Paediatrics Marrow Pg 1-10 (Neonatology)
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Paediatrics Marrow Pg 1-10 (Neonatology)

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Questions and Answers

What is the first priority of management in a newborn after birth?

  • Temperature
  • Cord management
  • Circulation
  • Respiration (correct)

    • Adrenaline is administered only if there is no heart rate detected after 30 seconds of assessment.

    True

    What are the four pre-birth questions asked during the initial assessment?

    Term gestation, clear amniotic fluid, risk factors present, umbilical cord management plan

    If the heart rate is less than 60 bpm, the next step is to perform __________.

    <p>chest compression</p> Signup and view all the answers

    Match the following time frames with the actions taken during neonatal resuscitation:

    <p>1 minute = Initial assessment and actions for no cry 30 seconds = Administer adrenaline if no response 20 minutes = Declare death if no response</p> Signup and view all the answers

    What is the purpose of using an uncuffed endotracheal tube in neonatal resuscitation?

    <p>To prevent tracheal necrosis from cuff pressure</p> Signup and view all the answers

    The insertion depth for an endotracheal tube is determined by the baby's weight alone.

    <p>False</p> Signup and view all the answers

    What is the recommended dose of adrenaline for neonatal resuscitation?

    <p>0.2 ml/kg</p> Signup and view all the answers

    In neonatal resuscitation, chest compressions are performed at a ratio of _____ compressions to _____ ventilations.

    <p>90, 30</p> Signup and view all the answers

    Match the following ET tube sizes to the corresponding weight of the baby:

    <p>2.5 mm = &lt; 1 kg 3 mm = 1 to 2 kg 3.5 mm = &gt; 2.5 kg</p> Signup and view all the answers

    What is defined as low birth weight (LBW)?

    <p>&lt; 2.5 kg</p> Signup and view all the answers

    Symmetrical IUGR is characterized by a uniformly small baby without any brain sparing effect.

    <p>False</p> Signup and view all the answers

    What does the Ponderal Index (PI) measure in newborns?

    <p>Weight to length ratio</p> Signup and view all the answers

    The newborn period lasts for the first ______ weeks after birth.

    <p>4</p> Signup and view all the answers

    Match the following types of birth weight with their definitions:

    <p>LBW = Low birth weight (&lt; 2.5 kg) VLBW = Very low birth weight (&lt; 1.5 kg) ELBW = Extremely low birth weight (&lt; 1 kg) SGA = Small for gestational age</p> Signup and view all the answers

    What is the first step in neonatal resuscitation?

    <p>Temperature regulation</p> Signup and view all the answers

    Gentle tactile stimulation can include rubbing the baby's back with a cotton towel.

    <p>True</p> Signup and view all the answers

    What is the purpose of assessing heart rate immediately after birth?

    <p>To check for significant hypoxia.</p> Signup and view all the answers

    O₂ supplementation can be provided via _____ or _____ for babies with poor respiratory effort.

    <p>O₂ hood, nasal prongs</p> Signup and view all the answers

    Match the techniques to their purposes:

    <p>Bag-and-mask ventilation = Non-invasive respiratory support CPAP = Invasive respiratory support for preterm babies O₂ hood = Commonly used for oxygen supplementation Tactile stimulation = Encouraging the baby to breathe</p> Signup and view all the answers

    What is the normal heart rate range for a term newborn?

    <p>120-160/min</p> Signup and view all the answers

    Capillary refill time (CRT) of 5-3 seconds is considered normal in neonates.

    <p>True</p> Signup and view all the answers

    What is the normal respiratory rate for a term newborn?

    <p>40-60/min</p> Signup and view all the answers

    Normal body temperature for a newborn is between _____ °C and _____ °C.

    <p>36.5, 37.5</p> Signup and view all the answers

    Match the following neonatal findings with their descriptions:

    <p>Erythema toxicum = Papulosaquamous lesions with eosinophils Pustular melanosis = Pustules with hyperpigmented patches</p> Signup and view all the answers

    What is a primary risk factor for necrotizing enterocolitis?

    <p>Low birth weight</p> Signup and view all the answers

    Necrotizing enterocolitis is more common in full-term infants than in preterm infants.

    <p>False</p> Signup and view all the answers

    Name a common symptom associated with neonatal sepsis.

    <p>Fever or hypothermia</p> Signup and view all the answers

    ___ is the condition characterized by the inflammation and necrosis of the intestines in neonates.

    <p>Necrotizing Enterocolitis</p> Signup and view all the answers

    Match the following complications with their descriptions:

    <p>Necrotizing Enterocolitis = Inflammation and necrosis of intestines Neonatal Sepsis = Systemic infection in newborns Prematurity = Birth before 37 weeks of gestation Hypothermia = Lower than normal body temperature</p> Signup and view all the answers

    What is the targeted SpO2 for a newborn at 3 minutes after birth?

