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Paediatrics > Neonatal > Flashcards

Neonatal Flashcards

1
Q

Name some perinatal risk factors for paediatric health conditions and give some specific examples

A
  • Maternal health conditions:
  • Infections: HIV, HBV, CMV, syphilis, rubella, toxoplasmosis, GBS
  • Medications and substances: teratogenic drugs, smoking, alcohol
  • Other: malnutrition, obesity, older age

Examples:

  • Congenital rubella infection and deafness, cataracts
  • Smoking and low birth weight
  • Folic acid deficiency and neural tube defects
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2
Q

Define the terms:

  • Low birth weight
  • Very low birth weight
  • Small for gestational age
  • Large for gestational age
A
  • LBW: <2500g
  • VLBW: <1500g
  • SGA: weight <10th centile for gestational age
  • LGA: weight >90th centile for gestational age
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3
Q

What are the components of routine antenatal screening?

A
  • Infection screen: HIV, HBV, syphilis
  • Blood group screen: ABO, RhD, other ABs
  • Haemoglobinopathy screening for high risk areas/based on family origin questionnaire: thalassaemia, sickle cell

-USS and combined screening: for chromosomal abnormalities and congenital anomalies

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4
Q

How would you describe antenatal screening tests to a patient?

A
  • Some tests we do in every pregnancy
  • Several tests to help us figure out if there are any health risks to baby
  • Allows us to treat you or monitor you and baby to make sure the pregnancy and baby are as healthy as possible
  • Several blood tests, looking for infections and blood type, as well as scan of baby to look for any problems
  • There is also the choice of combined screening, which is a blood test and a scan that will tell us how likely it is that baby will have a chromosomal abnormality eg. Down’s syndrome
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5
Q

What types of congenital anomalies can be seen on the anomaly scan?

A
  • CNS pathology eg. anencephaly, spina bifida
  • Cardiac
  • CDH, oesophageal atresia
  • Renal eg. hydronephrosis
  • Cleft lip
  • Hydrops
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6
Q

Give some examples of obstetric complications/conditions that can affect the baby

A
  • Pre-eclampsia: IUGR
  • GDM: macrosomia, neonatal hypoglycaemia
  • Multiple pregnancies: preterm birth, IUGR, twin-twin transfusion syndrome
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7
Q

How can maternal diabetes affect the baby?

A
  • Macrosomia –> shoulder dystocia
  • Neonatal hypoglycaemia
  • IUGR
  • Polyhydramnios
  • Malformation, early fetal loss
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8
Q

How can maternal hyperthyroidism affect the baby?

A

Graves antibodies can cross the placenta and cause hyperthyroidism in the fetus

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9
Q

How can maternal SLE affect the baby?

A

Antibodies (Ro and La) can cross the placenta and cause neonatal lupus syndrome (rash, heart block)

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10
Q

How does alcohol use in pregnancy affect the baby?

A
  • Small amounts do not cause fetal alcohol syndrome

- FAS: facies (low nasal bridge, flat philtrum, thin upper lip), developmental delay, microcephaly

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11
Q

Name some specific medications that can affect the fetus and describe the consequences

A
  • Warfarin: microcephaly, haemorrhage
  • Lithium: congenital heart disease
  • Opiates: neonatal withdrawal syndrome with jitters, irritability, poor feeding, seizures
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12
Q

List maternal infections that can significantly affect the fetus

A
  • HIV and HBV
  • Rubella
  • Toxoplasmosis
  • CMV
  • Syphilis
  • HSV (during delivery)
  • Parvovirus
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13
Q

Describe how rubella affects the fetus

A
  • The effect depends on the gestational age at time of maternal infection
  • Worst time is the 1st trimester
  • <8 weeks: deafness, CHD, cataracts in 80%
  • 13-16 weeks: hearing problems in 30%
  • 16-20 weeks: minimal effect eg. blueberry muffin rash
  • > 20 weeks: no effect
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14
Q

A 8 week pregnant woman comes to the GP complaining of a rash. It started 2 days ago on the face and is now covering her whole body. She also reports feeling tired and flu-like. There is cervical lymphadenopathy on examination. What is the most important diagnosis to consider and what would you do next?

