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Y4 Paeds > Neonatal > Flashcards

Neonatal Flashcards

1
Q

what is Early onset neonatal sepsis (EONS) defined as?

A

sepsis occurring within the first 48-72 hours of life

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2
Q

what is the most common infection to cause early onset neonatal sepsis?

A

group B streptococcus causing chorioamnionitis

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3
Q

what type of bacteria is group B streptococcus ?

A

gram + coccus

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4
Q

what are risk factors for infection ?

A

invasive group B strep in previous baby
pre labour rupture of membranes
<37 weeks gestation
intrapartum fever >38

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5
Q

what are red flags for suggestion of neonatal sepsis?

A

resp distress starting more than 4 hours after birth
seizures
need for mechanical ventilation in term baby
signs of shock
infection in a co-twin

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6
Q

what are some DD for neonatal sepsis?

A 
Transient Tachypnoea of the newborn (TTN)
Respiratory distress syndrome (RDS)
meconium aspiration 
haemolytic disease of the newborn 
meningitis 
UTI
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7
Q

what investigations can be done for neonatal sepsis?

A

FBC, CRP, blood cultures
swabs
LP

CRP should be repeated at 18-24hrs

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8
Q

what is the management of neonatal sepsis?

A

intravenous benzylpenicillin with gentamicin

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9
Q

when should the antibiotics for neonatal be considered stopping?

A

at 36hrs if

  • blood cultures negative
  • initial suspicion wasn’t strong
  • no clinical indicators
  • CRP is reassuring
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10
Q

how long should neonatal sepsis be treated for?

A

7-10days

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11
Q

what is the mortality from EONS?

A

16%

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12
Q

what % of pregnant women carry group B strep in their genital tract?

A

25%

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13
Q

how many term babies are jaundice ?

A

60%

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14
Q

how many pre mature babies are jaundice ?

A

80%

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15
Q

what is a complication of untreated jaundice ?

A

kernicterus

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16
Q

what % of breast fed babies are jaundice at 1 month?

A

10%

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17
Q

what pathological causes of jaundice is there?

A

haemolytic disease - ABO incompatibility, G6PD deficiency, spherocytosis

post natal infection

prolonged jaundice - infection, hypothyroidism, galactosaemia, breast milk jaundice, biliary atresia, choledocal cyst

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18
Q

state some risk factors of hyperbilirubinaemia ?

A 
Prematurity, low birth weight, small for dates
Previous sibling required phototherapy
Exclusively breast fed
Jaundice <24 hours
diabetic mother
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19
Q

how old does a baby have to be to use a transcutaneous bilirubinometer ?

A

> 35/40 gestation and >24 hours old for first measurement

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20
Q

how can bilirubin be measured if <35 weeks or <24hrs old?

A

serum bilirubin

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21
Q

what value should transcutaneous bilirubinometer be under or else serum bilirubin is done?

A

<250

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22
Q

what other investigations can be done for neonatal jaundice apart from serum bilirubin?

A 
U&amp;Es
infection screen 
glucose 6 phosphate dehydrogenase 
LFTs
TFTs
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23
Q

what is a treatment for neonatal jaundice?

A

phototherapy

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24
Q

how often should bilirubin levels be repeated during phototherapy treatment?

A

4-6hrs

6-12hrs once level is stable

25
Q

when should phototherapy be stopped?

A

once level >50µmol/L below treatment line on the threshold graphs

26
Q

vie which artery/vein is exchange transfusion for neonatal jaundice done?

A

via umbilical artery or vein

27
Q

in what circumstances is IV immunoglobulin used for neonatal jaundice?

A

rhesus haemolytic disease or ABO haemolytic disease.

28
Q

what is kernicterus ?

A

billirubin-induced brain dysfunction

Bilirubin is neurotoxic and at high levels can accumulate in the CNS gray matter causing irreversible neurological damage.

29
Q

when would U&Es be measured for neonatal jaundice?

A

for excessive weight loss

30
Q

when is the onset of physiological jaundice usually?

A

2-3days and peaks at day 5 and usually resolves by day 10

31
Q

How long after stopping phototherapy should bilirubin levels be checked to rule out rebound hyperbilirubinaemia?

