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Neonatal Flashcards

1
Q

What is the current survival in % for a 24/40

A

70%

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2
Q

How is ETT insertion depth calculated

A

Weight + 6

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3
Q

What two medications should be given to mum if a preterm delivery is eminent
What is the time window

A

Magnesium sulphate and steroids

Within 4 hours

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4
Q 
When are antenatal corticosteroids most useful 
What outcomes do they improve
What do they not improve 
Is there any benefit to repeating 
When should they be repeated
What hat is the gestational cut off?
A 
If given <48 hrs prior to delivery 
RDS, IVH, NEC, sepsis and fetal death 
Maternal death, chorioamnioitis, chronic lung disease 
Yes- improves short term neuro benefits 
After 7 days
35 weeks
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5
Q

What does antenatal magnesium benefit

When should it be given

A

Neurodevelopmental outcomes- reduces CP

within 4 hours of delivery

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6
Q

Trisomy 21 screening
What are two things on mums bloods that make it more likely
What is seen on antenatal scan

A

High beta HCG
Low PAPP A
Increased nuchal translucency

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7
Q

Which is done earlier- CVS or amniocentesis
What is the risk of fetal loss
What is the new test for trisomies? What is the most likely cause of a false positive result

A

Cvs
Around 1%
NIPT- confined parental mosaicism

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8
Q

What are three consequences of oligohydramnios

A

Pulmonary hypoplasia
Talipes
Potters faces

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9
Q

What are 4 complications of polyhydramnios

A

Preterm labour
APH
Cord prolapse
Malpresentation

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10
Q

What defines low birth weight

What is extreme low birth weight

A

<2.5kg

<1kg

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11
Q

What is the medical term for identical twins

A

Monochorionic monoamniotic

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12
Q

Which twins run in families

A

Dizygotic

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13
Q

What sign on ultrasound scanning suggests dichorionicity

A

Lambda sign

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14
Q

What are the main 9 conditions the Guthrie card can screen for?

A 
CF
Hypothyroidism 
SCID 
PKU
GALACTOSAEMIA 
BIOTINIDASE DEFICIENCY
homocysteineurina 
Maple syrup urine disease 
Fatty acid oxidation disorders
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15
Q

What does the newborn hearing screen assess for

If they fail what test is done next

A

Oto acoustic emissions

Brain stem evoked potentials

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16
Q

What is the difference between ortolanis and barlows

A

Ortolanis- hip is out and you put it back

Barlows- can you dislocate the hip

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17
Q 
What emergency makes brachial plexus injuries most likely 
What is involved in 
ERB palsy 
Klumpke palsy 
Complete lesion 
What will be seen clinically
A

Shoulder dystocia
ERb- c5 and 5. Waiters tip
Klumpke- c7- t1 wrist drop with reduced grip
Completec5- T1- completely flaccid with hornets syndrome in 1/3

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18
Q

What level should an umbilical artery catheter be at

“Umbilical vein. What does this correlate to?

A

Coeliac artery- t6-10

Below diaphragm- t8-9

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19
Q

What type of cleft palates is associated with a bifid uvula

A

Submucosal

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20
Q 
Malformation- anatomy 
When does gut rotation normally happen 
How does it rotate 
How is it normally fixed 
What causes a volvulus
A

5weeks onwards
270 degrees anti clockwise
Ligament of trietz
Lads bands (adhesions)

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21
Q 
Malrotation 
How does it present 
What may be seen on AXR 
what is the investigation of choice. What is seen?
How is it managed
A

Episodic bilious vomiting with abdominal distension and a palpable mass
Double bubble or gas less abdo
Upper GI contract- corkscrew
Urgent surgery and de Volving

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22
Q 
Pyloric stenosis 
What is seen on bloods 
What is characteristic about the vomiting 
What is the investigation of choice 
How are they managed- 2 stages
A

HypoCL hypoK metabolic alkalosis
Non bilious
Ultrasound
First resus then surgery- ramsteds pyloromyotomy

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23
Q

TOF
What is the most common subtype
Which is the least severe. How may it present
How are they diagnosed at birth?

