Week 1 Flashcards by Ella Weir

Define pre-term, term and post-term

Pre-term - <37w
Term - 37-41w
Post-term - >41w

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Why does hypoxia occur in labour?

Hypoxia due to contractions
Foetal hb from placenta helps to provide O2
Placenta reserves decr as labour continues

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Describe APGAR score

Heart rate
Respiratory rate
Responsiveness
Tone
Colour

Score/10
- 0, 1, 2 for each component
- normal 8

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Prevention of haemorrhagic disease of newborn

Vitamin K
(breast fed more common)

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Key infection prevention in neonates

Hep B (immunoglob, vax) and C
HIV (ARV)
Syphilis
TB
Group B strep

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Vaccinations post-birth

Maternal Pertussis and Influenza vaccines
Routine vaccination schedule
Hepatitis B at birth?
BCG first month?

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Describe head (and face) exam of neonate

OFC
Overlapping sutures
Fontanelles
Ventouse/forceps marks
Moulding
Cephalhaematoma
Caput succedaneum
(Facial palsy
Dysmorphism)

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Describe eye exam of neonate

Size
Red reflex
Conjunctival haemorrhage
Squints (frequent)
Iris abnormality

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Describe ear exam of neonate

Position
External auditory canal
Tags/pits
Folding
Family history of hearing loss

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Describe mouth exam of neonate

Shape
Philtrum
Tongue tie
Palate
Neonatal teeth
Ebsteins pearls
Sucking/rooting reflex

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Describe resp exam of neonate

Chest shape
Nasal flaring
Grunting
Tachypnoea
In-drawing
Breath sounds

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Describe cardio exam of neonate

Colour/Saturation (SaO2)
CHD screening
Pulses: femoral
Apex
Thrills/heaves
Heart sounds

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Describe abdo exam of neonate

Moves with respiration
Distension
Hernia
Umbilicus
Bile stained vomiting
Passage of meconuim
Anus

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Describe GU exam of neonate

Normal passage of urine
Normal genitalia
Undescended testes
Hypospadius

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Describe MSK exam of neonate

Movement & posture
Limbs and digits
Spine
Hip examination

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Describe neuro exam of neonate

Alert, responsive
Cry
Tone
Posture
Movement
Primitive reflexes

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Describe skin exam of neonate

Port wine stain
Strawb haemangioma
Erythema toxicum
Congentital dermal melanocytosis

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Risk factors for pre-term baby

> 2 preterm babies previously
Abnormally shaped uterus
Multiple pregnancy
IVF
Substance use
Poor nutrition
Chronic conditions

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Key points of the altered approach to preterm infants

delayed cord clamping
keeping warm e.g. bags/heater and skin-to-skin
gentle lung inflation
initial O2 concentration
using a saturation monitor

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Common problems in preterm babies

Temperature control
Feeding/nutrition
Sepsis
System immaturity/dysfunction e.g. ARDS
Metabolic issues

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Why does preterm baby struggle to regulate temp?

Low BMR
Minimal muscular activity
Subcutaneous fat insulation is negligible
High ratio of surface area to body mass

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Why are preterm babies at risk of nutritional issues?

Limited nutrient reserves
Gut immaturity
Immature metabolic pathways
Increased nutrient demands

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Causes of early and late onset neonatal sepsis

EOS
- due to bacteria acquired before and during delivery
- strep B, gm neg
LOS
- acquired after delivery (nosocomial or community sources)
- coag neg staph, staph A, gm neg

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Describe resp distress syndrome

Study These Flashcards

Surfactant defic and alveolar damage
Clin pres:
- tachypnoea (e.g. grunting), worsens over mins/hours
Manage:
- maternal steroid, surfactant, vents

Common CV issues of preterm infants

Patent ductus arteriosus Intraventricular haemorrhage (grade 1-4) Necrotising enterocolitis (NEC)

Normal clinical parameters for newborns

Respiratory rate: 40 – 60 / minute and Work of breathing HR: 120 - 140 bpm Cap refill 2 - 3 seconds Colour – pink/blue/white SaO2 95% or above No BP measurement

