Neonatal medicine Flashcards by alex brown

what is hypoxic - ischaemic encephalopathy?

neonatal brain injury secondary to prenatal, perinatal or postnatal asphyxia

How well did you know this?

Not at all

Perfectly

aetiology of hypoxic ischaemic encephalopathy

abnormal CTG,
poor Apgar scores
metabolic acidosis

How well did you know this?

Not at all

Perfectly

what does Apgar stand for?

appearance
pulse rate
grimace 
activity
respiration

How well did you know this?

Not at all

Perfectly

mild Signs and symptoms of hypoxic ischaemic encephalopathy

mild: irritable
increased one and reflexes
staring eyes
poor feeding

How well did you know this?

Not at all

Perfectly

moderate Signs and symptoms of hypoxic ischaemic encephalopathy

lethargy
reduced tone and reflexes
seizures

How well did you know this?

Not at all

Perfectly

severe Signs and symptoms of hypoxic ischaemic encephalopathy

coma, reduced tone , absent reflexes, prolonged seizures, multi organ failure

How well did you know this?

Not at all

Perfectly

Ix for hypoxic ischaemic encephalopathy

cerebra function monitor (CFM), electroencephalogram (EEG) , MRI brain

How well did you know this?

Not at all

Perfectly

Rx hypoxic ischaemic encephalopathy

respiratory and circulatory support
anticonvulsants
cooling

How well did you know this?

Not at all

Perfectly

Cx of hypoxic ischaemic encephalopathy

cerebral palsy
learning difficulties
epilepsy
hearing and visual impairment

How well did you know this?

Not at all

Perfectly

Aetiology of Respiratory distress in infants

meconium aspiration syndrome
comgenital pneumonia
persistant pulmonary hypertension the newborn (PPHN)
heart failure
pneumothorax
diaphragmatic hernia
transient tachypnoea of newborn

How well did you know this?

Not at all

Perfectly

what is meconium aspiration syndrome?

aspiration of meconium during delivery causing pneumonitis

How well did you know this?

Not at all

Perfectly

CXR findings in meconium aspiration syndrome

patchy infiltrates

How well did you know this?

Not at all

Perfectly

specific treatment for meconium aspiration syndrome

surfactant

How well did you know this?

Not at all

Perfectly

what is congenital pneumonia

congenital infection of lungs

How well did you know this?

Not at all

Perfectly

CXR findings in congenital pneumonia

focal consolidation

How well did you know this?

Not at all

Perfectly

specific treatment for congenital pneumonia

antibiotics

How well did you know this?

Not at all

Perfectly

pathology of pneumothorax

may be spontaneous
often iatrogenic
- high pressure ventilation / continuous positive airway pressure (CPAP)

How well did you know this?

Not at all

Perfectly

Rx of pneumothorax

often resolved small

chest drain if large / symptomatic

How well did you know this?

Not at all

Perfectly

what is a diaphragmatic hernia

herniation abdominal contents into chest cavity through diaphragm leading to pulmonary hypoplasia

How well did you know this?

Not at all

Perfectly

specific treatment of diaphragmatic hernia

surgical repair

How well did you know this?

Not at all

Perfectly

what is transient tachypnoea

delay in resorption of lung fluid, associated with Caesarean section,resolves spontaneously

How well did you know this?

Not at all

Perfectly

Signs and symptoms of respiratory distress in term infants

tachypnoea
grunting 
intercostal/ subcostal recession
tracheal tug
nasal flare
cyanosis

How well did you know this?

Not at all

Perfectly

Ix of resp distress syndrome in term infants

CXR

Echo if cardio cause

How well did you know this?

Not at all

Perfectly

Rx of resp distress in term infants

resp support: O2, continours positive ariway pressure (CPAP) invasive ventilation

How well did you know this?

