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Paediatrics > 3: Neonatology - Talipes Equinovarus and Congenital Infections > Flashcards

3: Neonatology - Talipes Equinovarus and Congenital Infections Flashcards

1
Q

What is talipes equinovarus also known as

A

Clubfoot

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2
Q

What gender is talipes equinovarus more common

A

Males (2:1)

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3
Q

How can the causes of talipes equinovarus be divided

A
  • Idiopathic (primary)

- Secondary

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4
Q

What % of club foot is secondary

A

20

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5
Q

What are 5 secondary causes of clubfoot

A
  • Spina bifida
  • DDH
  • Oligohydramnios
  • Edward’s
  • Cerebral Palsy
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6
Q

What % of talipes equniovarus is bilateral

A

50

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7
Q

How does the foot appear in clubfoot

A
  1. Inverted
  2. Adducted
  3. Equinus (plantar flexed)
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8
Q

Define vertical talus

A

Rare deformity where the foot appears ‘rocker-bottom’ shape

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9
Q

What condition is vertical talus associated with

A

Edward’s

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10
Q

What causes positional talipes

A

Uterine compression

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11
Q

Explain how positional talipes appear

A
  • Foot is normal size
  • Mild deformity
  • Foot can be passively positioned to normal shape
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12
Q

How does the foot appear in talipes calcenovalgus

A

Foot appears dorsiflexed and everted

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13
Q

What is talipes calcenovalgus associated with

A

DDH

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14
Q

Explain prognosis of talipes calcanevalgus

A

Self-resolving

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15
Q

When is talipes equinovarus identified

A

NIPE

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16
Q

What is used to correct talipes equinovarus

A

Ponsetti method

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17
Q

What is the poinsetti method

A

The foot is manipulated and placed in a long-leg plaster cast

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18
Q

What will 85% of people with talipes equinovarus require

A

Achilles tenotomy

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19
Q

How is child managed long-term with talipes equinovarus

A

Night-bracing until 4-years

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20
Q

What are congenital infections

A

Infections that are passed from mother to foetus usually trans-placentally or during delivery

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21
Q

What are the TORCH infections

A 
Toxoplasmosis 
Other 
Rubella
Cytomegalovirus 
HSV
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22
Q

What 4 infections are included in ‘other’

A
  • Parvovirus

-

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23
Q

What is the most-common congenital infection in the UK

A

CMV

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24
Q

Where is toxoplasmosis gondii aquired from

A
  • Undercooked meats

- Handling cat faeces

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25
Q

What % of foetuses are infected with toxoplasmosis if mother is

A

40

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26
Q

What % of foetuses infected with toxoplasmosis are symptomatic

A

10

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27
Q

What is the classical triad of congenital toxoplasmosis (HIC)

A

Hydrocephalus

Intracranial lesions presenting as ring-enhancing lesions on MRI

Chorioretinitis

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28
Q

What is used to confirm foetal infection with toxoplasmosis

A

Amniocentesis

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29
Q

What are two conservative measures to avoid toxoplasmosis

A
  • Do not handle cat faeces

- Avoid undercooked meats

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30
Q

What can be given to mother’s infected with toxoplasmosis to prevent foetal transmission

A

Spiramycin

Spiramycin does NOT treat foetal infection

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31
Q

How is toxoplasmosis treated

A

Pyrimethamine and sulfadiazine for 6W

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32
Q

What organism causes syphilis

A

Treponema pallidum pallidum

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33
Q

How is syphilis transmitted

A

Transmitted to mother sexually and then vertically to foetus

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34
Q

When does risk of vertical transmission increase with syphilis

A

Risk of vertical transmission increases with gestation

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35
Q

What is early congenital syphilis

A

Onset syphilis before 2-years

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36
Q

How does early congenital syphilis present

A
  • Hepatosplenomegaly
  • Jaundice
  • Painless lymphadenopathy
  • Osteodystrophy
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37
Q

What is late congenital syphills

A

Onset syphilis after 2-years

38
Q

How does late congenital syphilis present

A

Hutchinson’s triad

39
Q

What is hutchinson’s triad (HIS)

A
  1. Hutchinson’s teeth
  2. Interstitial keratitis
  3. SNHL
40
Q

What are other features of late congenital syphillis, aside from hutchinson’s triad

