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Y5: Paediatrics > Neonatal > Flashcards

Neonatal Flashcards

1
Q

Necrotising Enterocolitis

A
  • Premature babies + LBW
  • 20% morbidity/mortality
  • Cause unknown, combination of poor perfusion + infection
  • Often begins after starting enteral feeding
  • RFs:
    • PDA, pre-term
  • Sx
    • EARLY signs = Bilious vomiting, feed intolerance
    • Abdo distension
    • Blood-stained stool
    • Rapid deterioration + shock
  • Ix
    • Abdominal XR - “Gas cysts” in bowel wall. Air under diaphragm if perforation. Distended bowel loops
    • Blood cultures
  • Mx
    • Bell’s staging
    • Stop oral feeding/medications and switch to parenteral nutrition (for confirmed cases stop for 1wk)
    • NG tube
    • Broad spectrum Abx (cefotaxime + vancomycin)
    • Resp. support + Fluids
    • Surgery - if perforation or not responding to medical Tx
      • Laparotomy with resection of necrosed bowel
      • Primary anastamosis or defunctioning stoma
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2
Q

Duodenal atresia/stenosis

A
  • Bilious OR non-bilious vomiting <6hrs after birth
    • Depends if atresia is before or after sphincter of Oddi
  • 1 in 5000
  • Associations:
    • Down’s
    • Polyhydramnios
    • Congenital Heart Defects
  • AXR “Double bubble” sign
  • Mx
    • ABCDE ± NG tube decompression
    • Surgery = Duodenodudenostomy

In stenosis you don’t get vomiting, but there is potential for obstruction and double-bubble on AXR

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3
Q

Jejunal/Ileal atresia

A
  • Bilious vomiting <24hrs after birth
  • AXR - air-fluid levels
  • Tx = Laparotomy
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4
Q

Biliary atresia

A
  • Cause of jaundice >2wks old (conjugated BR)
  • Can be otherwise asymptomatic
  • Hepatosplenomegaly
  • Obstructive jaundice
    • Mild jaundice, pale stools, dark urine
    • Always hungry
    • NO vomiting
  • Normal birth weight -> poor growth
  • Ix
    • 1st = USS triangular cord sign
    • Gold standard = TIBIDA isotope scan
    • Confirmation = ERCP
  • Mx
    • Kasai’s hepatoportoenterostomy
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5
Q

Meconium aspiration

A

Aspiration:

  • 8-20% pass meconium BEFORE birth -> could aspirate
  • RFs:
    • GA >42wks
    • Foetal distress/hypoxia
    • Meconium-stained amniotic fluid
    • Oligohydramnios
    • Chorioamnionitis
    • Maternal Hx of HTN, PET, smoking, substance misuse
  • Sx
    • Resp. distress
      • Chest retraction, hypoxia
  • Ix
    • CXR (Diagnostic)
      • Overinflated lungs
      • Patches of collapse + consolidation
  • Mx
    • Normal term infant + meconium stained amniotic fluid, NO history of GBS = OBSERVE
    • Signs of infection = IV ampicillin + gentamicin
    • SEVERE = O2 + NIV
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6
Q

Meconium Ileus

A
  • Meconium hasn’t passed after 24hrs post-delivery
    • Hence presents 24-48hrs after birth
  • Associated w:
    • Cystic Fibrosis (90%)
    • Biliary atresia
  • Sx
    • Vomits meconium
    • Bilious vomit
  • Ix
    • CXR - ‘air-fluid levels’
  • Mx
    • 1st = Gastrograffin enema
    • 2nd = Surgical decompression
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7
Q

Summarise causes of bilious vomiting in neonates

A
  • <6hrs - Duodenal atresia
  • <24hrs - Jejunal/ileal atresia
  • 24-48hrs - Meconium ileus
  • 3-7 days - Malrotation/volvulus
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8
Q

Hypoxic Ischaemic Encephalopathy

A
  • Occurs if there has been perinatal asphyxia (i.e. cardio-respiratory depression)
    • Gas exchange across placenta - placental abruption
    • Blocked umbilical blood flow - shoulder dystocia -> cord compression
    • Inadequate placental perfusion - materanl hypotension
    • Compromised growth - IUGR
    • Failure to breathe at birth
  • Sx - Grade according to first 48hrs
    • Mild
      • Normal tone, strong Moro reflex, dilated pupils, NO SEIZURES, Irritable, hyper-alert, staring eyes
    • Moderate
      • HYPOTONIA, weak/incomplete moro reflex, pinpoint pupils, common/focal seizures, lethargic
    • Severe
      • ​COMATOSE (no response to pain)
      • Prolonged seizures refractory to Tx
      • Flaccid tone, decerebrate posture
      • Reflexes decreased/absent
      • Moro reflex absent
      • Unequal/unreactive pupil
  • Mx
    • Mild
      • ABCDE
      • Therapeutic hypothermia in NICU (>36w GA)
      • Ventilation
      • Cardio - consider invasive monitoring of BP/intropes, consider dobutamine to maintain BP
      • Fluids - 40ml/kg in first 24hrs
    • Moderate
      • Anticonvulsant for seizure, consider EEG
      • IM phyomenadione (Vit K)
      • Treat hypoglycaemia + electrolytes
      • Stop feeding for at least 48hrs (risk of NEC)
    • Severe
      • Cranial USS - exclude other causes like haemorrhage
      • MRI brain
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9
Q

