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FRACP > Neonatal > Flashcards

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
Q

Ano rectal atresia
What is the difference between a high and a low lesion
What syndrome is associated
What other organ may be involved

A

High involves the rectum. Low is just the anus
VACTRL
kidneys

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26
Q

What are the two main differences between omphalocoele and gastroschisis

A

Omphalocoele has a peritoneal covering and is more likely associated with syndromes
Gastroschisis is the opposite!

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27
Q

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

A

Bloody stools, abdominal distension and bilious vomits or aspirates
Yes!
Peritonitis
Week 2-3

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28
Q

What are the 4 main risks for NEC

What maternal antibiotic is associated with an increased risk

A

Enteral feeding
Bacteria
Reduced gut perfusion
IUGR or prematurity

Augmentin

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29
Q

Does delayed feeding reduce the risk of NEC

What are the two main things that reduce NEC

A

No

Breast feeding and probiotic usage

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30
Q

NEC
What are three late signs seen on X-ray
What antibiotic regime is used
What else is done to manage them

A

Pneumatosis Interstitialis
Portal venous gas
Pneumoperitoneum

Amox, metro and gent
Drip and suck
Cardioresp support

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31
Q

What is the mnemonic to remember lung development

When does the saccular phase start

A 
Each- embryonic
Person- pseudoglandular 
Can- canalicular 
Sprout- saccular 
Airways- alveolar

28 weeks

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32
Q 
Surfactant 
Where is it normally produced 
When is it given prophylactically
When else should it be given 
What is given
A

Type 2 pneumocytes
<27 weeks
Evidence of resp distress
Cryosurf

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33
Q

TTN
What causes it
When should it resolve
What is seen on chest X-rays

A

Delayed fluid clearance within the lungs
Within 48 hours
Fluid within the transverse fissure and flat diaphragms

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34
Q 
Hyaline membrane disease 
What is it otherwise called
What is deficient 
Who is most likely to get it 
What rarely can cause it
A

RDS
surfactant deficiency
Preterm babies
Congenital surfactant deficiency

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35
Q

Hyaline membrane disease
What is seen in chest X-ray
What ventilation settings are preferred

A

Ground glass appearance with multiple air bronchograms

High PEEP

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36
Q

What are 4 complications of RDS

A

Pneumothorax
Pulm HTN
Pulm haemorrhage
Chronic lung disease

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37
Q

Is there any evidence for inhaled nitric oxide in RDS?

A

No

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38
Q

Pulm hypertension
What is the main physiological reason why it happens
Give three mechanisms behind the development of pphn

A

Delayed reduction in pulmonary systemic vascular resistance

Smooth muscle hypertrophy
Obstruction
Pulmonary hypoplasia

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39
Q

PPHN
How does it present

What are two tell tale signs of pulmonary hypertension

What is seen on chest X-ray

A

Severe cyanosis and resp distress shortly after birth

Single loud s2
Wide fluctuations in o2 sats

Reduced lung markings and increased RV

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40
Q

Will PPHN improve with hyperoxia

What type of ventilation might be useful

A

No

HFOV

41
Q

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

A

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
Q

Meconium aspiration
Does it occur in all MEC stained liquor
When does aspiration occur
What are 4 physiological outcomes

A

No- only 15%
In utero

Chemical pneumonitis
V/Q mismatch
Pulmonary hypertension
Bacterial infection

43
Q

MEC aspiration

What is seen on chest X-ray

Should suctioning routinely be preformed
How should they be managed (3 things)

A

Coarse opacities and hyperinflation

No- only if under direct vision

Early ventilation and surfactant
If experienced- before breaths given suction
Consider antibiotics

44
Q

Pulmonary haemorrhage

How does it present
What is seen on X-ray
How should they be managed (4 stages)

A

Acute haemodynamic instability, blood from ETT or blood elsewhere (DIC)

White out
Fluid resus, increase PEEP, fluids and diuretics and blood, surfactant

45
Q

What is a bubble like chest X-ray indicative of

What are the babies at risk of

A

PIE

Pneumothorax

46
Q

What is the definition of chronic lung disease
How many have hyper- reactive airways
What is seen on chest X-ray

A

> 6 weeks o2 requirement or persisting chest X-ray changes
50%
Hyperinflated with fibrosis and cysts

47
Q

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

A

Higher rate of failure- likely to need CPAP anyway!

4-6 cm of H2O

Hudson prongs

48
Q

What are the two main goals of ventilation and what are the three variables affecting each

A

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
Q

What is NIPPV
What are the two possible settings and explain each
What does it not benefit

A

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
Q

What is the difference between SIPPV and SIMV

Which is preferred

A

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
Q

What is volume guarantee
When can you not use synchronised ventilation
What is the best ventilator mode to be used when weaning

A

A set tidal volume that is delivered with each breath to a set PIP
In transport settings
Pressure support ventilation

52
Q

In manual ventilation if the o2 is low what steps should you preform

A

Increase the fio2
Increase MAP- normally increase PIP. Increase PEEP if pulm haemorrhage
Or increase I time

53
Q

In manual ventilation if the co2 is high what should you do

A

Increase the tidal volume by increasing the PIP or reducing time on volume guarantee
Increasing the rate

54
Q

In HFOV

if the o2 is low what should you do

A

Increase the fio2

Increase the MAP

55
Q

In HFOV

if the co2 is high what should you do

A

Increase the amplitude

Reduce the frequency

56
Q

What is the normal expected weight loss
Term babies
Preterm

A

Term- 10%

Preterm- 15%

57
Q

What is the best way to measure neonatal tubular function
What is the formula
What is the normal value?

