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Paediatrics > Introduction to Neonatology > Flashcards

Introduction to Neonatology Flashcards

1
Q

What are the categories of term admissions to NNU?

A 
Sepsis
Respiratory
Cardiac
Hypoglycaemia
Hypothermia
Jaundice
Birth asphyxia
Surgical problems
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2
Q

What are the symptoms of neonatal sepsis?

A 
Baby pyrexia or hypothermia
Poor feeding
Lethargy
Early jaundice
Hypoglycaemia/hyperglycaemia
Asymptomatic
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3
Q

What are the risk factors for neonatal sepsis?

A

PROM
Maternal pyrexia
Maternal GBS carriage

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4
Q

What is the management for presumed neonatal sepsis?

A 
Admit NNU 
Partial septic screen and blood gas 
Consider CXR, LP 
IV penicillin and gentamicin 1st line 
2nd line vancomycin and gentamicin 
Add metronidazole if surgical/abdominal concerns 
Fluid management and treat acidosis 
Monitor vitals and support respiratory/cardio systems if required
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5
Q

What are the commonest causes of neonatal sepsis?

A 
Group B streptococcus 
E coli 
Listeria 
Coagulase negative staphylococci 
H influenzae
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6
Q

What are the complications of GBS sepsis?

A 
Meningitis 
DIC 
Pneumonia 
Respiratory collapse 
Hypotension 
Shock
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7
Q

What are the most common congenital infections?

A

Toxoplasmosis
Rubella
CMV
Herpes

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8
Q

What might congenital infections result in?

A 
IUGR 
Brain calcifications 
Neurodevelopmental delay 
Visual impairment 
Recurrent infections
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9
Q

What are the causes of respiratory problems?

A

Sepsis
Transient tachypnoea of the newborn (TTN)
Meconium aspiration

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10
Q

What are the signs of TTN?

A

Grunting
Tachpnoea
Oxygen requirement
Normal gases

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11
Q

How is TTN managed?

A 
Supportive 
Antibiotics 
Fluids 
O2 
Airway support
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12
Q

What is the pathophysiology of TTN?

A

Delay in clearance of foetal lung fluids

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13
Q

What are the risk factors for meconium aspiration?

A

Post dates (aged placenta)
Maternal diabetes
Maternal hypertension
Difficult labour

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14
Q

What are the symptoms of meconium aspiration?

A 
Cyanosis 
Increased work of breathing 
Grunting 
Apnoea 
Floppiness
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15
Q

What investigations are done for meconium aspiration?

A

Blood gas
Septic screen
CXR

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16
Q

What is the treatment for meconium aspiration?

A 
Suction below cord 
Airway support (intubation and ventilation) 
Fluids and IV antibiotics 
Surfactant 
NO or ECMO
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17
Q

What investigations should be done for “blue baby” syndrome?

A 
Examination and history 
Sepsis screen 
Blood gas and blood glucose 
CXR 
Pulse oximetry 
ECG 
Echo
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18
Q

What s the differential diagnosis of “blue baby”?

A 
TGA 
Tetralogy of Fallots
TAPVD
Hypoplastic left heart syndrome
Tricuspid atresia
Truncus arteriosus
Pulmonary atresia
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19
Q

What is transposition of the great arteries?

A

2 separate circulations

Need to keep duct open

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20
Q

What is the treatment for transposition of the great arteries?

A

Urgent septostomy

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21
Q

What conditions are classified as tetralogy of fallouts?

A

Pulmonary stenosis
Thickened right ventricle
VSD
Overriding aorta

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22
Q

What is total anomalous pulmonary venous drainage?

A

Pulmonary veins connected to one of the veins from the main circulation instead of left atrium
Oxygenated blood goes to the right side of the heart

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23
Q

What are the features of a hypoplastic left heart?

A

Underdeveloped left heart
Poor oxygenation
Poor perfusion
Worse when duct shuts

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24
Q

What is tricuspid atresia?

A

Absence of patent heart valve

Hypoplastic right ventricle

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25
Q

What is truncus arteriosus?

A

Single blood vessel from left and right ventricles

Requires surgery to create 2 vessels

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26
Q

What is pulmonary atresia?

A

Abnormal pulmonary valve
Obstructs blood from right ventricle to lungs
Shunts and surgical repair

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27
Q

What is the treatment for a “blue baby”

A 
ABC 
Inotropes as required 
Fluid resuscitation 
Respiratory support 
Prostin 
Nitric oxide 
Cardiology referral
28
Q

How is neonatal hypoglycaemia managed?

A 
Monitor blood glucose 
Start IV 10% glucose 
Increase fluids 
Increase glucose concentration 
Glucagon 
Hydrocortisone
29
Q

How is hypothermia managed?

A

Admit and place in incubator
Sepsis screen and antibiotics
Consider checking thyroid function
Monitor blood glucose

30
Q

What is the management for neonatal jaundice?

A

Intensive phototherapy or exchange transfusion

Incubator and IV fluids may be required

31
Q

What are the causes of birth asphyxia?

