood culture: sepsis
93
Necrotising Enterocolitis
inx of choice of dx
abdo X-ray
supine position (lying face up)
lateral and lateral decubitus views may be helpful
94
Necrotising Enterocolitis
what may x-ray show (5)
- dilated loops of bowel
- bowel wall oedema (thickened bowel walls)
- Pneumatosis intestinalis
- Pneumoperitoneum
- gas in the portal veins
95
Necrotising Enterocolitis
what is pneumatosis intestinalis
gas in the bowel wall - a sign of NEC
96
Necrotising Enterocolitis
what is pneumoperitoneum
free gas in the peritoneal cavity and indicates perforation
97
Necrotising Enterocolitis
mnx
- nil by mouth, IV fluids, TPN, abx
- nasogastric tube can be inserted to drain fluid + gas from the stomach + intestines
- surgical emergency, immediate referral to neonatal surgical team
98
Necrotising Enterocolitis
complications
- perforation + peritonitis
- sepsis
- death
- strictures
- abscess formation
- recurrence
- long term stoma
- short bowel syndrome after surgery
99
Neonatal Abstinence Syndrome
what is it
refers to the withdrawal symptoms that happens in neonates of mothers that used substances in pregnancy
100
Neonatal Abstinence Syndrome
substances that cause it
- opiates
- methadone
- benzos
- cocaine
- amphetamines
- nicotine or cannabis
- alcohol
- SSRI antidepressants
101
Neonatal Abstinence Syndrome
how long does it take after birth for withdrawal from most opiates, diazepam, SSRIs and alcohol to happen
between 3-72hrs
102
Neonatal Abstinence Syndrome
how long does it take for withdrawal from methadone and other benzos to occur
between 24h - 21d
103
Neonatal Abstinence Syndrome
CNS signs and symptoms (6)
- irritability
- increased tone
- high pitched cry
- not settling
- tremors
- seizures
104
Neonatal Abstinence Syndrome
vasomotor and resp signs and symptoms
- yawning
- sweating
- unstable temp + pyrexia
- tachypnoea
105
Neonatal Abstinence Syndrome
metabolic and GI signs and symptoms
- poor feeding
- regurg or vom
- hypoglycaemia
- loose stools with a sore nappy area
106
Neonatal Abstinence Syndrome
mnx pre birth
- mothers that are known to use substances have an alert on their notes so when they do give birth, the neonate can have extra monitoring and management
107
Neonatal Abstinence Syndrome
mnx of babies
- monitored on a NAS chart for at least 3d (48h for SSRIs)
- urine sample from neonate to test for substances
- quiet + dim environment w/ gentle handling + comforting
108
Neonatal Abstinence Syndrome
medical trx options for moderate to severe sx
opiate withdrawal:
- PO morphine sulphate
non-opiate withdrawal:
- PO phenobarbitone
gradually weaned off
109
Neonatal Abstinence Syndrome
does SSRI withdrawal typically require medical trx
no
110
Neonatal Abstinence Syndrome
additional considerations (6)
- test for hep B, C and HIV
- safeguarding + socials services
- safety net advice
- follow up: paeds, social services health visitors, GP
- support mother to stop using substances
- check suitability for breastfeeding in mothers with substance use
111
Neonatal Sepsis
common organisms
group B strep!
