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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
Q

Describe colostrum and when it is first produced.

A

First produced mid-pregnancy. High concentration, gold-yellow. Baby needs only a few gulps

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26
Q

When should a baby be fed?

A

Whenever they make signs of hunger (responsive feeding); this is ideally 8-12 times every 24h in first few weeks

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27
Q

What are the signs of hunger in a baby? (early, mid, late)

A

Early: stirring, mouth opening, head turning
Mid: stretching, physical movement, hand to mouth
Late: redness, agitation, crying (last sign)

28
Q

What are the signs of healthy growth in a baby after 5-6 days?

A
  • 6+ wet nappies/day

- 2+ soft-runny stools/day

29
Q

What are the four protein bases for infant formula in the EU?

A

Cows’, goats’, soya, and hydrolysed

30
Q

Describe the protein composition of cows’ and goats’ milk, compared to human milk.

A

proteins - whey, casein

  • human (mainly whey)
  • goats’/cows’ (whey:casein 60:40)
31
Q

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.
A
  • 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
Q

When does a baby co-ordinate sucking, swallowing, and breathing?

A

34-36 weeks

33
Q

Describe how preterm infants should be fed.

A
  • may need OG, NG, or IV tube feed
  • feed every 3hr to keep blood sugar stable
  • can express breast milk for later use
34
Q

How should a preterm infant be kept warm?

A

1st line - skin to skin contact (Kangaroo care)
2nd line - heated (transwarmer) mattress
Other options - incubators, plastic bag under radiant heater

35
Q

Describe the storage options for expressed breast milk.

A
  • fridge <8 days <4dC
  • ice compartment of fridge <2 weeks
  • freezer <6 months
36
Q

What are the three classifications of preterm babies and when do they span?

A

(preterm = 23wks - 37wks)

  • extremely preterm (23-28)
  • very preterm (29-32)
  • moderate to late preterm (33-37)
37
Q

Which weeks in gestation are term?

A

38-42 weeks

38
Q

Name some societal factors that contribute to increased preterm birth.

A
  • increased maternal age
  • increased rate of complication
  • greater use of infertility treatment
  • more caeserean section
39
Q

Name some maternal factors that contribute to increased preterm birth.

A
  • interval <6 months between pregnancies
  • IVF
  • smoking, alcohol, drug use
  • poor nutrition, diabetes, hypertension etc.
40
Q

Why does a preterm infant struggle with thermal regulation, when compared to a term infant?

A

Low BMR, minimal muscle activity, negligible s.c. fat

41
Q

Why does a preterm infant struggle with nutritional regulation, when compared to a term infant?

A

Limited nutrient reserves, gut immaturity, immature metabolic pathways, increased demand for nutrients

42
Q

Which organisms are responsible for early onset, and late onset, neonatal sepsis?

A

EOS - group B strep, gram negatives

LOS - coagulase negative staph, staph aureus, and gram negatives

43
Q

Which factors may lead to neonatal sepsis?

A

Preterm, immature immune system, in intensive care environment, indwelling lines and tubes

44
Q

What are the signs and treatment of respiratory distress syndrome (RDS)?

A

intercostal recession, grunting, tachypnoea, nasal flaring, cyanosis
maternal steroids, surfactant, ventilation

45
Q

What is the treatment for patent ductus arteriosus?

A

Paracetamol or ibuprofen (works by prostaglandin inhibition)

46
Q

What are the early and late metabolic complications that may arise in preterm infants?

A

Early - low glucose, Na

Late - osteopenia

47
Q

What is the normal birthweight for a term infant?

A

2.5 - 4kg (outside this range is large for gestational age LGA, or small for gestational age, SGA)

48
Q

Which factors in the mother may risk hypoxia to the foetus during birth? What does the foetus have for dealing with hypoxia during contractions?

A
  • smoking, drug use, preeclampsia

- foetus has HbF (2 alpha, 2 gamma subunits) which delivers oxygen more efficiently to hypoxic areas

49
Q

Name the categories and scoring of the Apgar system.

A

(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
Q

Why is vitamin K given to the newborn?

A

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
Q

Name and describe the two main head abnormalities of the newborn.

A

Caput succeolenum (fluid collects between skin and epicranial aponeurosis)
Cephalohaematoma (between epicranial aponeurosis and skull periosteum)
Both are harmless and resolve <3 months.

52
Q

Describe the key observations in the top-to-toe systemic examination of the newborn.

A
  • 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
Q

Name the five main GI surgical problems of the neonate and give key signs/treatment.

A

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
Q

During which timespan is the newborn considered a neonate?

A

0-27 days

55
Q

Give the key immediate management of the sick term infant.

A

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
Q

What are the key aspects of maternal and infant history for the sick term infant?

A

Maternal - PMH (diabetes - risk of hypo), pregnancy issues, drugs, and infections (e.g. herpes)
Infant - USS (dating, anomaly), delivery, resus

57
Q

What are the main organisms responsible for neonatal infection?

A

Bacterial - group B strep, E coli, staph
Viruses - CMV, parvoviruses, herpesviruses, enteroviruses (usually asymptomatic but may cause cardiomyopathy)
Fungal - almost unheard of

58
Q

What are the main respiratory and cardiac diseases of the sick term infant?

A 
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
Q

What is hypoxic ischaemic encephalopathy?

A

Perinatal multiorgan damage from hypoxia. Requires active resus and possible therapeutic hypothermia.

60
Q

What are adverse childhood experiences?

A

Potentially traumatic events that can leave negative lasting effects on health and wellbeing.

61
Q

Name the 10 adverse childhood experiences.

A 
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
Q

What is toxic stress?

A

Excessive activation of stress response on a child’s developing brain and biological systems (including hormonal and immunological)

63
Q

What is the name of the effect on children caused by toxic stress?

A

Allostatic load

64
Q

What is the name of the transmission of adverse childhood experiences from parent to child?

A

Intergenerational affect

65
Q

Describe the genetic testing undergone for high risk pregnancies.

A 
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
Q

What early interventions should be undertaken for a floppy baby?

A
  • respiratory and feeding support
  • physiotherapy, OT, parental involvement
  • bloods (genetic, metabolic, congenital infection, CK)
  • imaging
  • neurology review
67
Q

Which genetic abnormalities after birth should be screened immediately if suspected?

A
  • myotonic dystrophy
  • Prader-Willi
  • spinal muscular atrophy

3b. CHILD HEALTH (3 decks)

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