Hypoglycaemia

A
  • Common in GDM mothers - neonatal insulin higher at birth
  • Prevention = Feed baby within 30 mins of birth
  • Glucose <1.5
    • Admit to neonatal unit
    • Confirm BM with Blood glucose assay
    • IV 10% glucose 2ml/kg bolus
    • Followed by infusion of 10% glucose
    • Aim for glucose 3-4
  • Glucose 1.5-2.5
    • Feed immediately
    • If still low after 30 mins, consider admitting + IV glucose
  • Hypoglycaemia secondary to hyperinsulinism
    • Glucagon infusion
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10
Q

Congenital Anomalies of the Kidney and Urinary Tract (CAKUT)

A
  • PAX2 gene mutation
  • RF: 1st degree relative
  • Typically recurrent UTIs
  • Renal
    • Horseshoe kidney
    • Multicystic kidneys - AR PKD
    • Renal agenesis
    • Medullary spongy kidney
  • Non-renal
    • Pelvoureteric junction (PUJ) obstruction
    • Vesicoureteral reflux - 30% of children with UTIs
    • Bladder outlet obstruction
  • Sx
    • Antenatal: Oligohydramnios
    • Postnatal
      • Recurrent UTIs
      • Decreased UO
      • Intra-abdominal mass
      • Potter syndrome/sequence = bilateral renal agenesis leading to pulmonary hypoplasia
        • Low-set ears
        • Beaked nose
        • Prominent epicanthic folds
        • Down slanted eyes
        • Pulmonary hypoplasia -> resp. failure
        • Limb deformities
  • Ix
    • Renal USS
      • Echogenic kidneys - suggests inflammation/congenital anomalies
      • Signs of VUR
    • Micturating Urethrogram (MCUG)
      • Need antibiotic cover
      • Urinary catheter -> radio-opaque dye into bladder
      • Detects VUR + urethral obstruction
    • DMSA
      • Radiolabeled isotope injected into cannula
      • Kidneys filter this out, so scan shows areas of scarring which aren’t functioning
      • Scars take time to form so do 4-6wks after latest UTI
  • Mx
    • Immediate Renal USS during acute infection
      • Atypical UTI or recurrent UTI <6m
    • Urgent USS within 6wks
      • Recurrent UTI >6m
      • First UTI <6m, responds to Tx
    • Routine DMSA 4-6m (can’t be <2m before UTI)
      • ALL children with recurrent UTI
      • Atypical UTI in <3yo
    • MCUG
      • VUR suspected on USS
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11
Q

Diaphragmatic Hernia

A
  • 1 in 2000
  • Occurs at 6-8wks of pregnancy
  • 85% Bochdalek hernia
    • Intestine moves through LEFT CHEST
    • Stops lungs from developing properly
  • Prognosis depends on
    • Liver position
    • Lung:Head ratio
  • Diagnosed at routine USS or after resp. distress at delivery
  • Sx
    • Resp. distress in neonate (RR >60, absent breath sounds, cyanosis, etc..)
    • Concave chest at birth
    • Intestinal obstruction Sx
    • Volvulus of stomach Sx
  • Ix
    • CXR
      • Mediastinum displaced to left, collapsed left lung, bowel loops in thorax
  • Mx at birth
    • Intubate + ventilate (Positive pressure)
    • Wide-bore NG tube + Suction
    • IV + arterial access
    • Sedation + muscle relaxants
    • PPH common - may require inhaled NO
    • ECMO if PPH not improving
  • Surgery once PPH resolved
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12
Q

Ophthalmia neonatorum (Conjunctivitis of neonate)

A
  • Bacterial
    • Urgent same-day referral to ophthalmologist
    • MILD
      • Chloramphenicol eye drops
    • MODERATE-SEVERE
      • Systemic Abx
        • Chlamydial = erythromycin
        • Gonococcal = cefotaxime/ceftriaxone
        • Pseudomonal = Gent eye drops + systemic Abx
  • Viral
    • Topic antihistamine + artificial tears to relieve itching (no antiviral)
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13
Q

Down’s

A
  • Echo
    • 45% have congenital heart defects (mainly AVSD)
    • If abnormal refer to cardiologist
  • FBC + Blood film
    • 10% have transient abnormal myelopoeisis
    • Higher risk of leukemia
      • Refer to haematologist
  • Hearing screening test
  • Monitor for associated conditions
    • Duodenal atresia
    • Hirschprung
    • Coeliac
    • Hypothyroidism
    • Epilepsy
    • Hearing/visual defects
    • Atlantoaxial instability
    • Peridontal disease
  • SALT if difficulty swallowing
  • Ophthalmologist (3-6 months)
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14
Q

CMV

A
  • Urine salivary PCR for CMV
    • Definitive if done in first 2 wks of life
  • Antiviral therapy (Oral valganciclovir) for 6 months if CNS infection or acutely unwell
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15
Q

Cleft lip/ Palate

A
  • 1 in 1000
  • 4th most common birth defect
    • CHD, spina bifida, limb deformities
  • 85% unilateral, common on left side
    • Also bilateral
  • Polygenic inheritance
  • Types:
    • Combined cleft palate + lip (45%)
    • Isolated cleft palate (40%)
    • Isolated cleft lip (15%)
  • RFs:
    • Phenytoin/anticonvulsant use in pregnancy
    • Maternal smoking, alcohol
  • Sx
    • Difficulty feeding + poor weight gain
  • Ix
    • 75% detected at 20w anomaly scan
    • Ask about feeding difficulty, poor weight gain, hearing problems (higher risk of secretory otitis media)
  • Mx = Surgery
    • 3m for lip
    • 6-12m for palate
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Y5: Paediatrics (6 decks)

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