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Paediatrics > Ch 10 - Neonatal medicine > Flashcards

Ch 10 - Neonatal medicine Flashcards

1
Q

What is Hypoxic-ischaemic encephalopathy (HIE)

A

Perinatal asphyxia due to either placental or pulmonary dysfuction/comprimise resulting in brain damage

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2
Q

Causes of HIE (7)

A

Most cases happen during labour/delivery!
The following are due to reduced gas exchange from placenta: excessive/prolonged uterine contractions
placental abruption
uterine rupture
Interuption of umbilical flow: cord compression, shoulder dystocia, cord prolapse
Inadequate maternal placental perfusion: materal hypo/hypertension - usually causes IUGR as well
Failure of cardiopulmonary adaptation at birth i.e. failure to breathe

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3
Q

Clinical features of HIE can be mild/moderate or severe, give clinical features of mild HIE (3)

A

irritable, excessive response to stim
hyperventilation
staring of eyes + poor feeding

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4
Q

Clinical features of HIE can be mild/moderate or severe, give clinical features of moderate HIE (2)

A

marked ABNORMALITIES of TONE & MOVEMENT
no feeding
may have seizures

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5
Q

Clinical features of HIE can be mild/moderate or severe, give clinical features of severe HIE (4)

A

no response to pain or spontaneous movements
PROLONGED seizures - refractory to treatment
MULTI ORGAN failure
tone - fluctuate between hypo&hypertonia

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6
Q

Management of HIE (4)

A

Resp support + treatment of seizures
Fluid restrict (because of transiet renal impairment)
Treat hypotension with inotropes
Mild hypothermia within 6hrs of birth reduces brai damage (34 C for 3 days)

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7
Q

Prognosis of mild, moderate & severe HIE

A

Mild - complete
moderate - excellent for those who have recovered neurologicallyby 14 days (i.e. normal neuro exam) + feeding normally
severe - 30-40% mortality, > 80% of survivors will have neuro impairment - cerbral palsy

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8
Q

Give 3 examples of soft tissue birth injuries

A

Caput succedaeum
Cephalhaematoma
Chignon

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9
Q

Describe Caput succedaneum (2)

A

bruisig + oedema of presenting part, extending beyond margins of skull bones
resolves in few days

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10
Q

Describe cephalhaematoma (3)

A

haematoma from bleeding below periosteum
confined within margins of skull sutures
usually involves PARIETAL bone
centre of haematoma feels soft - resolves i few weeks

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11
Q

Describe a Chignon (2)

A

Oedema + bruising;

following ventouse delivery

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12
Q

Erb’s palsy definition(1) & causes(2)

A

upper brachial plexus injury (C5-6);

due to shoulder dystocia or breech delivery

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13
Q

Erb’s palsy features(3) & management

A

‘waiter’s tip’ i.e. hand internally rotated + pronated + flexed wrist
deltoid, biceps + brachialis paralysis + atrophy
loss of sensation in arm
manage - if doesnt selve resolve in 2 months refer

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14
Q

Facial nerve palsy: Cause, features (2), management

A

compression of facial nerve against mother’s ischail spine
features - facial weakness on crying + eye stays open
management - it usually is transient; may require methylcellulose drops for eye (lubricant)

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15
Q

Common fractures of neonates (2)

A

Clavicle - due to shoulder dystocia
Humerus/ femur - breech/ shoulder dystocia
both heal rapidly with mobilization

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16
Q

Respiratory distress syndrome: defintion

A

AKA hyaline membrane disease (because of the proteinaceous exudate seen in the airways on histology)
Definition - respiratory distress due to lack of surfactant (which functions to lower surface tension - prevent small alveoli collapse)

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17
Q

Respiratory distress syndrome: causes of surfactant def (4)

A 
Pre-term - usually if before 28 weeks
Sepsis
Diabetic mother
elective cs
2nd twin/ male
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18
Q

Respiratory distress syndrome: features (4)

A

Tachpnoea > 60 bpm
chest wall recession
nasal flaring
ground glass lung appearance (on CxR) + indistinct heart border

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19
Q

Respiratory distress syndrome: prevention/management (2)

A

corticosteroids antenatally - stimulates surfactant production
surfactant therapy

