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Child's Health MBCHB > Neonatal > Flashcards

Neonatal Flashcards

1
Q

What is classed as neonatal?

A

First 28 days of life

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2
Q

What does APGAR stand for in the APGAR scoring system?

A

Appearance
Pulse
Grimace
Activity
Respiration

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3
Q

What is the initial management of a sick newborn?

A

Stabilise temperature - 36.5-37.5
Airway and breathing - gentle support (open airway), consider oxygen as needed
Circulation - fluids and inotropes
Metabolic homeostasis - glucose management, correction of acid-balance
Antibiotics

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4
Q

What is the ongoing management for a sick newborn baby?

A

Diagnostic work up
Further support:
- ventilation
- drugs - vitamin K for haemorrhagic disease
- specific therapy
- surgery
- transfer
Care of family

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5
Q

How does sepsis present in a newborn baby?

A

Quiet
Poor feeding
Floppy
Tachypnoea
Apnoea
Tachycardia
Bradycardia
Temperature instability - high or low

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6
Q

Where can a baby get an infection?

A

Bloodstream -> bacteraemia/septicaemia
CNS -> Meningitis
Respiratory -> Pneumonia
Gastrointestinal -> Necrotising Enterocolitis
Urinary -> UTI
Skin
Bone

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7
Q

What are the most common bacterial organisms in newborns (most common to least)?

A

Group B Strep
E. Coli
Staphylococcus Aureus
Staph Epidermidis
Staph Capitis
Klebsiella Oxytoca
Listeria Monocytogenes

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8
Q

What are the best antibiotics for newborn babies?

A

Benzylpenicillin - gram +ve and gram -ve organisms
Gentamycin -> additional gram -ve cover
Cefotaxime is an alternative -> gram +ve and gram -ve

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9
Q

What are the common viral infections for newborns?

A

Toxoplasma
Syphilis
Hep B
Rubella
CMV
Herpes

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10
Q

What congenital abnormalities can syphilis cause?

A

bone abnormalities, anaemia, hepatosplenomegaly, eye problems, jaundice, meningitis, rashes

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11
Q

How is syphilis infection prevented in newborns?

A

Treatment for syphilis 30 days prior to delivery most important factor for reducing congenital infection.

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12
Q

What are the clinical signs of respiratory distress in newborns?

A

Tachypnoea
Recession
Grunting
Blue
Low saturations

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13
Q

What is the most common cause of respiratory distress in newborns?

A

Transient Tachypnoea of the newborn

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14
Q

What is TTN and how is it diagnosed and managed?

A

fluid in the lungs does not clear away. CXR shows fluid in the horizontal fissure. Resolves over the first 24 hours of life

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15
Q

What are some causes of respiratory distress in newborns?

A

TTN
Pneumothorax
RDS
MAS
Hypoxic Ischaemic Encephalopathy
Tracheo-oesophageal fistula
Diaphragmatic hernia

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16
Q

When can TTN most commonly occur?

A

In caesarean sections due to lack of adrenaline surge which switches off lung fluid production.

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17
Q

When does Respiratory Distress Syndrome occur?

A

Much more common in preterm infants.
Due to surfactant deficiency
Associated with IUGR, Maternal diabetes, infection, birth asphyxia, multiple births, PROM, meconium aspiration

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18
Q

What does RDS look like on a CXR and how is it treated?

A

CXR - ground glass appearance and air bronchograms
Treatment is with respiratory support and surfactant replacement.

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19
Q

What is Meconium Aspiration Syndrome and how does it present?

A
  • MAS usually occurs following signs of foetal distress
  • Can cause airway obstruction, inflammation, surfactant dysfunction
  • In severe form it is linked with asphyxia and persistent pulmonary hypertension
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20
Q

What does MAS look like on CXR?

A

Patchyness across lungs

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21
Q

What is hypoxic ischaemic encephalopathy?

A
  • Multi organ damage - brain, kidneys, liver, gut due to tissue hypoxia
  • Primary event may be placental failure, cord prolapse, uterine rupture or other major event
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22
Q

What is the treatment and prognosis of hypoxic ischaemic encephalopathy?

A
  • Poor apgar scores - active resuscitation required
  • Neurodevelopmental sequelae - variable prognosis
  • Therapeutic hypothermia improves neurodevelopmental outcomes
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23
Q

How does cardiac distress present in newborns?

A

Presents with tachypnoea, cyanosis not responsive to oxygen, murmur, femoral pulses may be weak or absent, circulatory collapse

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24
Q

When does hydrops foetalis occur?

A

rhesus disease - mum rhesus -ve and baby rhesus +ve
chromosomal

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25
Q

What is the condition associated with newborn baby and failure to adapt to postnatal life?

A

persistent pulmonary hypertension of the newborn (PPHN)

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26
Q

What are the critical congenital heart diseases of a newborn baby?

A
  • Tetralogy of Fallot
  • Transposition of the great arteries
  • Coarctation of the aorta
  • TAPVD
  • Hypoplastic heart
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27
Q

What neurological conditions can be present in a sick newborn?

