Postpartum Problems Flashcards
(57 cards)
What is Erb’s palsy
C5-C6
Loss of sensation on the arm and paralysis and atrophy of the deltoid, biceps and brachialis muscles
The arm hangs by the side and is rotated medialy, the forearm is extended and pronated. The arm cannot be raised from the side, all power of flexion of the elbow is lost as is also supination of the forearm
Waiter tip
Can resolve on its own in months or need therapy or surgery
What can you consider during neonatal resuscitation if ongoing bradycardia when delivered
Adrenaline
Blood transfusion 10ml per kg
Glucose 250mg per kg 10 % glucose
Sodium bicarbonate 2-4ml per kg 4.2% to reverse intracardiac acidosis
Baby born with poor resp effort and HR90 what is the next step In resuscitation
Give 5 inflation breaths initially in air at 30cm h20 pressure with PEEP 5-6cm h2o
What does the blood spot test test for
Done on day 5 of life
Tests for 9 conditions:
Sickle cell disease
CF
Congenital hypothyroidism
Inherited metabolic disease: PKU
Medium chain actual coA dehydrogenase deficiency
Maple syrup urine disease
Isovaleric acidaemia
Gluctaric acidaemia
Homocystinuria
What is the correct ratio of chest compressions to ventilations during neonatal resuscitation
3:1
Klumpke’s paralysis symptoms
C8-T1
The nerves injured affects the intrinsic muscles of the hand , the interossei, thenar and hypothenar muscles and flexors of the wrist and fingers
Classic presentation if Claw hand where the forearm is supinated , the wrist extended and the fingers flexed
If Horners syndrome is present there is meiosis (constriction of the pupils in the affected eye
Klumpke is lower plexus erbs is higher plexus
How does RDS show on an x ray
Air bronchograms with reticulogranular pattern
Usu occurs right after birth due to deficiency of surfactant due to either inadequate surfactant production or surfactant inactivation in the context of immature lungs- prematurity affects both of these things
What is staging used to classify intraventricular hemorrhage in neonates
Papile grading
intraventricular haemorhage is most at risk in babies born pre 33w at the time the germinal matrix involutes
Can cause CP
What decreases the risk of intraventricular haemrrhage
Antenatal steroids but also delayed cord clamping
MgSO decreases the risk of CP
Hypothermia is used in HIE not for preventing IVH
How to diagnose a intraventricular haemorrhage in baby
Cranial USS at 7-14 days of life don’t I all babies born less than 30 w of life
How to diagnose necrotizing enterocolitis in baby
Abdominal x ray
NEC is the MC disease affecting neonates and is the mist common like threatening emergency affecting the GI tract in infants
NEC usually occurs in the 2nd or 3rd week of life.
Several RF have been identified but prematurity, low birth weight and formula feeding have been identified as the primary risks . Especially high osmotic strength formula
70% of cases are in premature babies
Mortality is from 10-50%
Most severe cases involve perforation, peritonitis, sepsis, mortality approaches 100%
Most important test is abdominal plain film series with AP and left lateral views
Findings of dilated loops of bowel , pneumatosis intestinalis and portal venous air is diagnostic for necrotizing enterocolitis.
Pneumatosis intestinalis is the visualization of small amounts of air within the bowel wall and is athognomic for nectrotizing enterocolitis. Portal nervous air is not universally present but is a poor prognostic sign when found .
Free air in the abdomen may be seen when perforation has occurred. An abdominal radiograph is a valuable tool for tracking the progression of the disease as well.
Sometimes even needs to be repeated every 6 hours until definitive treatment has occurred.
What is the fist line med to close a patent ductus arteriosus?
Ibuprofen
The PDA closes by 12 to 24 hours of age in healthy full term newborn with permanent anatomical closure occurring within 2-3 weeks. In premature infants the ductus arteriosus may not close rapidly and may require pharmacological or surgical closure.
The patency of the ductus is kept open by prostaglandin E2. If the ductus remains patent after birth it is associated with pulmonary oedema and pulmonary haemorrhage, NEC, intraventricular haemorrhage, congestive heart failure and renal failure and bronchi pulmonary dysplasia
A PDA and also result in a left to right shunt , the steal from the aorta during diastole required increased cardiac output to compensate. Decreased blood flow to the lower body results in increased risk for NEC and renal failure.
Tx is with indomethacin, ibuprofen or paracetamol. Should be considered for preterm infants with a symptomatic PDA. Infants who are born weighting greater than 1000 grams are unlikely to require pharmacological therapy to close the ductus.
What is the prevelance of jaundice in the 1st week of life
60%
What is the prevelance of jaundice in the 1st weeks of like for preterm babies
80%
What is the prevelance of jaudince in the 1st week of life in preterm babies
80%
What is the initial treatment for NEC
Complete bowel rest and parenteral nutrition
An NG tube for decompression of the dilated bowels
IV antibiotics - amipillin, gent, and either clindamycin or metro
Babies overal survival rate born at 24 and 25 weeks
40% and 60%
When is neonatal jaudice pathological
When its on day 1
What is the rate of survival of babies born at 25w without disability
70%
Baby born in poor condition with NO resp effort , fist step, if over 28w
Give 5 inflation breaths with 25% oxygen at 25cm H20 pressure
What is the most common cause of conjugated hyperbilirubinemia in a neonate
Biliary atresia
How to treat bilirubin that is >450 micromol/litre in a neonate that is jaundiced at 48 hours
Exchange transfusion
Survival rate of babies born without disability at 23w
50%
If baby born at 27w with no resp effort and HR 90 how what to do first
Give 5 inflation breaths with 30% oxygen at 25cm H2O pressure
If baby is less than 28w!
This is for poor or absent resp effort
