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58 Cards in this Set
- Front
- Back
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What are the common short term conditions to worry about in a child born prematurely and of low birth weight? |
RDS Biochemical disorders - Acidosis Infection including necrotising enteric colitis (NEC) Brain heamorhage (IVH) Circulatory issues (PDA) Jaundice *the smaller and earlier they are the more at risk they are to all these conditions* |
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What are the common long term conditions to worry about in a child born prematurely and of a low birth weight? |
Retinopathy of Prematurity (ROP) Periventricular leukomalacia (PVL) Post haemorrhagic hydrocephalus (PHH) Chronic lung disease/ Broncho Pulmonary Dysplasia (BPD) Developmental delay and cerebral palsy |
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What are the common foetal causes of baby being born too small? |
Chromosomal (e.g Edwards Sy) Foetal infection (e.g CMV) Twin pregnancy - twin taking all the nutrients Placental |
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What is the range of weights which brings a baby under the bracket of extremely low body weight, very low b/w, low b/w? What age does a baby count as extremely preterm and preterm? |
Extremely low b/w = <1 kg Very low b/w = <1.5kg Low b/w = <2.5 kg Extremely preterm = <28 w Preterm = <37 w |
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RDS (fluid still in lungs) is a common complication of preterm low body weight babies, what treatment is used to as a prevention, what treatment is used to treat immedietly post birth? |
Prevention of RDS = Antenatal steroids Treatment of RDS: Surfactant (reduces the surface tension of liquid in the lungs) + |
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Apnoea/irregular breathing is the very common minor breathing problem associated with preterm babies. What is the treatment? |
Treat apnoea or irregular breathing at birth with Caffeine |
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What is the most common brain abnormality that preterm babies are at risk to developing at birth? |
Intra-ventricularhaemorrhage (IVH) Because the blood vessels in the neonate are not fully developed yet so v vulnerable to bursting. The smaller they are the more at risk they are. 75% have a long term adverse outcome |
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What is the prevention and treatment of neonatal babies born with or at risk of IVH? |
Prevention of IVH = Antenatal steroids Treatment = Sympthomatic |
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What is the main go-to prevention treatment for most acute neonatal/low birth weight conditions? |
Always think with low birth weight/prematurity = Likely to be... Antenatal steroids |
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What is the pathophysiology issues in a baby born with Persistent ductus arteriosus (lack of closure of the ductus arteriosus - connecting vessel between the aorta and pulmanory artery)? |
The pressure in the aorta is larger than the pulmonary artery.
Plus this means some of the blood is escaping the aorta back into the pulmonary circulation and so less oxygenated blood is circulating leading to peripheral tissue ischaemia.
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What are the long term consequences of Persistent ductus arteriosus (PDA) on the body? Think about the fact it causes pulmonary oedema and lack of oxygenated blood |
Pulmonary oedema as a result of the increased fluid in pulmonary artery leads to worsening of respiratory symptoms. +++ Due to the lack of renal perfusion there is more fluid retention in the body.