A
  • It is necessary to investigate rubella infection in any pregnant women with a rubella-like rash
  • Want to ask about immunisation history and exposure to rubella in the past several weeks
  • Notify the local health protection team as rubella is a notifiable disease, they will advise on testing
  • Recommend rest and to avoid any pregnant women
  • Refer to fetal medicine for review and counselling
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15
Q

What is the most common congenital infection?

A

CMV

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16
Q

What is the likelihood of a fetus being affected by CMV?

A

90% will be completely fine
5% will develop problems later in life eg. hearing loss
5% will have clinical features at birth (hepatosplenomegaly, petechiae, deafness, cerebral palsy, developmental delay)

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17
Q

What is the management of neonates with congenital CMV?

A

In neonates with severe symptoms: oral valganciclovir/IV ganciclovir to reduce further hearing loss and developmental delay

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18
Q

How is toxoplasmosis contracted? What are the risks to the fetus?

A
  • Through eating infected undercooked meat or the faeces of infected cats
  • 10% of fetuses will have symptoms at birth (retinopathy, cerebral calcification, hydrocephalus)
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19
Q

How is congenital toxoplasmosis managed?

A
  • 1 year of pyrimethamine, sulfadiazine and calcium folinate
  • Monitor LFTs and FBC every 4-6 weeks
  • Ophthalmology + audiology assessment
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20
Q

What are the implications to the fetus of maternal chickenpox/shingles?

A
  • <20 weeks: small risk (<2%) of permanent scarring, damage to eyes/brain and abnormal digits
  • Around the time of labour: risk of neonatal infection (rash, dissemination)
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21
Q

A 32 year old nurse attends GP clinic because she has been recently exposed to a patient with shingles at work. She informs you she is 12 weeks pregnant. What do you want to know and how would you manage this case?

A
  • Specific info about the exposure event, including date and contact with the infected individual
  • History of VZV infection or immunisation
  • Any symptoms (rash, feeling unwell)

Management:

  • If significant risk: inform to rest and stay away from any other pregnant women, time off work until 28 days from the time of exposure
  • VZV Ig if contact within the last 10 days
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22
Q

A 32 year old nurse attends GP clinic because she has developed a vesicular rash over her body after exposure to a patient with chickenpox at work. She first noticed the rash coming up yesterday afternoon. She informs you she is 12 weeks pregnant. How would you manage this case?

A
  • Consider prescribing oral aciclovir (800mg 5/day for 7 days)
  • Advise to stay away from pregnant women or babies until the lesions crust over
  • Refer to fetal medicine unit at 16-20 weeks/after 5 weeks for USS
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23
Q

A 33 year old woman attends MAS with regular, painful contractions. She reports feeling a gush of fluids this morning. She is currently being treated for chickenpox, after developing a rash 3 days ago. How would you like to manage this case?

A
  • Because labour is within 7 days of the onset of a rash, baby needs VZV Ig after birth and neonates should be called
  • Monitor baby for 28 days from onset of the mums rash
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24
Q

How can congenital syphilis present?

A
  • Can present at the time of birth with low birth weight/preterm birth, rash on the palms + soles
  • Or late congenital syphilis, with characteristic features of Hutchinson’s teeth, interstitial keratitis (eyes), deafness, bone + joint deformities
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25
Q

What is the treatment of congenital syphilis?

A

IM benzylpenicillin

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26
Q

Describe how the fetal circulation changes at birth

A
  • Before birth: oxygenated blood reaches the fetus in the umbilical veins –> liver –> ductus venosus –> IVC –> RA –> LA via foramen ovale to LV to aorta OR RV to pulmonary artery to aorta via ductus arteriosus –> body
  • At the time of birth: pressure drop in the pulmonary circulation when baby’s lungs fill with air –> closure of the FO and DA
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27
Q

How does C section affect the baby’s breathing?

