Summary
Summary Neonatology
High-yield comprehensive revision notes on Neonatology for the University of Cambridge Medicine Course. Written by a top decile student.
[Show more]
Connected book
Book Title:
Author(s):
- Edition:
- ISBN:
- Edition:
Seller
Follow
Content preview
NeonatologyNeonatolog 1. Small for gestational age – placental insufficiency,
y congenital infection, hypoglycaemia
2. Birth Asphyxia – hypoxic ischaemic encephalopathy,
3. Resuscitation
4. Prematurity
5. Respiratory distress syndrome, Intraventricular
haemorrhage, NEC, bronchopulmonary dysplasia,
pretinopathy apnoea
6. Respiratory distress – surfactant deficiency,
pneumonia, meconium aspiration, heart failure,
congenital diaphragmatic hernia
7. Collapse – sepsis, congenital heart disease, inborn
error of metabolism, congenital adrenal hyperplasia
8. Jaundice – ABO incompatibility, Rhesus
incompatibility, physiological, breast milk
9. Prolonged neonatal jaundice – neonatal hepatitis,
biliary atresia
10. Nutrition – infant feeding, breast feeding,
formula feeding, weaning
11. Intestinal Obstruction
12. Newborn Examination
1. Small for Gestational Age
Overview
- A fetus has an inherent growth potential dependent on several
factors: healthy mother, well-functioning placenta and the absence
of pathology.
- IUGR – a fetus that is pathologically small. SGA – estimated weight
is less than 10th centile for its gestational age.
- IUGR comes with increased risk of perinatal mortality, incidence of
cerebral palsy, stillborn birth.
Causes of IUGR:
Maternal Placental Fetal
Insufficiency
Chronic maternal Abnormal trophoblast Genetic – trisomy
disease – invasion – pre- 13,18, 21, Turner’s,
hypertension, cardiac eclampsia, placenta triploidy
disease, chronic renal accreta Congenital – cardiac,
failure Infarction gastroschisis
Substance abuse Abruption Congenital infection –
Smoking Placenta praevia CMV, rubella,
Autoimmune disease Tumours toxoplasmosis
Genetic disorders e.g. Abnormal umbilical Multiple pregnancy
,phenylketonuria cord or cord insertion
Poor nutrition
Low SES
Management
- Continue the pregnancy safely for as long as possible
- Deliver the fetus before it becomes excessively compromised.
Neonatal Hypoglycaemia
Overview
- Defined as plasma glucose <1.65 mmol/L in the first 24 hours of life
and less than 2.5mmol/L thereafter.
- It is the most common metabolic problem in new-borns.
- Fetus not really at risk of hyperglycaemia
Long-term sequelae:
- Neurological damage – mental retardation, recurrent seizure
activity, developmental delay, personality disorders
- Impaired cardiovascular function
Causes:
- Maternal diabetes mellitus
- Prematurity
- IUGR
- Hypothermia
- Neonatal sepsis
- Inborn errors of metabolism
- Nesidioblastosis
- Beckwith-Wiedemann syndrome
- Labetalol use
Presentation
Symptoms
- Hypotonia
- Lethargy, apathy
- Jittery
- Poor feeding
- Seizures
- Congestive heart failure
- Cyanosis
- Apnoea
- Hypothermia
- ANS activation – anxiety, tremulousness, diaphoresis, tachycardia,
pallor, hunger, nausea, vomiting
- Hypoglycorrhachia/neuroglycopenia – headache, mental confusion,
staring, behavioural change, visual disturbance, dysarthria,
seizures, ataxia, coma, stroke
,Investigations
- Serum/plasma glucose
- Serum insulin
- Urine – first void
- Screening for metabolic errors
Management
- Treat quickly – 5% or 10% dextrose drip for those unable to drink
- Early feeding encouraged
Transient Hypoglycaemia
- Transient hypoglycaemia in the first hours after birth is common
- For the babies of diabetic mothers, they will be commenced on a
hypoglycaemia protocol, which can be stopped once they have at
least 3 blood glucose values >2.5 mmol/L and are feeding
appropriately.
Congenital Infections
Rubella - Infection <8 weeks causes deafness, congenital
heart disease and cataracts
- Beyond 18 weeks, risk to fetus is minimal.
- Ix:
Seroconversion/serology in mother
Amniocentesis/CVS (PCR) in fetus
Placenta microscopy PCR
- Mx: rare now MMR
Cytomegalovir - Most common congenital infection
us - Infant may become infected following an episode
of recurrent infection in the mother
- 5% infants will develop hepatosplenomegaly and
petechiae, most of whom will have
neurodevelopmental disabilities e.g.
sensorineural hearing loss, cerebral palsy,
epilepsy and cognitive impairment
- 5% develop problems later in life e.g.
sensorineural hearing loss
- Mx: antiviral therapy for infected infants with
ganciclovir under investigation
Toxoplasmosis - Infection with toxoplasmsa gondii – from
consumption of raw or uncooked meat or contact
with faeces of infected cats.
- Fetal infection – retinopathy, cerebral
calcification, hydrocephalus, seizures,
hepatosplenomegaly, thrombocytopenia
- Long-term neurological sequelae.
Varicella zoster - Fetal varicella syndrome: <20 weeks – 2%
risk of fetus developing severe scarring of the
skin and ocular and neurological damage as well
, as digital dysplasia
- Neonatal varicella: 5 days before – 2 days
post-delivery – 25% develop vesicular rash. High
mortality
- Mx: exposed mothers treated with VZIG and
acyclovir (>20w and within 24h of rash). High-
risk infants given zoster immune globulin and
prophylactic acyclovir.
Syphilis - Congenital syphilis rare in UK
- Px: blunted upper incisor teeth (Hutchinson’s
teeth), ‘mulberry’ molars, rhagades (linear scars
at the angle of mouth), keratitis, saber shins,
saddle nose, deafness
- If mother identified and treated by 1 month
before delivery, excellent prognosis.
2. Hypoxic-Ischaemic Encephalopathy
Overview
- During perinatal asphyxia, gas exchange (either placental or
pulmonary) is compromised/ceases altogether cardiorespiratory
depression.
- Pathophysiology:
o Hypoxia, hypercarbia and metabolic acidosis follow
o Compromised cardiac output diminishes tissue perfusion
leading to hypoxic-ischaemic injury to the brain and other
organs.
- Neonatal condition is HIE, resulting in brain damage, disability or
death.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller cambridgemedic. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for £8.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
53068 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy revision notes and other study material for 14 years now