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Paeds > Neonatal Med > Flashcards

Neonatal Med Flashcards

1
Q

What is Hypoxic Ischaemic Encephalopathy (HIE)?

A

During perinatal aspyhxia gas exchange is reduced giving hypoxia and metabolic acidosis. This reduces tissue perfusion giving hypoxic injury to the brain and other organs

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2
Q

What are some causes of Hypoxic Ischaemic Encephalopathy?

A 
Uterine Contractions
Placental Abruption
Ruptured Uterus
Umbilical blood flow obstruction
Maternal Hypotension/Hypertension
Compromised Fetus - IUGR, Anaemia
Failure to breathe at birth
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3
Q

How will a neonate with mild Hypoxic Ischaemic Encephalopathy present?

A 
Irritable
Excessively responsive
Hyperventilation
Hypertonia
Impaired feeding
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4
Q

How will a neonate with moderate Hypoxic Ischaemic Encephalopathy present?

A

Marked movement abnormalities
Hypotonia
Seizures
Cannot feed

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5
Q

How will a neonate with severe Hypoxic Ischaemic Encephalopathy present?

A

No normal spontaneous movements
No response to pain
Multi-organ failure

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6
Q

What is the recommended management for confirmed Hypoxic Ischaemic Encephalopathy?

A

Respiratory support
Anticonvulsants for seizures
Fluid restriction for transient renal impairment
Voulme and Inotrope support for hypotension
Monitoring and treatment of electrolyte imbalance
Induced hypothermia is associated with improved outcomes

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7
Q

What is Necrotising Enterocolitis?

A

Necrosis of a section of bowel in a newborn

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8
Q

Why are neonates more vulnerable to Necrotising Enterocolitis?

A

Preterm bowel is vulnerable to ischaemic injury and bacterial invasion, making NEC more likely

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9
Q

Which formulation of milk increases the risk of developing Necrotising Enterocolitis?

A

Cows milk formula

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10
Q

What are some clinical signs of Necrotising Enterocolitis?

A

Feed intolerance
Bile-stained vomiting
Abdominal distension requiring mechanical ventilation
Fresh PR bleed

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11
Q

Which investigation is appropriate for suspected Necrotising Enterocolitis?

A

AXR

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12
Q

What may be seen on an AXR with Necrotising Enterocolitis?

A

Distended bowel loops
Thickening of bowel wall
Gas in Portal Venous tract

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13
Q

What is the recommended management of confirmed Necrotising Enterocolitis?

A

Stop oral feed
Broad spectrum Abx covering both Aerobic and Anaerobic
TPN
Surgery if perforation

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14
Q

What are some potential complications of Necrotising Enterocolitis?

A

Development of strictures
Malabsorption due to surgical resection
Poor neurodevelopmental outcome

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15
Q

Why is neonatal jaundice so common?

A

High Hb concentration at birth leads to excessive haemolysis
Red cell lifespan is shorter in infants
Hepatic bilirubin metabolism is less efficient in first few days of life

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16
Q

What may neonatal jaundice indicate?

A

Haemolytic anaemia
Errors of metabolism
Liver disease

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17
Q

What is the serious complication of untreated neonatal jaundice?

A

Kernicterus

18
Q

What is Kernicterus?

A

Encephalopathy secondary to unconjugated bilirubin being deposited in the brain

19
Q

What are some causes of Jaundice in first 24h following birth?

A 
Rh Haemolytic disease
ABO incompatibility - Coombs/DAT +ve
G6PDH Deficiency
Spherocytosis
Congenital infection
Sepsis
20
Q

What are some causes of jaundice within 2d-2w of birth?

A

Normal physiology - infant adapting
Breast milk jaundice
Dehydration
Infection

21
Q

What are some causes of jaundice after 2w of birth?

A

Biliary atresia
Breast-milk jaundice
Infection
Congenital hypothyroidism

22
Q

What are the treatment options available for acute neonatal jaundice?

A

Phototherapy

Exchange transfusion

23
Q

How does Phototherapy help with neonatal jaundice?

A

UV light converts unconjugated bilirubin into a water-soluble pigment that is renally excreted

24
Q

When is exchange transfusion the recommended treatment for neonatal jaundice?

A

If serum bilirubin reaches dangerous levels, the entire circulating volume is transfused.

25
Q

What is Neonatal Sepsis?

A

Sepsis demonstrated withihn 48-72h of life

26
Q

What are causes of Neonatal Sepsis?

A

Ascending infection in mother with Chorioamnitis
Perinatal contact in birth canal
Haematogenous spread of maternal infection

27
Q

What are some causative organisms of neonatal jaundice?

A 
Group B Strep.
E.Coli
Coagulase -ve Strep
H.Influenzae
Listeria
28
Q

If a mother is found to be carrying Group B Strep in her genital tract, how should this be managed?

A

Empirical Abx

29
Q

What are some risk factors for development of neonatal sepsis?

A 
Previous Group B Strep infection of baby
Known current Group B Strep
PROM/Pre-term birth
Suspected/Confirmed ROM for >18h in Pre-term child
Intrapartum Fever >38 degrees
Suspected/confirmed Chorioamnitis
30
Q

What are some Red Flag signs for potential neonatal sepsis?

A

Parental Abx given to mother for confirmed/suspected infection for 24h either before/after birth
Suspected/confirmed infection of another child in multiple pregnancy

31
Q

When should neonatal sepsis treatment be initiated?

A

Either 1 Red Flag sign or any 2 non red-flag signs are present

32
Q

What are some symptoms of neonatal sepsis?

A 
Altered behaviour
Altered muscle tone
Abnormal HR
Signs of RDS
Hypoxia
Jaundice at <24h age
Apnoea
Signs of Encephalopathy
Temperature anomaly
Unexplained bleeding
Metabolic acidosis
Local signs of infection
33
Q

What are some red flag signs suggestive of neonatal sepsis?

A

RDS >4h after birth
Seizures
Signs of Shock
Need for mechanical ventilation if term baby

34
Q

What are some potential differentials for suspected neonatal sepsis?

A

TTN
RDS
Haemolytic disease of the Newborn

35
Q

Which investigations are appropriate for suspected neonatal sepsis?

A

FBC
CRP
Cultures prior to Abx
LP if ?Meningitis/likely source of infection

36
Q

What is the recommended management for Neonatal Sepsis?

A

IV Benzylpenicillin and Gentamicin

37
Q

When should antibiotics for neonatal sepsis be stopped at 36h?

A

If cultures have returned as negative
Clinical suspicion is low
Clinical condition/CRP are reassuring

38
Q

If blood cultures for suspected neonatal sepsis return as positive, how long should the child receive Abx for?

A

7-10 days

39
Q

If CSF cultures for suspected neonatal sepsis return as positive, how long should the child receive Abx for?

A

14 days

40
Q

If blood cultures for suspected neonatal sepsis return as negative but CRP is still rising, how long should the child receive Abx for?

A

5 days

Paeds (11 decks)

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