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Paediatrics > Neonatal Medicine > Flashcards

Neonatal Medicine Flashcards

1
Q

Neonatal care

A

Level 1: special care
Level 2: short-term intensive care
Level 3: long term intensive care

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2
Q

Causes of hypoxic-ischaemic encephalopathy

A

Failure of gas exchange accross the placenta
Interruption of umbilical blood flow
Inadequate maternal placental perfusion
Compromised fetus
Failure of cardiopulmonary adaptation at birth

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3
Q

Clinical manifestation of hypoxic ischaemic encephalopathy

A

Mild: irritable infant, responds excessively to stimulation, staring of eyes, hyperventilation, hypertonia, impaired feeding
Moderate: marked abnormalities of movement, hypotonic, cannot feed, may have seizures
Severe: no normal spontaneous movement or response to pain, tone in limbs, fluctuation between hypotonia and hypertonia, prolonged seizures, multi-organ failure

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4
Q

Mx hypoxic ischaemic encephalopathy

A

Respiratoy support
Anticonvulsants for seizures
Fluid restriction: transient renal impairment
Inotrope and volume support of hypotension
Monitoring of hypoglycaemia and electrolyte imbalance
Cooling effective if initiated within 6h

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5
Q

Prognosis hypoxic ischaemic encephalopathy

A

Complete recovery in mild hypoxic iscahemic encephalopathy
Good prognosis if mostly recovered by 2w
Mortality severe HIE ~ 40%

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6
Q

Features suggestive of birth asphyxia

A

Evidence of severe hypoxia antenatally, during labour/delivery
Resuscitation needed at birth
Features of encephalopathy
Hypoxic damage to other organs
No other prenatal or postnatal cause identified

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7
Q

Multi-organ dysfunction in hypoxic iscahemic encephalopathy

A 
Abnormal neurological signs
Seizures
PPH of the newborn
hypotension
hypoglycaemia
hypocalcaemia
hyponatraemia
Renal failure
DIC
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8
Q

Soft tissue injury during birth

A

caput succedaneum: bruising and odema of presenting part extends beyond margins of skull bones
Cephalhaematoma: bleeding below periosteum, confined by skull sutures
Chignon: odema and bruising from ventouse
Abrasions: scalp electrodes/accidental incision during Csection
Subaponeurotic haemorrhage: diffuse boggy swelling of the scalp, blood loss can be significant

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9
Q

Features Brachial nerve plexus palsy during delivery

A

Traction to the brachial plexus nerve roots
-breech delivery
-shoulder dystocia
Upper nerve C5/6 causes Erb’s palsy

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10
Q

Features facial palsy during delivery

A

Compression against mothers ischial spine/ forceps pressure
Facial weakness on crying
Eye remains open
Usually transient

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11
Q

Cx prematurity

A 
Respiratory distress syndrome
Pneumothorax
Apnoea and bradycardia
Hypotension
Patent ductus arteriosus
Temperature control
Hypoglycaemia
Hypocalcaemia
Electrolyte imbalance
Osteopenia of prematurity
Nutrition
Infection
Jaundic
Intraventricular haemorrhage
Periventricular leukomalacia
Necrotixing enterocolitis
Retinopathy of prematurity
Anaemia of prematurity
Iatrogenic
Bronchopulmonary dysplasia
Inguinal hernias
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12
Q

Fractures during delivery

A 
Clavicle
-typically shoulder dystocia
-excellent prognosis
-callus lump at clavicle after several weeks
Humerus/femur
-occurs at breech deliveries or dystocia
-heal rapidly with immobilisation
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13
Q

Features respiratory distress syndrome

A

At delivery or within 4h of birth
Tachypnoea >60 breaths/min
Laboured breathing with chest wall recession and nasal flaring
Expiratory grunting (attempt to produce positive airway pressure)
Cyanosis

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14
Q

Ix respiratory distress syndrome

A

Typical chest Xray: diffuse granular or ground glass appearance of the lungs and air bronchogram

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15
Q

Mx respiratory distress syndrome

A

Corticosteroids prior to delivery in at risk patients reduces incidence
Oxygen, assisted ventilation, exogenous surfactant via endotracheal tube

