Difficulty feeding Flashcards

1
Q

What should you consider in a child with difficulty feeding

A
  • ? cleft palate
  • CHD - signs of resp distress/infection
  • Dysmorphia
  • Hypotonia - neuromuscular conditions
  • oesophageal or choanal atresia
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2
Q

What position may a baby make with hypotonia

A

from leg position

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3
Q

How does unilateral coanal atresia present

A
  • noisy breathing
  • feeding difficulties
  • choking
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4
Q

How does bilateral choanal atresia present

A

cyanosis at birth when not crying
they have to breath through their mouth
passing a NGT bilaterally without idfficulty would rule this out

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5
Q

What is choanal atresia

A

congenital disorder where the back of the nasal passage is blocked - abnormal bony or soft tissues

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6
Q

What is the management of choanal atresia

A

stent

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7
Q

What is oesophageal atresia

A

blind ending oesophagus

can involve a fistulae communicating between esophagus and trachea - tracheoesophageal fistula

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8
Q

What other conditions is oesophageal atresia associated with

A
  • VACTERL
  • CHARGE syndrome
  • Trisomies 13/18/21
  • Others: DiGeorge/Fanconi/Pierre-Robin
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9
Q

What is VACTERL

A
  • vertebral defects
  • anorectal malformation
  • CV defects
  • tracheo-oesophageal defects
  • Renal abnormalaties
  • Limb defects
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10
Q

What is CHARGE syndrome

A
  • Coloboma
  • Heart defects
  • Atresia choanae
  • Retarded development
  • Genital hypoplasia
  • Ear abnormalaties
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11
Q

What is coloboma

A

gap in iris, usually at the bottom of the eye, think Maddie McCann

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12
Q

What features would you expect to see on antenatal scan in a foetus with oesophageal atresia?

A

maternal polyhydramnios
small or absent fetal stomach bubble
- sensitivity of 50%

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13
Q

What is the post-natal presentation of oesophageal atresia

A
  • first few hours of life
  • respiratory distress
  • choking
  • feeding difficulties
  • frothing at the mouth
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14
Q

Investigations for oesophageal atresia

A
  • inability to pass NGT

- If passes into a blind end pouch it curls up and can be seen on CXR

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15
Q

Management of oesophageal atresia

A

surgical repair which usually involves ressecting the fistula
next step will depend on the gap between the stomach and oesophagus

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16
Q

Post operative complications of oesophageal atresia

A
  • anastomotic leak
  • stenosis at anastomotic sight
  • oesophageal dysmotility
  • GORD
17
Q

Common causes of polyhydraminios

A
  • idiopathic 50%
  • GI anomalies
  • skeletal dysplasia
  • fetal neuromuscular conditions
  • renal anomalies
  • trisomy 13/18/21
  • maternal diabetes
  • multiple pregnancy
  • fetal anaemia
    congenital infections
  • hydrops fetalis
18
Q

What GI anomalies impair fetal swallowing

A

oesophageal atresia
duodenal atresia
congenital diaphragmatic hernia

19
Q

Why can skeletal dysplasia cause polyhydramnios

A

insufficent thoracic space to facilitate oesophageal development

20
Q

Which congenital infections can lead to polyhydramnios

A
  • parvovirus B19
  • rubella,
  • cytomegalovirus