Presentation of sepsis in newborns

Quiet Poor feeding Floppy Tachypnoea Apnoea Tachycardia Bradycardia Temperature instability

Antibiotics of choice in newborns with suspected sepsis

Benzylpenicillin Gentamicin

TORCH mneumonic for viral infections of newborns

Toxoplasma Others (syphillis, HepB) Rubella CMV Herpes

Most common resp issue in newborn

Transient tachypnoea of newborn (TTN) - delay in clearing lung fluid, resolves in 24h - more common in C section due to lack of adrenaline

Causes of pneumothorax in newborn

Meconium Infection Resuscitation Surfactant deficiency

Management of HIE

Therapeutic hypothermia - improves neurodev outcomes

Features of circ issues in newborn

HF - rhesus disease, chromosomal Failure to adapt - PPHN

Clin pres of congenital cardiac conditions in newborn

Tachypnoea Cyanosis Murmur Weak fem pulses Circ collapse (e.g. ToF, transposition, aortic coarctation)

Key metabolic disorders of newborn

Bilious vomiting Hypoglycaemia Inborn errors of metabolism Jaundice

Which metabolic disorder is a cause of hypoglycaemia but is not tested for on newborn blood spot?

Galactosaemia

How does jaundice progress in newborns?

Cephalo-caudal progression (face first)

Which type of bilirubin in blood causes jaundice?

Unconjugated

Risk factors for newborn jaundice

decreasing gestation asphyxia acidosis hypoxia hypothermia meningitis sepsis

Cause of jaundice less than 24h after birth

ALWAYS PATHOLOGICAL Caused by: Haemolytic disorders Congenital infection Sepsis

Causes of jaundice 24h-14 days after birth

Physiologic jaundice Breast milk jaundice Dehydration Infection, including sepsis Haemolysis Bruising Polycythaemia Crigler-Najjar Syndrome

Causes of jaundice >14 days after birth

Physiologic jaundice Breast milk jaundice Infection Hypothyroidism Bililary obstruction (incl. biliary atresia) Neonatal hepatitis

Which type of excess bilirubin is always abnormal?

Conjugated

Management of neonatal jaundice

Treat cause Hydration/supported feeding Phototherapy Rarely exchange transfusion IV Ig for haemolytic disease

Define median vs limit age

Median - 50% pop achieves skill Limit - acquired by 97.5% kids

Primitive reflexes in motor development

Sucking and rooting Palmar and plantar grasp Moro ATNR Stepping and placing

When should primitive reflexes be absent to signify normal development?

3-6 months e.g. cerebral palsy, reflexes remain

Define developmental delay

Failure to attain dev milestones for child's corrected chronological age

3 main patterns of abnormal development

Delay -global e.g. down syndrome -specific e.g. duchenne musc dystrophy Deviation -e.g. ASD Regression -e.g. Rett's, metabolic disorders

Red flags for child development

Asymmetry in movement Not reaching for objects/primitive reflex at 6m Unable to sit by 12m Unable to walk by 18m No speech/pointing by 18m Vision/hearing concerns Loss of skills

Describe Duchenne's

X-linked recessive, males, mutation of dystrophin gene Clin pres: weakness, fatigue, psuedohypertrophy, wheelchair bound Assoc with: cardiomyopathy, resp failure, cognitive difficulties Gower's manoeuvre

Management of SMA

Genetic testing MSN1/2 Physio Nutrition Resp support Palliation Drugs - IT nusinersen, IV zolgensma

PMT tool for motor development assessment

Posture - position of limbs/trunk Movement - symmetry, anti-gravity, smooth/jerk Tone - floppy/stiff, head control

Clin pres of hypoglycaemic babies

Sleepiness, very quiet baby Potentially seizures

Significance of early jaundice

Must investigate infection/haemolysis

Functions of colostrum

High Ig Helps w gut health Anti-inflam Concentrated nutrition

When can CVS and amniocentesis be carried out?

CVS 11.5w Amnio 15w

Causes of floppy baby

Birth asphyxia Genetic e.g. trisomy 21, prader-willi Congen/acquired infections Drugs e.g. diazepines Metbolic (affects diff areas)

Week 1 Flashcards

(58 cards)