Breathless Baby Flashcards
History of poor feeding
Volumes of milk (before and now) (mls/kg/day)
Timescale of decline
Why/What happens when baby stops feeding?
Sleepiness?
Parents thoughts on precipitating factor
Minumum milk requirement for a baby up to a month of age
150mls/kg/day
Young child PMH
Scans and screening
Maternal health - congenital infections, vascular episodes following antenatal bleeds, trauma, medication, teratogenic agents including high sugar
Gestation
Mode of Delivery
Weight
Post delivery complications - neonatal unit
Intial inspection of a child
- General dysmorphism
- Neuro - alert, happy, interacting, responding to voice
- colour? jaundiced, mottled
- noises - grunting, stridor, wheeze, crying
- Signs of pain?
- marks or rashes present on his face?
secretions - eyes, nasal
Increased work of breathing
What is a tracheal tug (and AKA)?
Oliver’s sign
Abnormal downward movement of the trachea during systole that can indicate a dilation or aneurysm of the aortic arch
V I N D I C A T E
Vascular Infective, Inflammation, Immune, Neoplastic Degenerative, Developmental Iatrogenic, Idiopathic Coneginital Autoimmune Trauma Endocrine, Environmental
Signs of increased work of breathing?
Nasal flaring Head bobbing, hed thrust back, leant forward Tracheal tug > RR >HR Noise - grunting, wheezing, stridor Visible chest/abdominal movement Colour changes
What is posseting?
The regurgitation of small quantities of undigested milk following each feed
What is tetralogy of fallot?
Four congenital abnormalities:
- Ventricular septal defect (VSD)
- Pulmonary Valve Stenosis
- Misplaced Aorta
- Right ventricular hypertrophy
What is paradoxical breathing?
Instead of moving out when taking a breath, the chest wall or the abdominal wall moves in. Often, the chest wall and the abdominal wall move in opposite directions with each breath.
What is recession? (sternal, intercostal, subcostal)
Recession is a clinical sign of respiratory distress which occurs as increasingly negative intrathoracic pressures cause indrawing
What is dextrocardia?
Dextrocardia is a congenital heart condition in which your heart points toward the right side of your chest instead of the left side
Where to auscultate for a PDA?
Medium pitched, high-grade continuous murmur heard best at the pulmonic position, with a harsh machinelike quality that often radiates to the left clavicle
Over left scapula posteriorly
What is respiratory splinting?
Respiratory splinting is defined as reduced inspiratory effort as a result of sharp pain upon inspiration (severe pleuritic chest pain).
Causes of abnormal respiratory examination in a child
Primary respiratory disease (bronchiolitis)
Cardiac cause - compensation for poor perfusion, hypoxia and possible acidosis
Congenital abnormality (diaphragmatic hernia)
Acute blood loss
Metabolic acidosis/alkalosis
Endocrine (DKA - Kussmauls breathing)
What is 3rd space loss?
Too much fluid moves from the intravascular space (blood vessels) into the interstitial or “third” space-the nonfunctional area between cells. This can cause potentially serious problems such as oedema, reduced cardiac output, and hypotension
Investigations for children with respiratory distress
FBC U and Es LFT CRP Glucose Blood Cultures Lactate Ammonia ECG
Causes of a large heart on X-ray
Large L to R shunts - VSD, PDA Transposition of great arteries (can also be nirmal size) Tricuspid Atresia Truncus Arteriosus Ebstein's Anomaly
Causes of a small heart on X-ray
Fallot’s tetralogy
TAPVD - Infradiaphragmatic(under diaphragm into IVC)
What is TAPVD?
Total Anomalous Pulmonary Venous Drainage
TAPVD is a rare form of congenital heart disease where all four pulmonary veins drain to the systemic venous circulation
Ebstein’s Anomaly
Ebstein’s anomaly is a rare heart defect in which the tricuspid valve fails to form properly
What is truncus arteriosus?
Congenital heart disease in which a single blood vessel (truncus arteriosus) comes out of the right and left ventricles
Define Plethoric and Oligaemic
Plethoric: lung full of fluid (blood)
- L to R shunts - VSD, PDA or cardiac failure
Oligaemic: Reduced volume of fluid (blood)
- Fallot’s tetralogy, pulmonary atresia/stenosis
Areas of VSD
Membranous septum (most common) Muscular septum
Treatment of VSD
If asymptomatic (small and o2 levels adequate) no action taken
Large - surgery is required
Systolic murmurs in children
Fallot's Tetralogy VSD Pul/Aortic stenosis Truncus Arteriosus DORV TAPVD (can be no murmur) Single Ventricle
What is a DORV?
