3: Neonatology - Talipes Equinovarus and Congenital Infections Flashcards
1
Q
What is talipes equinovarus also known as
A
Clubfoot
2
Q
What gender is talipes equinovarus more common
A
Males (2:1)
3
Q
How can the causes of talipes equinovarus be divided
A
- Idiopathic (primary)
- Secondary
4
Q
What % of club foot is secondary
A
20
5
Q
What are 5 secondary causes of clubfoot
A
- Spina bifida
- DDH
- Oligohydramnios
- Edward’s
- Cerebral Palsy
6
Q
What % of talipes equniovarus is bilateral
A
50
7
Q
How does the foot appear in clubfoot
A
- Inverted
- Adducted
- Equinus (plantar flexed)
8
Q
Define vertical talus
A
Rare deformity where the foot appears ‘rocker-bottom’ shape
9
Q
What condition is vertical talus associated with
A
Edward’s
10
Q
What causes positional talipes
A
Uterine compression
11
Q
Explain how positional talipes appear
A
- Foot is normal size
- Mild deformity
- Foot can be passively positioned to normal shape
12
Q
How does the foot appear in talipes calcenovalgus
A
Foot appears dorsiflexed and everted
13
Q
What is talipes calcenovalgus associated with
A
DDH
14
Q
Explain prognosis of talipes calcanevalgus
A
Self-resolving
15
Q
When is talipes equinovarus identified
A
NIPE
16
Q
What is used to correct talipes equinovarus
A
Ponsetti method
17
Q
What is the poinsetti method
A
The foot is manipulated and placed in a long-leg plaster cast
18
Q
What will 85% of people with talipes equinovarus require
A
Achilles tenotomy
19
Q
How is child managed long-term with talipes equinovarus
A
Night-bracing until 4-years
20
Q
What are congenital infections
A
Infections that are passed from mother to foetus usually trans-placentally or during delivery
21
Q
What are the TORCH infections
A
Toxoplasmosis Other Rubella Cytomegalovirus HSV
22
Q
What 4 infections are included in ‘other’
A
- Parvovirus
-
23
Q
What is the most-common congenital infection in the UK
A
CMV
24
Q
Where is toxoplasmosis gondii aquired from
A
- Undercooked meats
- Handling cat faeces
25
What % of foetuses are infected with toxoplasmosis if mother is
40
26
What % of foetuses infected with toxoplasmosis are symptomatic
10
27
What is the classical triad of congenital toxoplasmosis (HIC)
Hydrocephalus
Intracranial lesions presenting as ring-enhancing lesions on MRI
Chorioretinitis
28
What is used to confirm foetal infection with toxoplasmosis
Amniocentesis
29
What are two conservative measures to avoid toxoplasmosis
- Do not handle cat faeces
| - Avoid undercooked meats
30
What can be given to mother's infected with toxoplasmosis to prevent foetal transmission
Spiramycin
| Spiramycin does NOT treat foetal infection
31
How is toxoplasmosis treated
Pyrimethamine and sulfadiazine for 6W
32
What organism causes syphilis
Treponema pallidum pallidum
33
How is syphilis transmitted
Transmitted to mother sexually and then vertically to foetus
34
When does risk of vertical transmission increase with syphilis
Risk of vertical transmission increases with gestation
35
What is early congenital syphilis
Onset syphilis before 2-years
36
How does early congenital syphilis present
- Hepatosplenomegaly
- Jaundice
- Painless lymphadenopathy
- Osteodystrophy
37
What is late congenital syphills
Onset syphilis after 2-years
38
How does late congenital syphilis present
Hutchinson's triad
39
What is hutchinson's triad (HIS)
1. Hutchinson's teeth
2. Interstitial keratitis
3. SNHL
40
What are other features of late congenital syphillis, aside from hutchinson's triad
- Saddle nose
- Mulberry molars
- Saber shins
41
What is used to treat syphilis
Penicillin G
42
What is prognosis of in-utero syphilis
40% still-birth
43
What is chickenpox
Primary infections tih VZV
44
What is shingles
Re-activation of VZV from DRG
45
What is the risk of VZV in pregnancy
Foetal varicella syndrome
46
