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Paeds > Neonatal > Flashcards

Neonatal Flashcards

1
Q

What are some causes of Hypoxic-ischaemic encephalopathy?

A

excessive/prolonged uterine contractions

placental abruption

cord compression (shoulder dystocia, cord prolapse)

maternal hypotension or hypertension

IUGR

failure to breath

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2
Q

How does mild hypoxic-ischaemic encephalopathy present?

A

irritable, response, hyperventilation, impaired feeding

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3
Q

How does moderate hypoxic-ischaemic encephalopathy present?

A

marked abnormalities of tone and movement, can’t feed and may have seizures

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4
Q

How does severe hypoxic-ischaemic encephalopathy present?

A

no normal spont movements or response to pain

tone in the limbs may flunctuate between hypo and hypertonia

seizures prolonged

multi-organ failure

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5
Q

How would you manage an infant with hypoxic-ischaemic encephalopathy?

A

respiratory support

EEG

anticonvulsants

fluid restriction

treat hypotension

treat hypoglycaemia and hypocalcaemia

*mild hypothermia (wrapping infant in cooling blanket) can reduce brain damage if started with 6 hrs of brth

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6
Q

What are examples of some soft tissue injuries?

A

Caput Succedeneum

Cephalhaematoma

Chignon

Subaponeurotic haemorrhage - severe blood loss, hypovolaemic shock and coagulopathy

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7
Q

How does Erb palsy present? What nerve is damaged?

A

arm lies straight and limp

hands pronated

fingers flexed

Brachial nerve

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8
Q

How would a facial nerve palsy present?

A

unilateral, facial weakness on crying but eye remains open

may need methylcellulose drops

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9
Q

What causes respiratory distress syndrome?

A

deficiency of surfactant leading to widespread alveolar collapse and inadequate gas exchange

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10
Q

What are risk factors for respiratory distress syndrome?

A

male sex
diabetic mothers
Caesarean section
second born of premature twins

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11
Q

Clinical features of respiratory distress syndrome?

A

tachypnoea

laboured breathing with recession

nasal flaring

expiratory grunting

cyanosis

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12
Q

How would you manage respiratory distress syndrome?

A

prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation

oxygen

assisted ventilation

exogenous surfactant given via endotracheal tube

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13
Q

What are some common conditions seen in preterm infants?

A

Pneumothorax

Patent ductus arteriosus

Haemorrhage

Necrotising Enterocolitis

Retinopathy of prematurity

Cerebral Palsy

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14
Q

Where is a common sign that brain haemorrhages occur in pre term infants?

A

germinal matrix above the caudate nucleus

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15
Q

What puts infants at higher risk of necrotising enterocolitis?

A

Drinking cow’s milk formula rather than only breast milk

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16
Q

How does necrotising enterocolitis present?

A

intolerant to feeds

milk aspirated - vomiting which may be bile-stained

abdomen becomes distended

stool sometimes has fresh blood

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17
Q

What investigation would you carry out in suspected necrotising enterocolitis? What would you see?

A

X-ray

dilated bowel loops (often asymmetrical in distribution)

bowel wall oedema

pneumatosis intestinalis (intramural gas)

portal venous gas

pneumoperitoneum resulting from perforation

air both inside and outside of the bowel wall (Rigler sign)

air outlining the falciform ligament (football sign)

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18
Q

What is treatment for necrotising enterocolitis?

A

stop oral feeding

broad-spec abx

parenteral nutrition needed

surgery for perforation

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19
Q

How do you define bronchopulmonary dysplasia? What causes it?

A

infants who require oxygen post-gestational age of 36 weeks

pressure and volume trauma from artificial ventilation, oxygen toxicity and infection

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20
Q

What would you see on x-ray of someone with bronchopulmonary dysplasia?

A

widespread areas of opacification

fibrosis

lung collapse

cystic changes

overdistension of lungs

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21
Q

How do you treat bronchopulmonary dysplasia?

