B MER 62-NEONATOLOGY CRASH COURSE Dr Zainab Vora - Oct 3), 202‘Wunacademy NEONATOLOGY CRASH COURSE DR. ZAINAB VORA MD RADIOLOGY ( AlIMS)(a2) Access both live and Recorded class ‘Soon, you'd be able to access our recorded classes anytime and ‘enywhere aL Study on the device of your choice Benefit rom the exclusive chance ‘of watching your classes ono bigger screen PLUS subscription Choose the best from the best EE GQ Learn from India’s Top Educators ‘Compete in Live for medical exams Tests and Quizzes Personatize your learning experience ‘Test your preparation with our with your favourite educator highly competitive quizzes ‘Access QBank ‘Coming soon Printed Notes with 25,000+ Questions with 12 month & above subscription. High yield clinical questions ‘S00n, you'd be able to access our with effective explanation recorded classes anytime and ‘onywhereIconic subscription Your access to the Best from 2 of the Best Unacademy & PrepLadder: gy With Unacademy All Resources Included in PLUS Subscription © Well-structured Live Batches # Recorded Classes* Covering Full Syllabus © QBank with 25,000+ Questions © Competitive Live Tests & Quizzes © Comprehensive Printed & Digital Notes* oO a Unacademy & PrepLadder: With PrepLadder All Resources of 2021 Dream Pack Including % Clinical & Integrated Essentials © Video Lectures from the Dream Team © QBank 3.0 with Active Guidance, System Tags & More © Rapid Revision & Snapshot © Treasures & 2021 Dream NotesateNET PG subscription samantha amanthe rd eer rises aur ano NET PG subscription ~ 48months 18 months months = = = -=_ = mor besa} a a =DATE Brant) TOPIC Py 31/10 Sunday 31/10 Sunday 41 Monday 2111 Tuesday at Wednesday ain Thursday 5/11 Friday ( 8pm 14pm 7pm 10pm 7pm 40pm 7pm 7pm 10pm 6pm Crash Course Series (CC): Neonatology YT Live @11pm : FMGE top 100 images Crash Course Series (CC): OBGYN 1, 2 Crash Course Series (CC): Medicine 1, 2 Crash Course Series (CC): Dermatology Crash Course Series (CC): PSM 1,2 Crash Course Series (CC): FMTTERMINOLOGIESLBW- an Ade Any LGA= >a adhe,IODM “ -Congenital j hypothyroidism =Sotos syndrome -BWS - Vi (a) TaRinad tuphabr ClipsvA Nw? Balled seve Expind oS. t & 3 8 8 -& -& ee) oS | SC | S| SE B BR -6- |-& FE As |astet | | | ,-| in| Dre‘Wunacademy NEONATAL RESUSCITATION as Rar olyQ. Order of suction: Mai rare Catheter: In Jy ¥ Pressure: Q. BMV Y) -Start within: bye a Saturation term: ark yen Saturation Iabochashead Q. Epinephrine: ni 410090 mg/kg/dose x3 |10.3mi/kg/dose x3NEONATAL FLOW ALGORITHMTerme | Tone / 4 ! coo + Awl — | OY He <|N C2 sO CL, Le matinNo resuscitation: weer | -Anencephaly -Trisomy: 3 fata -GA: QQ ules —Talo jade © Q. Delayed cord clamping» 3s -60s Q. Vit K at birth— (amg at ban i) Cbg Q.ROP screening- (jp 44 WHO: 422W4 / <1009 ZQwls aw WHEN: 7 Geb) et Q. Hearing test rprchon —acRg OAR) oleaemahe had BEQ. Injectables <31wks- M4 504 <32 wks with PDA- Ibu fof > Indannetece > greeEffective sign of neonatal resuscitation is: a. Color change b. Airentry i Heart rate increases d. None of the above Ideal route of drug delivery in neonatal resuscitation is: a. Intraosseous (be Through umbilical vein c. Through peripheral vein d. Through umbilical artery Correct order of suctioning during neonatal resuscitation is: Mouth-Nose b. Nose-Mouth c. Mouth-Nose-Trachea d. Trachea-Nose-MouthWhich of the following are components of step A? ae eee pe Minute |Warm and maintain normal temperature, Postion ely, ar scretos I stimulate, ‘Apnea or gasping? eee