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Paediatrics > Neonatal > Flashcards

Neonatal Flashcards

1
Q

What are the hearing tests used just after birth?

A

Otoacoustic emissions

Auditory brainstem response

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2
Q

Describe how the otoacoustic emission hearing test works

A

Earphone produces a sound which evokes an echo form the ear if cochlear function is normal

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3
Q

Describe how the auditory brainstem response test works

A

Computer analysis of EEG waveforms in response to a series of auditory stimuli

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4
Q

HIE is caused by perinatal asphyxia but what causes that?

A 
Excessive/prolonged contractions
Placental abruption
Ruptured uterus
Umbilical cord compression: prolapse, shoulder dystocia
Material hypo/hypertension
Intrauterine growth restriction
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5
Q

How common is HIE?

A

0.5-1 in 1000 live births

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6
Q

What is the neonatal management of HIE?

A 
Respiratory support
Anticonvulsants
Fluid restriction 
Fluids and inotropes for hypotension
Correct hypoglycaemia/hypocalcaemia
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7
Q

Describe respiratory distress syndrome

A

A deficiency in surfactant usually present in the alveoli. Increases surface tension and leads to widespread alveolar collapse and inadequate gas exchange.

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8
Q

RDS is very common if the baby is less than …

A

28 weeks

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9
Q

Describe the symptoms of RDS

A 
Within 4 hours of birth:
Tachypnoea
Laboured breathing
Expiratory grunting
Cyanosis
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10
Q

What does the CXR of RDS show?

A

Diffuse granular or ground glass appearance

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11
Q

What is the management of RDS?

A

Raised ambient oxygen
Surfactant therapy - tracheal tube
CPAP or high flow nasal cannula

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12
Q

What saturations are we aiming for when treating RDS?

A

91-95%

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13
Q

What can we use to treat apnoea of the newborn?

A

Caffeine

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14
Q

How do we close a patient ductus arteriosus?

A

Prostaglandin synthetase inhibitor

Ibuprofen

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15
Q

When in a infant’s life if NEC must likely to occur?

A

First few weeks

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16
Q

What are the symptoms/signs of NEC?

A

Feed intolerance
Vomiting
Distended abdomen
Blood in stools

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17
Q

What will the abdo X-ray show in NEC?

A

Distended loops of bowel
Intramural gas
Thickened walls

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18
Q

What is the management of NEC?

A

Nil by mouth - parental feeding

Broad spectrum antibiotics

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19
Q

Brain haemorrhages occur in what percentage of low birth weight infants?

A

20%

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20
Q

What imaging do we use for a suspected pre-term brain bleed?

A

Cranial ultrasound

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21
Q

Where is a preterm brain haemorrhage most likely to occur?

A

Above the caudate nucleus

Fragile blood vessel

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22
Q

Interventricular haemorrhage is most common at what point for neonates?

A

First 72 hours

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23
Q

IVH can lead to what Complication?

A

Cerebral palsy

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24
Q

What is bronchopulmonary dysplasia?

A

Infants with a chronic lung disease that require oxygen at 36 weeks gestation or 4 weeks after birth

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25
Q

What does the CXR of bronchopulmonary dysplasia show?

A

Widespread Opacification

Sometimes cystic changes

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26
Q

Why is it important to know if a child has bronchopulmonary dysplasia?

A

They have worse RSV infections

Need piluvisumab prophylaxis

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27
Q

What percentage of newborns will become jaundiced?

A

50%

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28
Q

Why do many infants become jaundiced?

A

Physiological release of Hb due to breakdown of RBCs
RBC lifespan in shorter in infants
Hepatic bilirubin metabolism is less efficient

29
Q

If jaundice occurs in <24 hours then it is likely to be caused by …

A

Rhea is haemolytic disease
ABO incompatibility
G6PD deficiency
Spherocytosis

30
Q

What type of bilirubin can be deposited in the brain?

A

Unconjugated

31
Q

What is kernicterus?

A

Unconjugated bilirubin deposited in the brain causing encephalopathy
Occurs when the bilirubin exceeds the binding capacity of albumin

32
Q

What are the causes of jaundice appearing between 24 hours and 2 weeks old?

A 
Physiological
Breast milk
Infection
Haemolysis
Bruising
Polycythaemia
33
Q

What are the causes of unconjugated jaundice occurring >2 weeks?

