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Cards (28)

  • Neonatology is important because 40% of under-five mortality in the developing world is due to deaths in the neonatal period (first 28 days of life)
  • Neonates are fully dependent on their caregiver and are at increased risk of hypothermia, hypoglycaemia and infection
  • Adaptation to the outside world: Circulation
    1. Oxygenated blood bypasses the lungs in the fetus
    2. At birth, lung expansion leads to fall in pulmonary vascular resistance
    3. Left atrial pressure rises (more filling) and contributes to closure of the foramen ovale
    4. Oxygenated blood flow through the ductus arteriosus causes closure
  • Adaptation to the outside world: Lungs
    1. Fetal catecholamines released during labour reduce secretion of lung fluid
    2. Lung fluid drains during delivery (thorax squeezed)
    3. Remaining fluid is absorbed by lymphatic and pulmonary circulations when the infant gasps after birth
    4. Marked negative intrathoracic pressure on gasping generates lung expansion and establishes functional residual capacity
  • Gestational age

    Term: 37-42 weeks<|>Preterm: Less than 37 completed weeks<|>Very Preterm: Less than 32 completed weeks<|>Extremely Preterm: Less than 28 completed weeks<|>Post-term: More than 42 weeks
  • Birth weight

    Normal range at term: 2.5-4kg<|>Low birth weight (LBW): 1.5-2.49kg<|>Very low birth weight (VLBW): 1-1.49kg<|>Extremely low birth weight (ELBW): <1kg
  • Growth

    Small for gestational age (SGA): Birth weight <10th centile for gestational age<|>Large for gestational age (LGA): Birth weight >90th centile for gestational age
  • Small for gestational age/IUGR
    • Asymmetrical: More common, suggests failure of growth late in pregnancy, head growth relatively preserved, associated with maternal disease e.g. pre-eclampsia, and multiple gestation
    • Symmetrical: Head growth reduced in line with body, suggests prolonged poor intrauterine growth, fetus may be small but normal, may be chromosomal abnormality or congenital infection
  • Every baby should be examined fully within 24 hours of birth
  • Things to examine in a newborn
    • Head: Circumference, sutures and fontanelle
    • Face: Dysmorphism, cataracts, palate
    • Chest: Heart, breathing
    • Abdomen: Masses, femoral pulses
    • Genitalia and anus
    • Neurology: Tone, spine
    • Hips
    • Skin: Plethora or pallor, jaundice
  • 'Danger signs' in a neonate
    • Unable to breastfeed
    • Drowsy or unconscious
    • Convulsions
    • Respiratory rate <20/min or apnoea (no breathing for >15 seconds)
    • Respiratory rate >60/min
    • Grunting
    • Severe chest indrawing
    • Central cyanosis
  • Factors making a newborn at high-risk of complications
    • Preterm
    • Low birth weight
    • Multiple births
    • Risk factors for infection
    • Congenital abnormality, for example: Cleft lip or palate, Gastroschisis/omphalocoele, Spina bifida
  • Extremely low birthweight

    <1kg
  • How is fetal lung fluid resorbed?
    1. Fetal catecholamines released during labour reduce secretion of lung fluid
    2. Lung fluid drains during delivery (thorax squeezed)
    3. Remaining fluid is absorbed by lymphatic and pulmonary circulations when the infant gasps after birth
  • Neonatology is important because 40% of under-five mortality in the developing world is due to deaths in the neonatal period (first 28 days of life)
  • Neonates are fully dependent on their caregiver and are at increased risk of hypothermia, hypoglycaemia and infection
  • Adaptation to the outside world: Circulation
    1. Oxygenated blood bypasses the lungs in the fetus
    2. At birth, lung expansion leads to fall in pulmonary vascular resistance
    3. Left atrial pressure rises (more filling) and contributes to closure of the foramen ovale
    4. Oxygenated blood flow through the ductus arteriosus causes closure
  • Adaptation to the outside world: Lungs
    1. Fetal catecholamines released during labour reduce secretion of lung fluid
    2. Lung fluid drains during delivery (thorax squeezed)
    3. Remaining fluid is absorbed by lymphatic and pulmonary circulations when the infant gasps after birth
    4. Marked negative intrathoracic pressure on gasping generates lung expansion and establishes functional residual capacity
  • Gestational age

    Term: 37-42 weeks<|>Preterm: Less than 37 completed weeks<|>Very Preterm: Less than 32 completed weeks<|>Extremely Preterm: Less than 28 completed weeks<|>Post-term: More than 42 weeks
  • Birth weight

    Normal range at term: 2.5-4kg<|>Low birth weight (LBW): 1.5-2.49kg<|>Very low birth weight (VLBW): 1-1.49kg<|>Extremely low birth weight (ELBW): <1kg
  • Growth

    Small for gestational age (SGA): Birth weight <10th centile for gestational age<|>Large for gestational age (LGA): Birth weight >90th centile for gestational age
  • Small for gestational age/IUGR
    • Asymmetrical: More common, suggests failure of growth late in pregnancy, head growth relatively preserved, associated with maternal disease e.g. pre-eclampsia, and multiple gestation
    • Symmetrical: Head growth reduced in line with body, suggests prolonged poor intrauterine growth, fetus may be small but normal, may be chromosomal abnormality or congenital infection
  • Every baby should be examined fully within 24 hours of birth
  • Things to examine in a newborn
    • Head: Circumference, sutures and fontanelle
    • Face: Dysmorphism, cataracts, palate
    • Chest: Heart, breathing
    • Abdomen: Masses, femoral pulses
    • Genitalia and anus
    • Neurology: Tone, spine
    • Hips
    • Skin: Plethora or pallor, jaundice
  • 'Danger signs' in a neonate
    • Unable to breastfeed
    • Drowsy or unconscious
    • Convulsions
    • Respiratory rate <20/min or apnoea (no breathing for >15 seconds)
    • Respiratory rate >60/min
    • Grunting
    • Severe chest indrawing
    • Central cyanosis
  • Factors making a newborn at high-risk of complications
    • Preterm
    • Low birth weight
    • Multiple births
    • Risk factors for infection
    • Congenital abnormality, for example: Cleft lip or palate, Gastroschisis/omphalocoele, Spina bifida
  • Extremely low birthweight

    <1kg
  • How is fetal lung fluid resorbed?
    1. Fetal catecholamines released during labour reduce secretion of lung fluid
    2. Lung fluid drains during delivery (thorax squeezed)
    3. Remaining fluid is absorbed by lymphatic and pulmonary circulations when the infant gasps after birth