PPV with bag and ier b. ea ider SpO, monitor gees ECG monitor ‘e. Supplement with O, No. t my ch Stay with mother for routine care: ‘Warm and maintain normal temperature, postion airway ‘lear secretions if needed, dry, ‘ongoing evaluation‘Wunacademy IUGR a ®,Q. Best parameter to diagnose IUGR is: a) FL bFAC c) HC d) BPD# Recent Update-ISUOG 2019 IV4R = FaR + <3 Contle <10™ conhile al. “<1 conte + abN ampleQ. True about symmetrical IUGR as compared to asymmetrical IUGR is: pase a) Head circumference lar; b) Associated with oplacental insufficiency c) Reversible one prognosisClassification of IUGR ONSET Early)n utero later onset ETIOLOGY Congenital infections, genetic disorders ‘o-placental insufficiency, Ponte ‘Maternal malnutrition, hypertension PATHOPHYSIOLOGY + Impaired cell division + Impaired cellular hypertrophy + Decreased cell number + Decreased cell size * irreversible * reversible CLINICAL FEATURES * inadequate growth of head and body + rain is spared, therefore + head:abdomen ratio may be normal head:abdomen ratio increased PROGNOSIS Poor prognosis More favorable prognosis Poncloral Index a () das as @)Apgar score 5 Gaimne pula uu ive movement Zoe Score 1 Score 0 Extremities blue Pale or blue <100 bpm No pulse Grimaces or No response to ‘wreak cry stimulation Arms, legs flexed No movement Slow, irregular No breathingTiming: 4) su itati : ole in Ades Resuscitation?: » ~! » “ / selec If 5min <7: Saverely Gapressad hs i7-- <2 —. APGAR stands for: a. Appearance, Pressure, Grimace, Activity respiration a Appearance, Pulse, Grimace, Activity, Respiration c. Appearance, Pressure, Grimace, Activity, Respiration d. Awareness, Pulse, Grimace, Activity, Respiration What should be the ideal temperature in delivery room for the neonates to be kept in warmer? BAEC A - 2E b. 2830°C c. 30-35°C re d. 37°C (0) ary Syn Ww Ponderal index is: a a — Sy = as a. Square root of height in feet by weight in grams (7 W Weight in grams by cube of height in cm 5 > c. Mid-upper arm circumference to head circumference ratio an d. Head circumference to abdominal circumference ratioNEONATAL SEPSIS-MCC of neonatal sepsis—(Liesiid>> -MCC of early onset s sepsis— 4s -Most effective method = preventi on) -Earliest C/f: Chg -loc: Hand a Blood aelne Fae ( amen sd G Lops Suge)Sepsis screen & L/* Leukopenia (TLC < 5000mm‘) | * [Neutropenia (ANC < 1800/mm%) Bd — \\* Immature neutrophil to total neutrophil (I/T) ratio Be M icro-ESR (> 15mm 1 hour) | = c\*]|CRP +ve *If two or more tests are positive treat infant as neonatal sepsisChoice of antibiotics >» Pneumonia or Sepsis Penicillin Aminoglycoside q (Ampicillin or Cloxacillin) (Gentamicin or Amikacin) —= >» Meningitis wey Gentamicin or Amikacin + Cefotaxime GC fi Pneumonia, Sepsis Meningitis, Osteomyelitis (Cont Ab X 7-10D) (Cont Ab X(3-6 wks) bubsSix steps of hand washing A Hand washing « Simplest, most effective measure for preventing () C) (J Pe Eakin * Sprint minutes hand washing prior to entering Wash pine wth fingers Washtectat hands Wash igor 8 kn rursery Oe eile VY) -= pA Bseoond seconds of hand washing before touching a Alcohal based hand based hand rub effective but costly Woah puma ios tr os werk tsNEONATAL CONJUNCTIVITISFindings Treatment Mild conjunctival irritation’ injection & tearing after silver | Eye lubricant nitrate ophthalmic prophylaxis Crnueh Intravenous or Marked eyelid swelling; profuse purulent discharge; | ntramuscular 9ftriaxone or ‘comeal edemalulceration Saran