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3b. CHILD HEALTH > Healthy Child Programme > Flashcards

Healthy Child Programme Flashcards

1
Q

When is sickle cell disease and thalassaemia screened for in pregnancy?

A

From preterm to 10 wks

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2
Q

Describe how sickle cell and thalassaemia is screened for in the UK. How should a positive baby be managed?

A 
Low incidence (<1.5/10,000) - family origin questionnaire (FOQ)
High incidence (>1.5/10,000) - FOQ and genetic tests.
Standard vaccinations and penicillin < 3 months old
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3
Q

What supplementation is recommended from preconception through pregnancy?

A

Folic acid, vitamin D 10ug/day

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4
Q

When should birth communicable disease and rhesus status be assessed?

A

Weeks 8-12

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5
Q

Which communicable diseases are screened for at weeks 8-12 gestation?

A

Hepatitis B (HBV), HIV, syphilis, and rubella

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6
Q

Describe the early foetal anomaly screening programme (FASP), conducted between 10-14wks.

A

Combined screening test (BUN):

  • blood tests (free beta HCG, PAPP-A)
  • ultrasound
  • nuchal translucency (NT)
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7
Q

Describe the late foetal anomaly screening programme (FASP), conducted between 14-20wks.

A

Quadruple blood tests:

  • free beta HCG
  • AFP
  • inhibin A
  • unconjugated oestriol
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8
Q

Which tests are used for further genetic screening regarding FASP?

A

Chorionic villous sampling (CVS), amniocentesis

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9
Q

What are the most common complications of Down syndrome?

A
  • heart defect
  • hearing impairment
  • Alzheimer’s
  • leukaemia
  • epilepsy
  • obesity
  • coeliac disease
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10
Q

Identify the four body areas assessed on post-birth physical examination and their associated diseases.

A

Eyes (cataract)
Heart (VSD, TGA, ToF)
Hip (DDH)
Testes (cryptorchidism)

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11
Q

When should the newborn hearing screening programme be conducted? Which two tests are used?

A

0-5wks after birth

  • automated otoacoustic emission test (AOAE)
  • automated auditory brainstem response (AABR)
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12
Q

When should the bloodspot test be conducted? Which type of inheritance does this screen for?

A

ideally 5 days (up to 8)

8/9 of the conditions screened for are autosomal recessive (CHT is not)

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13
Q

What are the nine conditions screened for on the bloodspot?

A
  • phenylketonuria (PKU)
  • congenital hypothyroidism (CHT)
  • SCT
  • CF
  • medium chain acyl CoA dehydrogenase deficiency (MCADD)
  • maple syrup urine disease (MSUD)
  • homocystinuria (HCU)
  • isovaleric acidaemia (IVA)
  • GC1 (?)
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14
Q

When should physical examinations be performed on the newborn?

A

<72hrs after birth

6-8wks after birth (usually by a GP)

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15
Q

What is progressive universalism?

A

Tailoring services to the needs and circumstances of the family.

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16
Q

Define sensitivity, specificity, and positive predictive value.

A

Sensitivity (correct true +)
Specificity (correct true -)
PPV (chance of a person having a disease after a + screening test)

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17
Q

If a test has low specificity, what does this mean?

A

(high spec = true -ve)

low spec means many false +ves)

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18
Q

If a test has low sensitivity, what does this mean?

A

(high sens = true +ve)

low sens means many +ve cases are missed

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19
Q

What are the benefits of breastfeeding for the baby?

A
  • lower risk of infection (esp GI)
  • contains nutrients, hormones, growth factors
  • easier to digest than infant formula
  • lower risk of SIRS, obesity, and CVD
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20
Q

What are the benefits of breastfeeding for the mother?

A

reduced risk of breast and ovarian cancer, osteoporosis, obesity, and cardiovascular disease

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21
Q

What does the NHS recommend for feeding a baby within the first year?

A

Exclusively breastmilk for first 6 months (nothing is superior)
From 6 months, complementary foods can be added

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22
Q

When should a mother not breastfeed?

A

If she has HIV, or taking medication that could affect baby’s growth

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23
Q

Describe the let-down reflex.

A

Nipple stimulation -> brain recieves stimulation -> brain releases oxytocin and prolactin -> breast secretes milk

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24
Q

What are the actions of oxytocin and prolactin on the mother and baby?