A
  • There is no stimulus to cause the fluid to empty from the lungs and stimulate breathing
  • Can have transient tachypnoea of the newborn (TTN)
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28
Q

Describe the care of the newborn at the time of birth.

A
  • Immediate skin to skin with mum
  • Dry baby, keep warm
  • Apgar scores at 1 min and again at 5 mins
  • Cord clamping and cutting at 1-5 mins
  • Vitamin K injection
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29
Q

How is the Apgar score calculated?

A

5 domains, scores 0-2 on each
Appearance (colour): cyanosis, peripheral cyanosis, pink
Pulse (HR): 0, <100, 100-140
Grimace: no response, grimace, cry
Activity (tone): floppy, some flexion, well flexed
Respiratory effort: apnoiec, slow breathing, strong cry

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30
Q

Describe the neonatal resuscitation pathway

A

Birth –>
Dry and warm, bag in <32 weeks –>
Assess tone, breathing, HR (Apgar) –>

**The goal is to aerate the lungs and have baby breathe on their own, and HR increase. If chest moves with the inflation breathes, you have aerated the lungs. Basic pathway: aerate lungs successfully (5 inflation breaths) –> 30 secs ventilation –> chest compressions

If gasping or apnoeic –> open airway, 5 inflation breaths

  • -> repeat 5 inflation breaths if not breathing/chest not moving with breaths. Consider having 2 person assistance, suction, etc.
  • -> When the chest is moving (aeration successful) continue ventilation for 30 seconds if HR <60
  • -> If after 30s HR is still <60, start compressions! (3:1)
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31
Q

What are preductal and postductal saturations? What is the accepted preductal sats in a newborn?

A
  • Preductal: areas where arteries supplying arise before the DA eg. right hand, ear
  • Postductal: areas where arteries supplying arise after the DA eg. feet

Accepted preductal sats in newborn:

  • 2 mins 60%
  • Increase by 10% every min (70, 80) until 85% at 5 mins
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32
Q

What are the patterns of growth restriction? What can they be caused by?

A
  • Symmetrical: head and abdo both small. This can be normal or abnormal caused by conditions present through pregnancy eg. chronic medical condition, infection, chromosomal abnormality
  • Asymmetrical: head > abdo. This is abnormal, due to preferential growth of the important areas (brain). Causes are conditions that affect late growth eg. pre-eclampsia, multiple pregnancy
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33
Q

What are the consequences of LBW in the neonatal period? How should this be managed?

A
  • Hypothermia, hypoglycaemia, hypocalcaemia, polycythaemia

- Keep baby warm, monitor BMs and sats, consider tube feeding/fluids

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34
Q

Describe the NIPE exam

A

Full physical assessment of the baby done before 72 hours of birth to detect any physical abnormalities that can be monitored or managed

  • Head: head shape + size (in cm), ears, fontanelles, eyes (+ red reflex), nose, mouth, palate, suck reflex
  • Neck and collarbones
  • Arms, hands: tone, grasp reflex, head lag
  • Abdo: inspection, heart and breathing, palpation
  • Genitals: inspect + anus, femoral pulses
  • Legs: DDH (Barlows + Ortolanis), tone, feet
  • Back: spine inspection + palpation
  • Moro’s reflex
  • Hearing test
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35
Q

Describe some normal findings on NIPE exam

A

-Mongolian blue spot, swollen eyelids, vaginal bleeding, milia, erythema toxicum

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36
Q

On a NIPE exam on the 2nd day of life, a baby girl has positive Barlow’s and Ortolani’s tests. What does this indicate and how should this be managed?

A
  • Indicates hip sublaxation, likely DDH. Arrange USS within 2 weeks
  • Refer to paediatric orthopaedics for review
  • Observe for 3 weeks and treat if not resolved, with Pavlik’s harness + evaluate at 6 months with Xray
  • Surgery as last resort
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37
Q

What are the indications for USS to diagnose DDH?

A
  • Breech presentation at 36/40
  • Breech delivery
  • Family history of DDH
  • –> USS at 6 weeks
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38
Q

On the routine NIPE at 12 hours of life, a soft murmur is heard on auscultation. What features of the CVS exam would reassure you?

