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Paediatrics > Neonatal > Flashcards

Neonatal Flashcards

1
Q

What are the causes of hypoxic ischaemic encephalopathy?

A
  1. Inadequate blood flow/gas exchange across placenta - placental abruption, cord compression
  2. Poor maternal perfusion - hypo/hypertension
  3. compromised foetus - anaemia, IUGR, failure to breathe at birth
  4. Inborn error of metabolism / kerniticus
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2
Q

Describe mild symptoms of hypoxic ischaemic encephalopathy

A

Irritable, staring eyes, hyperventilation, v. sensitive to stimulation

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3
Q

How can you tell mild hypoxic ischaemic encephalopathy is worsening?

A 
moderate = abnormal tone/posture, feeding refusal, +/- seizure
Severe = unresponsive to pain, prolonged seizures
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4
Q

What type of cerebral palsy can be a complication of hypoxic ischaemic enecephalopathy?

A

Athetoid - damage to basal ganglia - hypotonia, irregular unwanted movements

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5
Q

Management of hypoxic ischaemic encephalopathy?

A

Fluids to correct hypotension
Respiratory support - high flow oxygen
Seizures = benzodiazepines/anticonvulsants (buccal/IV)

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6
Q

Where are ‘stork bites’ normally located

A

Naevus flammeus are normally found on the face - eyelids, forehead and neck - usually fade

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7
Q

What is erythema toxicum?

A

a rash (white pin-point papules) around trunk that occurs 2-3 days after birth - 50% of newborns - resolves after 2 weeks - do not use oitnments

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8
Q

What is a mongolian bluespot?

A

Birth mark in sacral region - normally african/asian - most disappear after few years

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9
Q

What is a port-white stain?

A

red/purple lesion on face - caused by vascular abnormality, persists and grows with child - may refer for laser treatment

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10
Q

What is a cavernosus haemangioma?

A

aka strawberry naevus - bright red lesion that appears after 3 weeks - usually fades years later

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11
Q

For haemolytic disease to occur what Rh status does the mother need to be?

A

Negative - also requires previous pregnancy with Rh+ve baby (rarely caused within same pregnancy with threatened miscarriage, amniocentesis etc.)
Given anti-D prophylactically during pregnancy

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12
Q

What are the symptoms/signs of haemolytic disease?

A

Hydrops foetalis - severe oedema and hepatomegaly + Jaundice, yellow vernix, kernicterus, anaemia, congestive heart failure

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13
Q

How is it the baby managed if the haemolytic disease?

A

Aggressive phototherapy
Exchange transfusion
Follow-up for late onset anaemia if all the maternal Abs haven’t been flushed out

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14
Q

What is a cephalohaematoma?

A

Bleeding within periosteum (superficial to the skull) - resolves within a few weeks

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15
Q

When should anti D abs be given to a Rh -ve pregnant woman?

A

500U 28 weeks and a booster at 34 weeks

If baby delivered is Rh +ve give postnatally as well

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16
Q

In broad terms what is the management of prematurity <32weeks?

A

Transfer to specialized neonatal unit
Humidified and warm chamber - prevents fluid loss
Support with oxygen
Give surfactant and steroids to promote lung development
Supplement feeds with formula

17
Q

What long-term complications can arise from prematurity?

A 
Intra-ventricular haemorrhage (IVH)
Retinopathy of prematurity (ROP)
Cerebral palsy
PDA
Necrotising Enterocolitis
Chronic lung disease
18
Q

What is RDS and what is it’s cause?

A

Respiraotry distress syndrome - affects most babies born <28 weeks (M>F)
Cause = surfactant dificiency

19
Q

What are the symptoms/signs of RDS?

A

Tachypnoea
Increased work of breathing - grunting, nasal flaring
cyanosis
Decreased O2 sats

20
Q

What would you see on a CXR in RDS?

A

Ground glass appearance

21
Q

Management of RDS?

A

Surfactant ia endotracheal tube
O2 therapy - vapotherm
Corticosteroids - given antenatally to promote lung maturity

22
Q

What is the definition of small for gestational age?

A

<10th centile for height or weight

23
Q

What is clifford’s syndrome?

A

Babies affected by IUGR but are >10th centile

24
Q

What is talipes (equinovarus)?

A

aka clubfoot - Inversion, heel adducted relative to abducted forefoot
‘Equinus’ - foot cannot be dorsiflexed or everted in normal range

25
Q

What is talipes usually secondary to?

A

Oligohydramnios

26
Q

How do you manage talipes?

A

splint/strapping for 3 months. If persists >3 months operative reduction is required.

27
Q

What is the minimum level of billirubin (micro-mols/L) in the blood required for a diagnosis of neonatal Jaundice?

A

> 80micro-mols/L

28
Q

What is the cause of physiological neonatal Jaundice and when would you be concerned there is a pathological cause?

A

Immaturity of the liver - low levels of liver enzymes and increased RBC turnover as HbF –> HbA
If jaundice occurs <24 hrs or >14 days this would be worrying

29
Q

What is kernicterus?

A

When bilirubin >360micro-mols unconjugated bilirubin stains the basal ganglia –> acute encephalopathy with irritability, high pitched cry or v.sleepy/coma

30
Q

What are the long-term complications of kernicterus?

A

Neurotoxic damage to the basal ganglia –> nerve deafness, athetoid cerebral palsy and mental retardation

31
Q

What are the pre-hepatic causes of neonatal jaundice?

A

Rh/ABO incompatibility, breat-milk jaundice, bacterial infection, bruising, internal haemorrhage, prematurity, hypothyroidism

32
Q

What are the hepatic causes of neonatal jaundice?

A

Neonatal heaptitis, CMV, congenital disorders e.g. Wilson’s disease

33
Q

What would test for Rh incompatibility?

A

Coombes test

34
Q

What would indicate there is an obstructive (post-hepatic) cause of jaundice?

A

Pale stools - caused by biliary atresia. Early recognition and management is essential

35
Q

At what levels of bilirubin would you treat jaundice?

A

> 250micro-mols at 48 hrs = phototherapy

>350micro-mols at 48 hrs = exchange transfusion

36
Q

Opthalmia neonatorum

A

Conjunctivitis in first 28 days

Most common cause = chlamydia, then gonorrhoea

Paediatrics (14 decks)

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