e-coli
112
Neonatal Sepsis
RFs
- vaginal GBS colonisation
- GBS sepsis in a previous baby
- Maternal sepsis, chorioamnionitis or fever > 38ºC
- prem (<37w)
- PRoM (prolonged)
- early rupture of membrane
113
Neonatal Sepsis
Clinical Features
- Fever
- Reduced tone and activity
- Poor feeding
- Resp distress or apnoea
- Vomiting
- Tachycardia or bradycardia
- Hypoxia
- Jaundice within 24 hours
- Seizures
- Hypoglycaemia
114
Neonatal Sepsis
red flags
- Confirmed or suspected sepsis in the mother
- Signs of shock
- Seizures
- Term baby needing mechanical ventilation
- Respiratory distress starting >4h after birth
- Presumed sepsis in another baby in a multiple pregnancy
115
Neonatal Sepsis
mnx if there is 1 RF or clinical feature
monitor the observations and clinical condition for at least 12 hours
116
Neonatal Sepsis
mnx if there are ≥2 RFs or clinical features
start antibiotics
| 1st line: benzylpenicillin and gentamycin
117
Neonatal Sepsis
mnx if there is a single red flag sign
start antibiotics
| 1st line: benzylpenicillin and gentamycin
118
Neonatal Sepsis
what should be done alongside giving abx
- blood cultures
- check FBC + CRP
- lumbar puncture if meningitis suspected
119
Neonatal Sepsis
when to check CRP and blood cultures
Check the CRP again at 24 hours and 5d if still on trx and
blood culture results at 36 hours
120
Neonatal Sepsis
when to consider stopping abx at 36h
- if the baby is clinically well
- blood cultures are negative 36 hours after taking them
- both CRP results are <10
121
Neonatal Sepsis
when to consider stopping abx at 5d
- if the baby is clinically well
- lumbar puncture and blood cultures are negative
- CRP has returned to normal at 5 days.
122
Neonatal Sepsis
if any of the CRP results are >10, what do you consider performing
lumbar puncture
123
infant born >42w stuck during prolonged labour. at 18m. now has hypertonia and unable to walk. What is it
- infant has hypoxic ischaemic encephalopathy
HIE is a common antenatal cause of cerebral palsy
124
what is Transient tachypnoea of the newborn (TTN)
tachypnoea shortly after birth
caused by delayed resorption of fluid in the lungs and is strongly associated with caesarean section and prematurity
125
x ray signs of Transient tachypnoea of the newborn (TTN)
hyperinflation, and fluid in the horizontal fissure
126
mnx of Transient tachypnoea of the newborn (TTN)
oxygen. TTN should resolve in a couple of days with resorption of lung fluid.
127
Birth Injuries
what is Caput Succedaneum
oedema collecting on the scalp, outside the periosteum
128
Birth Injuries
what causes Caput Succedaneum
pressure to a specific area of the scalp during a traumatic, prolonged or instrumental delivery.
129
Birth Injuries
what is the periosteum
a layer of dense connective tissue that lines the outside of the skull and does not cross the sutures (the gaps in the baby’s skull).
130
Birth Injuries
can Caput Succedaneum cross the suture lines
yes as the fluid is outside the periosteum
131
Birth Injuries
is there any discolouration in Caput Succedaneum
no
132
Birth Injuries
trx of Caput Succedaneum
will resolve within a few days.
133
Birth Injuries
what is cephalohaematoma
a collection of blood between the skull and the periosteum
134
Cephalohaematoma
cause
damage to blood vessels during a traumatic, prolonged or instrumental delivery.
aka traumatic subperiosteal haematoma.
135
Cephalohaematoma
does the lump cross the suture line
no because the blood is below the periosteum
136
difference between Cephalohaematoma and Caput Succedaneum
Cephalohaematomas do not cross the suture line and there may be discolouration of the skin
137
Cephalohaematoma
why is there risk of anaemia and jaundice
blood collects in the haematoma and breaks down, releasing bilirubin
138
Cephalohaematoma
mnx
monitored for anaemia, jaundice
resolves without treatment within a few months.
139
Facial Paralysis
facial nerve injury is typically associated with what delivery
forceps delivery
140
Facial Paralysis
mnx
Function normally returns spontaneously within a few months.
If function does not return they may required neurosurgical input.
141
Erbs Palsy
what is it
injury to the C5/C6 nerves in the brachial plexus during birth
142
Erbs Palsy
what is it associated with
- shoulder dystocia
- traumatic or instrumental delivery
- large birth weight.
143
Erbs Palsy
presentation
weakness of:
- shoulder abduction + external rotation
- arm flexion
- finger extension
'waiter's tip' arm
- Internally rotated shoulder
- Extended elbow
- Flexed wrist facing backwards (pronated)
- Lack of movement in the affected arm
144
Erbs Palsy
mnx
- Function normally returns spontaneously within a few months.
- If not, then they may required neurosurgical input.
145
Fractured Clavicle
associated with what
shoulder dystocia, traumatic or instrumental delivery and large birth weight.