A
  • Soft midsystolic murmur
  • Not diastolic, no clicks
  • No heaves/thrills
  • Normal pulses
  • Small difference in pre and postductal sats
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39
Q

When should a baby with positive findings on the NIPE (for cardiac murmurs, testicular abnormalities, eye problems) be seen by a specialist?

A
  • Cardiac murmurs: usually within 24 hours and before discharge
  • Eye abnormality: within 2 weeks
  • Bilateral undescended testes: in 24 hours
  • Unilateral undescended testis: review at the infant NIPE at 6-8 weeks
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40
Q

What is screened for on the Guthrie spot test?

A
  • Sickle cell
  • Hypothyroidism
  • CF
  • MSUD
  • PKU
  • MCADD
  • Isovaleric acidaemia
  • Glutaric aciduria I
  • Homocystinuria
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41
Q

Describe the pathogenesis of hypoxic-ischaemic encephalopathy

A

In utero, reduced gas exchange (placental problems, umbilical cord prolapse, etc) for a prolonged period of time can lead to fetal asphyxia (oxygen deprivation). This causes hypoxaemia, hypercarbia and a metabolic acidosis. The combination of hypoxia and metabolic acidosis leads to hypoxic-ischaemic encephalopathy.

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42
Q

Name some causes of HIE

A 
Divided into 4 groups: 
Placental:
-Prolonged labour 
-Placental abruption
-Uterine rupture

Umbilical:
-Umbilical cord compression/prolapse

Maternal:
-Severe hypo or hypertension

Fetal: IUGR, anaemia

43
Q

Describe the presentation of HIE

A
  • Can range from mild to severe
  • Ranging from irritability and hypertonia on the mild end, to abnormal movements and seizures, to fluctuating tone with multi-organ failure
44
Q

What is the prognosis of HIE

A

For mild and even most cases of moderate, very good

For severe, a significant proportion will die and most will have long term neurodevelopmental delay (eg. CP)

45
Q

Describe the injuries that can occur during delivery

A
  • Asphyxia -> HIE
  • Normal VD -> caput and moulding
  • Forceps -> facial lacerations/bruising, facial palsy
  • Ventouse -> haemorrhage, cephalhaematoma
  • Shoulder dystocia/difficult delivery -> fractured clavicle/humerus, Erb’s palsy
46
Q

What is Erb’s palsy? Which other palsy may co-occur?

A

C5 + 6 palsy. May also occur with phrenic nerve palsy (affecting hemidiaphragm).

47
Q

What is neonatal respiratory distress syndrome?

A

Also called hyaline membrane disease.

A lung disease caused by a lack of surfactant in the alveoli –> absence of surface tension, poor gas exchange

48
Q

What are 2 important risk factors for neonatal RDS?

A

Prematurity

Maternal DM

49
Q

How does neonatal RDS present? What would you see on a CXR?

A

-Breathing difficulty: grunting, recessions, nasal flaring
-Tachypnoea
-Cyanosis
CXR: ground glass opacities, air bronchograms

50
Q

What is the most important intervention to reduce neonatal RDS?

A

Give maternal corticosteroids before delivery (typically want at least 24-48 hours)

51
Q

You are the neonatal SHO on call. You have been bleeped to the labour ward as there is a 32 week pregnant woman who has just delivered. The baby is tachypnoeic, and on examination the baby is grunting and you see recessions. What management might you consider?

A

This is likely neonatal RDS.

  • Oxygen
  • Surfactant therapy
  • Consider assisted ventilation eg. CPAP, intubation
52
Q

What is an important complication of ventilation used in the management of RDS?

A

Pneumothorax due to high positive airway pressures

53
Q

What are apnoeic and bradycardic episodes?

A
  • Episodes of absence of breathing for 20-30s –> desaturations
  • Heart rate slows as a result
  • Due to immaturity of the CNS cardiorespiratory centres
54
Q

What is the management of apnoea and bradycardia?

