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Flashcards in Peri and neonatal Medicine Deck (93)
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What can opioid analgesics use during labour do?

May suppress respiration at birth


Effect of epidural anaesthesia during labour?

Can cause maternal pyrexia which is often difficult to differentiate from fever caused by infection


What can oxytocin and prostaglandin use during labour do?

Can cause hyperstimulation of the uterus leading to fetal hypoxia


What is transient tachypnoea of the new born and when can it occur?

Rapid, laboured breathing for several hours after birth by c-section
Because lungs weren't squeezed during delivery therefore fluid was not squeezed out and there is still fluid in lungs


What does Apgar score measure?

Used to measure babys condition 1 and 5 mins after delivery and then every 5 mins afterwards if condition remains poor


What measurements are included in Apgar score?

Heart Rate >100 bpm = good
Respiratory effort
Muscle tone (flexion good)
Reflex irritability (grimace (1) or cry (2))
Colour (pink good)


When does passage of meconium become more common

Greater the infants gestational age, especially post-term


What can happen with passage of meconium?

If infants become acidotic from aspyhxia and try to breathe in utero then they can inhale thick meconium and develop meconium aspiration syndrome


Risk with aspiration of newborn and management

Can stimulate reflex bradycardia and cause newborn to be bradycardic
If regular breathing starts then nothing, if doesn't - aspiration and if bradycardic then Post-pressure ventilation


Way to manage respiratory depression following maternal opiate use

Give Naloxone if respiration continues to be depressed following initial resuscitation


Phases of neonatal resus

Airway opening maneouvres
Mask ventilation
Two-person airway control
Tracheal intubation
Chest compressions if HR


Resus of pre-term infants

Placed in a plastic bag or wrapped in plastic sheeting with exception of face
Use air/oxygen mixer to prevent excessive tissue oxygenation


What is erythema toxicum?

Neonatal urticaria
A common rash appearing at 2-3 days of age
Consisting of white pinpoint papules at the centre of an erythematous base
Fluid contains eosinophils
Mostly on the trunk - come and go at different sites


What is Mongolian blue spots

Blue/black macular discolouration at base of the spine and on buttocks
Usually but not invariably in Afro-Caribbean or Asian infants
Fade slowly over first few years


What is port-wine stain

Naevus flammeus
Due to vascular malformation of capillaries in dermis
Present from birth and usually grows with the infant


What can port-wine stain be associated with if in trigeminal nerve distribution?

Associated with intracranial vascular anomalies = Sturge-Weber syndrome


What are strawberry naevus?

Cavernous haemangioma
Not present at birth but appear in first month of life and may be multiple
More common in preterm


Development of strawberry naevus?

Increases in size until 3-15 months old
Then gradually regresses


Management of strawberry naevus

No treatment needed unless vision or airway are obstructed
Thrombocytopenia may occur with large lesions - therapy with systemic steroids or interferon-a may be required


Heart murmurs in newborn?

Most murmurs audible in first few days of life resolve shortly afterwards
Some are caused by congenital heart disease and if there is a significant murmur then investigation is needed


Vit K and newborn

Should be given to all newborns to prevent haemorrhagic disease of the newborn
At risk infants (mothers on anticonvulsant therapy) should be given IM
IM better than orally but controversial


What is screened for with the Guthrie test? x5

Cystic fibrosis
MCAD deficiency


When is Guthrie done?

Day 5-9 of life when feeding has been established


How is cystic fibrosis detected?

Serum immunoreactive trypsin - raised if there is a pancreatic duct obstruction


What is hypoxic-ischaemic encephalopathy?

Brain damage following perinatal asphyxia and diminished brain tissue perfusion


Causes of hypoxic-ischaemic encephalopathy? x5

Failure of gas exchange across placenta
Interruption of umbilical blood flow (cord compression)
Inadequate maternal placental perfusion
Compromised fetus (anaemia, IUGR)
Failure of cardiorespiratory adaptation at birth


Clinical features of mild HIE x5

Irritable infant, responds excessively to stimulation
May have staring of eyes and hyperventilation
Impaired feeding


Moderate HIE features x3

Infant shows marked abnormalities of tone and movement
Cannot feed
May have seizures


Severe HIE features x4

No normal spontaneous movements or response to pain
Limb tone may fluctuate between hypotonia and hypertonia
Seizures prolonged and often refractory to treatment
Multi-organ failure


Management of HIE

Respiratory support
Electrolyte balance
Restrict fluids as transient renal impairment
Treat any seizures with anticonvulsants
(wrapping in cooling blanket may help reduce brain damage - induced mild hypothermia)