A

prolonged artificial ventilation

CPAP

short course corticosteroid

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22
Q

What should given when discharging a premature baby?

A

iron as supplementation or in preterm formula for 6 months

multivitamins

prophylaxis against RSV if bronchopulm dysplasia (pavlizumab)

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23
Q

What problems do prem infants tend to develop later in life?

A

cerebral palsy

trouble with fine motor skills

concentration

behaviour problems

abstract reasoning

multi-tasking

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24
Q

What is a common non-pathological cause of neonatal jaundice?

A

marked physiological release of haemoglobin from the breakdown of RBC because of high Hb conc. at birth

RBC life span of newborn infants are shorter than adults

hepatic bilirubin metabolism is less efficient in the first few days of life

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25
Q

What are some pathological causes/consequences of neonatal jaundice?

A

haemolytic anaemia

infection

metabolic disease

liver disease

kernicterus

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26
Q

What is kernicterus?

A

encephalopathy resulting from the deposition of unconjugated bilirubin in the basal ganglia and brainstem nuclei

*bilirubin is fat-soluble and can therefore cross BBB

27
Q

How does kernicterus present?

A

lethargy

poor feeding

irritability

increased muscle tone (lie with arched back, opisthotonos)

seizures

coma

28
Q

Long-term complications of kernicterus?

A

choreoathetoid cerebral palsy

learning difficulties

sensorineural deafness

29
Q

What are causes of jaundice <24 hrs?

A

rhesus haemolytic disease

ABO haemolytic disease

hereditary spherocytosis

glucose-6-phosphodehydrogenase

30
Q

What causes jaundice 2-14 days

A

physiological

usually breastfed babies

dehydration

infection

31
Q

What are causes of prolonged jaundice?

A

biliary atresia

hypothyroidism

galactosaemia

urinary tract infection

breast milk jaundice

congenital infections e.g. CMV, toxoplasmosis

32
Q

What should investigations should be done if there is jaundice beyond 14 days?

A

PROLONGED JAUNDICE SCREEN

conjugated and unconjugated bilirubin: the most important test as a raised conjugated bilirubin could indicate biliary atresia which requires urgent surgical intervention

direct antiglobulin test (Coombs’ test)

TFTs

FBC and blood film

urine for MC&S and reducing sugars

U&Es and LFTs

33
Q

What should be done if jaundice is suspected?

A

In first 72 hrs all babies should be checked for jaundice clinically and if clinically jaundiced, a transcutaneous measurement made

34
Q

How would you manage jaundice?

A

phototherapy

exchange transfusion

35
Q

What are some causes of respiratory distress in term infants?

A

transient tacypnoea of the newborn

meconium aspiration

pneumonia

pneumothorax

milk aspiration

persisten pulmonary hypertension of the newborn

diaphragmatic hernia

36
Q

What causes transient tachypnoea of the newborn? What would you see on an X-ray?

A

delay in resorption of lung liquid, common after C-section

fluid in horizontal fissure

37
Q

What are the effects of meconium aspiration on the fetus?

A

mechanical obst of lungs

pneumonitis

pre-disposing to infection

lungs over-inflated

pneumothorax

persistent pulmonary hypertension of the newborn

38
Q

What are risk factors for pneumonia?

A

prolonged rupture of membranes

chorioamnionitis

low birthweight

39
Q

What is associated with persistent pulmonary hypertension of the newborn?

A

birth asphyxia

meconium aspiration

septicaemia

respiratory distress syndrome

40
Q

How does PPHN present?

A

cyanosis

pulm oligaemia

41
Q

How would you manage PPHN?

A

mechanical ventilation and circulatory support

inhaled NO

sildenafil

42
Q

How does diaphragmatic hernia present?

A

resp distress

failure to respond to resus

apex beat and heart sounds displaced to right side

43
Q

What is biggest complication assoc. with diaphragmatic hernia?

A

pulmonary hypoplasia

44
Q

What are the differences between early infection and late infection?