    <p>70-75%</p> Signup and view all the answers

    For a newborn greater than 35 weeks gestation, the initial FiO2 should be set to 21-30%.

    <p>False</p> Signup and view all the answers

    What is the normal respiratory rate goal for a newborn in distress during resuscitation?

    <p>40 to 60 breaths/min</p> Signup and view all the answers

    Excess O2 in preterm infants can lead to __________ damage.

    <p>hyperoxia</p> Signup and view all the answers

    Match the following components of the Ambu-bag with their functions:

    <p>Face mask = Fits around the nose and mouth of the newborn Pressure release valve = Prevents excess pressure in the bag Oxygen inlet = Allows for oxygen supply to the bag Reservoir bag = Stores additional oxygen</p> Signup and view all the answers

    What is the cause of caput succedaneum?

    <p>Prolonged labor and venous congestion</p> Signup and view all the answers

    Cephalhematoma is more common than caput succedaneum.

    <p>False</p> Signup and view all the answers

    What is witch's milk?

    <p>Milk-like fluid discharge from the nipple of female babies.</p> Signup and view all the answers

    What posture is typical for a term baby's limbs?

    <p>Flexed with normal tone</p> Signup and view all the answers

    __________ is a condition where blood accumulates between the skull and the periosteum.

    <p>Cephalhematoma</p> Signup and view all the answers

    Match the following head swelling conditions with their characteristics:

    <p>Caput succedaneum = More common, diffuse swelling, resolves in 2-3 days Cephalhematoma = Less common, localized swelling, recovery in 3-8 weeks Subgaleal hemorrhage = More severe, diffuse swelling, may cause shock</p> Signup and view all the answers

    A preterm baby typically shows present scapula-related flexibility during the arm recoil test.

    <p>False</p> Signup and view all the answers

    What is a common complication of preterm birth that results from surfactant deficiency?

    <p>Respiratory distress syndrome (RDS)</p> Signup and view all the answers

    The external genitalia of a preterm male baby often presents with an empty __________ due to incomplete descent of the testis.

    <p>scrotum</p> Signup and view all the answers

    Match the following characteristics with the type of baby:

    <p>Preterm Baby = Abundant lanugo Term Baby = Less lanugo present</p> Signup and view all the answers

    What score range does the Expanded New Ballard Score (ENBS) cover?

    <p>-10 to +50</p> Signup and view all the answers

    The accuracy of the Expanded New Ballard Score is ±2 weeks.

    <p>False</p> Signup and view all the answers

    What are the two main components assessed in the Expanded New Ballard Score?

    <p>Neuro muscular maturity and physical maturity.</p> Signup and view all the answers

    The skin of a newborn that is described as 'sticky, friable, and transparent' corresponds to a score of _____.

    <p>0</p> Signup and view all the answers

    Match the following features of physical maturity with their corresponding scores:

    <p>Skin - Parchment; deep cracking; no vessels = Score 5 Lanugo - Sparse = Score 1 Heel-toe - 40-50 mm = Score 0 Plantar Surface - Smooth = Score 3</p> Signup and view all the answers

    Study Notes

    Neonatal Resuscitation

    • Priority of management in newborn: Respiration, Temperature, Circulation
    • Initial assessment: Term gestation, Clear amniotic fluid, Risk factors present, Umbilical cord management plan
    • Timeline (Golden minute of Neonatal resuscitation):
      • 1 min: Initial assessment. If no cry after birth, Initial action (steps): Temperature, airway, circulation.
      • 30 sec: Assess Heart rate (HR) and respiratory effort. If HR < 100 → Positive Pressure ventilation (PPV). If HR < 60 → Chest compression (with ventilation)
      • 30 sec: If no response → Adrenaline. If no response → Consider volume expansion (NS: 10 ml/kg).
    • Duration: 20 min. If no response, declare death.

    Endotracheal Intubation

    • Visualization of airway: Via straight blade laryngoscope

    • Type of ET: Uncuffed

      • Prevents pressure tracheal necrosis due to cuff pressure on narrow sub-glottic area

    • Inner diameter of tube: Based on weight of body

      • < 1 kg: 2.5 mm

      • 1 to 2 kg: 3 mm

      • 2.5 kg: 3.5 mm

    • End tidal CO2 estimation (EtCO2): Best method to determine if placement is correct.