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20
Q

Pneumothorax - pathophysiology in pre-term infants with RDS

A

Overdistended alveoli (due to positive pressure O2 therapy) > some air enters intersitium = PIE (pulmonary interstitial emphysema) > air leaks in to pleural cavity

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21
Q

Pneumothorax - features (2) & Ix (1)

A

Features - Silent Chest with reduced movements on affected side
Ix - transillumination with bright fibre optic light source applied to CW

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22
Q

Pneumothorax - prevention & treatment

A

Prevent via low pressure ventilation

Treat if tension pneumothorax with chest drain

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23
Q

Bronchopulmonary dysplasia: defintion, causes (3), features (2), treatment (2)

A

D - infants who still have O2 requirement after 36 weeks
C - the lung damage comes from ventilation trauma, O2 toxicity & infection
F - Wide spread areas of opacification +/- cystic changes
T - CPAP, steroids

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24
Q

Apnoea and bradycardia and desaturation: causes (4), treatment (2)

A

Cause - mostly because of immaturity of central resp control. However must exclude hypoxia, anemia, infection, hypoglycaemia etc.
Treatment - caffeine, CPAP

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25
Q

Pre-term brain injuries: cause (1 & give common location)

A

Haemorrhages (occur in v. low BW infants) easily recognized on US. (usually occur in germinal matrix above the caudate nucleus - contains a fragile network of blood vessels) - within 72 hrs of life

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26
Q

Complications of pre-term brain injuries (2)

A 
Hydrocephalus (if large intraventricular haemorrhage impairs drainage of CSF). In this case may require ventriculoperitoneal shunt (after symptomatic relief e.g. LP/ventricular tap) 
Periventricular leukomalacia (loss of white matter) - will see BILATERAL CYSTS on US
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27
Q

Necrotising enterocolitis - what is it? who is at risk?

A

Affects pre-term infants in 1st few weeks of life.
Associated with bacterial invasion of ischaemic bowel
Risk - preterm infants fed cow’s milk formula

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28
Q

Necrotising enterocolitis: features (3) x-ray characteristics

A

Infant stops tolerating feeds, get milk aspiration; billous vomiting; distended abdomen; can get bloody stool;
x-ray: air under diaphragm if perf, distended bowel loops, air in portal tract

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29
Q

Necrotising enterocolitis: management (2)

A

stop oral feed
Broad spectrum ABs
parenteral nutrition

30
Q

Retinopathy of prematurity: what is it? cause? treatment?

A

ROP affects developing blood vessels at junction of vascular and non-vascularized retina. It results in vascular prolif which can cause retinal detachment, fibrosis & blindness.
Cause - O2 tox
Treatment - laser therapy

31
Q

Why are Preterm infants especially vulnerable to hypothermia? (4) How to prevent it? (1)

A 
High surface area to mass ratio
Very little subcut fat
Very thin + heat permeable skin
Often nursed naked & cannot curl/shiver to generate heat
INCUBATE
32
Q

Patent ductus arteriosus: features (3)

A

Pulses are ‘bounding’ (from an increased pulse pressure)
Prominent precordial impulse
systolic murmur (“machinery” like)

33
Q

Treatment of Patent ductus arteriosus (1)

A

Prostaglandin synthetase inhibitor e.g. ibuprofen/ indometacin (they cause closure of the PDA)

34
Q

Kernicterus - what is it? features? (4)

A

Encephalopathy due to deposition of unconjugated BR in basal ganglia + brainstem nuclei (due to saturation of albumin binding capacity)
Features - lethargy, poor feeding, hypertonia, irritability, seizures, coma

35
Q

Kernicterus - Causes if present

A

If present haemolyses group A infant), PKD,

36
Q

Kernicterus - Causes if present between 2 & 14 days of life (4)

A

Physiological - adaptation to transition from fetal life
Breast milk - more common + prolonged in breast-fed infants (unconjugated)
Dehydration e.g. if delay in establishing breast feeding
Infection - would develop unconjugated bilirubinaemia from poor fluid intake, haemolysis + reduced hepatic function. This is particularly true of UTIs
Other - Crigler-Najjar syndrome - absence of glucouronyl transferase