Eyelid swelling; chemosis; watery, bloody, or Oral erythromycin mucopurulent eye discharge =—A 14-day-old infant presented with Conjunctivitis following which 5 days later, the patient developed pneumonitis. What is the most likely causative agent? (May 17) seChlamydia trachomatis b. Streptococcus agalactiae ¢. Gonococcus d. Haemophilus influenzaeHYPOTHERMIA —Temp =) <3é5 '¢ Route- Time- Sule = Physiological aoe ‘enolAxillary temperature in the newborn (°C) fo 37.5° Normal range 36.5° Cold stress = => o 36.0° Moderate hypotlermia— ——————— Severe hypothermia )JET (bn Pach bow ae {brane fa = =—_—Prevention of hypothermia: Warm chain ” wear Warm delivery room (>25°C) 6 Bathing postponed 2. Warm resuscitation 7. Appropriate clothing 3. Immediate drying s. Mother & baby together Skin-to-skin contact 9. Professional alert Cueshe lnk” 5. Breastfeeding 10.( Warm transportationThe Kangaroo method ca ar y 7 mr a Red”NEONATAL JAUNDICE<> or HlntercF-T\Tol ol GUL edam or.) _ B.. Defective uptake from plasma Pee Defective conjugation oe Lp) Terese) Increased entero-hepatic circulationAppears within 24 hours of age Increase of bilirubin > 5 mg / dl / day Serum bilirubin mg / dl Jaundice persisting after 14 days clay / white colored and staining clothes yellow Loy tev edi mg / dlBREAST pl meectnaty VS BREAS' AAUNDICE land S] manrediol Propamadiit | He QQ) Glacnamd’ = —@ Ae le ® ee HeeAppearing within 24 hours of age isease of NB : Rh, ABO Unto (oli ane) Cau ecu aac Appearing between 24-72 hours of life Physiological ns enn leone Mean) eon en emu) e1 Meee nec tte Causes syndrome jaundicefone UbT 4! ay hsCauses Idiopathic neonatakhey Infections -Hepatitis B, TORCH, sepsis ( y atresia, ) Vt S tos i . i hypothyroidismAidt = >2 EHBA d ~~ ¢ INITIAL— (0%) HIGHEST NPV—(1i04 xn) GOLD STANDARD=— Put, banshey [inte Ch -IRRANDIANCE USING FLUX METER: 30 aw | on? [nea =———*Side effects of phototherapy eM ateig 12mg% Consider E hangehoice of blood for exchange blood transfusion yz, 5 ABO incompatibility a US od eel Fea ue (mel eke suspended in AB plasm: Os mneliasear6: abnormal SEVEREModified Downe’s Scoring System Coed 0) Respiratory Rate <60 (rate/min) Cyanosis None in room air Retractions None Grunting None Air Entry Good 60-80 No cyanosis with ‘oxygen support Mild Audible with Stethoscope Decreased >80 Cyanosis in spite ‘oxygen support Moderate to Severe Audible without Stethoscope Barely AudibleStage Systemic signs Abdominal signs Radiographic signs “Gastric retention, 7" Temperature instability, | shdominal distention, ermat or intestinal jon, mild Hleus ‘Same as above Intestinal dilation, ileus, NPO, antibiotics » 7 10 10 days NPO, antibiotics » Sameas tA, plas ascites | NYS ee TNPO, anther a at asp ta ea, combined ‘Same as IA, plus ayeites, paroactentreny soi See Seen | ewitem aa Wester nore mt oe coy oe : seme ern same at ahve pen ‘reePRETERM FEEDINGLBW: Indications for hospitalization o Birth weight <1800 g o Gestation <34 wks o Unable to feed* o Sick neonate*< 2B weeks 28-31 weeks 92-34 weeks > 34 weeks Maturation offeding skils Inadequate sucking efits Lack of gut malty Sucking buss develop Lack of coorinaton between suck, swalow and breathing Sighty mature sucking patter Coortnation between betting ad swalowing begins Mature sucking pattern Coordination between betting and swaloningo Begin at 60 to 80ml/kg/day o Increase by 15ml/kg/day o Maximum of 180-200ml/kg/day o First feed at 2 hrs of age then every 2 hourlyCAPUT VS CEPHALHEMATOMA