A

12-18hrs

32
Q

what can meconium aspiration cause?

A

respiratory distress
neonatal sepsis
iscahemic insults

33
Q

what can cause in utero peristalsis ?

A

foetal hypoxic stress or vagal stimulation due to cord compression

34
Q

when meconium is aspirated what does it stimulate?

A

the release of many vasoactive and cytokine substances that activate inflammatory pathways, as well as triggering vasculature changes. It also inhibits the effect of surfactant in the lungs.
this can cause persistent pulmonary hypertension

35
Q

state some risk factors for meconium aspiration?

A

Gestational Age > 42 weeks
Foetal distress (tachycardia / bradycardia)
Intrapartum hypoxia secondary to placental insufficiency
Thick meconium particles
Apgar Score <7
Chorioamnionitis +/- Prolonged pre-rupture
Oligohydramnios
In utero growth restriction (IUGR)
Maternal hypertension, diabetes, pre-eclampsia or eclampsia, smoking and drug abuse

36
Q

what are some clinical signs of meconium aspiration?

A

Tachypnoea – a respiratory rate of >60 breaths per minute
Tachycardia – a heart rate of >160 beats per minute
Cyanosis – this requires immediate management
Grunting
Nasal flaring
Recessions – intercostal, supraclavicular, tracheal tug
Hypotension – systolic blood pressure of <70 mmHg

37
Q

what does APGAR score stand for?

A 
activity 
pulse 
grimace
appearance 
respiration
38
Q

is meconium aspiration a clinical diagnosis?

A

yes

39
Q

what will CXR show for meconium aspiration?

A 
increased lung volumes
asymmetrical patchy pulmonary opacities 
pleural effusions
pneumothorax or pneumomediastinum
multifocal consolidation – due to chemical pneumonitis
40
Q

what investigations can be done for meconium aspiration ?

A 
FBC, CRP, Blood cultures 
ABG
dual pulse oximetry 
ECHO
cranial US - to assess hypoxic damage
41
Q

what are DD for meconium aspiration?

A

transient tachypnoea of the newborn
surfactant deficiency
persistent pulmonary HTN

42
Q

will transient tachypnoea of the newborn have normal or abnormal ABG?

A

normal

43
Q

what is the treatment of refractory pulmonary hypertension ?

A

inhaled NO

44
Q

what are some complications of meconium aspiration?

A

air leak - ball valve effect causing a pneumothorax or pneumomediastinum

PPHN - 1/3rd MAS patients affected

cerebral palsy

chronic lung disease

45
Q

what investigation is done for PPHN?

A

echo

46
Q

what % of MAS new borns are discharged safely after 3-4days ?

A

80%

47
Q

In up to what percentage of pregnancies does aspiration of meconium stained amniotic fluid occur?

A

23%

48
Q

in a newborn infant, tachycardia is characterised what heart rate?

A

> 160

49
Q

at what gestation is preterm?

A

<37 weeks

50
Q

what is the number one cause of neonatal death globally

A

prematurity

51
Q

why would an abdo X-ray be done on a premature baby?

A

used to assess the position of the umbilical venous and umbilical arterial catheters after insertion

risk of developing necrotising enterocolitis, perforation

52
Q

why would a cranial US be done on a pre mature baby?

A

risk of intraventricular haemorrhage or ischaemic periventricular white matter damage

53
Q

What tool can be used to estimate gestational age?

A

Dubowitz/Ballard examination

54
Q

What percentage of babies delivered at 26 weeks are expected to survive?

A

75%

55
Q

under what gestation should resuscitation be performed?

A

<23weeks

56
Q

what resp complications occur during prematurity ?

A

Respiratory distress syndrome, Surfactant deficient lung disease

57
Q

what CVS complications occur during prematurity ?

A

Hypotension, perfusion abnormalities, PDA

58
Q

what neuro complications occur during prematurity ?

A

Intraventricular haemorrhage, seizures, post haemorrhagic ventricular dilatation

59
Q

what endo complications occur during prematurity ?

A

Jaundice, hyperglycaemia, hypoglycaemia

Y4 Paeds (15 decks)

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