A
  • Physical stimulation
  • Caffeine
  • CPAP if frequent
55
Q

What are the ideal sats for premature neonates? Why?

A

91-95%

  • <91% increased risk of NEC
  • > 95% increased risk of retinopathy
56
Q

What is the management of PDA?

A

-IV indomethacin (NSAID- prostaglandin synthetase inhibitor)

57
Q

List the complications of prematurity

A
  • HIE, IVH and PVL
  • Retinopathy of prematurity
  • RDS, BPD, apnoea and bradycardia
  • PDA
  • Hypothermia
  • Hypoglycaemia, NEC
  • Infection
  • Osteopenia, Fe deficiency
58
Q

What are some types of preterm brain injury? What are the consequences?

A

-Parenchymal infarction (haemorrhagic)
-Intraventricular haemorrhage
Can lead to neurodevelopmental delay, hydrocephalus, CP, periventricular leukomalacia (cysts forming as a result of white matter loss)

59
Q

What is necrotising enterocolitis?

A

-Severe inflammation of the bowel that leads to damage and tissue death

60
Q

Name some risk factors for NEC

A
  • Prematurity
  • Cows milk feeds
  • Ischaemic injury
61
Q

How can NEC present?

A
  • Vomiting
  • Abdominal distension
  • Poor feeding
  • Shock
62
Q

What is the management of NEC?

A

Stop enteral feeding -> switch to parenterl
Broad spectrum antibiotics
Possible need for surgery to remove necrotic bowel
Ventilation and circulatory support as needed

63
Q

Define bronchopulmonary dysplasia.

A

-Needing oxygen at 36 weeks post-menstrual age

64
Q

What are some long term consequences of prematurity?

A
  • Poor growth
  • GORD, GI problems from NEC
  • Learning disabilities, CP
  • Respiratory disease
  • Prone to infections
65
Q

How common is neonatal jaundice?

A

50% of babies have visible jaundice

66
Q

Describe the causes of physiological jaundice.

A
  • Large amounts of RBCs at birth, shorter lifespan –> breakdown
  • Reduced ability to metabolise bilirubin
67
Q

What is the most serious complication of neonatal jaundice? Describe.

A

Kernicterus.
Unconjugated bilirubin crosses the BBB, deposits in the basal ganglia and brainstem
Presents with lethargy, poor feeding, increased muscle tone –> opisthotonos, seizures, coma
Can develop long term complications such as choreoathetoid CP, learning disabilities, and deafness

68
Q

Describe the causes of neonatal jaundice.

A

<24 hours: Haemolytic disease of the newborn: Rhesus haemolytic disease, ABO incompatibility, thalassaemias, G6PD deficiency, congenital infection

24hours - 2 weeks:

  • Physiological jaundice, breastmilk jaundice, breastfeeding jaundice
  • Gilberts
  • Infection, dehydration
  • Crigler-Najjar syndrome (absent/reduced UGT)

> 2 weeks (prolonged jaundice):

  • Biliary atresia
  • Hypothyroidism
69
Q

A mother brings in her 10 day old son to the GP complaining that he is very yellow. What is important to ask, and what is the first investigation to do?

A

From the history:

  • Onset, progression
  • Pale stools and dark urine, quantity of urine
  • Feeding: breastfeeding? Poor feeding?
  • Irritability, lethargy, general health, fever, vomiting
  • Pregnancy: problems, infections, care after birth, ABO/RhD
  • Family history: jaundice, blood conditions

First, take a bilirubin level with a transcutaneous bilirubin meter

70
Q

A mother brings in her 22 day old son to the GP complaining that he is very yellow. Which feature on the history would make you very worried about a specific cause? What investigations would you do and what is the management of this condition?

A

If the baby had pale stools and dark urine, this suggests a conjugated bilirubinaemia, which is caused by obstruction. In particular, I would be very worried about biliary atresia.
I would do a bilirubin level with a transcutaneous bilirubin meter, and also a serum bilirubin level. I would urgently refer to the paediatric department for further investigation.
The management of biliary atresia is surgery (Kasai’s procedure) to remove the bile ducts and anastamose the small intestine to the liver.

