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Life Support > Neonatal Emergencies > Flashcards

Neonatal Emergencies Flashcards

1
Q

What are the main types of neonatal emergency?

A 
Sepsis
Birth asphyxia
Respiratory distress
Abdo emergency
Duct-dependent cardiac issues
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2
Q

What are common clinical respiratory symptoms in the neonate?

A

apnoea
gasping
recession

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3
Q

What are the main features of APGAR examination?

A 
Appearance
Pulse
Grimace
Activity
Respiration
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4
Q

What are the 3 main causes of neonatal sepsis?

A

Congenital infection
Early onset sepsis
Late onset sepsis

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5
Q

What constitutes congenital infection?

A

Present at birth

Usually infection is direct from mother

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6
Q

What is early onset sepsis?

A

Onset between birth and 1 week old

infection comes from the birth canal

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7
Q

What is late onset sepsis?

A

onset after 1 week old

Maternal or external source of infection

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8
Q

Bacterial causes of neonatal sepsis:

A

Group B streptococcus
Listeria
Gram -ve
(present in the genital tract)

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9
Q

Which antibiotics are used to treat neonatal sepsis?

A

Penicillin/Gentamicin

Cefotaxime/ampicillin

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10
Q

Investigations performed for suspected Dx of neonatal sepsis?

A

blood cultures

FBC (particularly WCC and platelets)

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11
Q

What are the clinical signs that may indicate neonatal sepsis?
(non-specific)

A 
Fever or hypothermia
poor feeding
vomiting
pallor
tachypnoea
drowsy
irritability
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12
Q

What features may be present on a CXR for a septic neonate?

A

poor aeration

increased lung markings

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13
Q

What is the broad management of neonatal sepsis?

A

Resuscitate
Antibiotics
(Supportive care) ventilation, fluid rescus. coagulopathy, ionotropes

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14
Q

Conditions that are associated with increased risk of birth asphyxia:

A 
IUGR
Prematurity
Abnormal CTG
Abnormal fatal blood gas
difficult delivery
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15
Q

What does intrapartum asphyxia increase your is of?

A

Cerebral palsy

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16
Q

What are the early signs of birth asphyxia?

A

acute bradycardia or asystole at delivery

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17
Q

What is the late presentation of birth asphyxia?

A

hypoxic ischemic encephalopathy

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18
Q

What are the 3 grades of hypoxic ischemic encephalopathy and what do they mean?

A

Grade 1: irritability, poor feeding
Grade 2: fits, bad feeding, hypertonia
Grade 3: floppy, intractable seizures, apnoea

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19
Q

What observations can be found by ultrasound in asphyxia?

A

periventricular flare
cystic leukomalacia
(white matter brain injury)

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20
Q

What observations can be found by CT/MRI in asphyxia?

A

swollen basal ganglia

enhancement of white matter

21
Q

What is the time window during which effects of asphyxia are reversible?

A

< 6hr of injury

22
Q

What metabolic intervention could minimise tissue injury following asphyxia?

A

Cooling of baby

to ~35C

23
Q

What the alternative DDx for respiratory distress ?

A 
Respiratory distress syndrome
Pneumothorax
Abdominal emergency
Cardiac malformation
Pneumonia
24
Q

What are predictors of respiratory distress syndrome?

A 
Prematurity
Asphyxia
Cold stress
Diabetic mum
lower segment C-section (LCSC)
25
Q

What is the specific clinical sign of respiratory distress syndrome?

A

Recession

use of accessory muscles

26
Q

How do alveoli function between breaths in RDS?

A

Alveoli fully collapse between breaths, requiring massive breaths during each inspiration to-reinflate the alveoli

27
Q

What are the 4 pathophysiological components of RDS?

A

Weak chest wall
excess lung liquid
no blood-air approx.
surfactant delivery

28
Q

What the radiological features observed on a CXR for RDS?

A

poor expansion
air bronchograms
ground glass appearance

29
Q

What are the predictive conditions for meconium aspiration syndrome?

A

post-term baby

asphyxia

30
Q

Predictors of abdominal emergencies inc;

A

other congenital malformations

polyhydramnios

31
Q

What are the clinical features of an abdominal emergency?

A

specific: abdo distension, bilious vomiting, obvious loops

non-specific: poor feeding, vomiting, pallor, tachypnoea, drowsy, irritability

32
Q

Type of abdominal emergency include?

A 
NEC
Malrotation
Volvulus 
gastroschisis
meconium ileum
Hirshprung's diseases
33
Q

What is volvulus?

A

intestine twists around itself and its mesentery

34
Q

What is gastrochiasis?

A

congenital defect in which baby’s intestine extend outside body cavity through hole in or near umbilicus

35
Q

What is Hirshprung’s disease?

A

Congenital defect in which the nerves in the intestine are missing
Constipation is the predominant symptom

36
Q

What are the main types of duct-dependent heart defects?

A 
pulmonary atresia
critical pulmonary stenosis
Critical coarctation
Transposition of the great arteries
Hypoplastic left ventricle
37
Q

What does tetralogy of Fallot include?

A

VSD
Right ventricular hypertrophy
pulmonary artery stenosis
overriding aorta

38
Q

What are the specific clinical features for duct-dependent heart defects?

A

minimal recession for cyanosis

absent femoral pulses

39
Q

What are the non-specific clinical features for duct-dependent heart defects?

A

poor feeding, vomiting, pallor, cyanosis, tachypnoea, sleepiness, irritability

40
Q

What investigations should be done to confirm duct-dependent heart defects?

A

echocardiogram

CXR

41
Q

What is the broad aetiology of neonatal emergencies?

A

an unpreparedness for birth and extra-uterine life

42
Q

What is a risk factor for transient tachypnoea of the newborn?

A

C-section

43
Q

What is transient tachypnoea of the newborn?

A

common respiratory distress disorder in newborn
Symptoms usually start within the first hours after birth
thought to result from delayed absorption of foetal lung fluid.
It is a self-limiting condition.
Risk factors include prematurity, cesarean section, and male sex

44
Q

What is intusseception?

A

invagination of one portion of bowel into the lumen of the adjacent bowel

most commonly around the ileo-caecal region.

usually affects infants at 6-18mo
M>F

45
Q

What are the clinical features of intusseception?

A
  • paroxysmal abdominal colic pain
  • during paroxysm the infant will characteristically draw their knees up and turn pale
  • vomiting
  • bloodstained stool: ‘red-currant jelly’ - is a late sign
  • sausage-shaped mass in RUQ
46
Q

What investigation is performed for intusseception?

A

USS

may show target-like mass

47
Q

What are the clinical features common to respiratory stress in the neonate?

A
  • tachypnoea
  • intercostal recession
  • expiratory grunting
  • cyanosis
48
Q

What is the classical CXR for respiratory distress/surfactant deficiency in the newborn?

A

ground glass appearance

indistinct heart border

49
Q

What is the management of respiratory distress/surfactant deficiency?

A
  • maternal corticosteroids to induce foetal lung maturation (during pregnancy)
  • oxygen
  • assisted ventilation
  • exogenous surfactant given via ET tube

Life Support (13 decks)

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