A

Proximal atresia with a distal TOF
H type- late with brassy cough and recurrent infections
Place an NG tube then X-ray- will be coiled you in the oesophagus

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24
Q

What syndrome is associated strongly with duodenal atresia
What is seen on X-ray
How do they present

A

T21
Double bubble sign
Like a malrotation with volvulus

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25
Ano rectal atresia What is the difference between a high and a low lesion What syndrome is associated What other organ may be involved
High involves the rectum. Low is just the anus VACTRL kidneys
26
What are the two main differences between omphalocoele and gastroschisis
Omphalocoele has a peritoneal covering and is more likely associated with syndromes Gastroschisis is the opposite!
27
What is the normal triad for NEC can it happen In term babies too What does erythema of the abdominal wall indicate When does it normally occur
Bloody stools, abdominal distension and bilious vomits or aspirates Yes! Peritonitis Week 2-3
28
What are the 4 main risks for NEC | What maternal antibiotic is associated with an increased risk
Enteral feeding Bacteria Reduced gut perfusion IUGR or prematurity Augmentin
29
Does delayed feeding reduce the risk of NEC | What are the two main things that reduce NEC
No | Breast feeding and probiotic usage
30
NEC What are three late signs seen on X-ray What antibiotic regime is used What else is done to manage them
Pneumatosis Interstitialis Portal venous gas Pneumoperitoneum Amox, metro and gent Drip and suck Cardioresp support
31
What is the mnemonic to remember lung development When does the saccular phase start
``` Each- embryonic Person- pseudoglandular Can- canalicular Sprout- saccular Airways- alveolar ``` 28 weeks
32
``` Surfactant Where is it normally produced When is it given prophylactically When else should it be given What is given ```
Type 2 pneumocytes <27 weeks Evidence of resp distress Cryosurf
33
TTN What causes it When should it resolve What is seen on chest X-rays
Delayed fluid clearance within the lungs Within 48 hours Fluid within the transverse fissure and flat diaphragms
34
``` Hyaline membrane disease What is it otherwise called What is deficient Who is most likely to get it What rarely can cause it ```
RDS surfactant deficiency Preterm babies Congenital surfactant deficiency
35
Hyaline membrane disease What is seen in chest X-ray What ventilation settings are preferred
Ground glass appearance with multiple air bronchograms | High PEEP
36
What are 4 complications of RDS
Pneumothorax Pulm HTN Pulm haemorrhage Chronic lung disease
37
Is there any evidence for inhaled nitric oxide in RDS?
No
38
Pulm hypertension What is the main physiological reason why it happens Give three mechanisms behind the development of pphn
Delayed reduction in pulmonary systemic vascular resistance Smooth muscle hypertrophy Obstruction Pulmonary hypoplasia
39
PPHN How does it present What are two tell tale signs of pulmonary hypertension What is seen on chest X-ray
Severe cyanosis and resp distress shortly after birth Single loud s2 Wide fluctuations in o2 sats Reduced lung markings and increased RV
40
Will PPHN improve with hyperoxia | What type of ventilation might be useful
No | HFOV
41
What is the mechanism behind inhaled nitric oxide What is it’s half life What are 3 side effects What may be used if it fails
Endothelial derived relaxing factor- increases cGMP causing selective pulmonary vasodilation 3-6 seconds! Methhaemoglobin if high concentrations or failure of ventilator Pulmonary toxicity Inhibition of platelets causing bleeding Prostacyclin
42
Meconium aspiration Does it occur in all MEC stained liquor When does aspiration occur What are 4 physiological outcomes
No- only 15% In utero Chemical pneumonitis V/Q mismatch Pulmonary hypertension Bacterial infection
43
MEC aspiration What is seen on chest X-ray Should suctioning routinely be preformed How should they be managed (3 things)
Coarse opacities and hyperinflation No- only if under direct vision Early ventilation and surfactant If experienced- before breaths given suction Consider antibiotics
44
Pulmonary haemorrhage How does it present What is seen on X-ray How should they be managed (4 stages)
Acute haemodynamic instability, blood from ETT or blood elsewhere (DIC) White out Fluid resus, increase PEEP, fluids and diuretics and blood, surfactant
45
What is a bubble like chest X-ray indicative of | What are the babies at risk of
PIE | Pneumothorax
46
What is the definition of chronic lung disease How many have hyper- reactive airways What is seen on chest X-ray
>6 weeks o2 requirement or persisting chest X-ray changes 50% Hyperinflated with fibrosis and cysts
47
Why is high flow o2 not used as much as CPAP in extinction failure What is the normal pressure of cpap used What prongs are normally used