Double Outlet Right Ventricle
Diastolic murmurs in children?
Truncus Arteriosus
Mitral Stenosis
Pul/ Aortic Regurg
Acute management of VSD
Inform senior colleague
O2 (consider CPAP) - caution as can close duct dependent cardiac lesions
Stop oral feeds (consider NGT when stable)
IV maintenance with glucose
IV antibiotics (sepsis)
Symptoms of cardiac failure in children
SOB - tachypnoea, dyspnoea Poor feeding (Weight) Inc. HR Hepatomegaly Poor pulses Acidosis Sweating
Oedema not always seen in children younger than 2/3 years
Management of Cardiac Failure
Diuretics: Furosemide, Amiloride etc. ACE inhibitors: Captopril, Enlapril (shorter acting) O2 (never for duct dependent lesions) Prostin (Prostaglandin E1) Diet/Fluid Intake Inotropes: Dopamine, Dobutamine Angioplasty Surgery
Effects of Prostin
Used in duct dependent lesions
Keeps duct open
Given intravenously
SE: Apnoea, pyrexia, hypotension
Characteristics of PDA
Connects branch pulmonary arteries to the aorta
Bounding pulses
Continuous murmur
Characteristics of Coarctation of the aorta
Constriction of aorta
Femoral weak/absent
Systemic HTN of upper limbs
Commonly associated with other left sided lesions - VSD, bicuspid aortic valve
Risk of necrotising enterocolitis
Most common cyanotic Congenital Heart Disease
Fallot’s Tetalogy
TGA
Complete Atrio-Ventricular Septal Defects
What is TGA?
Transposition of Great Arteries
Deoxygenated blood in aorta, oxygenated blood in pulmonary artery
No murmurs
Clinical presentation of Fallot’s Tetralogy
Central cyanosis
Pulm. oligaemia on CXR
Hypercyanotic episodes
Loud ES murmur (from pulm. stenosis)
Features of AVSD
Atrio-Ventricular Septal defects
Higher incidence in trisomy 21
Left axis deviation on ECG
Conditions associated with congenital heart conditions
Trisomy 13 Trisomy 18 Trisomy 21 Turner's Kartagener's Syndrome DiGeorge
What is Kartagener’s Syndrome?
Autosomal recessive genetic ciliary disorder
Triad of situs inversus (transposition of viscera), chronic sinusitis, and bronchiectasis.
Defective movement of cilia, leads to recurrent chest infections, ear/nose/throat symptoms, and infertility
What is DiGeorge syndrome?
22q11 deletion
Autosomal Dominant
Symptoms include:
Heart defects
Learning difficulties
Cleft Palate
Clinical features of Edward’s Syndrome (13)
1 / 8,000
Low birthweight Prominent occiput Small mouth and chin Short sternum Fixed, overlapping fingers 'Rocker-bottom' feet Cardiac and renal malformations
Clinical features of Patau syndrome (18)
1 / 14,000
Structural defect of brain
Scalp defects
Small eyes (microphthalmia) and other eye defects
Cleft lip and palate
Polydactyly
Cardiac and renal malformations (80% have CHD
Clinical features of Turner’s syndrome? (45 X)
Lymphoedema of hands and feet in neonate (may persist) Spooned-shaped nails Short stature - cardinal features Cubitus Valgus Widely spaced nipples CHD (Coarctation of aorta) Delayed puberty Ovarian dysgenesis - Infertilty Hypothyroidism Renal anomalies Pigmented moles Recurrent otitis media
Treatment of Turner’s
Growth hormone therapy
Oestrogen replacement
Which are tested for the neonatal heel prick test?
MCADD
HCU (Homocystinuria)
Isovalaric Acidaemia
Other metabolic conditions
Sickle Cell
Cystic Fibrosis
Hypothyroidism
Phenylketonuria
Autosomal dominant conditions
Neurofibromatosis
Marfan’s
Familial Adenomatous Polyposis
Features of autosomal dominant inheritance
Males and Females equally affected Transmitted by both sexes Incomplete penetrance Variable expression New mutations Risk to offspring is 50%
Parts of a chromosome?
Telomere
P arm
Centromere
Q arm
What 3 things should you always check in a baby?
Ammonia
Glucose
Gas
Sound and Site of VSD
Pansystolic murmur
Left lower sternal border