A 
Placental problem
Long, difficult delivery
Umbilical cord prolapse
Infection
Neonatal airway problem
Neonatal anaemia
32
Q

What is the 1st stage of birth asphyxia?

A

Within minutes without O2

Cell damage occurs with lack of blood flow and O2

33
Q

What is the 2nd stage of birth asphyxia?

A

Reperfusion injury
Can last days or weeks
Toxins are released from damaged cells

34
Q

What are the symptoms of mild hypoxic-ischaemic encephalopathy?

A 
Slightly increased muscle tone 
Brisk deep tendon reflexes 
Poor feeding 
Irritability 
Excessive crying or sleepiness
35
Q

What are the symptoms of moderate hypoxic-ischaemic encephalopathy?

A 
Lethargic 
Hypotonia 
Diminished deep tendon reflexes 
Grasping and sucking reflexes sluggish or absent 
Apnoea 
Seizures
36
Q

What are the symptoms of severe hypoxic-ischaemic encephalopathy?

A

Seizures

37
Q

What is the management fro hypoxic-iscahemic encephalopathy?

A 
Supportive 
Fluid restriction 
Monitor for renal and liver failure 
Respiratory support 
Cardiac support 
Treat seizures 
Therapeutic hypothermia
38
Q

What is the cooling criteria for hypoxic-ischaemic encephalopathy?

A

Infants >/= 36 weeks with at least 1 of
(Apgar score of <=5 at 10 minutes
Continued need for resuscitation > 10 minutes, acidosis within 1st hour (pH <7), base deficit >= 16 within 1 hour)
Seizures
At least 30 minutes of abnormal electrical activity

39
Q

What is the management for therapeutic hypothermia?

A 
Baby cooled to 33C for 72 hours
Rewarmed slowly over 12 hours 
Sedated for cooling 
Monitored for CFAM 
Cranial ultrasounds 
MRI at 7-10 days 
Neurodevelopmental follow up
40
Q

What are the different types of oesophageal atresia/fistula?

A 
Atresia with distal fistula 
Atresia with proximal fistula 
Atresia 
Atresia with double fistula 
Fistula
41
Q

What is the treatment for oesophageal atresia/fistula?

A

IV fluids and suction

Surgical repair

42
Q

What are the causes of failure to pass stool?

A 
Constipation 
Large bowel atresia 
Imperforate anus 
Hirschsprungs disease 
Meconium ileus
43
Q

How is a diaphragmatic hernia managed?

A

Intubation at birth
Respiratory support
Surgery
ECMO

44
Q

What are some examples of abdominal wall defects?

A

Exomphalos

Gastroschisis

45
Q

What is IUGR?

A

Intrauterine growth restriction

46
Q

What is SGA?

A

Small fro gestational age

47
Q

What are the causes of SGA?

A

Maternal
Foetal
Placental
Twin pregnancy

48
Q

What are the common problems associated with SGA?

A 
Perinatal hypoxia 
Hypoglycaemia 
Hypothermia 
Polycythaemia 
Thrombocytopenia 
GI problems
49
Q

What are the long term problems associated with SGA?

A

Hypertension
Obesity
Reduced growth
Ischaemic heart disease

50
Q

What is pre term?

A

<37 weeks

<28 weeks (extremely pre term)

51
Q

How can respiratory distress syndrome be prevented?

A

Antenatal steroids

52
Q

How can respiratory distress syndrome be prevented?

A

Early surfactant treatment
Early extubation
Non invasive support (NCPAP)
Minimal ventilation

53
Q

What is the treatment for broncho-pulmonary dysplasia?

A

Nutrition and growth

Steroids

54
Q

How can intraventricular haemorrhage be prevented?

A

Antenatal steroids

55
Q

What is the pathophysiology of pulmonary ductus arteriosus?

A 
Additional blood to circulation 
Over perfusion of lungs 
Lung oedema 
Steal from systemic circulation 
Systemic ischaemia
56
Q

What are the consequences of pulmonary ductus arteriosus?

A

Worsening of respiratory symptoms
Retention of fluids
GI problems

57
Q

When is the critical period of heart development?

A

Days 20-50

58
Q

Where does a foetus receive circulation via?

A

Umbilical vein
Foramen vale (LA, LV)
Patent ductus arteriosus (RV, PA)

59
Q

What is the function of the ductus arteriosus in the foetus?

A

Protects lungs against circulatory overload

Allows the right ventricle to strengthen

60
Q

What is the ductus venosus?

A

Blood vessel that connects the umbilical vein to the IVC

61
Q

How can a newborn’s breathing be assessed?

A 
Blood gases 
Transcutaneous pCO2 
Capnography 
Tidal volume 
Minute ventilation
62
Q

What happens when the foetus takes it’s first breath?

A

Ductus arteriosus, venosus and umbilical veins and arteries become ligaments
Foramen ovale close, leaving a depression

63
Q

What is the normal heart rate range for neonates?

A

120-160bpm

64
Q

How do neonates thermoregulate?

A

Maternal thermoregulation in womb

Brown fat due to lack of shivering

65
Q

When will physiological neonatal jaundice appear?

A

Day of life 2-3

Paediatrics (20 decks)

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