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87 Cards in this Set
- Front
- Back
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What changes in circulation occur in the newborn?
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Pulmonary vascular resistance falls and blood flows to the lungs.
Cord clamping causes peripheral vascular resistance to rise and the foramen ovale is kept shut. The rise in oxygen and withdrawal of prostaglandins causes the ductus to close. |
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What happens in infants with persistent pulmonary hypertension?
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There contibues to be a right to left shunt at the atrium (FO) and the ductus. Such infants are tachycardic and cyanosed.
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What is the fluid in the lungs of the foetus?
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Fluid secreted by the pulmonary epithelium. It movs into the aminiotic fluid with breathing movements during foetal life.
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What do hormonal changes do to the fluid in the lungs of the baby at birth?
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Catecholamines lead to reabsorption of some fluid into alveolar sacs.
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How is the majority of the fluid removed from the lungs at birth?
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"Squeezed" out during labour, appears as clear fluid around nose and mouth.
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What happens when the newborn takes its first breath?
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Chest recoil --> lungs fill with aire --> surfactant released from type II pneumocytes --> lowered surface tension in the alveoli --> residual lung volume is established.
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Why are infants born by caesarean more likely to have respiratory problems?
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More likely to have retained lung fluids.
Can cause transient tachypnoea of the newborn. |
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What are the concerns with newborns and temperature control?
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Larger surface area compared to their weight.
Become cold rapidly. Wet at birth and lose heat through evaporation, radiation... need to be clothed. Core temperature normally 36.5 - 37. |
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What is one of the signs of hypothermia in the infant, apart from temperature?
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Tachypnoea, because they will increase oxygen consumption required for basal metabolism.
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How does the foetus get glucose?
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From the maternal supply of glucose via the placenta. Glycogen stores laid down.
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What babies are at risk of hypoglycaemia?
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Delayed feeding.
Preterm. Growth-retarded. Sick infants. Infants of diabetic mothers. |
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How often should health term infants demand to feed?
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8 times per day.
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When should meconium be passed?
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By the time an infant is 48 hours of age.
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Before birth, how is unconjugated bilirubin excreted?
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Via the placenta.
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Why do all newborn infants have raised serum bilirubin levels to some degree?
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Because there is transition from placental excretion of bilirubin to hepatic conjugation and excretion of bilirubin.
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Why do all infants have low levels of Vitamin K and Vitamin K clutting factors (2, 7, 9, 10)?
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Because intrinsic vitamin K production follows bacterial colonisation of the gut.
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What is the risk of Vitamin K deficiency?
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Haemorrhage.
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What does APGAR stand for?
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Appearance (colour)
Pulse rate Grimace (reflex irritability - the response to nasal suction) Activity (tone) Respiratory rate |
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What are the scores for appearance?
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0 pale or blue
1 body pink, extremities blue 2 pink |
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What are the scores for pulse rate?
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0 absent
1 < 100 2 > 100 |
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What are the scores for grimace?
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1 none
2 some, e.g. grimace 3 vigorous, cry |
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What are the scores for activity (tone)?
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1 floppy
2 some flexion 3 good flexion |
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What are the scores for respiratory rate?
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apnoeic
irregular, weak active crying |
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What are some of the limitations of an Apgar score?
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Different observers record different scores.
Don't describe HOW the score came to be. Do not predict long-term outcome or future disability. |
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What is a Laerdal?
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Self-inflating bag.
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What is a neopuff?
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T-piece resuscitator.
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What equipment should be present at a complicated birth?
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Infant overhead warmer
Air oxygen supply Suction apparatus Self-inflating bag and T-piece Intubation equipment Umbilical catheter Drugs |
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What would you do if the infant was vigorous and crying at birth?
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Leave with mother
Prevent heat loss Ongoing evaluation |
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What would you do if the infant was cyanosed and breathing irregularly, HR > 100, at birth?
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Prevent heat loss
Ensure open airway (head in neutral position) Stimulate +/- suction |
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What would you do if the infant was cyanosed and breathing irregularly, HR < 100, 30 seconds after birth?
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Three slow breaths
Bag and mask (40 - 60 per minute) Aim for visible chest movement and increase in HR. |
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What would you do if the infant had HR < 60 and not incraseing, inadequate respirations or apnoea.
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Advance Resus.
Intubate. 3 compressions to 1 breath. Consider IV adrenaline. |
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How much adrenaline should be given?
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10 - 30 micrograms/kg.
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Where should the oxygen probe be placed to get a preductal reading?
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R hand or wrist.
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How long may it take for even healthy term infants to reach an oxygen saturation of 90%?
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5 to 10 minutes.
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When should PPV be used in resus?
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When the heart rate is below 100.
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How many deliveries are mec-stained?
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10 - 20%.
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Should mec-stained deliveries be suctioned when head is delivered?
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No, a well-designed study found no benefit.
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When should a mec-baby be suctioned?
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If the infant is floppy or has inadequate respirations.
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What are capillary naevi/salmon patches/strok marks?
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Faint pink lesions over they eyelids, temples, upper lip, nape of the neck, else where on teh face.
Benign. |
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What are milia?
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Tiny white spots on the forehead, nose, cheeks. These are inclusions cysts in the epidermis
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What is caput?
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Oedema over the presenting part of the scalp. Resloves within a day or two.
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What is a cephalhaematoma?
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Haemorrhage under the periosteum of a skull bone.
Most commonly parietal and will not cross the suture lines. May film firm at the edges with a fluctuant centre. |
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What is a subgaleal haemorrhage?
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Bleeding into the scalp in the subaponeurotic space. Significant hypovolaemia and anaemia can result.
