B PAEDS PART 1 TO DO Flashcards
TOF
What is the management of a hyper-cyanotic tet spell in TOF?
- Morphine for sedation + pain relief
- IV propranolol as peripheral vasoconstrictor
- IV fluids, sodium bicarbonate if acidotic
TGA
What are the investigations for TGA?
- May be Dx antenatally, pre (R arm) + post duct (foot) sats
- CXR may show narrow mediastinum with ‘egg on its side’ appearance
- ECHO confirms Dx
COARCTATION OF AORTA
What is the clinical presentation of coarctation of aorta?
How may it present if severe?
- Weak femoral pulses + radiofemoral delay
- Systolic murmur between scapulas or below L clavicle
- Heart failure, tachypnoea, poor feeding, floppy
- LV heave (LVH)
- Acute circulatory collapse at 2d as duct closes (duct dependent)
HYPOPLASTIC LEFT HEART
What is the clinical presentation of HLHS?
- Sickest neonates with duct-dependent circulation
- No L side flow so ductal constriction > profound acidosis + rapid CV collapse
- Weakness or absence of all peripheral pulses
EBSTEIN’S ANOMALY
What is Ebstein’s anomaly associated with?
- Wolff-Parkinson-White syndrome + lithium in pregnancy
EBSTEIN’S ANOMALY
What is the clinical presentation of Ebstein’s anomaly?
- Evidence of heart failure
- SOB, tachypnoea, poor feeding, collapse or cardiac arrest
- Gallop rhythm with S3 + S4
- Cyanosis few days after birth if ASD when ductus arteriosus closes
AORTIC STENOSIS
What is aortic stenosis associated with?
- Bicuspid aortic valve + William’s syndrome (supravalvular)
- Also may be mitral stenosis + coarctation of aorta too
AORTIC STENOSIS
What is the normal clinical presentation of aortic stenosis?
- Most asymptomatic with ejection-systolic murmur at upper right sternal edge (aortic area) radiating to neck (carotid thrill)
- Ejection click before murmur
- Palpable systolic thrill
- Slow rising pulses + narrow pulse pressure
PULMONARY STENOSIS
What is the clinical presentation of pulmonary stenosis?
- Ejection systolic murmur at upper left sternal edge with ejection click
- ?RV heave due to RVH
- Critical PS = duct-dependent pulmonary circulation so cyanosis in first few days of life
RHEUMATIC FEVER
What are the major criteria in rheumatic fever?
JONES –
- Joint arthritis (migratory as affects different joints at different times)
- Organ inflammation (pancarditis > pericardial friction rub)
- Nodules (subcut over extensor surfaces)
- Erythema marginatum rash (pink rings of varying sizes on torso + proximal limbs)
- Sydenham chorea
RHEUMATIC FEVER
What are the minor criteria in rheumatic fever?
FEAR –
- Fever
- ECG changes (prolonged PR interval) without carditis
- Arthralgia without arthritis
- Raised CRP/ESR
SUPRAVENTRICLAR TACHYCARDIA
What is the management of a supraventricular tachycardia?
- 1st line = Vagal stimulation (carotid sinus massage, cold ice pack to face)
- 2nd line = IV adenosine
- 3rd line = Electrical cardioversion
- Long term = ablation of pathway or flecainide
INFECTIVE ENDOCARDITIS
What is the management?
High dose IV Abx (penicillin with aminoglycoside like vancomycin) for 6w
TOF
What are some risk factors?
- Rubella,
- maternal age >40,
- alcohol in pregnancy,
- maternal DM
TGA
What is it associated with?
Duct dependent lesion, associated with PDA, ASD + VSD
TRICUSPID ATRESIA
How is it managed?
Shunt between subclavian + pulmonary artery with surgery later
CROUP
What is the management of croup?
- PO dexamethasone 0.15mg/kg 1st line, can repeat at 12h
- Nebulised budesonide (steroid)
- High flow oxygen + nebulised adrenaline (more severe/emergency cases)
- Monitor closely with anaesthetist + ENT input, intubation rare
ACUTE EPIGLOTTITIS
What is the management of epiglottitis?
