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Paediatrics for Finals > Neonatal > Flashcards

Neonatal Flashcards

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?

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?

A

Short: seizures, coma, lethargy

Long: deafness, CP

20
Q

What are some long term problems associated with prematurity?

A
  • Hearing difficulty
  • Behavioural problems
  • Respiratory infections
21
Q

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

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?

A

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

23
Q

Define low birth weight

A

<2500g (5 pound 5 ounces)

24
Q

Define small for gestational age

A

Birth weight <10th centile

25
Q

What are the causes of small for gestational age?

A
  • Constitutionally small (relating to maternal size, ethnicity)
  • IUGR
26
Q

What are the causes of IUGR?

A

Placenta mediated
- maternal smoking, alcohol, pre-eclampsia, malnutrition, anaemia, infection

Non-placenta mediated
- chromosomal abnormalities, inborn error of metabolism, fetal infection

27
Q

How is a mum/baby with ?SGA monitored and investigated?

A
  • Estimated fetal weight
  • Fetal abdominal circumference
  • Karyotyping
  • TORCH infection screen
  • Uterine artery doppler
  • Amniotic fluid volume measurements
28
Q

What are the neonatal signs and symptoms of IUGR?

A 
Hypoglycaemia 
Hypothermia 
Lack of buccal fat
Loose folds of skin
Thin arms and legs - limited fat
29
Q

What can cause persistent neonatal hypoglycaemia?

A
  • infection/ sepsis
  • maternal diabetes
  • IUGR
  • pre-term
  • hypothermia
30
Q

How may a neonate acquire an infection?

A
  • via the placenta
  • via ascending maternal infection
  • via the birth canal/ genitals
  • via breastfeeding
31
Q

What are the most common organisms causing neonatal sepsis?

A

GBS, e.coli, listeria

32
Q

What are the risk factors for neonatal sepsis?

A
  • premature
  • PROM
  • maternal fever >38 or chorioamnionitis
  • maternal GBS colonisation
33
Q

How does neonatal sepsis present?

A

fever + apnoea + hypotonia + poor feeding

34
Q

How is neonatal sepsis managed?

A

Benzylpenicillin + Gentamicin

35
Q

How may neonatal sepsis be prevented?

A

Maternal IV benzylpenicillin if:

  • previous GBS baby
  • fever or chorioamnionitis
  • PROM
36
Q

How may neonatal herpes simplex present? How is it managed?

A

meningoencephalitis and seizures

IV aciclovir

37
Q

What parameters form the APGAR score? What is considered a normal score?

A 
Appearance (colour)
Pulse
Grimace (stimulation = reflex, cry, grimace etc)
Activity (movement vs floppy) 
Respiratory rate

7-10

38
Q

What are the signs and symptoms of biliary atresia? When does it present?

A

Within first 8 weeks:

  • Chalky stool and dark urine
  • Jaundice
  • Hepatomegaly
  • Poor growth
39
Q

What are the signs that a baby may be hypotonic?

A
  • 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
Q

What are the causes of a floppy/ hypotonic baby?

A
  • Sepsis
  • Congenital disorders eg Prader-Willi
  • Hypoxic ischaemia injury
  • Congenital hypothyroidism
  • SMA
  • Myasthenia gravis
  • Myotonic dystrophy
41
Q

What are the advantages and disadvantages of breastfeeding?

A 
\+ 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
Q

What diseases are tested for on the neonatal heel prick test?

A

Cystic fibrosis
Sickle cell disease
Congenital hypothyroidism

Metabolic disorders: PKU, homocystinuria, maple syrup urine disease, MCAD, IVA, GA1

43
Q

Define perinatal, early neonatal and late neonatal death

A

perinatal: stillbirth and death due to obstetric events occurring in first week

Early: first 7 days

Late: 7-28 days

44
Q

Define puerperal death

A

Maternal death occurring within 6 weeks of birth

Paediatrics for Finals (11 decks)

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