What are the main ways of assessing the health of a newborn baby?
What would be the normal values of each of the following for a neonate:
What would be some signs/symptoms to look out for in a term baby which might suggest that they were becoming ill?
Low tone (floppy)
What are some organisms which may cause bacterial infections in a term baby?
Group B Strep
What are some viruses which can be passed from mother to baby in utero?
What is significant about these viruses in the mother?
Cytomegalovirus, parvovirus, herpes, enteroviruses
The mother is often asymptomatic
What is hypoxic ischaemic encephalopathy?
What is required to treat this?
What is the outcome?
Multi-organ damage due to tissue hypoxia
Neurodevelopmental sequeli with variable prognosis
What are the two types of pneumothorax which can occur in newborns?
What are some examples of congenital lung disease?
Spontaneous, or secondary to active resuscitation
Tracheo-oesophageal fistula / diaphragmatic hernia
What is the main presentation of heart failure in newborns?
What does this cause clinically?
What are some causes?
What is a cardiac disease which can occur in newborns due to failure to adapt to postnatal life?
Swollen abdomen - hepatosplenomegaly
Rhesus disease, or chromosomal abnormalities (alpha thalassaemia)
Persistent pulmonary hypertension of the newborn
What are some examples of congenital heart diseases which can be seen in newborns?
Tetralogy of Fallot
Coarctation of the aorta
Transposition of the great arteries
What are the 4 features of Tetralogy of Fallot?
Ventriclar septal defect
Right ventricular hypertrophy
What arteries are switched in transposition of the great arteries?
What happens in coarctation of the aorta?
What is a clinical sign of coarctation of the aorta?
The pulmonary artery and aorta
There is narrowing of the aorta, usually where the DA used to be
Inability to feel femoral pulses
What are some neurological congenital anomalies which can occur?
What is a renal congenital condition which can occur? - what causes this?
What is a muscular congenital condition which can occur?
Microcephaly / spina bifida
Potter's syndrome - usually due to oligohydramnios causing bilateral renal agenesis
In terms of the pathway of haemolytic disease of the newborn, what happens during the first pregnancy when foetal red cells containing the Rh antigen are released into the maternal circulation?
What happens during the second pregnancy when foetal red cells containing the Rh antigen are released into the maternal circulation?
Maternal B cells recognise the antigen as foreign, produce anti-Rh IgM and create memory B cells
Memory B cells get exposed to the antigen, the maternal immune response is triggered and IgG antibodies pass into the foetal circulation to destroy red cells
What is Anti-D and what does it do?
It is a blood product which helps to remove Rh+ foetal blood cells from the maternal circulation before sensitisation
When is Anti-D given to Rh- mothers?
If there has been a potentially sensitising event (ideally within 72 hours but can be up to 10 days)
Prophylactically at 28 and 34 weeks gestation (regardless of whether it has already been given at a sensitising event)
How long does 1 dose of Anti-D last?
Therefore, if there are recurrent sensitising events, how often is dosing required?
What test can be used to monitor response to Anti-D?
What does this test actually do?
Every 6 weeks
Measures the amount of foetal Hb present in the mother's bloodstream
When is blood groups screening to detect atypical antibodies offered to pregnant mothers?
At booking, and then again at 28 weeks
Damage to the foetal red blood cells in haemolytic disease of the newborn causes what?
What is a clinical sign due to increased erythropoiesis?
What is a clinical sign due to hyperbilirubinaemia?
What are some clinical signs due to high output cardiac failure?
Oedema and polyhydramnios
If a mother is detected as having abnormal antibodies at screening, what test is done next?
If the results of the above test are high, what is done next?
How is anaemia detected in high risk pregnancies?
Determine foetal genotype with cell free foetal DNA testing
Doppler US of the foetal middle cerebral artery (will show increased blood flow velocity)
How is haemolytic disease of the newborn treated?
If significant anaemia with foetal compromise, blood transfusions can be given weekly up to week 35
After this point, delivery is deemed safer. All babies should be delivered by 37-38 weeks.