- Prevention HiB vaccine, rifampicin prophylaxis for close household contacts
- Do NOT examine throat, anaethetist, paeds + ENT surgeon input
- Intubation if severe, may need tracheostomy
- IV ceftriaxone + dexamethasone given once airway secured
PNEUMONIA
How can CXR indicate what the causative organism may be?
- Lobar consolidation (dense white area in a lobe) = pneumococcus
- Rounded air-filled cavities (pneumatoceles) + multi-lobar = S. aureus
PNEUMONIA
What is the management of pneumonia?
- Newborns = IV broad-spec Abx
- Older = PO amoxicillin with broad-spectrum Abx (co-amoxiclav) if unresponsive or influenza
- Macrolides (erythromycin) to cover for mycoplasma, chlamydia or if unresponsive
ASTHMA
What is the stepwise management of chronic asthma in <5y?
- SABA
- SABA + 8-week trial of MODERATE dose ICS
- SABA + LOW dose ICS + LTRA
- stop LTRA and refer to paeds asthma specialist
ASTHMA
What is the stepwise management of chronic asthma >5y?
- SABA
- SABA + LOW dose ICS
- SABA + ICS + LTRA
- SABA + ICS + LABA
- SABA + MART (includes LOW dose ICS)
- SABA + MART (includes MODERATE dose ICS) / SABA + MODERATE dose ICS + LABA
- SABA + HIGH dose ICS/theophylline and seek advise from expert
ASTHMA
What is the management of exacerbations of asthma?
O SHIT ME –
- Oxygen (SpO2 94–98%)
- Salbutamol (spacer or neb B2B, IV if no response to this + ipratropium as 2nd line)
- Hydrocortisone IV or PO pred
- Ipratropium bromide (neb if poor response to salbutamol)
- Theophylline (IV)
- Magnesium sulfate (IV)
- Escalate early > ICU if not improving for ventilation ± intubation
CYSTIC FIBROSIS
What is the pathophysiology of cystic fibrosis?
- Decreased Cl- excretion into airway lumen + increased reabsorption of Na+ into epithelial cells means less excretion of salt (+ so water) > increased viscosity of airway secretion
CYSTIC FIBROSIS
How does cystic fibrosis present in older children + adolescents?
- DM (pancreatic insufficiency)
- Cirrhosis + portal HTN
- Distal intestinal obstruction
- Pneumothorax or recurrent haemoptysis
- Sterility in males as absent vas deferens
CYSTIC FIBROSIS
What are some signs of cystic fibrosis?
- Low weight or height on growth charts
- Hyperinflation due to air trapping
- Coarse inspiration crepitations ± expiratory wheeze
- Finger clubbing
CYSTIC FIBROSIS
What are some typical causes of respiratory tract infections in cystic fibrosis?
- S. aureus
- H. influenzae
- Pseudomonas aeruginosa
- Bulkholderia cepacia associated with increased morbidity + mortality
ASTHMA
What are some risk factors for asthma?
LBW, FHx, bottle fed, atopy, male, pollution
VIRAL INDUCED WHEEZE
What are some risk factors?
Maternal smoking during/after pregnancy + prematurity
VIRAL INDUCED WHEEZE
What is the management?
1st line = PRN salbutamol
2nd line = Montelukast or ICS or both
ASTHMA
What are the important side effects of ICS?
Oral thrush,
adrenal + growth suppression,
DM,
osteoporosis
ASTHMA
What are the important side effects of theophylline?
Vomiting,
insomnia,
headaches
PNEUMONIA
What are the common causes of pneumonia in infants + young children?
RSV most common,
pneumococcus #1 bacterial,
H. influenzae,
Bordatella pertussis,
chlamydia trachomatis
(S. aureus rarely but = serious)
COELIAC DISEASE
What is the aetiology of coeliac disease?
- Genetics = HLA-DQ2 + HLA-DQ8
COELIAC DISEASE
What are the characteristic features seen on small intestinal biopsy?
