1
Q
risk factors for neonatal resus
A
- PROM
- Bleeding in 2nd/3rd tri
- Hypertension
- Substance abuse
- Diabetes
- Infection
- Heavy sedation
- Previous fetal/neonatal death
- Multiple gestation
- Preterm
- Post term
- LGA
- FGR
- Polyhydramnios/oligo
- DFM
- Non-reassuring CTG
- Abnormal presentation
- Cord prolapse
- Precipitate labour
- APH
- Mec
- Morphine
- Forceps
- Vacuum
2
Q
equipment for general resus
A
- Warmer, light, clock, towels, polybag, stethoscope, pulse oximeter
3
Q
airway management equipment
A
- Suction catheters
- Oropharyngeal airways
- Intubation
- Laryngoscopes with blades
- Batteries
- Endotracheal tubes
- Endotracheal introducer
- Supplies for fixing endotracheal tubes
- End-tidal c02 detector
- Meconium aspirator
- Magill forceps
4
Q
supporting breathing
A
- Face masks
- Positive pressure ventilation (t-piece)
- Oxygen with flow meter
- Feeding tubes for gastric decompression
5
Q
drugs and fluids
A
- Adrenaline ; 1:10 000 concentration (0.1mg/ml) 0.5ml term baby
- N/S
6
Q
pre-ductal sats on right hand (what % sats you would like)
A
1 min - 60-70%
2 min - 65-85%
3 min - 70-90%
4 min - 75-90%
5 min - 80-90%
10 mins - 85-90%
7
Q
choanal atresia
A
- congenital anomaly of the nasal cavity in which there is narrowing of one or both nasal passages. As newborn babies breathe through their nose, in bilateral choanal atresia there is immediate obstructive breathing that is relieved only when the baby cries
8
Q
micrognathia - pierre robin sequence
A
- triad of features that cause respiratory compromise
- small jaw, large tongue and cleft palate
- risk of resp distress 3x greater at 37 weeks compared to 39-40 weeks
9
Q
RDS and hyaline membrane disease
A
- caused by inadequate production of surfactant in the lungs.
- Surfactant is normally produced by type II pneumocytes and has the property of lowering surface tension. Most alveolar surfactant is produced after 30 weeks of gestation. Inadequate surfactant production causes air sacs to collapse on expiration and greatly increases the energy required for breathing
- Leads to hypoxia and retention of co2
- Signs = tachypnoea, expiratory grunting, diminished breath sounds, cyanosis and nasal flaring
10
Q
transient tachypnoea
A
- Aka wet lung
- retained fetal lung fluid and can be complicated by a mild surfactant deficiency. It is more common in infants born by caesarean without labour
- rapid breathing, nasal flaring, sternal recession, grunting and cyanosis
11
Q
meconium aspirate syndrome
A
- breathes a mixture of meconium and amniotic fluid into the lungs around the time of birth. it occurs rarely in infants born at less than 36 weeks gestation. In approximately 10%–15% of labours there is meconium-stained amniotic fluid (MSAF). The majority of infants born through MSAF will experience only mild respiratory distress that resolves over 24–48 hours
12
Q
chronic lung disease
A
- need for either mechanical ventilation or CPAP and / or receiving supplemental oxygen at a corrected gestational age of 36 weeks or beyond the 28th day of life. It is a multifactorial condition
- mechanical ventilation, prematurity, severity of respiratory distress syndrome, oxygen toxicity, patent ductus arteriosus, inflammatory changes in the lung and duration of mechanical ventilation
13
Q
air leak syndrome
A
- Pneumothorax is a lung disorder in which air in the lungs leaks out through holes in the lung tissue into the spaces outside the lung airways
- pneumothorax —air leaks into the space between the chest wall and the outer tissues of the lungs
14
Q
pneumomediastinum
A
air leaks into the mediastinum (the space in the thoracic cavity behind the sternum and between the two pleural sacs containing the lungs)
15
Q
pneumopericardium
A
air leaks into the sac surrounding the heart
16
Q
pulmonary interstitial emphysema (PIE)
A
air leaks and becomes trapped between the alveoli, the tiny air sacs of the lungs
17
Q
Congenital diaphragmatic hernia
A
- defect in the diaphragm muscle with herniation of the abdominal contents into the thorax through the defect.
- pulmonary hypoplasia (PH), the response to artificial ventilation and the presence of therapy-resistant pulmonary hypertension
18
Q
oesophageal atresia
A
- congenital anomaly in which the oesophagus ends in a blind pouch
- 85% of cases it is associated with a fistula (connection) between the trachea and the oesophagus
19
Q
Pneumonia
A
- a form of acute respiratory infection that affects the lungs.