    • Insertion depth: Naso-tragal length (in cm) + 1 cm

    Chest Compression

    • Done alongside ventilation (performed by 2 people).
    • Ratio: 3:1 (90 compressions : 30 ventilations in 1 minute).
    • Response monitoring: Using cardiac monitor.
    • HR > 60

    Adrenaline

    • Route:
      • Preferred: IV (Through umbilical vein)
      • If inaccessible: Intraosseous route
    • Dose: 0.2 ml/kg
    • Strength: 1: 10,000

    INITIAL STEPS

    • Temperature: Keep baby under warmer.
    • Breathing: Gentle tactile stimulation
      • Methods: Rubbing over back (with cotton towel), Flicking soles.
    • Airway:
      • Positioning: Slight extension of neck (Sniffing position) using tower under shoulder.
      • Suctioning: Suctioning visible secretions. Order: mouth → Nose

    ASSESSMENT OF HR AND RESPIRATORY EFFORT

    • Purpose of HR assessment: No cry after birth (No breathing) → Significant hypoxia → ↓ HR ( < 100/min)

    Assessment of baby

    HR < 100/min OR Not breathing/apneaHR > 100/min + poor/labored breathingPPV (upon failure)O₂ supplementation via* Non Invasive* : Bag-and-mask ventilation (BMV) (used initially)* Invasive*:* O₂ hood (box over head): Commonly used* Nasal prongs.* If preterm: Continuous positive airway Pressure (CPAP) ( > 100/min). 1st pressure: 30-40 cm of H₂O. Subsequent: 15-20 cm of H₂O.

    Normal Newborn

    • Newborn period: First 4 weeks
      • 1st week: Early
      • Next 3 weeks: Late
    • Birth weight:
      • Low birth weight (LBW): < 2.5 kg
      • Very Low Birth Weight (VLBW): < 1.5 kg
      • Extremely Low Birth Weight (ELBW): < 1 kg

    Intrauterine Growth Retardation (IUGR)

    SGA (Small for Gestational Age)

    • Constitutional (Normal):

    • Pathological (IUGR):

    • Identification points:*

    • a.Loose skin folds.

    • b.Skin peeling.

    • c.Thin umbilical cord.

    FeatureSymmetrical IUGR (Maternal)Asymmetrical IUGR (Fetal)EtiologyUteroplacental insufficiency (2nd & 3rd trimester)Genetic defects (e.g., Trisomy), organ anomalies (1st trimester)CauseDuring placenta-dependent growth of the body.OnsetEffectBrain sparing effect present, normal sized head, body size small for gestational age.No brain sparing effect, uniformly small baby.OutcomeGoodPoor

    Assessment of IUGR

    • New Allms intrauterine growth curves

    Ponderal Index (PI)

    PI=Weight of baby (g)Length of baby (cm)3×100PI = \frac{Weight \ of \ baby \ (g)}{Length \ of \ baby \ (cm)^{3}} \times 100PI=Length of baby (cm)3Weight of baby (g)​×100

    • (Interpretation):*

    • 2: Symmetrical IUGR

    • < 2: Asymmetrical IUGR

    Necrotizing Enterocolitis and Neonatal Sepsis

    • Etiopathogenesis*

    • Prematurity (< 32 weeks) leads to:→ Immature gut → ↓ gut motility, bowel ischemia → Bacterial overgrowth (mostly Gram-negative) → Inflammatory bowel disease (IBD) → Necrotizing enterocolitis (NEC)

    Neonatal Sepsis

    • Etiology:→ Early onset ( < 7 days) → Late onset ( > 7 days)
    • Clinical Presentation:→ ↓ temperature → ↑ respirations → ↓ feeding → Lethargy → Apnea → ↑ HR → Jaundice

    VITAL SIGNS

    • Term: Heart rate: > 100/min, Respiratory rate: 40-60/min

    • Preterm: Heart rate: 120-180/min, Respiratory rate: [unclear value, possibly 40-60/min].

    • Capillary refill time (CRT): checked by pressing ball of finger over sternum.

      • Blanching of skin
      • Skin becomes pink
      • CRT: 5-3 sec

    • Temperature: 36.5 °C to 37.5 °C

    NORMAL FINDINGS

    FindingsDetails1.Erythema toxicum/erythema neonatorumPapulosquamous lesions. Histology: Eosinophils present. Onset: > 24 hr after birth2.Pustular melanosisPustules + hyperpigmented patches. Onset: 1st week.3.MiliaSmall white papules on nose, chin, forehead4.Epstein pearlsSmall white papules on palate5.Mongolian spotsBlue-grey macules on buttocks, sacrum and back.

    FiO2 (Based on gestational age)

    • 35 weeks: room air (21% O2)

    • < 35 weeks: start with 21-30% O2, Titrate to target SpO2 (measured at right hand)

    Minutes After Birth

    MinutesTargeted SpO21 min60-65%2 min65-70%3 min70-75%4 min75-80%5 min80-85%10 min85-95%

    • Need for matching targeted SpO2:*

    • Excess O2 (Preterm) → Hyperoxia damage

    • ↓ Retinopathy of prematurity (ROP) → Blindness

    Ventilation correction steps if response inadequate : In order undertaken:**

    • Mnemonic: MRSOPA*

    1.Mask repositioning: Incorrect position: m/c cause of inadequate response. 2.Readjust head position. 3.Suction: Remove all secretions. 4.Open mouth. 5.Pressure increase over bag. 6.Alternate airway: If all steps fail.(ET tube)

    Absolute C/1: Congenital diaphragmatic hernia.