A

early - <48 hrs after birth, bacteria that have infected birth canal

late - >48 hrs, source of infection is the victims environment

45
Q

Antibiotics are given to cover which organisms in an early infection?

A

group B strep

listeria

gram positive (amox or benzylpenicillin)

gram negative (gentamicin)

46
Q

Antibiotics are given to cover which organisms in an late infection?

A

flucloxacillin and gentamicin

if doesn’t work > vancomycin

47
Q

What can be used to monitor responsiveness to treatment in infection?

A

blood cultures

CRP

48
Q

Risk factors for group b strep infection?

A

preterm

prolonged rupture of membranes

maternal fever during labour

mater chorioamnionitis

previously infected infant

49
Q

What organisms can cause conjunctivitis in neonate? What are the specific treatments?

A

Staph/Strep - neomycin

Gonococcal (gram stain discharge immediately - can lead to blindness ) - cephalosporin

Chlamydia trachomatis -erythromycin

50
Q

How would a herpes simplex virus infection present in a neonate?

A

anytime up to 4 weeks of age

localised herpetic lesions on the skin or eye

encephalitis

disseminated disease

51
Q

Hypoglycaemia usually seen in what groups of neonates?

A

IUGR

preterm

diabetes mums

large-for-dates

hypothermic

polycythaemic

52
Q

How would hypoglycaemia present in a neonate?

A

jitteriness

irritability

apnoea

lethargy

drowsiness

seizures

53
Q

How would you manage a hypoglycaemic infant?

A

prevented by early and frequent milk feeding

IV glucose

glucagon

hydrocortisone

54
Q

If a neonate is having a seizure, what should be ruled out first?

A

hypoglycaemia

meningitis

55
Q

Causes of seizures in neonates?

A

HIE

Cerebral infarction

septicaemia/meningitis

metabolic (glucose, sodium, calcium, magnesium)

intracranial haemorrhage

drug withdrawal

infection

kernicterus

56
Q

What is cleft lip and palate associated with?

A

maternal anticonvulsant use

57
Q

Who should be involved in the care for a baby with cleft lip and palate?

A

Plastics

ENT

Paediatrician

Orthodontist

audiologist

speech therapist

58
Q

How does oesophageal atresia present?

A

persistent salivation

drooling

cough and choking during feeding

yanotic episodes

59
Q

What are causes of small bowel obstruction in neonates?

A

atresia or stenosis of duodenum

atresia or stenosis of jejunum

malrotation with volvulus

meconium ileus

meconium plug

60
Q

What are causes of large bowel obstruction in neonates?

A

hirschprung

rectal atresia

61
Q

What are the steps to neonatal resuscitation?

A
  1. Dry baby and maintain temperature
  2. Assess tone, respiratory rate, heart rate
  3. If gasping or not breathing give 5 inflation breaths*
  4. Reassess (chest movements)
  5. If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
62
Q

What are prenatal. perinatal and postnatal causes of cerebral palsy?

A

Prenatal - cerebral malformation, TORCH infection, metabolic

Perinatal - hypoxia, intrapartum trauma, prematurity complications

Postnatal - head trauma, stroke, meningitis

63
Q

How does cerebral palsy present?

A

spasticity = UMN signs, rigidity, hyperreflexia/tonia, delayed milestones, poor co-ordination, persistent primitive reflexes

epilepsy

audiovisual development

resp problems

poor growth

64
Q

APGAR

A 
Score
Pulse
Respiratory effort
Colour
Muscle tone
Reflex irritability
2
> 100
Strong, crying
Pink
Active movement
Cries on stimulation/sneezes, coughs
1
< 100
Weak, irregular
Body pink, extremities blue
Limb flexion
Grimace
0
Absent
Nil
Blue all over
Flaccid
Nil

A score of 0-3 is very low score, between 4-6 is moderate low and between 7 - 10 means the baby is in a good state

Paeds (13 decks)

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