- Villous atrophy
- Crypt hyperplasia
- Increased intraepithelial lymphocytes
COELIAC DISEASE
What are some complications of coeliac disease?
- Anaemias
- Osteoporosis
- Lymphoma (EATL)
- Hyposplenism
- Lactose intolerance
ABDOMINAL PAIN
What are some causes of recurrent abdominal pain?
- No structural cause in >90%
- GI = IBS, abdominal migraine, coeliac
- Gynae = ovarian cysts, PID, Mittelschmerz (ovulation pain)
- Hepatobiliary = hepatitis, gallstones, UTI
- Psychosocial = bullying, abuse, stress
CONSTIPATION
What are some causes of constipation?
- Usually idiopathic
- Meds (opiates)
- LDs
- Hypothyroidism
- Hypercalcaemia
- Poor diet (dehydration, low fibre)
- Occasionally forceful potty training
CONSTIPATION
What are some red flags in constipation?
- Delayed passage of meconium = Hirschsprung’s, CF
- Failure to thrive = hypothyroid, coeliac
- Abnormal lower limb neurology = lumbosacral pathology
- Perianal bruising or multiple fissures = ?abuse
CONSTIPATION
What is the medical management of constipation?
- 1st = macrogol (osmotic) laxative like polyethylene glycol + electrolytes (Movicol)
- 2nd = lactulose (osmotic) if movicol is not tolerated +/- stimulant e.g. Senna
- 3rd = consider enema ± sedation or specialist manual evacuation
- Continue for several weeks after regular bowel habit then gradual dose reduction
GORD
What are the investigations for GORD?
- Usually clinical but if atypical Hx, complications or failed Tx…
– 24h oesophageal pH monitoring
– Endoscopy + biopsy to identify oesophagitis
– Contrast studies like barium meal
GORD
What are some complications of GORD?
- Failure to thrive from severe vomiting
- Oesophagitis = haematemesis, discomfort on feeding or heartburn, Fe anaemia
- Aspiration > recurrent pneumonia, cough/wheeze
- Sandifer syndrome = dystonic neck posturing (torticollis)
GORD
What is the management of more significant GORD?
- Acid suppression = H2 receptor antagonists (ranitidine) or PPI (omeprazole)
- Surgical Mx (fundoplication) if complications, unresponsive to intensive medical treatment or oesophageal strictures
GASTROENTERITIS
What is a complication of E. coli 0157?
- Destroys blood cells + can lead to haemolytic uraemic syndrome
- Abx increase this risk so avoid
BILIARY ATRESIA
What is the clinical presentation of biliary atresia?
- Prolonged jaundice >2w
- Pale stools + dark urine (obstructive pattern)
- Failure to thrive
- Hepatosplenomegaly
BILIARY ATRESIA
What is the management of biliary atresia?
- Kasai portoenterostomy (attach section of small intestine to opening of liver where bile duct attaches)
- Some will need full liver transplant
- Success decreases with age so early Dx crucial
NEONATAL HEPATITIS
What are some investigations for neonatal hepatitis syndrome?
- Deranged LFTs with raised unconjugated + conjugated bilirubin
- Liver biopsy = multinucleated giant cells + Rosette formation
NEONATAL HEPATITIS
What are 4 main causes of neonatal hepatitis?
- Congenital infection
- Alpha-1-antitrypsin (A1AT) deficiency
- Galactosaemia
- Wilson’s disease
FAILURE TO THRIVE
How is failure to thrive defined by height?
- Mild = fall across 2 centile lines on growth chart
- Severe = fall across 3 centile lines on growth chart
FAILURE TO THRIVE
How does NICE define faltering growth in children by weight?
- ≥1 centile spaces if birth weight was <9th centile
- ≥2 centile spaces if birth weight was 9th–91st centile
- ≥3 centile spaces if birth weight was >91st centile
- Current weight is below 2nd centile for age, regardless of birth weight
KWASHIOKOR
what are the clinical features?