A

Microencephalopathy
Spina Bifida

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28
Q

What renal conditions can be present in a sick newborn?

A

Potter’s Syndrome - fatal - no treatments currently

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29
Q

What muscular conditions can be present in a sick newborn?

A

Myotonic Dystrophy

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30
Q

How does hypoglycemia occur in newborn babies?

A

Low birth weight and Small for gestational age -> reduced to reserves
IDM, medicines -> related to maternal disease
Evidence of more complex metabolic disease

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31
Q

What is the presentation of inborn errors of metabolisms in babies?

A

Presentations may be of acidosis, hypoglycaemia or jaundice.

32
Q

What is the aetiology of neonatal sepsis?

A
  • Early onset (EOS) - mainly due to bacteria acquired before and during delivery
    • Group B streptococcus
    • Gram negatives
  • Late onset (LOS) - acquired after delivery (nosocomial or community sources)
    • Coagulase negative staphylococci
    • Gram negatives
    • Staph. aureus
33
Q

What are the risk factors for neonatal sepsis in premature infants?

A
  • Immature immune system
  • Intensive care environment
  • Indwelling tubes and lines
34
Q

What is the typical presentation of neonatal sepsis?

A
  • Fever
  • Reduced tone and activity
  • Poor feeding
  • Vomiting
  • Respiratory distress orapnoea
  • Tachycardia or bradycardia
  • Hypoxia
  • Jaundice within 24 hours
  • Seizures
  • Hypoglycaemia
35
Q

What is the management of neonatal sepsis?

A
  • Prevention - hand washing, vigilance, infection screening
  • Antibiotics
  • Supportive measures
36
Q

What are the causes of respiratory distress in the newborn?

A

RDS
Metabolic -> acidosis, inborn errors of metabolism, hypoglycaemia
Haematological -> polycythaemia, blood loss/anaemia
Neurological -> seizures, intracranial bleed, withdrawal
Congenital -> congenital lung malformations e.g., CCAM
Anatomical abnormalities -> chest wall deformities

37
Q

What is the pathophysiology of RDS?

A
  • Inadequate surfactant leads to high surface tension within alveoli
  • This leads to atelectasis (Lung collapse), as it is more difficult for the alveoli and the lungs to expand
  • This leads to inadequate gaseous exchange, resulting in hypoxia, hypercapnia (high CO2) and respiratory distress
38
Q

What is the typical presentation of RDS?

A
  • Respiratory distress → tachypnoea, grunting, intercostal recessions, nasal flaring, cyanosis
  • Worsens over minutes to hours until 2-4 days then gradual improvement
39
Q

What is the management of RDS in a newborn?

A
  • Maternal steroid
  • Surfactant Replacement
  • Ventilation (non-invasive preferred over invasive)
40
Q

What is neonatal abstinence syndrome?

A

Refers to the withdrawal symptoms that happens in neonates of mothers that used substances in pregnancy

41
Q

What substances cause NAS?

A
  • Opiates
  • Methadone
  • Benzodiazepines
  • Cocaine
  • Amphetamines
  • Nicotine or cannabis
  • Alcohol
  • SSRI antidepressants
42
Q

What is the clinical presentation of NAS?

A
  • CNS - irritability, tremors, seizures
  • Vasomotor and respiratory - sweating, unstable temperature, tachypnoea
  • Metabolic and GI - poor feeding, regurgitation/vomiting, hypoglycaemia
43
Q

What is the management of NAS?

A
  • Mothers that are known to use substances should have an alert on their notes so that when they give birth the neonate can have extra monitoring and management of NAS
  • Babies are kept in hospital with monitoring on a NAS chart for at least 3 days (48 hours for SSRI antidepressants) to monitor for withdrawal symptoms
  • The neonate should be supported in a quiet and dim environment with gentle handling and comforting
  • Medical treatment options are available for moderate to severe symptoms.
44
Q

What is defined as neonatal hypoglycaemia?

A

Defined as a BGL <2.6 mmol/L

45
Q

What are the contributing factors to neonatal hypoglycaemia?

A
  • Preterm
  • Small for gestational age
  • Low birth weight (<2.5kg)
  • Infants of diabetic mothers
  • Hypothermia
  • Feeding
  • Infection/Sepsis
  • Neonatal abstinence syndrome
46
Q

What is the presentation of a newborn with hypoglycaemia?

A
  • lethargy
  • Jitteriness
  • Seizure activity
47
Q

What is the management for a newborn with hypoglycaemia?

A
  • early feed and keeping baby warm (36.5-37.5) helps prevent hypoglycaemia
  • If safe to feed hypoglycaemic baby enterally, feed and assess (and repeat)
  • If unsafe to feed baby requires IV glucose
  • If recurrent - hypoglycaemia screen (when BM<2.6)
48
Q

What is hydrocephalus?

A

Describes cerebrospinal fluid (CFS) building up abnormally within the brain and spinal cord

49
Q

What causes hydrocephalus?