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16
Q

Cx respiratory distress syndrome

A 
pneumothorax
lobar collapse
bronchopulmonary dysplasia
chronic lung disease of prematurity
Cor pulmonale
intraventricular haemorrhage
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17
Q

Apnoea and bradycardia in premature infants

A

Common until 32w gestational age
Bradycardia associated with apnoea >20-30s
Usually immaturity of centrl respiratory control
Breathing restarts with gentle physical stimulation/ caffeine stimulation

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18
Q

Factors predisposing preterm infants to hypothermia

A

large SA:V
thin heat permable skin and transepidermal water loss
Little subcut fat
often nursed naked
Cannot curl up or shiver to conserve or generate heat

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19
Q

Prevention of heat loss in newborns

A 
Raise temp of ambient air in incubator
Clothe including head covering
Double walls of incubator
Dry and wrap at birth
Nurse on heated mattress
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20
Q

Features patent ductus arteriosus

A 
Common in preterm infants, esp in RDS
Bounding pulse
Increased pulse pressure
Prominent precordial impulse
Systolic murmur
Signs of heart failure
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21
Q

Mx patent ductus arteriosus

A

prostaglandin synthetase inhibitor .e.g. indomethacin or ibuprofen
Surgical ligation

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22
Q

Features septicaemia

A

Risk factors: PROM, GBS positive mother, maternal temperature
Typically bradycardia, desaturations
Complete septic screen including blood culture, urine culture, lumbar puncture, CRP and leucocyte count
Immediate broad spectrum Abx to symptomatic and at risk neonates

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23
Q

Features Nectrotising enterocolitis

A

Risk increases with increasing prematurity
Common in formula feeding
Presents in the first few weeks, stops tolerating feeds, bile stained vomit, abdo distention, fresh blood in stools

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24
Q

Xray features necrotising enterocolitis

A

dilated bowel loops, bowel wall edema, pneumatosis intesinalis, portal venous gas, Rigler sign, football sign

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25
Q

Mx Necrotising enterocolitis

A

Urgent IV fluid resuscitation and maintenance, parenteral feeding, broad spectrum Abx .e.g. Penicillin, metronidazole and gentamicin
Possible development of structures/adhesions, malabsorption in bowel resection

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26
Q

Risk factors Respiratory distress syndrome

A 
Male
Diabetic mothers
C section
2nd born twin
Infants <28w
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27
Q

Features pneumothorax newborn

A

More common in ventilation hence associated with RDS
Increased oxygen requirement and reduced breath sounds unilateral
Transillumination of the chest wall by bright optic light source
Urgent decompression of tension pneumothorax
Avoidance by low pressure ventilation

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28
Q

Intraventricular haemorrhage features

A

Haemorrhage in 20% of low birthweight infants
Typically in germinal matrix above caudate nucleus: fragile network of blood vessels
Usually occurs within the first 72 hours
Associated with RDS, perinatal asphyxia
Most severe form causes hemiplegia
Impairing of CSF daining: separation cranial sutures, rapidly increasing head circumference, tense fontanelle

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29
Q

Mx Intraventricular haemorrhage

A

Symptomatic relief by CSF removal via LP or ventricular tap

Ventriculoperitoneal shunt can be used for CSF drainage

30
Q

Newborn retinopathy

A

Developing blood vessels and the junction of vascularised and non-vascularised retina
May progress to retinal detachment, fibrosis and blindness
Associated with uncontrolled use of oxygen

31
Q

Features bronchopulmonary dysplasia

A

Infant with oxygen requirement at 36 weeks
Lung damage due to delay in maturation
Chest xray shows widespread areas of opacification with cystic changes
Progression of RDS to pulmonary interstitial emphysema

32
Q

Mx bronchopulmonary dysplasia

A

Nutritional optimisation, oxygen supplementation and intubation as required
Corticosteroids and diuretics may improve lung function

