Neonatal medicine Flashcards
What does the TORCH infection screen include
Toxoplasmosis Other (syphilis, varicella-zoster, parvovirus B19) Rubella Cytomegalovirus Herpes HIV
What can Toxoplasmosis infection cause during pregnancy to the child
- Hydrocephalus
- Intracranial calcification
- Chorioretinitis
- Neurological damage
What is RDS
Respiratory distress caused by a lack of surfactant production
What are the clinical signs of RDS
From birth to 4 hours: • Tachypnoea with a RR of over 60 breaths/min • Recession – subcostal or intercostal • Cyanosis • Nasal flaring • Expiratory grunting
What would you see on x ray in RDS
Ground glass appearance
What is the treatment and management for RDS
Glucocorticoids given antenatally if birth predicted before 37 weeks
artificial surfactant therapy via endotracheal tubes
Oxygen
CPAP via nasal cannulae
What can RDS develop into
Chronic lung disease of prematurity - officially needing oxygen at 36 weeks corrected age (manage with oxygen)
What are the causes of jaundice in the first 24 hours
Rhesus haemolytic disease of the newborn
ABO incompatibility
G6PD deficiency
Spherocytosis
What is rhesus haemolytic disease of the newborn
When Rh negative mother exposed to Rh-positive infant/ blood transfusion.
What is ABO incompatibility
Mismatch between maternal and foetal blood group
What are the causes of jaundice between 2 days to 2 weeks
Physiological jaundice Breast milk jaundice infection excess haemolysis bruising polycythemia
What are the causes of jaundice after 2 weeks
Unconjugated: Physiological or breast milk jaundice Infection (particularly urinary tract) Hypothyroidism Haemolytic anaemia, e.g. G6PD deficiency High gastrointestinal obstruction, e.g. pyloric stenosis Conjugated (>25 μmol/L): Bile duct obstruction Neonatal hepatitis
What are causes of unconjugated jaundice in a neonate
Physiological or breast milk jaundice Infection (particularly urinary tract) Hypothyroidism Haemolytic anaemia, e.g. G6PD deficiency High gastrointestinal obstruction, e.g. pyloric stenosis
What are the causes of conjugated jaundice in neonates
biliary atresia
neonatal hepatitis
What is Kernicterus
- Encephalopathy resulting from deposits of unconjugated bilirubin in the basal ganglia and brainstem nuclei
- Free bilirubin can pass the blood-brain barrier
How would you treat jaundice in a neonate
- Phototherapy – first line
* Exchange transfusion – used if phototherapy fails
What are the clinical signs for biliary atresia
- Persistent neonatal jaundice – predominantly conjugated hyperbilirubinaemia
- Dark urine
- Pale stools
- Failure to thrive
- Malabsorption
- Enlargement of liver and spleen
- Tendency to bleed due to vitamin K deficiency
What is the treatment for biliary atresia
The Kasai procedure before the age of 6 weeks.
Further liver biopsy by the age of 20.
What are the key risk factors for necrotising enterocolitis
Prematurity Infection Congenital heart defects perinatal hypoxia early feeding with formula milk
What are the clinical features of necrotising enterocolitis
- apnoea
- Bilious vomiting
- Distended shiny abdomen
- Haemodynamic instability
What would you see on X-ray in necrotising enterocolitis
dilated, thick walled bowel loops, free air or intramural gas
What is the treatment and management for necrotising enterocolitis
Medical:
• Nil by mouth, NG tube on free drainage
• Parental nutrition or IV dextrose
• Antibiotics: penicillin, gentamycin and metronidazole
Surgical:
• Surgical resection of necrotic bowel might be required in severe cases/perforation has occurred
• Infant can be left with short gut syndrome – risk of malnutrition