146
Fractured Clavicle
presentation
- lack of movement or asymmetry in the affected arm
- asymmetry of shoulders
- pain + distress on movement of arm
147
Fractured Clavicle
dx
US or Xray
148
Fractured Clavicle
mnx
conservative, occasionally with immobilisation of the affected arm. It usually heals well
149
Fractured Clavicle
complication
injury to the brachial plexus, with a subsequent nerve palsy.
150
Neonatal Resuscitation
what are the Principles of Neonatal Resuscitation
1. warm the baby
2. calculate APGAR score
3. stimulate breathing
4. inflation breaths
5. chest compressions
151
Neonatal Resuscitation
when is the APGAR score calculated
done at 1, 5 and 10 minutes whilst resuscitation continues
152
Neonatal Resuscitation
how to stimulate breathing
- dry vigorously with towel
- neutrally positioned head to keep airway open
- gasping or unable to breath: check for airway obstruction (i.e. meconium) and consider aspiration
153
Neonatal Resuscitation
when are inflation breaths given
when the neonate is gasping or not breathing despite adequate initial simulation.
154
Neonatal Resuscitation
how many inflation breaths can be given
Two cycles of 5 inflation breaths (lasting 3 seconds each)
155
Neonatal Resuscitation
if there is no response to 2 cycles of 5 inflation breaths, what next
30 seconds of ventilation breaths
156
Neonatal Resuscitation
if there is no response to 30 seconds of ventilation breaths, what next
chest compressions
157
Neonatal Resuscitation
when performing inflation breaths what should be used in term or near term babies
air
158
Neonatal Resuscitation
when performing inflation breaths what should be used in pre-term babies
air and oxygen
159
Neonatal Resuscitation
when should you perform chest compressions
HR <60bpm despite resus and inflation breaths
160
Neonatal Resuscitation
what ration of chest compressions to ventilation breaths
3:1
161
Neonatal Resuscitation
severe situational mnx (prolonged hypoxia--> HIE)
therapeutic hypothermia, IV drugs, intubation
162
Neonatal Resuscitation
when should Neonates that require neonatal resuscitation have their umbilical cord clamped
sooner to prevent delayed in getting the baby to the resuscitation team
163
Newborn Examination
when is it performed
within the first 72h after birth
repeated at 6-8w by GP
164
Newborn Examination
before starting, what q's should you ask parents
- Has the baby passed meconium?
- Is the baby feeding ok?
- Is there a family history of congenital heart, eye or hips problems?
165
Newborn Examination
before examination., what should be checked
pre-ductal and post-ductal oxygen saturations
| ductus arteriosus
166
Newborn Examination
how are pre-ductal sats measured and why
baby's right hand
right hand received blood from R subclavian artery, a branch of the brachiocephalic artery. which branches from the aorta before the ductus arteriosus
167
Newborn Examination
how are post-ductal sats measured and why
in either foot
foot receives blood from the descending aorta. which occurs after the ductus arteriosus
168
Newborn Examination
structure of examination
- general appearance
- head
- shoulders + arms
- chest
- abdomen
- genitals
- legs
- back
- reflexes
- skin
169
Newborn Examination
general appearance: what are you looking for
- Colour (pink is good)
- Tone
- Cry
170
Newborn Examination
head: what are you looking for
- general appearance
- circumference
- anterior + posterior fontanelles
- sutures
- ears
- eyes
- red reflex
- mouth
- suckling reflex
171
Newborn Examination
shoulders and arms: what are you looking for
- shoulder symmetry
- arm movements
- brachial pulse
- radial pulse
- palmar creases
- digits
- pre ductal reading (right wrist)
172
Newborn Examination
chest: what are you looking for
- observe breathing
- heart sounds
- breath sounds
173
Newborn Examination
abdomen: what are you looking for
- observe the shape
- umbilical stump
- palpate
174
Newborn Examination
genitals: what are you looking for
- observe
- palpate testes + scrotum
- inspect penis
- inspect anus
- meconium?
