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Summary Neonatology - medical school exams

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Contains everything you will need to know for medical school exams and beyond. Based off up to date guidance. Top decile exam results based off these notes.

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  • February 8, 2021
  • 20
  • 2020/2021
  • Summary

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Neonatology

Resus
HIE
Birth injuries
Prematurity complications
Hypotonia
Respiratory distress
Shock/cyanosis
Jaundice

Changes

Circulatory
- Opening of airways and fall in pulmonary resistance
- Increased pulmonary venous return closing FO
- Increase ppO2 closing DA
- Cutting umbilical cord to increase systemic resistance


Physiological jaundice: breakdown fHb and liver & kidneys taking over placenta.
Apparent on D2-3, peaks D5-7, fades by D10.
Pre-term peak may be later and resolve over more time.
Newborn liver has low conjugating ability (UGT)  increased unconjugated bilirubin.
Dehydration (breast milk problems) can make worse as reduced output via urine.

, Resuscitation
Birth: dry baby, remove wet towels, cover and start clock.
 Hypothermia can lower O2, increase metabolic acidosis, lead to hypoglycaemia and
inhibit surfactant production.

Within 30s: assess tone, breathing (40-60), heart rate (120-150)
Within 60s: if not breathing  neutral position, 5 inflation breaths
Start SpO2 +/- ECG
?Suction of meconium in liqour

Reassess: if no increase in HR look for chest movement
If not moving: repeat inflation
If moving: if HR slow (<60), give compressions (100/min) with 3 compressions to
each breath

Drugs: give via umbilical venous catheter, IO or ETT
Bicarbonate, Adrenaline, Dextrose

Once stable, move to NICU and consider ventilation +/- abx (especially if PPROM).

If uncompromised  delayed cord clamping for 1 minute
If meconium stained  assess before suction (don’t do blind suction)
If preterm  plastic wrap, heater, less air pressure


Shock
Signs
Weak & fast pulse 180bpm+
Capillary refill 3s+
Extremities cold

 Provide warmth, ABC (neutral position, start O2 if <90%, correct hypoglycaemia).
 Establish IV access and give normal saline 20ml/kg over 1 hour (10 min + Vit K if
bleeding)
 Treat for sepsis

Hypovolemic – dehydration (poor feeding/sunken fontanelle), bleeding (birth trauma)
Septic – Sepsis (GBS, HSV, may have had PROM/chorioamnioitis)
Cardiogenic - SVT, hypoplastic left heart, severe aortic coarctation (murmurs, delayed
femoral pulse)

Lung – congenital diaphragmatic hernia
Metabolic – propionic acidaemia, methylmalonic acidaemia
Endocrine - panhypopituitarism

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