Higher rate of failure- likely to need CPAP anyway! 4-6 cm of H2O Hudson prongs
48
What are the two main goals of ventilation and what are the three variables affecting each
Adequate oxygenation - fi o2 - MAP - surface area for gas exchange and diffusion Adequate ventilation - tidal volume - rate - surface area for gas exchange and diffusion.
49
What is NIPPV What are the two possible settings and explain each What does it not benefit
Using a ventilator with nasal prongs- bi level support Synchronised- every time the baby breaths their respirations are supported Non synchronised- pressure rise intermittently at a set pressure. Mortality, chronic lung disease
50
What is the difference between SIPPV and SIMV Which is preferred
SIPPV- synch intermittent positive pressure ventilation. Breathing at a set rate Extra or non triggered breaths are supported SIMV- synch intermittent manual ventilation Only supports breaths at the set rate and not breaths above this SIMV
51
What is volume guarantee When can you not use synchronised ventilation What is the best ventilator mode to be used when weaning
A set tidal volume that is delivered with each breath to a set PIP In transport settings Pressure support ventilation
52
In manual ventilation if the o2 is low what steps should you preform
Increase the fio2 Increase MAP- normally increase PIP. Increase PEEP if pulm haemorrhage Or increase I time
53
In manual ventilation if the co2 is high what should you do
Increase the tidal volume by increasing the PIP or reducing time on volume guarantee Increasing the rate
54
In HFOV | if the o2 is low what should you do
Increase the fio2 | Increase the MAP
55
In HFOV | if the co2 is high what should you do
Increase the amplitude | Reduce the frequency
56
What is the normal expected weight loss Term babies Preterm
Term- 10% | Preterm- 15%
57
What is the best way to measure neonatal tubular function What is the formula What is the normal value?
Fractional excretion of sodium Urine/ serum na over urine/serum creat <2.5%
58
What shifts the o2 binding curve left | What does it indicate
Less h, co temp and 2,3 DPG HBF Greater affinity to o2, gives up less
59
What does delayed cord clamping benefit (2 things)
Mortality and need for transfusion
60
What is the transfusion threshold for a neonate
<70 and symptomatic
61
What type of antibodies are involved in rhesus disease of the newborn What are three possible triggering events
IgG | Previous delivery or miscarriage, poorly matched blood transfusions
62
When should anti D be given to rhesus negative mums (2 scenarios)
28 weeks and within 72 hrs of delivery of baby rhesus positive
63
What type of antibodies form in ABO incompatibility | Is it more or less severe than rhesus disease
IgM as the baby makes them | Less
64
What is the definition of polycythaemia
>65% haematocrit
65
What Causes haemorrhagic disease of the newborn Where is the most common site for bleeding to occur Name 3 conditions that make it more likely
Vitamin K deficiency GI CF and alpha 1 AT def, malabsorption, biliary atresia and hepatitis
66
Haemorrhagic disease of newborn What is seen on bloods After vitamin K what is given
Prolonged PT but normal APTT | FFP
67
Alloimmune thrombocytopenia What type of antibodies form and to what How do you differentiate from maternal ITP Can it affect the first pregnancy?
IgG Anti hpA 1 a Mum has normal platelets Yes!
68
What defines a neonatal apnoea What is the most common type What is the treatment- what three other things does it benefit
Pause in breathing >20 secs Central Caffeine- reduces CLD, helps PDA close and some improved long term Neuro outcomes
69
PDA Is there any difference between indomethacin and ibuprofen What are 2 adverse effects
No! | Reduce renal blood flow and platelet function
70
Outline the physiology of retinopathy of prematurity
Too much o2 to the retina, reduced new vessel formation, release of VEGF and abnormal angiogenesis
71
ROP Outline the 5 stages What is pulse disease What are the three zones Is type 1 ROP good or bad?
``` 1- fine line between vascular and a vascular portions 2- ridge “ 3- neovascularisation 4- partial detachment 5- total detachment ``` Dilated and torturous vessels 3- outermost 1- innermost (1 therefore worse than 3) Bad!
72
Can EPO treatment increase risk of ROP
Yes!
73
What is the biggest risk factor for developing HIE
IUGR
74
HIE What is the biggest risk factor How does it present if mild vs severe What is the worst prognostic factor
IUGR Mild- irritable, hyperreactive and poor feeding Severe- encephalopathy, seizures and posturing Very low ph
75
HIE What is the best imaging modality What is seen What is the management strategy. When and for how long.
MRI Increased signal usually in the deep white matter Therapeutic cooling to 33.5 deg. Within 6 hrs and for 72 hrs
76