A

Oxytocin - contracts alveolar muscle, improves mothers and babies mood/bond
PRL - causes milk glands to secrete milk

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25
Describe colostrum and when it is first produced.
First produced mid-pregnancy. High concentration, gold-yellow. Baby needs only a few gulps
26
When should a baby be fed?
Whenever they make signs of hunger (responsive feeding); this is ideally 8-12 times every 24h in first few weeks
27
What are the signs of hunger in a baby? (early, mid, late)
Early: stirring, mouth opening, head turning Mid: stretching, physical movement, hand to mouth Late: redness, agitation, crying (last sign)
28
What are the signs of healthy growth in a baby after 5-6 days?
- 6+ wet nappies/day | - 2+ soft-runny stools/day
29
What are the four protein bases for infant formula in the EU?
Cows', goats', soya, and hydrolysed
30
Describe the protein composition of cows' and goats' milk, compared to human milk.
proteins - whey, casein - human (mainly whey) - goats'/cows' (whey:casein 60:40)
31
Regarding soya based infant formula; - when is it recommended? - is it suitable for vegetarians/vegans? - what must it be supplemented with? - describe its relationship with CMPA.
- only recommended with supervision > 6 months - yes vegetarian, no vegan (vitamin D comes from lanolin from sheep wool) - lacks sulfur-based amino acids; supplement with L-methionine - cannot be recommended for those with the allergy, or preventitive
32
When does a baby co-ordinate sucking, swallowing, and breathing?
34-36 weeks
33
Describe how preterm infants should be fed.
- may need OG, NG, or IV tube feed - feed every 3hr to keep blood sugar stable - can express breast milk for later use
34
How should a preterm infant be kept warm?
1st line - skin to skin contact (Kangaroo care) 2nd line - heated (transwarmer) mattress Other options - incubators, plastic bag under radiant heater
35
Describe the storage options for expressed breast milk.
- fridge <8 days <4dC - ice compartment of fridge <2 weeks - freezer <6 months
36
What are the three classifications of preterm babies and when do they span?
(preterm = 23wks - 37wks) - extremely preterm (23-28) - very preterm (29-32) - moderate to late preterm (33-37)
37
Which weeks in gestation are term?
38-42 weeks
38
Name some societal factors that contribute to increased preterm birth.
- increased maternal age - increased rate of complication - greater use of infertility treatment - more caeserean section
39
Name some maternal factors that contribute to increased preterm birth.
- interval <6 months between pregnancies - IVF - smoking, alcohol, drug use - poor nutrition, diabetes, hypertension etc.
40
Why does a preterm infant struggle with thermal regulation, when compared to a term infant?
Low BMR, minimal muscle activity, negligible s.c. fat
41
Why does a preterm infant struggle with nutritional regulation, when compared to a term infant?
Limited nutrient reserves, gut immaturity, immature metabolic pathways, increased demand for nutrients
42
Which organisms are responsible for early onset, and late onset, neonatal sepsis?
EOS - group B strep, gram negatives | LOS - coagulase negative staph, staph aureus, and gram negatives
43
Which factors may lead to neonatal sepsis?
Preterm, immature immune system, in intensive care environment, indwelling lines and tubes
44
What are the signs and treatment of respiratory distress syndrome (RDS)?
intercostal recession, grunting, tachypnoea, nasal flaring, cyanosis maternal steroids, surfactant, ventilation
45
What is the treatment for patent ductus arteriosus?
Paracetamol or ibuprofen (works by prostaglandin inhibition)
46
What are the early and late metabolic complications that may arise in preterm infants?
Early - low glucose, Na | Late - osteopenia
47
What is the normal birthweight for a term infant?
2.5 - 4kg (outside this range is large for gestational age LGA, or small for gestational age, SGA)
48
Which factors in the mother may risk hypoxia to the foetus during birth? What does the foetus have for dealing with hypoxia during contractions?
- smoking, drug use, preeclampsia | - foetus has HbF (2 alpha, 2 gamma subunits) which delivers oxygen more efficiently to hypoxic areas
49
Name the categories and scoring of the Apgar system.
(A)ppearance (colour) - (pale - blue extremities - pink) (P)ulse (HR) - (no pulse - <100bpm - >100bpm) (G)rimace (responsiveness) - (floppy - minimal - prompt) (A)ctivity (tone) - (none - flexed extremities - active) (R)espiratory rate - (none - slow - vigorous) Score given out of 10 (0 - 1 - 2); 8 or above is normal
50
Why is vitamin K given to the newborn?
