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Paediatrics > Neonatal Medicine > Flashcards

Neonatal Medicine Flashcards

0
Q

Define prolonged jaundice

A

Jaundice present > 14 days for term baby, >21 days for preterm baby

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1
Q

Define early jaundice

A

<24 hours, always pathological

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2
Q

Define physiological jaundice

A

Jaundice arising after 24 hours, typically peaking at 3-4 days and subsiding by 10 days (max 14)

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3
Q

What causes physiological jaundice?

A

High fetal Hb so excess rbcs broken down
Immature enterohepatic circulation
Poor hepatic bilirubin metabolism
Short lifespan of newborn rbcs (70 days)

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4
Q

What serious complication can unconjugated hyperbilirubinaemia cause and why?

A

Kernicterus - unconjugated bilirubin is fat soluble and normally carried by albumin. If too high it can cross BBB and get deposited in basal ganglia/brain stem -> encephalopathy

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5
Q

Symptoms of kernicterus?

A 
Tiredness and lethargy, irritability
Poor feeding
Increased muscle tone causing back arching - opisthotonos
Seizures
Coma
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6
Q

Long term complication of severe kernicterus?

A

Choreoathetoid cerebral palsy

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7
Q

At what bilirubin level does jaundice become clinically recognisable?

A

80umol/L

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8
Q

Most common causes of early jaundice? (Unconjugated hyperbilirubinaemia)

A

Acute intravascular haemolysis

  • rhesus haemolytic disease
  • ABO incompatibility
  • G6PD deficiency
  • spherocytosis
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9
Q

How does ABO incompatibility work?

A

Can seriously affect first baby
Most maternal Abs are IgM and so don’t cross placenta, however some type Os will have antiA IgGs (haemolysin) which can cross and cause mild symptoms, no hepatosplenomegaly
Occasionally antiB haemolysins

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10
Q

Testing for ABO incompatibility?

A

Coombes test (DCT) - positive result

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11
Q

Investigating spherocytosis

A

Blood film to observe abnormal spherocytes

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12
Q

Major causes prolonged jaundice?

A 
Biliary atresia
Breast milk jaundice (unconjugated)
UTI
TPN related (conjugated)
Neonatal hepatitis
Dehydration
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13
Q

Weird causes of prolonged jaundice?

A

Crigler-Najjar (glucoronyl transferase deficiency)
Galactosaemia - test urine reducing substances
A1 anti trypsin deficiency
Polycythaemia
Hypothyroid (?hypopituitary)

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14
Q

Drugs which can exacerbate neonatal jaundice?

A

Sulphonamides

Diazepam

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15
Q

How does phototherapy work?

A

450nm green-blue light converts unconjugated bilirubin to harmless water soluble pigment excreted in urine. Can cause eye problems (cover eyes), temp problems (as uncovered) and macular rash if conjugated hyperbilirubinaemia

16
Q

How does exchange transfusion work?

A

Arterial line or umbilical vein

Exchange 2x baby total blood volume (2x80ml/kg)

17
Q

Basis of cyanotic heart disease?

A

Significant R -> L shunting so systemic circulation receives deoxygenated blood

18
Q

Cyanotic heart disease mnemonic?

A

4Ts, 2Ps, H E

19
Q

4Ts of cyanotic heart disease?

A

Tetralogy of Fallot
Transposition of great arteries
Tricuspid atresia
Total anomalous pulmonary venous return (pulm venous malposition)

20
Q

2Ps of cyanotic heart disease?

A

Persistent truncus arteriosus

Pulmonary atresia

21
Q

H and E of cyanotic heart disease?

A

Hypoplastic L heart syndrome

Ebstein’s Anomaly

22
Q

Mnemonic for non-cyanotic heart disease?

A

4S, 2As and a P

23
Q

4S of non cyanotic heart defects?

A

Septal defects - VSD, ASD

Stenosis - pulmonary and aortic

24
Q

2As of non cyanotic heart disease?

A

Aortic coarctation

AV canal / endocardial cushion defect

25
Q

P of non cyanotic heart disease?

A

Patent ductus arteriosus

26
Q

Risk factors for congenital heart defects

A 
FH - maternal more than paternal
Maternal viral infection e.g. Rubella
Maternal drugs - lithium, alcohol
Syndromes e.g. Down's, digeorge and turners
Maternal DM, maternal PKU
27
Q

What are ductus dependent conditions?

A

Severe L sided obstruction that only presents some time after birth, as it is masked by patency of ductus arteriosus

28
Q

Initial management of ductus dependent conditions?

A

Resuscitation and PG(E1) infusion to prevent closure

29
Q

Types of ductus dependent conditions?

A

Hypoplastic left heart syndrome, critical aortic stenosis, pulmonary atresia, transposition of the great arteries, interrupted aortic arch

30
Q

What postural position when breathless is indicative of cyanotic heart disease in older kids?

A

Squatting

31
Q

2 key abnormalities of ToF and 2 other ones?

A

Large VSD
RVOT obstruction (pulmonic stenosis)
Also overriding aorta and RVH
(+ ASD = pentalogy of Fallot)

32
Q

Clinical signs of ToF?

A

RV heave, lower LSE systolic thrill
Aortic ejection click and no pulm valve closure sound (S2 is one bit only)
Long loud systolic RVOT murmur, quieter the worse the obstruction gets
Cyanosis, clubbing

33
Q

Non cardiac clinical findings of ToF?

A

Scoliosis, retinal vessel engorgment, haemoptysis

Paediatrics (9 decks)

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