- growth retardation
- diarrhoea
- anorexia
- oedema - defining characteristic
- skin/hair depigmentation
- abdominal distension with fatty liver
KWASHIOKOR
what are the investigations?
bloods - FBC, U+E, serum protein, urine dipstick
- hypoalbuminaemia
- normo/microcytic anaemia
- low calcium, magnesium, phosphate and glucose
HERNIA
what are the risk factors for developing a hernia?
- premature, underweight babies
- male gender
- family history
- medical conditions - undescended testes, CF
- African descent
CHOLEDOCHAL CYST
How may it present?
- Cholestatic jaundice
- abdominal mass
- pain in RUQ
- nausea and vomiting
- fever
CHOLEDOCHAL CYST
what are the investigations?
can be detected on ultrasound before the child is born
after the baby is born, the parent’s may notice lump in RUQ, the following tests are then done:
- CT scan
- cholangiography
CHOLEDOCHAL CYST
what are the different types?
Type 1 - cyst of extrahepatic bile duct (most common)
Type 2 - abnormal pouch/sac opening from duct
Type 3 - cyst inside the wall of the duodenum
Type 4 - cysts on both intrahepatic and extrahepatic bile ducts
LIVER FAILURE
what are the causes?
- chronic hepatitis
- biliary tree disease
- toxin induced
- A1AT deficiency
- autoimmune hepatitis
- wilson’s disease
- CF
- budd-chiari syndrome
- primary sclerosing cholangitis
IBD
what is the histology of ulcerative colitis?
- Increased crypt abscesses,
- pseudopolyps,
- ulcers
COELIAC DISEASE
What is the pathophysiology?
Autoimmune response to alpha-gliadin portion of protein gluten causes inflammation in small intestine (particularly jejunum)
NEONATAL HEPATITIS
How does it present?
- Intruterine growth restriction (IUGR),
- hepatosplenomegaly at birth,
- failure to thrive
- dark urine
NEONATAL HEPATITIS
What is the cause of A1AT deficiency?
AR on chromosome 14
NEONATAL HEPATITIS
What is the presentation of A1AT deficiency?
- Prolonged neonatal jaundice (cholestasis), worse on breast feeding,
- can have (prolonged) bleeding due to vitamin K deficiency,
- COPD
NEONATAL HEPATITIS
How does galactosaemia present?
- Poor feeding,
- vomiting,
- jaundice + hepatomegaly when fed milk
NEONATAL HEPATITIS
What are the genetics for Wilson’s disease?
AR on chromosome 13
CMPA
What is cow’s milk protein allergy (CMPA) associated with?
- More common in formula fed babies
- those with personal or FHx of atopy
NEONATAL HEPATITIS
What is the management of Wilson’s disease?
Penicillamine for copper chelation
PROTEINURIA
What are some causes of proteinuria?
- Transient (febrile illness, after exercise = no investigation)
- Nephrotic syndrome
- HTN
- Tubular proteinuria
- Increased glomerular perfusion pressure
- Reduced renal mass
NEPHROTIC SYNDROME
What are some complications of nephrotic syndrome?
- Hypovolaemia as fluid leaks from intravascular to interstitial space
- Thrombosis due to loss of antithrombin III
- Infection due to leakage of immunoglobulins, weakening the immune system + exacerbated by Tx with steroids
NEPHRITIC SYNDROME
What is the clinical presentation of nephritic syndrome?
- Haematuria (often macroscopic) + proteinuria of varying degree
- Impaired GFR (rising creatinine), decreased urine output + volume overload
- Salt + water retention > HTN (?seizures) + oedema (eyes)
HSP
What are some investigations for HSP?
- Exclude DDx of non-blanching rash
– FBC + blood film (thrombocytopenia, sepsis + leukaemia), CRP, cultures, HSP = afebrile - Urinalysis for proteinuria + haematuria
- PCR to quantify proteinuria
- Renal biopsy if severe renal issues to determine if Tx
HAEMOLYTIC URAEMIC SYNDROME
What are some causes of HUS?