37
Q

Kernicterus - Causes if present > 2 weeks post life (conjugated (2) unconjugated (2))

A

Persistent/prolonged jaundice if > 2 weeks of life
BILIARY ATRESIA - main thing to exclude. it gives a CONJUGATED bilirubinaemia (dark urine + pale stools)
other causes of conjugated e.g. neonatal hepatitis syndrome (A1AT def, infection)
Most common cause is unconjugated bilirubinaemia: due to breast-milk jaundice (disappears by 5 weeks of age), UTI, hypothyrdoisim

38
Q

Jaundice management (2)

A

Depends on severity (clinically jaundiced > 80 umol/l)
Gestation - pre-term infants more susceptible to damage so treatment threshold is lower
Management:
Phototherapy - 450nm light converts unconjugated Br to harmless pigment excreted in urine (AE - rash + bronze discoloration)
Exchange transfusion - if Br v. high, blood removed and replaced with donor blood

39
Q

Respiratory distress in term infant: signs (5)

A 
nasal flaring
tachypnoea > 60/min
recession
tracheal tug
expiratory grunting
cyanosis
40
Q

Respiratory distress in term infant: transient tachypnoea of new born - what is it? CxR will show (1), management (1)

A

commonest cause, due to delay in resorption of lung liquid (more common post C-section)
CxR - fluid in horizontal fissure
Manage - O2 maybe, self-resolving usually

41
Q

Respiratory distress in term infant: meconium aspiration: complications (3), features (3), management (1)

A

Meconium may be response to fetal hypoxia
Complications - at birth infants may inhale thick meconium > obstruction + chemical pnuemonitis + predisposing to infection
Features - over-inflated lungs, patches of collapse + consolidation, lung field ‘white out’, can get pneumothorax
managment - artificial ventilation

42
Q

Respiratory distress in term infant: pneumonia- predispositions (3), management (1)

A

Predisposed by PROM, chorioamnionitis + low BW

manage - broad spectrum ABs

43
Q

Respiratory distress in term infant : pneumothorax causes (3)

A

Meconium
Ventilation
RDS

44
Q

Respiratory distress in term infant: persistent pulmonary HTN of new born: associations (3), features (4), management (3)

A

lifethreatining condition associated with:
birth asphyxia, meconium aspiration, RDS, septicaemia
Features - cyanosis, murmur, right to left shunting, pulmonary oligaemia (reduction in blood vol of pulmonary circ)
management - artificial ventilation, inhaled NO, sildenafil

45
Q

Diaphragmatic hernia: Presentation (1), which side usually? (1) features (2)

A

Presents with failure to respond to resusc or resp distress
Usually a left sided herniation via posterolateral foramen of diaphragm
Features - displacement of apex beat + heart sounds to right, poor entry in left side

46
Q

Diaphragmatic hernia: management (2), main complication (1)

A

Pass large NG tube and apply suction to prevent distension of intracthoracic bowel. Once stable surgical repair of diaphragmatic hernia
Complication - main thing is pulmonary hypoplasia - basically the herniated viscera compresses the lungs and prevents their development (in utero)

47
Q

Early onset infection (

A

Usually due to vaginal/ in utero infection (risk increased if PROM/chorioamnionitis)
Presentation - RDS, temp instability
Treat - ABs immediately

48
Q

Late onset infection (>48hrs): RFs (3), most common pathogen(1), treatment (2)

A

Usually due to environment e.g. venous catheters, invasive procedures, tracheal tubes,
Most common pathogen - staph epidermidis
Treatment - immediate Fluocloxacillin + gentamicin

49
Q

Neonatal meningitis: presentation (2) + treatment (1)

A

Bulging fontanelle + neck/back hyperextension

Treat with Cefotaxime

50
Q

GBS: Percentage of women carrying it in vag/faeces (1), RFs for infection (3), treatment (1)

A

10-30%
PROM/ chorioamnionitis/ intrapartum fever
Treat - prophylactic IV AB

51
Q

Listeria monocytogenes infection: RFs (2), complications (3), features (3), Treatment (1)