71
Q

You are the neonatal SHO on call. You have been bleeped to the postnatal ward to review a 12 hours old baby who appears jaundiced. What is your approach to this case?

A
  • Review the mums notes from pregnancy, especially looking at ABO group and RhD status, as well as family history/results of haemoglobinopathy, serology for maternal infections
  • History: onset, other symptoms eg fever, lethargy, poor feeding. Did mum receive antenatal anti-D if RhD -ve?
  • Examine: signs of kernicterus, general wellbeing
  • Bloods: FBC including Hct, bilirubin level, blood film, DAT test
72
Q

How do we determine when a baby needs treatment for jaundice? What are the treatment options?

A
  • Threshold table
  • Phototherapy
  • Exchange transfusion
73
Q

What is biliary atresia? How can it present?

A
  • A disease of the biliary tree, in which one or more of the biliary ducts are narrowed, causing an obstructive jaundice
  • Prolonged jaundice, pale stools and dark urine
74
Q

When is a serum bilirubin preferred to a transcutaneous bilirubin?

A
  • In premature babies <35 weeks
  • If the first 24 hours of life
  • If the transcutaneous bilirubin is >250umol/L
75
Q

Opisthotonus is a sign of?

A

Kernicterus

76
Q

Describe the presentation of a neonate in respiratory distress.

A
  • Tachypnoea
  • Grunting, nasal flaring, recessions
  • Cyanosis
77
Q

Define transient tachypnoea of the newborn. What is the main risk factor?

A
  • Increased respiratory effort after birth, due to fluid retention in the lungs
  • Common after C section
78
Q

What can happen when a fetus is distressed that might later cause respiratory distress?

A
  • The fetus can pass meconium if hypoxic/distressed

- It may then aspirate the meconium which can cause respiratory distress

79
Q

What are the complications of meconium aspiration?

A
  • Pneumothorax
  • Pneumomediastinum
  • Pneumonia
  • Persistent pulmonary hypertension
80
Q

What are some risk factors for neonatal pneumonia?

A
  • Prolonged labour
  • Maternal GBS
  • Chorioamnionitis
  • LBW baby
  • Meconium aspiration
81
Q

What is persistent pulmonary hypertension?

A

A severe respiratory disease caused by increased resistance in the pulmonary vasculature, causing a right to left shunt
-Associated with RDS, meconium aspiration, pneumonia

82
Q

What is a diaphragmatic hernia? How does it present?

A

Herniation of the abdominal contents through the diaphragm into the thorax, causing displacement of the heart and lungs

  • Usually seen on antenatal screening
  • Or presents at birth with RDS
83
Q

Define early onset sepsis and late onset sepsis. What are the risk factors?

A

Early: Sepsis occurring in the 48 hours after birth
-RFs: prolonged labour, maternal GBS, chorioamnionitis, prematurity
Late: sepsis occurring after 48 hours
-RFs: environmental.

84
Q

You are the neonatal SHO. A midwife bleeps you to come to postnatal ward to review a baby boy born 30 hours ago who is now spiking a temperature and not feeding. Explain your management.

A
  • History: ask about risk factors for early onset neonatal sepsis (birth stuff), feeding, nappies
  • Examine baby: general exam, obs
  • Investigations: CXR, blood cultures and FBC, CRP, U+Es, LP
  • Management: broad spectrum antibiotics to cover GBS and Listeria eg. amoxicillin + gentamicin
85
Q

You are the SHO in paediatric A&E. A mum brings in her newborn boy born 3 days ago who is now spiking a temperature and not feeding. Explain your management.

A
  • History: ask about birth, feeding, nappies, drowsiness, rashes, jaundice
  • Examine baby: general exam, obs
  • Investigations: CXR, blood cultures and FBC, CRP, U+Es, LP if blood cultures +ve
  • Management: broad spectrum antibiotics to cover gram +ves eg. flucloxacillin + gentamicin
86
Q

What are some organisms that can cause conjunctivitis in neonates? What treatments would you use for each?