A
  • Saddle nose
  • Mulberry molars
  • Saber shins
41
Q

What is used to treat syphilis

A

Penicillin G

42
Q

What is prognosis of in-utero syphilis

A

40% still-birth

43
Q

What is chickenpox

A

Primary infections tih VZV

44
Q

What is shingles

A

Re-activation of VZV from DRG

45
Q

What is the risk of VZV in pregnancy

A

Foetal varicella syndrome

46
Q

What is risk of VZV infection in pregnancy to mother

A

Pneumonitis

47
Q

When is the risk of foetal varicella syndrome highest

A

If transmitted before 20W

48
Q

When are NO cases of VZV transmission seen

A

Beyond 28W

49
Q

What are the symptoms of foetal varicella syndrome

A
  • Hypoplastic limbs
  • Hypertrophic scars
  • Seizures
  • Hydrocephalus
  • Cortical atrophy
50
Q

What is neonatal varicella virus

A

When mother is infected 5d prior to delivery to 2d afterwards she can transmit during vaginal delivery

51
Q

What is the risk of neonatal varicella

A

High mortality

52
Q

What is the prognosis of neonatal varicella

A

High mortality

53
Q

How can foetal varicella be diagnosed

A

PCR of amniotic fluid

54
Q

If suspect mother has VZV what should you do

A

Test for antibodies

55
Q

If not immune, what do you give to the mother

A

IVIg VZV

56
Q

When is VZV IVIg effective

A

If given in 10d

57
Q

What time frame should oral acyclovir be given

A

24h of rash-onset

58
Q

When does parvovirus B19 affect infants if transmitted

A

Before 20W

59
Q

What does parvovirus B19 cause if vertically transmitted

A

Severe anaemia

Foetal hydros

60
Q

What is foetal hydrops

A

Collection fluid in two or more fluid compartments

61
Q

How is parvovirus B19 examined for

A

Amniotic fluid PCR

62
Q

How is in-utero parvovirus B19 infection managed

A

Foetal blood transfusion

63
Q

What is listeriosis

A

Infection listeria monocytogenes

64
Q

How can listeriosis be transmitted

A

Vertically or during delivery

65
Q

How can listeriosis be transmitted

A
  • Unpasteurised milk: soft-cheese

- Processed vegetables eg. processed salads

66
Q

What does early-onset listeriosis cause

A
  • Systemic infection characterised by disseminated abscesses
67
Q

What does late transmission of listeriosis cause

A

Meningitis

68
Q

What does listeriosis cause if transmitted

A

Pre-mature birth

Spontaneous abortion

69
Q

What is rubella

A

Infection togavirus

70
Q

Why is congenital rubella rare

A

MMR vaccine

71
Q

When is risk of vertically transmitting rubella highest

A

Before 20W

72
Q

When is there no risk of vertically transmitting rubella

A

After 28W

73
Q

How can symptoms of congenital rubella infection be remembered

A

3C’s

74
Q

What are the 3C’s of congenital rubella infection

A

Cataract
Cardiac anomalies: PDA and Pulmonary stenosis
Cochlear defect: bilateral SNHL

75
Q

What cardiac defects are present in congenital rubella

A

PDA and pulmonary stenosis

76
Q

What are early features of congenital rubella

A
  • Jaundice
  • hepatosplenomegaly
  • thrombocytopenia
  • haemolytic anaemia
  • Salt and pepper chorioretinitis
  • Meningitis
  • Pneumonia
77
Q

What are late defects of congenital rubella syndrome

A

Microcephaly

Cerebral palsy

78
Q

If rubella infection prior to 16W, what is the managed

A

Termination

79
Q

If rubella infection after 16W, what is the managed

A

Re-assurance

80
Q

What is the most-common congenital infection

A

CMV

81
Q

How can CMV be transmitted

A

Vertical
Delivery
Breast feeding

82
Q

What is the chance a foetus will be infected if mother has CMV

A

40%

83
Q

What are 3 features of foetal CMV infection

A
  • IUGR
  • oligohydramnios or polyhydramnios
  • US: hyperechogenic bowel, hydrops foetal is
84
Q

What are long-term features of CMV infection

A 
SNHL 
Chorioretinitis 
Blueberry muffin rash 
SGA
Seizures
85
Q

What skin features are present in CMV

A

Blueberry muffin rash

86
Q

What may be seen on CNS imaging in congenital CMV

A

Periventricular calcifications

87
Q

Explain transmission of HSV2 from mother to foetus

A
  • Rare to have trans-placental

- Transmitted during delivery

88
Q

If intra-uterine how may foetus present

A
  • Pre-mature
  • Low birth weight
  • Microcephaly
89
Q

If post-natal how may foetus present

A
  • Skin lesions
  • Keratoconjunctivitis
  • Meningoencephalitis
90
Q

When are women with HSV2 advised to have a C-section

A

If primary infection following 28W gestation

91
Q

If recurrent attack what is risk of transmission

A

Rare

92
Q

What is given to treat neonate of HSV

A

Acyclovir

Paediatrics (61 decks)

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