A

result of either over-production of CSF or a problem with draining or absorbing CSF

50
Q

What is the presentation of hydrocephalus?

A
  • enlarged and rapidly increasing head circumference
  • Bulging anterior fontanelle
  • Poor feeding and vomiting
  • Poor tone
  • Sleepiness
51
Q

What is the management of hydrocephalus?

A

Ventriculoperitoneal shunt

52
Q

What is necrotising enterocolitis?

A

Disorder affecting premature neonates, where part of the bowel becomes necrotic

53
Q

What causes necrotising enterocolitis?

A

Serious intestinal injury to a relatively immature gut (e.g., premature baby being fed too early) resulting in perforation

54
Q

How does necrotising enterocolitis present?

A
  • intolerance to feed
  • vomiting, particularly with green bile
  • Generally unwell
  • Distended, tender abdomen
  • Absent bowel sounds
  • Blood in stools
55
Q

What can be seen on an abdominal x-ray in necrotising enterocolitis?

A
  • dilated loops of bowel
  • bowel wall oedema
  • gas in bowel wall
  • gas in peritoneal cavity (pneumoperitoneum) indicates perforation
56
Q

What is the management of necrotising enterocolitis in newborns?

A
  • Nil by mouth, clindamycin and cefotaxime
  • Immediate referral to neonatal surgical team
57
Q

What is intraventricular haemorrhage?

A

Bleeding into the ventricles inside the brain - in neonates occurs mainly in premature infants

58
Q

What is the pathophysiology of intraventricular haemorrhage?

A
  • Germinal matrix is the most common type → related to perinatal stress affecting the highly vascularised germinal matrix
  • By 35-36 weeks gestation, the germinal matrix has essentially disappeared and thus the risk of haemorrhage is markedly reduced
59
Q

How is intraventricular haemorrhage’s classified?

A
  • Grade 1 and 2 - neurodevelopmental delay up to 20|%, mortality 10%
  • Grade 3 and 4 - neurodevelopmental delay up to 80%, mortality 50%
60
Q

What is jejunal atresia?

A

Congenital anomaly characterised by obliteration of the lumen of the jejunum

61
Q

What is the typical presentation of jejunal atresia?

A

neonates typically present with abdominal distension and bilious vomiting within the first 24 hours of birth

62
Q

What is the management of jejunal atresia?

A

surgical correction

63
Q

What is malrotation?

A

Congenital anatomical anomaly that results from an abnormal rotation of the gut as it returns to the abdominal cavity during embryogenesis

64
Q

What is the presentation of malrotation?

A
  • most common presentation in the infant is midgut volvulus → presents with bilious green vomiting
  • Up to 40% of patients with malrotation show signs within the first week of life
  • 50-60% diagnosed by 1 month and 75% diagnosed by age 1.
65
Q

What investigations are needed for malrotation?

A

upper GI contrast and follow through

66
Q

What is the management of malrotation?

A

surgical correction

67
Q

What is meconium ileus?

A

Refers to a neonatal bowel obstruction of the distal ileum due to abnormally thick and impacted meconium

68
Q

What can cause meconium ileus?

A

Usually a manifestation of cystic fibrosis

69
Q

What is an inguinal hernia?

A

Weakness in the muscle around the groin, resulting in a loop of bowel bulging through and causing a lump

70
Q

What is the management of an inguinal hernia?

A

Surgical correction

71
Q

What are the central causes of a floppy baby?

A
  • Hypoxic ischaemic encephalopathy
  • Intracranial haemorrhage
  • Cerebral haemorrhage
  • Chromosomal abnormalities e.g., Trisomy 21
  • Congenital infections (TORCH)
  • Acquired infections
  • Peroxisomal disorders
  • Drug Effects e.g., benzodiazepines
72
Q

What are the spinal cord causes of a floppy baby?

A
  • Birth trauma especially breech delivery
  • Syringomyelia
73
Q

What causes of floppy baby are related to anterior horn cells?

A
  • Spinal Muscular Atrophy
  • Pompe’s Disease
74
Q

What neuromuscular junction causes are there fore floppy baby?

A
  • Myasthenia Gravis
  • Infantile botulism
75
Q

What is the presentation of floppy baby?

A
  • rag doll
  • lack of head control
  • increased range of movement
  • frog legged
  • feel like they’ll fall out your grasp
  • possibly breathing difficulties
76
Q

What investigations are needed for floppy baby?

A

**Bloods:**

  • Genetics - NGS
  • Metabolic
  • Congenital infection screening
  • Creatinine kinase

******Neurology review******

  • EEG
  • EMG

****Imaging****

  • cranial USS
  • MRI
77
Q

What is the management of floppy baby?

A
  • Early intervention - respiratory and feeding support, physiotherapy, occupational therapy, patient involvement
  • Regular review of growth and development - clinic follow up, health visitor and GP communication
  • Some specific management may be available depending on cause e.g., RNA targeted therapy for spinal muscular atrophy
    • Early diagnosis is key as there is often a critical window for treatment (e.g., in PKU, SMA)

Child's Health MBCHB (8 decks)

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