- Mostly E. Coli 0157 producing Shiga toxin, can be Shigella (?Petting zoo)
- Use of Abx + antimotility agents to treat gastroenteritis caused by these pathogens can increase risk of HUS
HAEMOLYTIC URAEMIC SYNDROME
What is the clinical presentation of HUS?
- Prodrome of bloody diarrhoea
- Urine > reduced output, haematuria or dark brown
- Abdo pain, lethargy
- Oedema, HTN, bruising
HAEMOLYTIC URAEMIC SYNDROME
What are some investigations for HUS?
- FBC (anaemia, thrombocytopenia), fragmented blood film
- U+Es reveal AKI
- Stool culture
HAEMOLYTIC URAEMIC SYNDROME
What is the management of HUS?
- ABCDE as emergency
- Often self-limiting so supportive > refer to paeds renal unit for ?dialysis
- Anti-hypertensives, careful fluid balance, blood transfusions
- Plasma exchange if severe + not associated with diarrhoea
HAEMATURIA
What are some non-glomerular causes of haematuria?
- Wilm’s tumour,
- trauma,
- stones (esp if FHx),
- sickle cell disease
- other bleeding disorders
HAEMATURIA
What investigations for haematuria should all patients get?
- Urinalysis + urine MC&S
- FBC, platelets, clotting + sickle cell screen
- U+Es, creatinine, albumin, Ca2+, phosphate
- USS kidneys + urinary tract
UTI
When is a UTI classified as atypical?
- Septicaemia
- Poor urine flow
- Non-E. Coli
- Failure to respond
UTI
What are some risk factors for UTI?
- Incomplete bladder emptying
- Vesico-ureteric reflux
- Structural abnormality (horseshoe kidney, ureteric strictures)
- Inadequate toilet hygiene
UTI
In terms of performing ultrasounds scans in UTI, what are the guidelines?
- USS within 6w if 1st UTI + <6m but responds well to Tx
- within 48h or during illness if recurrent or atypical bacteria
UTI
What is the management of children under 3m in UTI?
ALL children <3m + fever get immediate IV cefuroxime + full septic screen (blood cultures, FBC, CRP lactate, LP etc)
UTI
What is the management of UTI for >3m with upper UTI?
?Admission for IV, if not PO co-amoxiclav for 7–10d
UTI
What is the management of UTI for >3m with lower UTI?
3d PO trimethoprim, nitrofurantoin, amoxicillin or cephalosporin with follow-up if still unwell after 24-48h
UTI
What is a recurrent UTI?
- ≥2 UTIs with ≥1 with systemic Sx (or ≥3 without)
UT ABNORMALITIES
Name 6 urinary tract abnormalities
- Renal agenesis
- Multicystic dysplastic kidney
- Polycystic kidney disease
- Pelvic/horseshoe kidney
- Posterior urethral valves
- Prune-belly syndrome
UT ABNORMALITIES
What are some complications of autosomal recessive polycystic kidney disease?
Often liver involvement with portal + interlobular fibrosis
UT ABNORMALITIES
How can posterior urethral valves present in utero?
What is a complication of posterior urethral valves?
- Oligohydramnios + potentially pulmonary hypoplasia
- Risk of dysplastic kidneys, at its worse if bilateral could lead to potter syndrome
ACUTE KIDNEY INJURY
What is acute kidney injury (AKI)?
What is it characterised by?
- Spectrum of potentially reversible, reduction in renal function
- Rapid rise in creatinine + development of oliguria (<0.5ml/kg/h)
ACUTE KIDNEY INJURY
What are some renal causes of AKI?
- Vascular = HUS, vasculitis, embolus)
- Glomerular = glomerulonephritis
- Interstitial = interstitial nephritis, pyelonephritis
- Tubular = acute tubular necrosis
ACUTE KIDNEY INJURY
What are some investigations for AKI?