A

unpasterurized milk/soft cheese/ poultry
may result in - spontaenous abortion/ pre-term delivery or neonatal sepsis
Features - meconium staining of liquor, widespread rash, pneumonia + meningitis (30% mortalitity)
Treatment - ampicillin

52
Q

Gram-ve infections - source (1), treatment (2)

A

usually from central venous lines

treat with Tazocin or gentamicin

53
Q

Neonatal conjunctivitis (opthalmia neonatorum): causative pathogens(4). Typical presentation (2)

A

Gonococcal/chlamydia/HSV-2/S. Aureus/ S. pneumonia
Notifiable disease
Sticky + red eyes on day 3/4
treatment of most can be via saline or neomycin (topical AB)

54
Q

Presentation (2) & Management of gonococcal conjunctivitis (1)

A

Purulent discharge + conjunctival injection + eyelid swelling
IV Cefotaxime

55
Q

Presentation (2) & management of staphylococcal conjunctivitis (1)

A

Purulent discharge + eyelid swelling

PO erythromycin for 2 weeks

56
Q

Umbilical infection - management of inflammation (1) & granuloma (1)

A

Systemic ABs

Silver nitrate

57
Q

HSV Transmission (2) presentation (2), treatment (1)

A

Usually via birth canal, sometimes ascending infection
Presentation: can be localised - herpectic lesions on skin & eye. Or disseminated - encephalitis
treat - Aciclovir

58
Q

Hep B infection management

A

Give both mother and infant Hep B vaccine

59
Q

Neonatal hypoglycaemia: definition (1), causes (4), features (3), Prevention (1), management (2)

A

D -

60
Q

Neonatal seizures: causes (6) management (2)

A

HIE, stroke, metabolic - hypoglycaemia/calcaemia/natreimia, increased ICP, meningitis, kernicterus (1st rule out hypoglyacemia & meningitis)
Treat the cause & anticonvulsants for prolonged seizures

61
Q

Neonatal stroke: prognosis

A

only 20% have hemiparesis/ epilepsy later in childhood

62
Q

Define cleft lip

A

Failure of fusion of frontonasal & maxillary proceesses

63
Q

Define Cleft palate

A

failure of fusion of palatine processes + nasal septum

64
Q

Complications of cleft lip/palate (2)

A

feeding difficulties - choking & coughing; acute otitis media

65
Q

Pierre robin sequence: triad (3), complications(3), management (2)

A 
Small jaw (micrognathia) + posterior displacement of tongue + midline cleft of soft palate
Complications: feeding difficulties + obstruction (due to tongue - cyanotic episodes), failure to thrive
M - self resolves usually, nasopharyngeal airway
66
Q

Oesophageal atresia: Features (3), associations (VACTERL)

A

if suspected a tube is passed and checked by x-ray to see if it reaches oesophagus
Features - salivation/drooling, cyanotic episodes, aspiration
Assocations - polyhydramnios, tracheo-oesophageal fistula. These babies often have other congenital malformations as part of the VACTERL association( Vertebral, Anorectal, Cardiac, Tracheo-Esophageal, Renal, radial Limb)

67
Q

SBO: features (1), causes (5)

A

F - Billous vomiting (unless above ampulla of vater)
Causes:
Duodenal atresia/ stenosis: on axr will see ‘double bubble’ due to stomach distension & duodenal cap on both sides of diaphragm
Jejunal/ileal atresia/stenosis - surgical treatment
malrotation with volvulus - can lead to midgut infarction!
meconium ileus - thick sticky meconium impacted in lower ileum (almost all affected have CF)
Meconium plug - lower intestinal obstruction - spontaneous passing

68
Q

Large bowel obstruction: causes (2)

A

Hirschprung’s disease - absence of myenteric nerve plexus> no meconium passed in 48hrs > abdo distension
Rectal atresia - absence of anus at normal site. Can be a ‘high lesion’ - bowel ends above levator ani muscles
‘low lesion’ - bowel ends below levator ani muscles

69
Q

What is an exomphalos

A

Abdo contents protrude through umbilical ring. Contents covered by amniotic sac + peritoneum.

70
Q

what is a gastroschisis

A

Bowel protrudes through defect anterior abdo wall - not covered in any peritoneum - higher risk of dehydration + protein loss.

Paediatrics (22 decks)

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