``` Neonatal stroke How can it present in a term baby How many babies will have normal ND outcomes What should be used to manage seizures What form of CP will they go on to have ```
Apnoeas 1/3 Phenobarbitone Hemiplegic
77
Is intraventricular haemarrhoge possible in term babies anatomically what occurs In mum, what might be protective
Yes- only if there was trauma or severe asphyxia Rupture of the germinal matrix and bleeding into the ventricles PET
78
When does IVH tend to present | How do they present
Within the first few days to first week- apnoea seizure and lethargy
79
IVH | Whatever are the 4 stages of bleeding seen on scans
1- subependymal 2- intraventricular with no ventricular dilatation 3-“ with dilatation 4- intraparenchymal too
80
From what point of are the cysts of PVL seen | What is another complication of IVH
3 weeks | Hydrocephalus
81
What percent of blood can be lost into a sub Galeal haemorrhage?
Up to 40%
82
How does breast milk link to late onset vitamin k deficient bleeding
Increases risk
83
When could choroid plexus cysts be concerning | What else would be seen on ultrasound
Trisomy 18 | Clenched fists
84
What blood findings will be seen in a hypoglycaemic infant of a diabetic mum
High insulin Low ketones Negative reducing substances in urine
85
``` Congenital toxoplasmosis Is it common? How is it spread? How does it present? Which trimester is it worst? What should mums be treated with? How long should babies be treated for How long should babies be treated for ```
No! Cats or unwashed veges Asymptomatic at birth then chorioretinitis after 2 years with widespread calcifications 1st Spiramycin, add in pyrimethane if amino positive 12 months
86
``` Congenital rubella When is it worst to contract What is the most severe complication How does it present What are late features What test in baby is diagnostic What treatment is there for mum or baby ```
First trimester Abortion IUGR and cataracts with blueberry muffin rash. Cardiac lesions- pulm stenosis and PDA Developmental delay and SN hearing loss IgM immunoglobulin to mum. Nothing for baby
87
CMV What is worse- mum with primary infection or mum with recurrent infections. How does it present What is seen on MRI What is the best test When should treatment be started at birth? What is given?
Primary Blueberry muffin rash, chorioretinitis and SGA Hearing loss later on. Periventricular calcification Urine PCR If baby is moderately or severely symptomatic at birth- delays hearing loss Gancyclovir
88
``` Syphillis When is transmission worst How does it present at birth If missed what can occur What test is diagnostic How is it treated and why Should mum be treated in pregnancy ```
Late in pregnancy Snuffles, skin peeling with red rash, pseudoparapariesis and jaundice Saddle nose and bossing, abnormal teeth, ID Positive treptonemal igM Iv penicillin for 10 days- prevents and treats Neurosyphillis Yes!
89
What is the risk to the baby if mum comes into contact with parvovirus b19
Severe anaemia leading to hydrops
90
What is the risk to the fetus if mum has primary varicella infection. Should she be treated When should baby get VZIG How does congenital varicella present Should mum breast feed if she has active varicella
Only 2-3%- yes with VZIG If mum exposed 5d prior or 2d post delivery Scarring, cataracts, microcephalic and hypoplasric limbs No!
91
HIV From what point of gestation should mum be treated if found to be positive. What is the aim Is CS necessary? Should the baby be treated at birth Should the baby have a BCG vaccine at birth Is pcp prophylaxis needed for baby Is breastfeeding contraindicated?
``` 28 weeks- aiming for an undetectable viral load If suppressed no Yes for 4-6 weeks then test No- wait for tests first No Yes ```
92
Hep c | Can mums breast feed
Yes unless cracked nipples
93
What calculation is used to show the need for ECMO | What are 3 contraindications
Oxygenation index- fiO2xMAP/pao2 Grade 3/4 IVH, severe cardiac lesions, liver or kidney disease, lethal malformations
94
HSV | Mum has lesions at birth and baby is born by cs and well. What investigations should they have
Swabs 24-48 hrs after birth of this is a reactivation. If primary infection start acyclovir straight away
95
What is a pathognomonic finding on post mortem with intra utero listeria infection If baby survives what rash might be seen at birth
Granulomatosis infantiseptica Salmon pink papules
96
What is the best opiate to take while breastfeeding
Buprenorphine
97
What is the trisomy risk 28 40 45
28- 1:1000 40- 1:100 45-1:25
98
What are the calorie requirements Term baby Preterm Sick preterm
100kcal/kg/day 120” 150”
99
When do the following features first appear in a neonate Light reflex Glabellar tap Breast tissue
Light reflex- 30w Glabellar tap-34 W Breast tissue- 36w

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