    • Air enters via esophagus → Inflates intrathoracic viscera → Compression of lungs (↑ Respiratory distress)
    • Goal: Respiratory rate 40 to 60 breaths/min

    Ambu-bag for BMV

    • Cover nose and mouth adequately
    • No leakage of air

    Findings

    • 6.Breast findings
      • Breast engorgement.
      • Witch's milk: milk-like fluid discharge from nipple.
    • 7.Bleeding per vagina
      • Uterine shedding in female babies → sudden withdrawal of maternal hormones.
      • D/t stress of normal delivery
    • 8.Small subconjunctival/retinal hemorrhage
    • 9.Hymenal skin tags
    • 10.Physiological phimosis
      • Note: These conditions do not require treatment, only reassurance.

    Head Swellings in Newborn

    FeatureCaput succedaneumCephalhematomaSub galeal hemorrhageIncidence/severitymore commonLess commonmore severeExtentDiffuse swellingLocalised swellingDiffuse swellingPlanSuperficialDeepSuperficialLocationScalpSub-pereostealBelow galea aponeuroticaReasonD/t prolonged labour, venous congestionD/t trauma to skull in instrumental deliveryTraction on layers of scalp, separation of scalp layersContentFluid leakageBloodBlood (Fluctuant swelling)OnsetAt birth/soon after birthSlowly increased after 12-24 hr after birthAppears soon after birthRecovery2-3 days after birth3-8 wks after birthAssociationsNoneLinear skull fractures.Jaundice (D/t heme breakdown).Shock (D/t ↓ blood volume).Pallor.Jaundice.

    Prenatal Baby Assessment

    • Antenatal Assessment:
      • Based on mother's last menstrual period (LMP).
      • Based on first-trimester ultrasound scan.
    • Postnatal Assessment:
      • Expanded New Ballard Score (ENBS):
        • Neuro muscular maturity and physical maturity.
        • Total score range: -10 to +50.
        • -10 to 20 weeks.
        • +50 to 44 weeks.
        • Accuracy: ±1 week.

    Physical Maturity Table:**

    FeatureScore 0Score 1Score 2Score 3Score 4Score 5WeeksSkinSticky,friable, transparentGelatinous,red translucentSmooth,pink visible veinsSuperficial peeling and/or rash; few veinsCracking,pale areas; rare veinsParchment; deep cracking; no vesselsLeathery,cracked,wrinkledLanugoNoneSparseAbundantThinning---Heel-toe40-50 mm>50 mm, no crease-----Plantar SurfaceEar

    Differences Between Preterm & Term Baby

    Features

    FeaturePreterm BabyTerm BabyPosture of limbsExtended (↓ tone)Flexed (Normal tone)Square window testAbsentPresentArm recoilFingers do not touch forearm (↓ flexibility)Finger touches forearm (Flexible worst)Scarf signElbow does not cross midline (D/t↓ tone & resistance)Elbow does not cross midlinePopliteal angle (Angle b/w thigh & leg when flexed)ObtuseNot possibleHeel to earPossibleNot possibleBreast buds5 mmExternal genitalia- FemaleBoth labia majora & labia minora seenOnly labia majora seen (Labia minora hidden)External genitalia-MaleEmpty scrotum d/t incomplete descent of testisScrotum: more pigmented Scrotum contains testis (Fully descended by 36 weeks)Lanugo hairAbundantLess/absentEar pinna recoilSlow (D/t poorly developed elastic cartilage)Fast

    Complications of Preterm Birth

    • Respiratory distress syndrome (RDS): D/t surfactant deficiency.
    • Necrotizing enterocolitis (NEC).
    • Intraventricular hemorrhage: D/t bleeding from germinal matrix into ventricles (Fragile blood vessels).
    • Kernicterus: Bilirubin crosses immature blood-brain barrier (BBB).

    Normal Observations in a Newborn

    Sign0aActivity (muscle tone)Limp (Absent tone)Some flexionPulse (Heart rate)Nil100/minCry/cough or sneezeCry/cough or sneezePink all overPink all overGood cryGood cry

    APGAR Scoring

    • Timing: 1 min after birth Followed by
    • Total maximum score: 10.
    • Total minimum score: 0.
    • Normal APGAR score: 7 to 10/10.
    • Low APGAR score: < 7/10.

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    Test your knowledge on the essential steps of neonatal resuscitation and airway management. This quiz covers topics like initial assessment, the timeline of intervention, and endotracheal intubation techniques. Perfect for medical students and professionals involved in neonatal care.

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