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Paediatrics for Finals > Neonatal > Flashcards

Neonatal Flashcards

(44 cards)

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1
Q

What defines prematurity?

A

<37 weeks

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2
Q

What are some acute problems a premature baby may have?

A 
RDS
Necrotising enterocolitis 
Intraventricular haemorrhage 
Hypothermia 
Jaundice 
Hypoglycaemia 
Hypocalcaemia 
Congenital heart defects (PDA)
Infection
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3
Q

What happens to the lungs in respiratory distress syndrome?

A

There is a lack of surfactant so the lungs are non-compliant and stiff. This leads to hypoxia

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4
Q

What are the risk factors for respiratory distress syndrome?

A

Diabetic mother
C-section
Meconium aspiration

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5
Q

Describe the CXR in respiratory distress syndrome

A

Ground glass appearance with air bronchograms and an indistinct heart border

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6
Q

How is respiratory distress syndrome managed?

A

O2
Exogenous surfactant given via ET tube
Dexamethasone to the mother for prevention

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7
Q

How and when does necrotising enterocolitis present?

A

Within first 2 weeks of life

  • Bloody, mucous stool
  • Abdominal distention
  • Bilious vomiting
  • Feeding difficulties
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8
Q

What are the AXR findings in necrotising enterocolitis?

A

Bowel dilation
Thickened oedematous bowel wall
Gas filled loops and intramural gas
+/- pneumoperitoneum and Riglers sign

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9
Q

How is necrotising enterocolitis managed?

A

NG tube
Fluids
Gentamicin and metronidazole

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10
Q

What are the complications of necrotising enterocolitis?

A

Perforation
Sepsis
DIC
Short bowel syndrome

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11
Q

What is short bowel syndrome and how does it present?

A

Lack of functioning small intestine leads to malabsorption

- diarrhoea

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12
Q

What is the pathophysiology of retinopathy of prematurity?

A

If O2 is given following an episode of hypoxia then there is proliferation of vessels at the border of vascular and non-vascular retina

  • reduced visual acuity
  • retinal detachment
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13
Q

When and how does intraventricular haemorrhage present?

A

Within first few days

  • apnoea
  • bulging anterior fontanelle
  • bradycardia
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14
Q

How is intraventricular haemorrhage diagnosed?

A

Cranial USS

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15
Q

What are your differentials for neonatal jaundice occurring within 24 hours?

A
  • ABO incompatibility
  • Rhesus incompatibility
  • G6PD deficiency
  • TORCH infections
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16
Q

When are you not worried about neonatal jaundice? What could be the cause within this time frame?

A

2-14 days

  • physiological (fHb breakdown)
  • breast milk
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17
Q

What can cause neonatal jaundice occurring after 14 days?

A
  • Biliary atresia
  • Congenital hypothyroidism
  • Galactosaemia
  • Infection eg UTI
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18
Q

What is the stepwise management of neonatal jaundice?

Study These Flashcards
A
  1. Phototherapy
  2. Exchange transfusion (transfusion through the umbilical vessels)

Can give IV Ig is haemolytic cause

19
Q

What are the short and long term sequalae of kernicterus?

Study These Flashcards
A

Short: seizures, coma, lethargy

Long: deafness, CP

20
Q

What are some long term problems associated with prematurity?

Study These Flashcards
A
  • Hearing difficulty
  • Behavioural problems
  • Respiratory infections
21
Q

What is hypoxic ischaemic encephalopathy and what does it lead to?

Study These Flashcards
A

prolonged or severe hypoxia leading to ischaemic brain damage
leads to CP

22
Q

How can babies at risk of hypoxic ischaemic encephalopathy be managed?

Study These Flashcards
A

Therapeutic hypothermia - cool to 33 degrees for 72 hours and then rewarm

23
Q

Define low birth weight

Study These Flashcards
A

<2500g (5 pound 5 ounces)

24
Q

Define small for gestational age

Study These Flashcards
A

Birth weight <10th centile

25
What are the causes of small for gestational age?
- Constitutionally small (relating to maternal size, ethnicity) - IUGR
26
What are the causes of IUGR?
Placenta mediated - maternal smoking, alcohol, pre-eclampsia, malnutrition, anaemia, infection Non-placenta mediated - chromosomal abnormalities, inborn error of metabolism, fetal infection
27
How is a mum/baby with ?SGA monitored and investigated?
- Estimated fetal weight - Fetal abdominal circumference - Karyotyping - TORCH infection screen - Uterine artery doppler - Amniotic fluid volume measurements
28
What are the neonatal signs and symptoms of IUGR?
``` Hypoglycaemia Hypothermia Lack of buccal fat Loose folds of skin Thin arms and legs - limited fat ```
29
What can cause persistent neonatal hypoglycaemia?
- infection/ sepsis - maternal diabetes - IUGR - pre-term - hypothermia
30
How may a neonate acquire an infection?
- via the placenta - via ascending maternal infection - via the birth canal/ genitals - via breastfeeding
31
What are the most common organisms causing neonatal sepsis?
GBS, e.coli, listeria
32
What are the risk factors for neonatal sepsis?
- premature - PROM - maternal fever >38 or chorioamnionitis - maternal GBS colonisation
33
How does neonatal sepsis present?
fever + apnoea + hypotonia + poor feeding
34
How is neonatal sepsis managed?
Benzylpenicillin + Gentamicin
35
How may neonatal sepsis be prevented?
Maternal IV benzylpenicillin if: - previous GBS baby - fever or chorioamnionitis - PROM
36
How may neonatal herpes simplex present? How is it managed?
meningoencephalitis and seizures | IV aciclovir
37
What parameters form the APGAR score? What is considered a normal score?
``` Appearance (colour) Pulse Grimace (stimulation = reflex, cry, grimace etc) Activity (movement vs floppy) Respiratory rate ``` 7-10
38
What are the signs and symptoms of biliary atresia? When does it present?
Within first 8 weeks: - Chalky stool and dark urine - Jaundice - Hepatomegaly - Poor growth
39
What are the signs that a baby may be hypotonic?
- Head lag - Straight legs - On holding them their arms go up so they can slip through your hands - Poor feeding (can't suck and swallow)
40
What are the causes of a floppy/ hypotonic baby?
- Sepsis - Congenital disorders eg Prader-Willi - Hypoxic ischaemia injury - Congenital hypothyroidism - SMA - Myasthenia gravis - Myotonic dystrophy
41
What are the advantages and disadvantages of breastfeeding?
``` + free + infection prevention + bonding + further uterine contraction + protects against obesity, DM and SIDS ``` - lacks vitamin D - may not get enough food - transfer of infections eg HIV - maternal breast issues eg mastitis
42
What diseases are tested for on the neonatal heel prick test?
Cystic fibrosis Sickle cell disease Congenital hypothyroidism Metabolic disorders: PKU, homocystinuria, maple syrup urine disease, MCAD, IVA, GA1
43
Define perinatal, early neonatal and late neonatal death
perinatal: stillbirth and death due to obstetric events occurring in first week Early: first 7 days Late: 7-28 days
44
Define puerperal death
Maternal death occurring within 6 weeks of birth

Paediatrics for Finals (11 decks)

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