Not at all

Perfectly

Cx of resp distress in term infants

chronic lung disease

what is prematurity

28-36 weeks

what is extreme prematurity

23-27 weeks

Cx of prematurity | what are they susceptible to?

``` respiratory distress syndrome (RDS) persistent ductus arteriosus (PDA) retinopathy of prematurity (ROP) intraventricular haemorrhage (IVH( hypoglycaemia hypothermia sepsis ```

management of the pre term infant

require feeding support with high energy nasogastric/ orogastirc tube (NGT/OGT) feeds ± total parenteral nutrition (TPN) nursing in warm humid incubator, cot warmer,

Cx prematurity what is respiratory distress syndrome (hyaline membrane disease)

lack of surfactant secreted by type 2 pneumocytes

Cx prematurity what is respiratory distress syndrome (hyaline membrane disease) Symptoms and signs

resp distress tachycardia hypoxia CXR

Cx prematurity Tx respiratory distress syndrome (hyaline membrane disease)

antenatal steroids exogenous surfactant resp support as for resp distress syndrome

Cx prematurity | patent ductus arteriosus what is it?

failure of ductus arteries to close leading to left right shunting, fluid overload and heart failure

Cx prematurity patent ductus arteriosus Tx

fluid restriction ibuprofen surgical : ligation of duct

Cx prematurity | necrotising enterocolitis what is it?

``` ischaemia of gut wall and secondary infection of bowel risk factors: prematurity milk feeding (higher risk with formula) sepsis ibuprofen ```

Cx prematurity necrotising enterocolitis Signs and symptoms

intolerance of feeds distended abdo vomiting per rectum bleeding

Cx prematurity necrotising enterocolitis Tx

nil by mouth TPN antiB surgery if severe

Cx prematurity | retinopathy of prematurity what is it?

proliferation of blood vessels at junction of non-vascularised and vascularised retina risk factors: extreme prematuri excessive O2 therapy all at risk infants require ophthalmology screening

Cx prematurity retinopathy of prematurity Tx

laser therapy for sever disease

Cx prematurity | intraventricular haemorrhage what is it?

haemorrhage of blood vessels in germinal matrix secondary to hypoxia/ resp distress syndrome RDS

Cx prematurity intraventricular haemorrhage Tx

treatment of ventricular dilatation (CSF taps, shunt insertion)

A of neonatal sepsis

``` prolonged rupture of membranes chorioamnionitis materna pyrexia/ sepsis maternal carriage of GPS prematurity indwelling central lines poor hand hygiene ```

pathogens causing neonatal sepsis

GBS | E. coli

S of Neonatal sepsis

``` resp distress apnoea temperature instability poor feeding often non specific ```

Ix Neonatal sepsis

``` inflammatory markers - CRP WBC blood culture lumbar puncture urine microscopy, culture and sensitive MC+S CXR ```

Rx neonatal sepsis

maternal antiB when risk factors for sepsis present broad spectrum antiBs (to cover GBS ad gram negatives), strict hand washing and infection control measures on neonatal unit

What is classed as hypoglycaemia in neonates?

glucose level below 2.5 mmol/L

Aetiology for hypoglycaemia

``` prematurity small for gestational age (SGA), macrosomina, infants of diabetic mothers, sepsis, polcythaemia, metabolic ```

S of hypoglycaemia in neonates

``` jitteriness poor feeding irritability drwosiness apnoea seizures ```

Ix hypoglycaemia neonates

blood glucose level, metabolic screen of persistent of sever hypoglycaemia

Rx hypoglycaemia neonates

early and frequency milk feeds, iv 10 per cent dextrose

Cx hypoglycaemia neonates

seizures | neurological impairment

what is oesophageal atresia?

oesophagus ends in blind ended pouch rather than connecting normally to stomach often associated with trachea-oesophageal fistula

S of oesophageal atresia

polyhydramnios (fetes unable to swallow amniotic fluid), excess oral secretions, aspirations and regurgitation when fed

Ix oesophageal atresia

CXR

Rx oesophageal atresia

surgical repair

aetiology of birth injuries

large babies, instrumental/difficult delivery

what is Erb's palsy ?

C5 / C6 brachial plexus injury

Sings of Erb's palsy

asymmetrical Moro reflex (limp arm, waiters tip position)

treatment of era's palsy

physio

what is Klumkes palsy?

C8/T1 brachial plexus injury

Signs of Klumpke's Palsy

wrist / hand muscle weakness

Tx for Kulmpke's palsy

Phyiso