To prevent haemorrhagic disease of the newborn (spontaneous bleed of GI, lung, CNS) IM covers first month; oral preperation available if parents don't want injections
51
Name and describe the two main head abnormalities of the newborn.
Caput succeolenum (fluid collects between skin and epicranial aponeurosis) Cephalohaematoma (between epicranial aponeurosis and skull periosteum) Both are harmless and resolve <3 months.
52
Describe the key observations in the top-to-toe systemic examination of the newborn.
- eye (red reflex - cataract) - ear (tags/pits - sign of systemic disorder) - mouth (tongue tie, cleft palate, sucking reflex) - respiratory (grunting, in-drawing, breath sounds) - cardiac (SO2 (CHD screen), heart sounds and murmurs) - abdomen (hernia, bile stained vomitus, meconium, patent anus) - GU (passage of urine, normal genitalia) - MSK (movement/posture, DDH, spina bifida) - Neuro (alert, responsive, crying, reflexes) - Skin (erythema toxicum, Mongolian blue spot) (n. b.; it is important to note conjunctival haemorrhage or Mongolian blue spot in case there is future concern over parental abuse)
53
Name the five main GI surgical problems of the neonate and give key signs/treatment.
Necrotizing enterocolitis (NEC) - bacteria enters the gut and causes air bubbles on the lumen and peritoneum (Rigler sign) Meconium ileus - contrast may help dislodge, otherwise surgery required Jejunal atresia - absence of mesentery Inguinal hernia - x-ray not needed, but if taken shows laddering sign Malrotation - green-tinged vomitus, surgical emergency as risk of volvulus
54
During which timespan is the newborn considered a neonate?
0-27 days
55
Give the key immediate management of the sick term infant.
ABCDE - airway/breathing: use oxygen sparingly - circulation: may need fluids, blood, or resus - disability (DEFG): glucose management, acid-base balance - heart rate (120-140bpm) - resp rate (40-60)
56
What are the key aspects of maternal and infant history for the sick term infant?
Maternal - PMH (diabetes - risk of hypo), pregnancy issues, drugs, and infections (e.g. herpes) Infant - USS (dating, anomaly), delivery, resus
57
What are the main organisms responsible for neonatal infection?
Bacterial - group B strep, E coli, staph Viruses - CMV, parvoviruses, herpesviruses, enteroviruses (usually asymptomatic but may cause cardiomyopathy) Fungal - almost unheard of
58
What are the main respiratory and cardiac diseases of the sick term infant?
``` Resp: - TTN - pneumothorax - tracheo-oesophageal fistula - diaphragmatic hernia Cardiac: - hydrops foetalis (cardiac failure) - PPHN (treat with nitric oxide) - congenital (ToF, TGA, coarctation, hypoplasia, TAPVD) ```
59
What is hypoxic ischaemic encephalopathy?
Perinatal multiorgan damage from hypoxia. Requires active resus and possible therapeutic hypothermia.
60
What are adverse childhood experiences?
Potentially traumatic events that can leave negative lasting effects on health and wellbeing.
61
Name the 10 adverse childhood experiences.
``` Abuse (physical, emotional, sexual) Neglect (physical, emotional) Adversity - mother treated violently - household substance misuse - household mental illness - parent seperation or divorce - incarcerated household member ```
62
What is toxic stress?
Excessive activation of stress response on a child's developing brain and biological systems (including hormonal and immunological)
63
What is the name of the effect on children caused by toxic stress?
Allostatic load
64
What is the name of the transmission of adverse childhood experiences from parent to child?
Intergenerational affect
65
Describe the genetic testing undergone for high risk pregnancies.
``` High risk pregnancy - family genetic disorders - foetal anomaly on scan (e.g. small size, increased nuchal thickness, structural) ------------ Non invasive prenatal testing (free foetal DNA in maternal serum), which allows - sex determination - trisomy testing ------------ After a positive NIFT, invasive testing done; - CVS, 11.5wks - amniocentesis >15wks - allows aCGH ------------ TOP limited to second trimester unless - serious anomaly in the child - risk to mother's life ```
66
What early interventions should be undertaken for a floppy baby?
- respiratory and feeding support - physiotherapy, OT, parental involvement - bloods (genetic, metabolic, congenital infection, CK) - imaging - neurology review
67
Which genetic abnormalities after birth should be screened immediately if suspected?
- myotonic dystrophy - Prader-Willi - spinal muscular atrophy

3b. CHILD HEALTH (3 decks)

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