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Disorders of the newborn Cheat Sheet (DRAFT) by

Paediatrics- neonatal medicine

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Respir­atory disease of the newborn

Clinical feature:
- apnoea (>15 secs)
- tachypnoea (RR >60­/min)
- exp grunting
- nasal flaring
- cyanosis
- subcos­tal­/in­ter­costal recession

Commonest causes of rest distress in the newborn:

- Transient tachypnoea of the newborn
- RDS- lack of surfactant
- Meconium aspiration syndrome- post term/f­oetal distress in ureto

Differ­ential diagnosis:

1. Transient tachypnoea of the newborn
2. Resp distress syndrome
3. Meconium aspiration syndrome

4. Infection
5. Pneumo­thorax
6. Non-pulmon causes
7. Congenital diaphr­agmatic hernia
8. Persistent pulmonary HTN of the newborn
 

TTN

- benign and lasts up to 48 hours.
- presents wishing 2 hours of birth
- caused by persistent lung liquid

Risk factors:
1. Male
2. Macrosomia
3. Maternal DM
4. CS

RDS

- Commonest cause is preteen delivery
- Due to structural and functional immaturity
- Risk factors: premat­urity, IDM, male

Pathop­hys­iology:
- Immature type 2 pneumo­cytes so less surfactant
- less alveolar surface area
- less blood vessels in lung
- stiff low volume lungs
- hypo perfusion
- pulmon HTN

Meconium aspiration syndrome

Results in:
- mechanical airway obstru­ction
- chemical pneumo­nitis
- sever hypoxia
- air leaks
- pulmon HTN

Sepsis­/ea­rly­-onset pneumonia

Bacteria from birth canal:
- group B strep
- staph aureus
- gram negative bacilli

Risk factors:
- premat­urity
- ROM (rupture of membranes >24hrs)
- maternal fever
 

Principles of management

Antenatal care:
- good jobs care
- maternal cortic­ost­eriods
- optimal timing of delivery

Postnatal care
- initial evaluation
- effective resus
- safe transfer to NPICU
- proven cold injury

In NPICU:
- neutral temp and humidity
- invasive and non-in­vasive monitoring
- resp support
- water, glucose and e- balance
-nutri­tional support: TPN, milk
- antibi­otics
- adequate analgesia and sedation
- minimal handling policy

Resp support:
- nasal prong O2
- nCPAP; BiPAP
- mechanical ventil­ation
- airway management

Water and glucose infusion
Early parenteral nutrition

Compli­cations of resp distress

- hypoxic injury, shock and organ failure
- IVH
- brain white matter injury
- renal failure, water overload
- hypona­tremia and hyperk­alaemia
- ileus
- pneumo­thorax
- patent arterial duct
- retino­pathy
- iatrogenic injury: vascular, burns, skin necrosis