Week 5 part 1 Flashcards by Joanna Lowrie

What does the avergae male weigh at term?

3550g, 15% fat

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Normal weght of baby born?

2.5kg - 4kg

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What is a normal apgar score?

Greater than 8/10

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5 aspects of apgar score?

HR
Resp
Responsiveness
Tone
Colour

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What is important for establishing breast feeding?

Skin to skin contact

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What are the three shunts present in the foetus prior to borth?

`1. Ductus Venosus

Foramen Ovale
Ductus Arteriosis

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What shunt in foetal circulation: crosses through the liver to the IVC?

Ductus venosus

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What shunt in foetal circulation: is kept open by pressure being higher in right atrium, allowing blood to cross to left side of heart and supply brain?

Foramen Ovale

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What shunt in foetal circulation: has blood pass through it to go out of right side of heart to systemic circulation?

Ductus arteriosis

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How does the baby prepare for labour in 3rd trimester?

Stores oxygen in liver, muscle, and heart to withstand hypoxic phase of labour.

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During delivery of baby what occurs in lung aeration?

Pulls lung fluid from alveolar to interstitial tissue back into lymphatics as babies take deep breath

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When baby takes deep breath, lungs open up, vessels have no more room to expand and P02 increases. 100% of CO now goes to lungs. As pulmonary vascular resistancen decreases, systemic vascular resistance increases to allow left side pressure to be greater than right - thus closing off …

Foramen ovale

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What becomes ligamentum arteriosis?

Ductus arteriosus

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What does ductus venosis become?

Ligamentum teres

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Main cause of sepsis in neborn?

Group B strep

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How is PPHN treated in newborn?qN

NO gas, inotropes, keep warm

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How do babies keep warm in first few hours if they cannot shiver?

Breakdown of adipose tissue in response to catecholamines

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Labetalol is used to treat pregnancy in hypertension - what might it induce?

Neonatal hypoglycaemia

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Is losing 10% of birth weight during first 5 days normal for baby?

Yes due to high proportion of fluid in body - if more than 10% then admit for hyponatraemia

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Why is it normal for babies to be a bit anaemic at 8-10 weeks?

Lack of time between foetal and adult HB synthesis - babies have higher haematocrit in utero

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Name a physiological cause of neonatal jaundice?

Rhesus or ABO incompatibility

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Is jaundice in newborn less than 24 hours bad?

Always pathalogical

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Is conjugated hyperbilirubinaemia normal in newborn?

Always abnormal - hepatitis, biliary atresia

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What is meconium ileus a sign of?

probably been born with CF

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ABDOMINAL distension and bile stained vomit?

Malrotation until proven otherwise

Biggest bacterial infection affecting neonates?

Strep Group B

Name two pregnancy/birth related respiratory problems?

1. Transient tachypnoea of the newborn (TTN) | 2. Pneumothorax

In baby: swollen liver, severe abdominal swelling?

Hydrops fetalis

Tetralogy of Fallot?

1. Pulmonary stenosis 2. Right ventricular hypertrophy 3. Over-riding aorta 4. Ventricular septal defect

Name two congenital respiratory disease of sick term infant?

1. Tracheooesophageal fistula | 2. Diohragmatic hernia

What is normal resp rate of newborn?

40-60 - periodic breathing normal

What is normal newborn heart rate?

120-140

a birth that occurs after 42 completed weeks of gestation?

post term

extremely preterm weeks?

Less than 27

Very preterm weeks?

Less than 31 weeks

What is the biggest cuase of preterm birth?

Spontaneous preterm labour

Greater than how many preterm deliveries increase the risk of another preterm baby by 70%?

By how muich does an abnormally shaped uterus increase risk of giving birth early?

19%

wHAT MAKES women 9 times more likely to give birth early?

If have multiple pregnancy

An interval of less than how many motnsh between pregnancies increases preterm risk?

6 months

Is preterm risk increased with conceiving throgh in vitro fertilisation?

Yes

In relation to preterm babies and cord clamping: if baby is ok and can be kept warm what should you do?

Pause for at least one montie to allow placental transfusion

What might damage from overinflation of preterm lungs predispose to?

Inflammatory cascade leading to bronchiopulmonary dysplasia

What four systemic immaturities/dysfunctions are common concerns in preterm infants?

1. Respiratory discress syndrome 2. Patent ductus arteriosus 3. Intraventricular haemorrhage 4. Necrotsiing enterocolitis

give four reasons thermal regulastion is ineffective in preterm infants?

1. Low BMR 2. Minimal muscular activity 3. Subcut fat insulation negligible 4. High ratio of surface area to body mass

Name organisms likely to cause late onset neonatal sepsis?

Gram positive - staph auireus, stpah epidermidis, strep pneumoniae, strep pyogenes

Name organisms likely to cause early onset neonatal sepsis?

Group B strep | gram neg - klebsiellam, e.coli, pseudomonas,

What increases infection which is used for preterm infants?

