Summary
Summary Essential Notes: Neonatology
- Module
- Medicine (MBBS)
- Institution
- St Georges (University Of London)
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Neonatology HypoglycaemiaGlucose > 2.6 mmol/L desirable for optimal neurodevelopment Neo
Prolonged, symptomatic hypoglycaemia can cause permanent Also k
neurological disability This o
Respiratory Distress Syndrome (RDS) Many babies can tolerate low BM in the first few days of life, able to
Jaundi
Over 5
Deficiency in surfactant production by Type II pneumocytes of the utilise lactate + ketones as energy stores 1.
alveolar epithelium Aetiology 2.
Structural immaturity of lungs leads to alveolar collapse + reduced gas Preterm + IUGR low glycogen stores 3.
exchange Neona
Maternal DM normal glycogen stores, but hyperplasia of b-cells Sign o
RF Male, diabetic mothers, caesarean section, 2nd born of premature Hyperinsulinaemia Uncon
twins, preterm [(26-28 weeks = 50%) (30-31 weeks = 25%)] IUGR
Signs + Symptoms Beckwith-Wiedemann Syndrome Ti
Tachypnoea >60 breaths/min elap
Hypothermic
postn
Laboured breathing- chest wall recession, expiratory grunting + nasal Polycythaemia
flaring Mx
Cyanosis (severe) Early, frequent milk feeding
Ix If asymptomatic infant has 2 low readings (<2.6 mmol/L) inspite of
Bloods: Hb, neutrophil, Plt, U&Es, culture, glucose, CRP, coagulation feeding
screen OR 1 very low reading (1.6mmol/L)/ symptomatic
XR: ‘ground glass’ appearance + check if tracheal tube + central lines Give IV dextrose (101520%) using a central venous catheter
correct
Mx
Prevention during pregnancy- maternal glucocorticoid (induce
foetal lung maturation)
Oxygen
Assisted ventilation Birth Asphyxia
Exogenous surfactant via endotracheal tube When the foetus experiences a lack of oxygen during labour and/or < 24
delivery.
It does not necessarily mean that the brain has been injured but asphyxia
APGAR score brain injury or death
The Apgar score is used to describe a baby’s condition at 1 and 5 min A foetus deprived of oxygen in utero will attempt to breathe become
after delivery. It is also measured at 5-minute interval thereafter, if the apnoeic (primary apnoea), during which time the HR is maintained
infant’s condition remains poor If oxygen deprivation continues irregular gasping second period of
Score apnoea (secondary/ terminal apnoea) HR + BP fall
0 1 2 If delivered at this stage= recovery ONLY by providing lung expansion
Appearance (Colour) Pale/blue Body pink/ Pink e.g. by PAP by mask or tracheal tube
extremities blue
Pulse Absent < 100 bpm > 100 bpm The human foetus rarely experiences a continuous asphyxia insult,
Grimace (Reflex None Grimace Cry, cough
except after placental abruption or complete occlusion of umbilical blood
irritability) flow in a cord prolapse.
Usually intermittent e.g. from prolonged and frequent uterine
Activity (Muscle Flaccid Some flexion of Well flexed, contractions 24 ho
tone) limbs active 2w
Respiratory effort Absent Gasping/irregular Regular, strong Other causes birth trauma, maternal analgesia or anaesthetic agents,
cry retained lung fluid, preterm infant or a congenital malformation (interfere
with breathing)
>2w
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