- PROM, maternal fever, chorioamnionitis risk factors
- GBS (poor feeding, lethargy, cyanosis) bad resp signs
- Chest x-ray, FBC, blood cultures, arterial blood gases IV abx
20
Q
apnoea
A
- No resp effort for more than 20 secs
- Not accompanied by cyanosis or brady
- Pre-term infants of <34 weeks = admin methylxanthine (caffeine citrate or aminophylline) – smooth muscle relaxant and a cardiac muscle and CNS stimulant
21
Q
circulation
A
- Colour in presence of a patent airway and adequate ventilation is useful in assisting diagnosis
- Cyanotic – indicate congenital heart disease
- Pallor indicates shocks and haemorrhage
- Yellow – severe ABO incompatibility
22
Q
congenital heart disease
transposition of the great arteries
A
- Most common approx. 5% of all CHD cases
- Two circulations – the pulmonary artery arising from the left ventricle and the aorta from the right ventricle
- Severe cyanosis is important clinical sign and immediate arterial oxygen sats should be recorded
- Chest x-ray shows ‘egg on the side’ outline of the heart – echo for diagnosis
- Intact ventricular septum and no atrial communication is a cardiac emergency – needs balloon atrial septostomy – commence prostaglandin and stabilisation
23
Q
tetralogy of fallot
A
- Comprises a large ventricular septal defect, an overriding aorta and a right ventricular outflow obstruction and right ventricular hypertrophy
24
Q
left sided heart obstruction
A
- Coarctation of the aorta narrowing of aorta, takes blood from the ventricle of the heart to the rest of the body
- Hypoplastic left heart syndrome underdeveloped left ventricle, atrial septal anomalies and hypoplastic ascending aorta and coronary arteries with blood passing into the aorta through the patent ductus arteriosus – maintained with prostaglandin
- Tachypnoea, enlarged liver, decreased femoral pulses, decreased urine output, murmur
25
pallor
- Haemorrhage is one cause – can occur in utero or during or soon after birth
- Check for anaemia
- Monitor / fluid resus
- Ensure vitamin k given
- Cross-match blood
26
Cephalohematoma
- Bleeding that occurs between the periosteum and the skull bone
- Appears 12-72 hrs after birth
27
subgaleal haemorrhage
- Bleeding into the space between the epicranial aponeurosis and the periosteum
- Rupture of the emissary veins
- Blood loss and boggy swelling of the scalp
28
group B strep
- Bacteria naturally found in the digestive tract and birth canal – most common of early-onset sepsis
29
Torch infections
Toxoplasmosis
Other (syphilis, VZV, parvovirus B19)
Rubella
CMV
Herpes infection
- Suspected when there is microcephaly, calcifications in the periventricular region, brain atrophy, hydrocephalus, subependymal cysts and lenticulostriate vasculopathy
30
jaundice
- Occurring less than 48 hours after birth is usually due to haemolysis – ABO incompatibility, rhesus immunisation or sepsis
- Decrease bilirubin level
31
Hypoxic ischaemic encephalopathy (HIE)
- Neural tissue destruction from hypoxic and ischaemic causes such as placental abruption and uterine rupture
- Therapeutic hypothermia (cooling) can benefit babies – standard care
- Within 6 hours of birth
32
neural tube defects
- Disruption of the CNS – problem with embryology
- Anencephaly
- Encephalocele
- Spina bifida
33
Anencephaly
- Incompatible with life
- Lumbosacral region commonly affected
- Defect of the bone seen by a tuft of hair or sinus at the base of the spine
34
Hydrocephalus
- Cerebrospinal fluid is not absorbed adequately resulting in enlargement of the cerebral ventricles
- Causes NTDs, infections, intraventricular haemorrhage, trauma and tumours
35
Gastroschisis
- Contents of the abdomen, primarily the small and large intestine, stomach, liver, spleen, bladder and uterus, protrude through a defect in the abdominal wall, near umbilicus
36
Exomphalos/omphalocele
- Herination of the abdominal viscera through the base of the umbilical cord, covered in a sac formed by the peritoneum and amniotic membrane
37
management of abdominal wall defects
- Stabilising the bowel in a midline position and avoidance of twisting or constriction as this compromises blood supply to the eviscerated intestine
- Appropriate circulation monitoring and fluid resus
- Gastric tube inserted to vent the stomach and remain NBM
- Blood sugars checked
- IV abx and blood cultures
38
necrotising enterocolitis
The condition inflames intestinal tissue, causing it to die. A hole (perforation) may form in your baby's intestine. Bacteria can leak into the abdomen (belly) or bloodstream through the hole
- Pre-term mostly
- Abdominal distension, poor tolerance of feeds, vomiting, temp instability and lethargy
- NBM, gastric tube and left on free drainage
- Abx, blood cultures
Complex care 2
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