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What is the name of the GI related condition common in neonates which causes ischaemia and inflammatory changes and necrosis of the bowel? |
Necrotisingentero-colitis(NEC) *surgical intervention often required, although conservative management possible with antibiotics* |
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What is the most important treatment for a baby born of low birth weight and prematurely? |
Nutrition, nutrition, nutrition
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What percentage of extremely premature babies die? (born before 28 weeks) |
1/3 die if born before 28 weeks *1/3 life long disability* |
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A low birth weight baby is admitted to the Neonatal unit with: Babypyrexia Poorfeeding Lethargy Earlyjaundice Hypoglycaemia/hyperglycaemia |
Sepsis Neonatal babies are at much higher risk of sepsis. This risk plus the pyrexic, lethargic systemic symptoms suggests potential pyrexia |
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What is the management for a neonate you believe to have sepsis? |
AdmitNNU Partialseptic screen (FBC, CRP, blood cultures) and blood gas
IVpenicillin and gentamicin = 1st line Addmetronidazole ifsurgical/abdominal concerns Give IV fluids and treat any acidosis Monitor vital signs and support resp and cardio system as required |
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What infective organism is the most common cause of neonatal sepsis? |
GroupB Streptococcus |
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What are the common complications of sepsis in a neonate? |
Meningitis DIC Pneumonia and respiratory collapse Hypotension and shock |
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What is the most common reason for a baby to be admitted to the neonatal unit? |
RDS Prevent with - Antenatal steroids Treat with - Surfactant |
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If a baby presents with grunting and tachypnoea within the first few hours of life then what is the possible cause? |
Transienttachypnoea (TTN) ofthe newborn *classically presents with the grunting and tachynponea within an hour* |
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What is the treatment for TTN of the new born? |
Supportive,antibiotics (prophylaxis), fluids, O2, airway support |
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If a baby on birth has cyanosis,increased work of breathing, grunting, apnoea, floppiness. What very serious respiratory condtion are you thinking it might be? |
Meconiumaspiration Caused by Meconium (earliest stool of an infant) inhaled into the lungs *do blood gas, septic screen (meconium is effectively poo so high risk of sepsis) * |
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What is the treatment for a baby presenting with meconium aspiration? *acute serious condition* |
Treatment: Suctionbelow cords Airwaysupport Intubation and ventilation Fluidsand antibiotics iv Surfactant NO - nitros oxide |
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If a baby is born blue "blue baby" and you suspect an congenital heart condition which is the likely cause, what is the management to make sure tissue is perfused as well as it can be? |
Inotropes asrequired - Positively inotropic agents increase the strength of muscular contraction
Respiratorysupport (care with O2) Prostin(prostaglandin E2) - to keep any closed foramen open Nitricoxide |
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What is the management for a baby born with hypoglycemia (another condition more common in neonates)? |
1st line - Try enteral feeding to see if levels increase then step up to... IV Glucose Glucagon Hydrocortisone |
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If a baby is born prematurely presenting with increased muscle tone, brisk reflexes, lethargic, slow suckling reflexes, apnoea and seizures what condition is most likely to be the cause in a neonate? |
HypoxicIschaemicencephalopathy * low birth weight, seizures, and lethargy with icnreased tone straight after birth then think ischaemic encephalopathy* |
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What is the management for a neonate presenting with Hypoxic ischaemic encephalopathy? |
Fluid restriction - to avoid cerebral oedema Monitor for renal and liver failure Respiratorysupport Cardiacsupport Treatseizures Therapeutichypothermia (cooling) – improves outcome especially in moderate group |
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What signs and symptoms indicates a baby to elligable to be hypothermically cooled? |
Born <36 weeks Acidosiswithin 1st hour (pH <7) Seizuresor moderate to severe encephalopathy presenting with abnormal tone, reflexes and conciousness |
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What is the name of the 2 abdominal wall problems common in neonates? |
Exomphalos or Gastroschisis *still relitively rare* |
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Diaphragmatic hernias are more common in neonates; What sex are they more common in? What side do they commonly affect? What is the management? |
More common in males 90% on left side Treat with immediate intubation, respiratory support, surgery |
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A neonate is at a much higher risk of jaundice, what are the 3 common physiological causes of jaundice in a neonate? |
Heamolysis - often due to Rhesus incompatibility (leads to excessive billirubin in blood) Infection - damaging liver function
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What investigations would you carry out on a neonatal baby who appears to have jaundice? |
Bilirubinometer Serum bilirubin(including conjugated fraction) FBC Blood film Blood group and coombs test |
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What is the treatment of jaundice in a neonate? |
Treat underlying cause Hydrate Phototherapy – reduces total serum bilirubin in days Exchange transfusion Immunoglobulin |
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Conjugated jaundice is a rare cause of Neonatal jaundice, however if they do have conjugated jaundice what condition is it important to exclude straight away? |