What is risk of VZV infection in pregnancy to mother
Pneumonitis
47
When is the risk of foetal varicella syndrome highest
If transmitted before 20W
48
When are NO cases of VZV transmission seen
Beyond 28W
49
What are the symptoms of foetal varicella syndrome
- Hypoplastic limbs
- Hypertrophic scars
- Seizures
- Hydrocephalus
- Cortical atrophy
50
What is neonatal varicella virus
When mother is infected 5d prior to delivery to 2d afterwards she can transmit during vaginal delivery
51
What is the risk of neonatal varicella
High mortality
52
What is the prognosis of neonatal varicella
High mortality
53
How can foetal varicella be diagnosed
PCR of amniotic fluid
54
If suspect mother has VZV what should you do
Test for antibodies
55
If not immune, what do you give to the mother
IVIg VZV
56
When is VZV IVIg effective
If given in 10d
57
What time frame should oral acyclovir be given
24h of rash-onset
58
When does parvovirus B19 affect infants if transmitted
Before 20W
59
What does parvovirus B19 cause if vertically transmitted
Severe anaemia
| Foetal hydros
60
What is foetal hydrops
Collection fluid in two or more fluid compartments
61
How is parvovirus B19 examined for
Amniotic fluid PCR
62
How is in-utero parvovirus B19 infection managed
Foetal blood transfusion
63
What is listeriosis
Infection listeria monocytogenes
64
How can listeriosis be transmitted
Vertically or during delivery
65
How can listeriosis be transmitted
- Unpasteurised milk: soft-cheese
| - Processed vegetables eg. processed salads
66
What does early-onset listeriosis cause
- Systemic infection characterised by disseminated abscesses
67
What does late transmission of listeriosis cause
Meningitis
68
What does listeriosis cause if transmitted
Pre-mature birth
| Spontaneous abortion
69
What is rubella
Infection togavirus
70
Why is congenital rubella rare
MMR vaccine
71
When is risk of vertically transmitting rubella highest
Before 20W
72
When is there no risk of vertically transmitting rubella
After 28W
73
How can symptoms of congenital rubella infection be remembered
3C's
74
What are the 3C's of congenital rubella infection
Cataract
Cardiac anomalies: PDA and Pulmonary stenosis
Cochlear defect: bilateral SNHL
75
What cardiac defects are present in congenital rubella
PDA and pulmonary stenosis
76
What are early features of congenital rubella
- Jaundice
- hepatosplenomegaly
- thrombocytopenia
- haemolytic anaemia
- Salt and pepper chorioretinitis
- Meningitis
- Pneumonia
77
What are late defects of congenital rubella syndrome
Microcephaly
| Cerebral palsy
78
If rubella infection prior to 16W, what is the managed
Termination
79
If rubella infection after 16W, what is the managed
Re-assurance
80
What is the most-common congenital infection
CMV
81
How can CMV be transmitted
Vertical
Delivery
Breast feeding
82
What is the chance a foetus will be infected if mother has CMV
40%
83
What are 3 features of foetal CMV infection
- IUGR
- oligohydramnios or polyhydramnios
- US: hyperechogenic bowel, hydrops foetal is
84
What are long-term features of CMV infection
```
SNHL
Chorioretinitis
Blueberry muffin rash
SGA
Seizures
```
85
What skin features are present in CMV
Blueberry muffin rash
86
What may be seen on CNS imaging in congenital CMV
Periventricular calcifications
87
Explain transmission of HSV2 from mother to foetus
- Rare to have trans-placental
| - Transmitted during delivery
88
If intra-uterine how may foetus present
- Pre-mature
- Low birth weight
- Microcephaly
89
If post-natal how may foetus present
- Skin lesions
- Keratoconjunctivitis
- Meningoencephalitis
90
When are women with HSV2 advised to have a C-section
If primary infection following 28W gestation
91
If recurrent attack what is risk of transmission
Rare
92
What is given to treat neonate of HSV
Acyclovir