A 
Physiological/breast milk
Infection
Hypothyroidism
Haemolysis 
Upper GI obstruction
34
Q

What are the causes of conjugated jaundice >2 weeks?

A

Bile duct obstruction

Hepatitis

35
Q

How can we treat jaundice in babies?

A

phototherapy

Exchange transfusion

36
Q

Describe development dysplasia of the hip

A

Acetabulum is shallow and does not adequately cover the femoral head therefore the joint is easily dislocated

37
Q

What are the risk factors for development dysplasia of the hip?

A

Breech birth
Family hx
Female
Impaired limb movement

38
Q

What is DDH associated with?

A

Talipes - club foot

39
Q

What tests are performed for suspected DDH?

A

Barlow test - pushing backwards will dislocate hip

Ortolani test - a dislocated hip will not abduct fully and clunks as relocates

40
Q

When do we perform an USS if the examination is abnormal in an infant’s hips?

A

2 week

41
Q

When do we perform an USS if the baby has risk factors but a normal exam of the hips?

A

6 weeks

42
Q

What is the treatment of DDH?

A

Harness or splint worn for several months - held in flexion and abduction

43
Q

What factors increase the risk of intrauterine growth restriction?

A 
Maternal age <16 or >35
Decreased social economic status 
Previous small-for-gestational-age baby 
Maternal substance abuse
Heavy physical work during pregnancy 
Maternal medical disorders
Maternal infection
Placental dysfunction or Abruption
44
Q

How do we define a neonate?

A

A baby up to 28 days old

45
Q

How do we define a premature baby?

A

Born <37 weeks gestation

46
Q

Low birth weight is anything under …

A
  1. 5kg

5. 5lb

47
Q

Very low birth weight is anything under …

A
  1. 5kg

3. 3lb

48
Q

Extremely low birth weight is anything under…

A

1kg

2.2lb

49
Q

A high birth weight is anything over …

A
  1. 5kg

9. 9lb

50
Q

How many calories does 1 ounce of breast milk contain?

A

20 calories

51
Q

1 ounce is equivalent to how many millilitres?

A

30 ml

52
Q

100 ml of formula contains how many calories?

A

67

53
Q

What is the fluid requirement for a newborn?

A

150ml/kg

54
Q

What is the daily calorie requirement for a pre-term baby?

A

110-130 Calories/kg

55
Q

What is the daily calorie requirement for a term baby?

A

90-120 calories/kg

56
Q

When do we give maternal steroids?

A

If the baby is likely to be born <34 weeks

57
Q

Why are newborns predisposed to hypothermia?

A

Poor temperature regulation
Lack of subcutaneous tissue
Large surface area to volume ratio so lost in evaporation

58
Q

What is the definition of apnoea of prematurity?

A

The absence of breathing for >20 seconds in a premature baby

59
Q

What are the consequence of apnoea?

A

Desaturations

Bradycardia

60
Q

What is the management of apnoea of prematurity?

A

Stimulate the baby

IV or NG caffeine

61
Q

Why are neonates at increased risk of hypoglycaemia?

A

Lack of glycogen storage in the liver

Lack of fat as alternative ATP supply

62
Q

What is the management of hypoglycaemia in neonates?

A

IV 10% dextrose

Prevent fluid loss - humidify

63
Q

Why are neonates more predisposed to infections?

A

Thin skin - thinner barrier
Immature immune system
Premature babies get less IgG through the placenta as they spend less time in the third trimester

64
Q

When does suckling and swallowing develop?

A

34-35 weeks gestation

65
Q

NG feeding in a neonate increases the risk of …

A

Necrotising enterocolitis

66
Q

When do we have to worry most if jaundice appears?

A

In the first 24 hours after birth

67
Q

Describe the mechanism of physiological jaundice

A

HbF has a shorter half life than normal Hb - 90 days - therefore increased haemolysis
Low albumin due to low protein levels and immature liver
Lack of bacteria in bowel for conversion of bilirubin to stercobilim

68
Q

What is the management of jaundice in a neonate?

A

Phototherapy - 450nm blue-green light

Exchange transfusion

69
Q

What are the features of congenital hypothyroidism?

A 
Coarse facial features
Hypotonia
Large tongue
Hoarse cry
Umbilical hernia
Constipation
Prolonged jaundice

Paediatrics (8 decks)

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