- FBC, U+Es (high urea), high creatinine, USS to identify if obstruction
- Can have hyperkalaemia, hyperphosphataemia + metabolic acidosis
CHRONIC KIDNEY DISEASE
What are some causes of chronic kidney disease (CKD)?
- Structural malformations (congenital dysplastic kidney)
- Glomerulonephritis
- Hereditary nephropathies
- Systemic diseases
CHRONIC KIDNEY DISEASE
What is the clinical presentation of CKD?
- Failure to thrive, anorexia + vomiting
- HTN, acute-on-chronic renal failure, anaemia
- Bony deformities from renal osteodystrophy
- Incidental proteinuria, polydipsia + polyuria
CHRONIC KIDNEY DISEASE
What are some investigations for CKD?
- Monitor growth
- FBC = anaemia due to reduced EPO
- U+Es + electrolytes (Ca2+ low, phosphate high)
CHRONIC KIDNEY DISEASE
What is the management of CKD?
- Diet + NG or gastrostomy feeding may be needed for normal growth
- Phosphate restriction + activated vitamin D to prevent renal osteodystrophy
- May need recombinant growth hormone
- Recombinant erythropoietin to prevent anaemia
- Dialysis + transplantation if in ESRF (GFR <15ml/min/1.73m^2)
VESICOURETERIC REFLUX
what is the management?
aim is to prevent renal scarring
- antibiotic prophylaxis
- surgery - not commonly recommended
PYELONEPHRITIS
what are the risk factors?
- vesicoureteral reflux (VUR) = most common + most important
- previous history of UTI
- siblings with a history of UTI
- female sex
- indwelling urinary catheter
- intact prepuce in boys
- structural abnormalities of the kidneys and lower urinary tract
PYELONEPHRITIS
what is the management?
- empirical antibiotics then targeted based on cultures
- severe = hospitalisation and IV antibiotics
PYELONEPHRITIS
how can it be prevented?
children <2yrs diagnosed with a UTI should have a renal USS
NOCTURNAL ENURESIS
what are the causes?
- not waking to bladder signals
- inadequate levels of vasopressin (ADH)
- overactive bladder
- constipation
- UTIs
- Family history
- Anxiety/stress
- poor bedtime routines
NOCTURNAL ENURESIS
what is the presentation of inadequate levels of vasopressin?
- large volumes of urine passed at night
- wet in the early part of the night
- wet more than once per night
NOCTURNAL ENURESIS
what is the presentation of an overactive bladder?
- damp patches that occur at night also occur during the day
- the volume of urine passed is variable
- children often wake after wetting at night
NOCTURNAL ENURESIS
what are the investigations?
- physical examination (back, genitalia + lower limbs)
- urinalysis + MS&C
- bladder scan
- uroflowmetry
- ultrasound
ALPORT SYNDROME
what is the clinical presentation?
- haematuria
- oedema
- hypertension
- loss of kidney function
- progressive hearing loss
- proteinuria
- vision problems
ALPORT SYNDROME
what is the management?
ACE inhibitors
dialysis
kidney transplant
ALPORT SYNDROME
what are the investigations?
- genetic testing
- tissue biopsy
- urinalysis
- hearing tests
RDS
What are some risk factors of RDS?
- Prematurity #1
- Maternal DM
- 2nd premature twin
- C-section
RDS
What are the short and long term complications of RDS?
- Short = pneumothorax, infection, apnoea, necrotising enterocolitis
- Long = bronchopulmonary dysplasia, retinopathy of prematurity
NEC. ENTEROCOLITIS
What are some risk factors for necrotising enterocolitis?
- Very LBW + premature
- Formula feeds (breast milk protective)
- RDS + assisted ventilation
- Sepsis
- PDA + other CHD
JAUNDICE
What are some risk factors for jaundice?
- LBW
- Breastfeeding
- Prematurity
- FHx
- Maternal diabetes
JAUNDICE
What is Gilbert’s syndrome?
How does it present?
- AR deficiency of UDP-glucuronyltransferase = defective bilirubin conjugation
- Unconjugated hyperbilirubinaemia (not in urine), jaundice may only be present if ill, exercising or fasting
HIE
What happens as a result of cardiorespiratory depression?