A

Fractional excretion of sodium
Urine/ serum na over urine/serum creat
<2.5%

58
Q

What shifts the o2 binding curve left

What does it indicate

A

Less h, co temp and 2,3 DPG
HBF
Greater affinity to o2, gives up less

59
Q

What does delayed cord clamping benefit (2 things)

A

Mortality and need for transfusion

60
Q

What is the transfusion threshold for a neonate

A

<70 and symptomatic

61
Q

What type of antibodies are involved in rhesus disease of the newborn
What are three possible triggering events

A

IgG

Previous delivery or miscarriage, poorly matched blood transfusions

62
Q

When should anti D be given to rhesus negative mums (2 scenarios)

A

28 weeks and within 72 hrs of delivery of baby rhesus positive

63
Q

What type of antibodies form in ABO incompatibility

Is it more or less severe than rhesus disease

A

IgM as the baby makes them

Less

64
Q

What is the definition of polycythaemia

A

> 65% haematocrit

65
Q

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

A

Vitamin K deficiency
GI
CF and alpha 1 AT def, malabsorption, biliary atresia and hepatitis

66
Q

Haemorrhagic disease of newborn
What is seen on bloods
After vitamin K what is given

A

Prolonged PT but normal APTT

FFP

67
Q

Alloimmune thrombocytopenia
What type of antibodies form and to what
How do you differentiate from maternal ITP
Can it affect the first pregnancy?

A

IgG
Anti hpA 1 a
Mum has normal platelets
Yes!

68
Q

What defines a neonatal apnoea
What is the most common type
What is the treatment- what three other things does it benefit

A

Pause in breathing >20 secs
Central
Caffeine- reduces CLD, helps PDA close and some improved long term Neuro outcomes

69
Q

PDA
Is there any difference between indomethacin and ibuprofen
What are 2 adverse effects

A

No!

Reduce renal blood flow and platelet function

70
Q

Outline the physiology of retinopathy of prematurity

A

Too much o2 to the retina, reduced new vessel formation, release of VEGF and abnormal angiogenesis

71
Q

ROP
Outline the 5 stages
What is pulse disease

What are the three zones

Is type 1 ROP good or bad?

A 
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
Q

Can EPO treatment increase risk of ROP

A

Yes!

73
Q

What is the biggest risk factor for developing HIE

A

IUGR

74
Q

HIE
What is the biggest risk factor
How does it present if mild vs severe
What is the worst prognostic factor

A

IUGR
Mild- irritable, hyperreactive and poor feeding
Severe- encephalopathy, seizures and posturing
Very low ph

75
Q

HIE
What is the best imaging modality
What is seen
What is the management strategy. When and for how long.

A

MRI
Increased signal usually in the deep white matter
Therapeutic cooling to 33.5 deg. Within 6 hrs and for 72 hrs

76
Q 
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
A

Apnoeas

1/3

Phenobarbitone

Hemiplegic

77
Q

Is intraventricular haemarrhoge possible in term babies anatomically what occurs

In mum, what might be protective

A

Yes- only if there was trauma or severe asphyxia
Rupture of the germinal matrix and bleeding into the ventricles

PET

78
Q

When does IVH tend to present

How do they present

A

Within the first few days to first week- apnoea seizure and lethargy

79
Q

IVH

Whatever are the 4 stages of bleeding seen on scans

A

1- subependymal
2- intraventricular with no ventricular dilatation
3-“ with dilatation
4- intraparenchymal too

80
Q

From what point of are the cysts of PVL seen

What is another complication of IVH

A

3 weeks

Hydrocephalus

81
Q

What percent of blood can be lost into a sub Galeal haemorrhage?

A

Up to 40%

82
Q

How does breast milk link to late onset vitamin k deficient bleeding

A

Increases risk

83
Q

When could choroid plexus cysts be concerning

What else would be seen on ultrasound

A

Trisomy 18

Clenched fists

84
Q

What blood findings will be seen in a hypoglycaemic infant of a diabetic mum

A

High insulin
Low ketones
Negative reducing substances in urine

85
Q 
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
A

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
Q 
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
A

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
Q

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?

A

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
Q 
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
A

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
Q

What is the risk to the baby if mum comes into contact with parvovirus b19

A

Severe anaemia leading to hydrops

90
Q

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

A

Only 2-3%- yes with VZIG

If mum exposed 5d prior or 2d post delivery

Scarring, cataracts, microcephalic and hypoplasric limbs

No!

91
Q

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?

A 
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
Q

Hep c

Can mums breast feed

A

Yes unless cracked nipples

93
Q

What calculation is used to show the need for ECMO

What are 3 contraindications

A

Oxygenation index- fiO2xMAP/pao2

Grade 3/4 IVH, severe cardiac lesions, liver or kidney disease, lethal malformations

94
Q

HSV

Mum has lesions at birth and baby is born by cs and well. What investigations should they have

A

Swabs 24-48 hrs after birth of this is a reactivation. If primary infection start acyclovir straight away

95
Q

What is a pathognomonic finding on post mortem with intra utero listeria infection

If baby survives what rash might be seen at birth

A

Granulomatosis infantiseptica

Salmon pink papules

96
Q

What is the best opiate to take while breastfeeding

A

Buprenorphine

97
Q

What is the trisomy risk
28
40
45

A

28- 1:1000
40- 1:100
45-1:25

98
Q

What are the calorie requirements
Term baby
Preterm
Sick preterm

A

100kcal/kg/day
120”
150”

99
Q

When do the following features first appear in a neonate
Light reflex
Glabellar tap
Breast tissue

A

Light reflex- 30w
Glabellar tap-34 W
Breast tissue- 36w

FRACP (23 decks)

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