175
Newborn Examination
legs: what are you looking for
- observe legs + hips
- barlow + ortolani
- count toes
176
Newborn Examination
back: what are you looking for
Inspect and palpate the spine
177
Newborn Examination
which reflexes to check
- moro
- suckling
- rooting
- grasp
- stepping
178
Conditions Arising in Pregnancy
what can alcohol in early pregnancy lead to
- miscarriage
- small for dates
- preterm delivery
- fetal alcohol syndrome
179
Conditions Arising in Pregnancy
features of fetal alcohol syndrome
- microcephaly
- thin upper lip
- smooth flat philtrum (the groove between the nose + upper lip)
- short palpebral fissure (horizontal distance from one side of the eye and the other)
- learning disability
- behavioural difficulties
- hearing + vision problems
- cerebral palsy
180
Conditions Arising in Pregnancy
to prevent rubella syndrome, what should women planning to become pregnant have
MMR vaccine
if in doubt they can be tested for rubella immunity
181
Conditions Arising in Pregnancy
can pregnant women receive the MMR vaccine
no because it is a live vaccine
Non-immune women should be offered the vaccine after giving birth.
182
Conditions Arising in Pregnancy
features of congenital rubella syndrome
- congenital cataracts
- PDA, pulmonary stenosis
- learning disability
- hearing loss
183
Conditions Arising in Pregnancy
what can chickenpox in pregnancy lead to
- mum: varicella pneumonitis, hepatitis or encephalitis
| - neonate: fetal varicella syndrome, severe neonatal varicella infection
184
Conditions Arising in Pregnancy
if in doubt if mother has had chickenpox?
IgG levels for VZV can be tested
+ve = immunity
185
Conditions Arising in Pregnancy
if woman not immune to VZV, what can they be treated with if within 10d of exposure
IV varicella immunoglobulins
186
Conditions Arising in Pregnancy
trx if chickenpox rash starts in pregnancy
PO aciclovir
if they present within 24h and >20w gestation
187
Conditions Arising in Pregnancy
typical features of congenital varicella syndrome
- FGR
- microcephaly, hydrocephalus, learning disability
- scars + significant skin changes following the dermatomes
- limb hypoplasia (underdeveloped)
- cataracts + inflammation in the eye (chorioretinitis)
188
Conditions Arising in Pregnancy
features of congenital cytomegalovirus
- FGR
- microcephaly
- hearing loss
- vision loss
- learning disability
- seizures
189
Conditions Arising in Pregnancy
how is toxoplasma gondii primary spread
contamination with faeces from a cat this a host of the parasite
190
Conditions Arising in Pregnancy
what is the classic triad of features in congenital toxoplasmosis
- intracranial calcification
- hydrocephalus
- chorioretinitis
191
Conditions Arising in Pregnancy
how is zika virus spread
- by host Aedes mosquitos
| - by sex with someone infected with the virus
192
Conditions Arising in Pregnancy
features of congenital Zika syndrome
- microcephaly
- FGR
- intracranial abnormalities: ventriculomegaly + cerebellar atrophy
193
Conditions Arising in Pregnancy
Pregnant women that may have contracted the Zika virus should be tested for
?
the viral PCR and antibodies to the Zika virus
194
Conditions Arising in Pregnancy
trx for zika virus
none
195
Sudden Infant Death Syndrome
what is it
a sudden unexplained death in an infant.
usually occurs within the first six months of life.
196
Sudden Infant Death Syndrome
RFs(4)
- prematurity
- low birth weight
- smoking during pregnancy
- male baby
197
Sudden Infant Death Syndrome
how to reduce the risk
- put baby on back when not supervised
- keep head uncovered
- place their feet at foot of bed to prevent them sliding down + under blanket
- keep cot cleat of toys + blankets
- room temp of 16-20 degrees
- avoid smoking
- avoid co-sleeping
- If co-sleeping avoid alcohol, drugs, smoking, sleeping tablets or deep sleepers
198
Sudden Infant Death Syndrome
what support is available for parents
- the lullaby trust
| - Bereavement services and bereavement counselling
199
Sudden Infant Death Syndrome
what is the CONI team
Care of Next Infant
- supports parents with their next infant after a sudden infant death.
- provides extra support, home visits, resuscitation training, movement monitors