Incubators

Name three respiratory complicatoins of prematurity?

1. Resp distress syndrome 2. Apnoea of prematurity 3. Bronchopulmonary dysplasia

What si the primary pathology of respiratory distress syndrome?

1. Surfactant deficiency | 2. Structural immaturity

``` Tachypnoea Grunting Intercostal recessions Nasal flaring Cyanosis? ```

Respiratory distress syndrome of newborn

Management of respiratory distress of newborn?

1. Maternal steroid 2. Surfactant 3. Ventilation

Name a complication of respiratory disress syndrome of newborn?

tension penumothorax

Why are premature infants at risk of patnet ductus arteriosus?

Duct not responding to close signals that occur in labour

What does intraventricular haemorrhage begin with bleeding into?

Germinal matrix

What are the two major risk factors for intraventricular haemorrhage in newbonr?

Prematuriry | Resp distress syndrome

When do most intraventricular haemorrhages of newbirn occur?

In first day of life - usually present within 72 hours

How do you prevent intraventricular haemorrhage?

Antenatal steroids | Prompt and appropriate resuscitation

Inrelation to intraventricular haemorrhage: what is grade 1 and 2 classification and outcome?

Neurodevelopmental delay up to 20% | Mortality 10%

In relation to intraventricular haemorrhage: what is grade 3 and 4 classification and outcome?

Neurodevelopmental delay up to 80% | Mortality 50%

wHAT is the most common neonatal surgical emergency?

Necrotising enterocolitis NEC

Usually after RDS recovery Early signs: lethargy and gastric residuals Blood stool, temp instability, apnoea and bradycardia?

NEC

Name a large molecular weight drug which doesnt cross placenta?

Heparin

What pharmacokinetics might be disrupted by morning sickness?

Volume of distribution increases - increased plasma volume and fat stores Increased free drug (decreased protein binding) Increased liver metabolism e.g. phenytoin

What abnormality does lithium cause in pregnancy?

Ebsteins anomaly

In what stage of pregnancy might hypertensive patients be more susceptible to drugs?

2nd trimester - BP naturally falls

Pre-conception, what should women take?

Folic acid 400mg daily for 3 months prior and into

In pregnancy when is greatest teratogenic risk?

4th to 11th weeks

Teratogenic effects of: ACE/ARBs?

Renal hypoplasia

Teratogenic effects of: androgens

virulisation of female foetus

Teratogenic effects of: antiepileptics

Cardiac, faical, limb, neural tube defects

Teratogenic effects of: cytotoxics

multiple defects, abortion

Teratogenic effects of: lithium

Cardiovascular defects

Teratogenic effects of: methotrexate?

Skeletal defects

Teratogenic effects of: retinoids

ear, cardiovascular, skeletal defects

Teratogenic effects of: warfarin

Limb and facial defects

wHAT CAuses finger hypoplasia?

Carbamazepine in pregnancy

What can cause abnormal closure of ductus arteriosus ?

NSAIDs taken by mother in opregnancy

What drugs in pregnancy can cause respiratory depression in newborns?

Opiates

What drug can lead to vaginal adenocarcinoma in female children aged 15-20 years ?

Diethylstilbestrol

What are frequent seizurse during pregnancy associated with?

Lower verbal IQ in child, hypoxia, bradycardia, antenatal death, maternal death

What two antiepileptic drugs should be carefully AVOIDED in pregnancy?

Phenytoin and valproate

What diabetic drugs are not safe in pregnancy?

Sulfonylureas

Significant side effect of methyldopa?

Depression

Is cylizine fine to take in pregnancy if mother has nausea and vomiting?

Yes

Pregnant women with significant risk factors for VTE shpuld receive what?

Thromboprophylaxis with LMWH

Name some risk factors for VTE?

``` Obesity Over 35 Smoking para more than 3 Previous DVT cs delivery ```

What is foremilk rich in?

Protein

What is hindmilk rich in?

Higher fat content

Name a drug that is actively concentrated in breast milk and leads to suckling difficulties?

Phenobarbitone

When breastfeeding, what can occur if taking amiodarone?

Neonatal hypothyroidism

When breastfeeding, what can occur if taking cytotoxics

bone marrow suppression

When breastfeeding, what can occur if taking benzodiazepines

drowsiness

When breastfeeding, what can occur if taking bromocroptine

suppresses lactation

Which antibiotic given during pregnancy or in early childhood can cause this appearance of staining bones and teeth?

Tetracycline

Which drug taken in excess in early pregnancy causes short palpable fissures, flat mid face, short nose, idistinct philtrum, thin upper lip, low nasal bridge and a small chin?

Alcohol

Which antiepileptic drug is particularly associated with cleft lip and palate?

Phenytoin

Which drug taken during pregnancy can cause this problem in female offspring - adenocarcinoma vaginal?

Stilbestrol

Which antiepiletpic drug is particulalry associated with spina bifida and anencephaly?

Valproate