A
  • Chlamydia: oral erythromycin
  • Gonorrhoea: IM/IV cefotaxime/ceftriaxone
  • Staphylococcus: chloramphenicol eyedrops
  • Streptococcus: chloramphenicol eyedrops
87
Q

You are the SHO in paediatric A&E. A mum brings in her newborn boy born 3 days ago. She says he has a red, swollen eyelid with crusty yellow discharge. Explain your management.

A

This sounds like a possible bacterial conjunctivitis.

  • History: onset, one/both eyes, discharge, fever, systemic symptoms, maternal STIs/discharge, GBS.
  • Exam: eye, general exam
  • Investigations: send swab, including MC+S and can consider viral PCR
  • Management: refer to ophthal for urgent review, start appropriate antibiotic treatment
88
Q

How can HSV infection in neonates present?

A
  • Skin/eye lesions
  • Encephalitis
  • Disseminated infection (sepsis)
89
Q

A baby is born to a woman who was noted to be HBsAg +ve at booking. What is the management?

A
  • Vaccinate within the first day of life + 4 weeks + 1 year to prevent transmission
  • Also give HBIg at the same time
  • Also continue with the normal hexavalent vaccine at the usual times (8, 12, 16 weeks)
90
Q

Define neonatal hypoglycaemia. Name some causes

A

Blood glucose <2.6mmol/L

  • Prematurity
  • Infection
  • Macrosomia/GDM
  • Hypothermia
  • Polycythaemia
91
Q

How can neonatal hypoglycaemia present?

A

-Jitteriness, irritability, apnoea, lethargy, seizures

92
Q

How can neonatal hypoglycaemia be prevented?

A

Early and frequent feeding from birth

93
Q

Name some causes of neonatal seizures.

A
  • Metabolic: hypoglycaemia, HIE, kernicterus, IMDs, electrolyte abnormalities
  • Infection: meningitis/encephalitis
  • Drug withdrawal
  • Intracranial pathology eg. haemorrhage
94
Q

Describe the pathology of cleft lip + cleft palate

A

Cleft lip: failure of fusion of the frontonasal + maxillary processes
Cleft palate: failure of fusion of the palatine processes + nasal septum

95
Q

Describe the management of cleft lip + cleft palate

A
  • Refer to feeding team for special advice on feeding, including appliances to aid feeding
  • Refer to paediatric ENT for surgical repair (at 3 months for lip, 6-12 months for palate)
96
Q

What is Pierre-Robin sequence?

A
  • Micrognathia
  • Posterior tongue
  • Midline cleft of the soft palate
97
Q

What is oesophageal atresia? How does it present?

A

Oesophageal atresia occurs when there is malformation of the oesophagus, causing a blind-ending pouch and no connection to the lower oesophagus. It often occurs with TOF.
It can be seen on antenatal USS with coexisting polyhydramnios, or at birth with persistent salivation and drooling, coughing and choking during feeds (due to TOF), cyanotic episodes, aspiration

98
Q

If a baby is diagnosed with oesophageal atresia, what else should be investigated?

A
  • About 50% of babies with have other anomalies (eg. VACTERL)
  • Investigate for vertebral, anorectal, cardiac, renal and lung anomalies
99
Q

A newborn baby presents with abdominal distension, irritability, and bilious vomiting at 12 hours after birth. What are some possible causes of this presentation?

A
  • Sounds like a SBO

- Duodenal atresia, jejunal/ileal atresia, meconium ileus

100
Q

Duodenal atresia is a complication of which (relatively) common condition.

A

Down’s syndrome

101
Q

A mother is concerned that her baby has not passed meconium at 36 hours of life. What could be the reasons for this?

A
  • Meconium ileus
  • Hirschprungs disease
  • Rectal atresia
  • Prematurity
102
Q

What is the pathology of Hirschsprungs disease?

A

Absence of ganglion cells in the myenteric plexus of the rectum

103
Q

How is biliary atresia confirmed?

A

Liver biopsy and cholangiogram

Paediatrics (13 decks)

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