Need to exclude Biliary Atresia *if so high chance transplant will be needed* |
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What other condition are babies with a cleft palate at 70% increased likelyhood of having? |
70% of babies with a cleft palate will also have a cleft lip |
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What is the cause of a cleft palate? |
A cleft palate occurs when the 2 plates of the skull forming the hardpalate fail to merge by 9 weeks gestation, can occur after lip closure. Affects soft palate too. |
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What is the genetic condition that presents with a small jaw and cleft palate at brith? |
Pierre-Robin Sequence |
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What is the difference between a complete and incomplete cleft palate? |
Can be complete = soft and hard palateinvolved, gap in jaw or Incomplete = ‘hole’ in the roof of the mouth, softpalate involved |
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What issues does a cleft palate cause for a new born? |
Feeding issues - need special bottle Airway problems |
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What is the most common opthamoligcal issue in neonates? |
Neoantes are at an increased risk of cataracts. *always check for the presence of the red reflex when baby is born to rule out cataracts* |
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Developmental dysplasia of the hip is a common abnormality in neonatal babies, what is the cause of the hip dysplasia? |
DDH Caused by a congenitally shallow acetabulumresults in femur slipping out of the socket. Acetabulum is more likely shallow in a neonate because there is less time for the joint to develop |
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What examinations would you perform on a baby born with a DDH? |
Leg length General movement of the legs Groin creases Ortolani test Barlow test Ultrasound |
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What is the treatment for DDH? |
Goal = Relocate head of femur to acetabulum sohip develops normally Action: Pavlik harmess Surgical reduction |
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What abnormality related to the hand are neonates of an increased risk to? |
Accessorydigits *most are rudimental and so removed by plastic surgeons* *in some there is a minor degree of fusion of 2nd and 3rd toesis common* |
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If a child is born with: Low set ears, downward slanting palpebralfissures, epicanthic folds, single palmar creases, wide sandal gap. What genetic condition are you thinking they have? |
Trisomy 21 e.g Downs |
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What day will physiological jaundice of the new born typically occur?
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Appears on Day of life (DOL) 2-3. Should disappear within 7-10 DOL in terminfants and up to 21 DOL in premature infants. |
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What type of jaundice is physiological jaundice of the new born? |
75%bilirubin comes from haemoglobin So un-conjugated jaundice. |
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What is the risk to the brain if jaundice continues in the new born? |
At high concentrations cause irreversiblechanges in the brain – kernicterus. |
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Why is Phototherapy an effective treatment of jaundice of the new born? |
Blue light converts bilirubin to watersoluble form. |
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Why is weight loss of up to 10% in the new born normal? |
Loss is due to:Shift of interstitial fluid tointravascularDiuresis *remember it is normal for baby to not pass urine in first 24 hours* |
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What differences is there in a premature baby in terms of body fat, GFR, Na reabsorption, ability to to dilute urine? |
Less fat in body composition Slower GFR Reduced Na reabsorption Decreased ability to concentrate ordilute urine *all affect the babies fluid and lead to increased loss of fluid through kidneys* |
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What blood condition is common in the new born and not to be worried about? |
All new borns are born slightly anaemic Should improve - so be worried if doesn't |
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What is the role of the ductus arteriolsis in the foetal circulation? |
Protects lungs against circulatoryoverload Allows the right ventricle to strengthenhigh pulmonary vascular resistance, lowpulmonary blood flow. Carries mostly low oxygen saturatedblood |
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What is the ductus venousus in teh foetal circulation? |
Foetal blood vessel connecting theumbilical vein to the IVC
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What is the normal levels for HR, resp rate and BP in the new born? |
Normal values for new born: HR = Normal Heart rate 120-160 b/min BR = 40-60/min (pericordial breathing) BP = after 1 hr 70/40 then rising to 77/49 in 3 days |
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Why do new born babies require brown fat and metabolic heat production to stay warm after leaving the maternal circulation? |
Because babies initially lack shivering reflex So need to stay warm by other means |
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What organs are likely to be affected and in what way in a baby born at 26 weeks? |
By this point the lungs wont be developed - they’ll be missing surfactant (which is like a detergent and keeps the alveoli from collapsing like it is forming bubbles like washing up liquid) RDS LIKELY! The bowels wont be developed - puts them at risk of necrotising which is a condition in premature babies, means they cant feed by mouth, it undergoes necrosis due to vascular spasm. Immune system underdeveloped - they are at risk of sepsis so plow in anti biotics as soon as they are out. The brain is small and soft and v prone to inter-ventricular hemorrhage. |
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What is the immediate treatment for a baby born with RDS? |
Intubation of airways |