33
Q

Newborn hypoglycaemia

A

Onset in first 24 hours
Typically IUGR, prematurity, diabetic mothers, large for dates, hypothermic, polycythaemia, illness
Optimal blood glucose 2.6mmol/L
Lethargy, poor feeding, jitteriness, seizures, apnoea
Abnormal blood glucose: confirmed by lab

34
Q

Mx neontala hypoglycaemia

A

Good feeding is sufficient to treat hypoglycemia
IV dextrose if necessary
Rarely diazoxide is used to suppress insulin

35
Q

Features Jaundiced baby

A

Deposition of bilirubin in the skin: common in newborns. Typically starts with face and progresses to limbs

36
Q

Causes Jaundice <24hr

A 
Rhesus incompatibility
ABO incompatibility
G6PD deficiency
Spherocytosis
Pyruvate Kinase Deficiency
Congenital Infection
37
Q

Causes Jaundice 24h-2w

A 
Physiological
Breast milk jaundice
Infection
Haemolysis (late presentation)
Bruising
Polycythaemia
Crigler-Najjar Syndrome
38
Q

Causes Jaundice >2w

A 
Physiological/Breast milk Jaundice
Infections especially UTIs
Hypothyroidism
Haemolytic anaemias
High GI obstruction
Neonatal hepatitis
Bile duct obstruction
39
Q

Ix Jaundice

A

transcutaneous bilirubin, serum bilirubin if within 50 of treatment thresholds

40
Q

Mx Neonatal Jaundice

A

dual emission phototherapy (450nm) with a bilirubin above 350 (plateau by day 3), and rebound bilirubin after 2 weeks. Possible exchange transfusion if phototherapy unsuccessful replacing twice the neonatal blood volume

41
Q

Cx Neonatal Jaundice

A

kernicterus (basal ganglia damage from excess bilirubin crossing BBB causing encephalitis)

42
Q

Features physiological jaundice

A

Inefficient bilirubin metabolism: common
High Hb concentration at birth, shorter RBC life span and inefficiency of metabolism all contribute to slower breakdown
Mild, presents at day 2-3
self resolves within first week

43
Q

Features neonatal hepatitis

A

Bruising, poor weight gain, dark urine, pale stools

Check maternal hepatitis status

44
Q

Features biliary atresia

A

Presents after 2-3 weeks
Dark urine, pale stools
Surgical intervention immediately
Late recognition can result in need for transplantation

45
Q

Features haemolytic ABO disease newborn

A 
Presents within 12-72 hours
AB IgM antibodies do not cross the placental but IgG can
Group OF mothers with A/B/AB babies
Hepatosplenomegaly absent
Coombs test positive
46
Q

Features congenital hypothyroidism

A

Coarse facial features, hoarse cry, dry umbilicus

Screening at day 7 via heel prick, serum TSH and T4

47
Q

Features rhesus haemolytic disease

A

Affected infants usually identified antenatally
Severe presentation of anaemia, hydrops, hepatosplenomegaly
Antibiotics typically to rhesus D, but may develop against Kell and Duffy blood groups

48
Q

Features G6PD deficiency

A

X linked recessive condition
Typically mediterrean,. Middle East and African populations
Mainly affects males
Intravascular haemolysis, splenomegaly, gallstones
Heinz bodies on blood film

49
Q

Mx G6PD deficiency

A

Avoidance of specific drugs which precipitate jaundice: Anti-malarias .e.g. Primaquine, ciprofloxacin, sulph-drug groups .e.g. Sulphonamides, sulfasalazine, sulfonylureas
Safe medications: penicillins, cephalosporins, macrolides, tetracyclines, trimethoprim

50
Q

Features spherocytosis

A

Autosomal Dominant affecting shape of rbc
Diagnosis by spherocytes on blood film: round, lack of central pallor
Northern European populations
Extravascular haemolysis
Haemolytic crisis precipitated by infection
Osmotic fragility test is diagnostic

51
Q

Features polycythaemia

A

Venous haematocrit >0.65

Babies typically have a high packed cell volume

52
Q

Features Crigler Najjar

A

Autosomal Recessive
Absolute deficiency of UDP-glucuronosyl (type 1)
Type 1 do not survive to adulthood
Type 2 may improve with phenobarbital