- Hypoxia, hypercarbia + metabolic acidosis
- Compromised cardiac output reduces tissue perfusion > hypoxic ischaemic injury to brain
HIE
What is used to stage the severity of HIE?
What are the stages?
Sarnat staging –
- Mild = poor feeding, generally irritable + hyperalert, resolves in 24h
- Moderate = poor feeding, lethargic, hypotonic, seizures, can take weeks to resolve
- Severe = reduced GCS, apnoeas, flaccid + reduced/absent reflexes, half die
TORCH
What are the characteristic features of toxoplasmosis?
- Cerebral calcification, chorioretinitis + hydrocephalus
TORCH
What is the clinical presentation of CMV?
- 90% normal at birth
- 5% = hepatosplenomegaly, petechiae at birth, growth issues, neurodevelopmental disabilities (cerebral palsy, epilepsy, microcephaly)
- 5% = problems later in life, mainly sensorineural hearing loss
TORCH
How does syphilis present?
- Rash on soles of feet + hands
- Hutchinson’s triad = keratitis, deafness, small + pointed teeth
MECONIUM ASPIRATION
What are some risk factors for meconium aspiration?
- Post-term deliveries at 42w
- Maternal HTN or pre-eclampsia
- Smoking or substance abuse
- Chorioamnionitis
BRONCHOPULMONARY DYSPLASIA
What investigations would you do for bronchopulmonary dysplasia?
- CXR = widespread areas of opacification, cystic changes, fibrosis
- Formal sleep study to assess SpO2 during sleep supports Dx + guides Mx
PREMATURITY
What are some metabolic complications of prematurity?
- Hypoglycaemia,
- hypocalcaemia,
- electrolyte imbalance,
- fluid imbalance
- hypothermia
JAUNDICE
How does kernicterus present?
What are the outcomes?
- Lethargy, poor feeding > hypertonia, seizures + coma
- Permanent damage = dyskinetic cerebral palsy, LD + deafness
JAUNDICE
What are some side effects of phototherapy?
- Temp instability,
- macular rash,
- bronze discolouration
NEONATAL HYPOGLYCAEMIA
What are some risk factors for neonatal hypoglycaemia?
- Preterm + intrauterine growth restriction (IUGR) = lack of glycogen stores
- Maternal DM = infantile hyperinsulinaemia
- LGA, polycythaemia or ill
- Transient hypoglycaemia common in first hours after birth
LISTERIA INFECTION
what is the clinical presentation?
symptoms are similar to sepsis - listlessness, irritable, poor feeding
- Early onset = low birth weight, obstetric complications, evidence of sepsis soon after birth
- late onset = usually full-term, previously healthy neonates, present with meningitis/sepsis
LISTERIA INFECTION
what is the management?
ampicillin + aminoglycoside (gentamycin)
IBD
How do you treat flares of crohns disease?
PO prednisolone or IV hydrocortisone
IBD
How do you induce remission in Ulcerative colitis?
Mild to moderate disease
- 1st line = aminosalicylate (e.g. mesalazine oral or rectal)
- 2nd line = corticosteroids (e.g. prednisolone)
Severe disease
- 1st line = IV corticosteroids (e.g. hydrocortisone)
- 2nd line = IV ciclosporin
IBD
How do you maintain remission in Ulcerative colitis?
What should be cautioned?
- PO/PR mesalazine, azathioprine or mercaptopurine
- Mesalazine can cause acute pancreatitis
IBD
How do you induce remission in crohns disease?
1st line = steroids (e.g. oral prednisolone or IV hydrocortisone).
If steroids alone don’t work, consider adding immunosuppressant medication under specialist guidance:
Azathioprine
Mercaptopurine
Methotrexate
Infliximab
Adalimumab
IBD
How do you maintain remission in crohns disease?
1st line = Azathioprine or Mercaptopurine
Alternatives:
Methotrexate
Infliximab
Adalimumab