All of the scalp feels boggy and loose. |
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What are potential causes of facial assymetry?
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Facial nerve palsy (due to pressures of delivery)
Congenital nerve palsy |
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What is the rooting reflex?
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Stroke the infants cheek, the infant's head turns.
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What else can you test for when doing the sucking reflex?
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Submucous cleft.
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What is the Pierre Robin sequence?
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Cleft palate and micrognathia (small jaw). Can make sucking difficult.
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What should be done to a natal tooth?
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It should be removed (they are easily dislodged) because it could be choking risk if it fell out.
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Are subconjunctival haemorrhages a cause for concern?
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No, they are common and resolve without problems.
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What could sticky eyes and swollen conjuntiva be causeed by?
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Gonococcal opthalmitis.
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Unilateral sticky eye?
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Bacterial or blocked tear duct.
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Bilateral swollen eyes that are not red?
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Chlamydial infection.
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What should be done in follow up of preauricular skin tags and pits?
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They are common but should be followed with a formal hearing test.
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What is the normal respiratory rate in a newborn?
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40 - 60 breaths per minutes.
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What is the normal heart rate in a newborn?
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90 - 160 (when crying). Sinus arryhtmia and occasional ectopic beats are common.
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Which pulses should be felt for in a newborn?
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Brachial and femoral.
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What is divarication of the rectus abdominis?
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Seperation of rectus abdominus. There is a soft bulge above the umbilicus.
Normal. |
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What are normal masses to feel in a newborn abdomen?
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Can palpate the liver 1 - 2cm below R costal margin.
Spleen tip. Lower pole of both kidneys. |
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How does one demonstrate a hydrocele?
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Transillumination of the scrotum.
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Can the foreskin be retracted in the newborn?
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No.
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How does one check for anal agenesis?
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Parting the buttocks and fully examining the perineum.
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What is Erb's palsy?
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Injury to the brachial plexus, normally during shoulder dystocia or instrumental deliveries.
Arm is flaccid by the side. |
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What's a differential for Erb's palsy?
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Fractured clavicle. Detect drepitus over the bone. Needs no specific treatment.
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What is talipes calcaneovalgus?
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The dorsum of the foot is pressed against the front of the shin.
Usually positional and ankle can be moved normally. |
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What is talipes equinovarus?
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The foot is inverted.
More likely to be restricted. Requires orthopaedic referral. Club foot. |
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What is normal tone for an newborn?
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Flexed limbs.
Can just move the head to midline. Head lag. Ventral suspension: hips, shoulders and head will raise up a little. (i.e. not rag doll) |
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What is the walking reflex?
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Walking movements of the legs stimulated by the soles of the feet touching a surface when the baby is held vertical.
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What is a simple sacral dimple?
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Less tahn 5mm in size and less than 2.5cm from the anus in the gluteal fold. Benign.
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What should a baby who was found to have a SUA in utero have as a newborn?
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Renal artery ultrasound to check the function of the urinary tract.
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What is the main focus of a newborn examination at 1 week and beyond?
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Head - check for congenital hydrocephalus
Heart - check for new murmurs or heart failure Hepar - check jaundice Hips - check for dislocation Hearing - check the baby is responsive |
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How would a congenital hydrocephalus be picked up in the newborn?
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Full fontanelle
Widening sutures Abnormally large head circumference |
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What is good analgesia for the newborn?
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0.5 - 1.0 mL 24% sucrose in 0.25 mL aliquots.
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What is Vitamin K deficiency bleeding?
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Uncommon but potentially fatal disorder presenting with spontaneous bruising or internal haemorrhage.
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What are the three kinds of Vitamin K deficiency bleeding?
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Early: day one of life, associated with maternal use of anticonvulsants.
Classical: day 2 - 6 of life. Without prophylaxis may occur in 1 in 400 breastfed infants. Late: 1week to 6 months. Usually in breastfeed infants and associated with liver disease or malabsorption. |
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Is Vitamin K prophylaxis recommended?
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Yes.
Normally 1mg IM following birth. Or three oral doses of Konakion given over several weeks. |
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What injections do all term infants get at birth?
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Hepatitis B
Vitamin K |
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What is the protocol for infants born to Hepatitis B carriers?
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1. Early bath in clorhexadine 1% cream to remove maternal blood and fluids.
2. Hepatits B immunoglobulin 100IU IM. 3. Hepatits B vaccine IM (in other leg) |
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What is the status of a hepatis B carrier?
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HBsAg-positive
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What does the heel prick test for and when is it done?
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Within first 48 hours of life.
PKU Hypothyroidism CF |
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What are the changes of weight in the newborn?
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Lose up to 8% of birthweight in first 3 to 5 days.
Regain birth weight by 7 to 10 days. |
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How often does a normal feeding infant pass urine?
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Every 3 -4 hours.
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What is the normal colour of urine in the newborn?
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Clear and colourless but may turn pink in the nappy because of presence of urates exposed to air.
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When should meconium be passed by? What could it indicate if there is failure to pass meconium?
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Should be passed within first 48 hours of life.
May indicate Hirschsprung disease, meconium plug syndrome, or other bowel obstruction. |
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What is a posset?
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Tiny 1 - 2mL vomits.
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After birth, how long are normal infants usually awake and active for?
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30 minutes.
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On average, how many hours do infants sleep for per day, during first week of life?
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18 hours.
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How good is newborn eyesight?
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Can look at objects within a focal distance of 20 - 45cm and can preferentially focus on the edges of objects, lines and shapes.
Can distinguish human face from others objects. Can distinguish mother's voice and smell. |