53
Q

dDx breathing difficulty in the newborn

A 
Respiratory distress syndrome
Transient tachypnoea of the newborn
Meconium aspiration
Birth Asphyxia
Diaphragmatic hernia
Laryngomalacia
Tracheoesophageal fistula
Pneumonia
Persistent pulmonary hypertension of the newborn
54
Q

Features transient tachypnoea of the newborn

A

Most common cause of respiratory distress in term babies
Delay in clearance of fluid in lungs: C section greater incident ? fluid not squeezed out
Respiratory distress and cyanosis
Self resolves within a few days

55
Q

Chest Xray transient tachypnoea of the newborn

A

hyperinflation of lungs, fluid in horizontal fissure, cardiomegaly and prominent perihilar markings

56
Q

Features meconium aspiration

A

Passage of meconium before birth, typically in post-dates

Typically causes a chemical pneumonitis

57
Q

Risk factors meconium aspiration

A

post-dates, maternal hypertension, preeclampsia, chorioamnionitis, smoking, substance misuse

58
Q

Chest Xray meconium aspiration

A

over inflation and heterogeneous opacification (collapse and consolidation)

59
Q

Mx Meconium aspiration

A

Mechanical ventilation often required

Inotropic support of blood pressure and inhaled NO

60
Q

Features diaphragmatic hernia

A

Usually diagnosed on antenatal screening
Failure to respond to resuscitation or respiratory distress
Displaced apex beat and heart sounds to right side of chest
Poor air entry on left side

61
Q

Mx diaphragmatic hernia

A

NG tube to drain and prevent distention

Surgical repair

62
Q

Cx diaphragmatic hernia

A

Compression can prevent lung development causing hypoplastic lungs

63
Q

Newborn pneumonia causative organisms

A

Gram negative bacilli (E.coli, klebsiella, pseudomonas), group B strep and staphylococcus

64
Q

Features persistent pulmonary hypertension of the newborn

A

Acute neonatal emergence
Persistence of intracardiac shunts due to high pulmonary vascular resistance
All cases before 72 hours
Usually associated with birth asphyxia, meconium aspiration, septicaemia, RDS
Worsening cyanosis, hypoxia and tachypnoea
Echocardiogram includes cardiac pathology and shows increased pulmonary pressures and tricuspid regurgitation

65
Q

Mx PPH of newborn

A

Requires mechanical ventilation and respiratory support
Inhaled NO and potent vasodilators
Systemic BP is kept high to prevent right lieft shunting

66
Q

MX neonatal conjunctivitis

A

Common in neonatal period
Saline cleaning allows for spontaneous resolution
Purulent discharge, infection, swelling of eyelid suggest gonococcal infection- third gen cephalosporin
Chlamydia present at 1-2 weeks- treated with oral erythromycin for 2 weeks

67
Q

Features Early onset neonatal infection

A

Illness within 48 hours
Usually vertical transmission from mother
Prophylactic treatment if mother exhibiting signs of infection, GBS positive, PROM, prematurity
Fever and temperature instability, irritability, poor feeding, panoea, bradycardic, respiratory distress, jaundice, neutropenia, hypoglycemia, lethargy, seizures
Usually GBS, rarely listeria, klebsiella, pseudomonas

68
Q

Mx Early onset infection in newborn

A

CRP may take 12-24 hours to increase: prophylactic antibiotics can be stopped if no CRP rise
Blood culture and inflammatory markers: consider LP
Broad Spectrum Abx .e.g. Benzylpenicillin + gentamicin

69
Q

Features Late onset infection in newborn

A

Likely environmental agent
Onset after 48 hours
Coagulase negative staph most common

70
Q

Mx late onset infection in newborn

A

Initially flucloxacillin and gentamicin

Neuropenum and vancomycin may be required if initial treatment resistance

71
Q

Features umbilical injection

A

Usually umbilicus dries and separates spontaneously
Redness and inflammation suggests infection hence antibiotics are used
Granulous tissue should be ligated or treated with silver nitrate

Paediatrics (22 decks)

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