Neonatal medicine Flashcards
What are the features of foetal alcohol syndrome?
Growth restriction Characteristic face (Saddle shaped nose, small head) Developmental delay Cardiac defects Smooth/Flat philtrum
What is the management of congenital CMV infection?
When born, IV ganciclovir or oral valganciclovir
What is the management of congenital toxoplasmosis infection?
When born, pyrimethamine + sulfadiazine + calcium folinate
Why is a vitamin K injection given to a newborn?
To prevent haemorrhagic disease of the newborn
What does the Guthrie test screen for?
Phenylketonuria Sickle Cell Thalassaemia Cystic fibrosis MCAD deficiency
What hearing tests are conducted in children?
At birth, perform otoacoustic emission test
If abnormal, perform auditory brainstem response test
At 6-9 months perform distraction test
From 18 months - 2.5 years perform familiar object recognition “where is the teddy?”
> 2.5 years performance testing, speech discrimination
> 3 years pure tone audiometry
What are the features of APGAR score?
Appearance - Pink/Blue peripheries/Blue central
Pulse - >100 BPM, <100 BPM, Nil
Respiratory effort - Strong/Irregular/None
Activity - Active movement, Flexed position, Flaccid
Reflex irritability - Cries, grimaces, none
What are the manifestations of each grade of hypoxic-ischaemic encephalopathy?
Mild - Irritable, responds excessively to stimulation, hyperventilation
Moderate - Abnormal tone and movement, cannot feed, may have seizures
Severe - No spontaneous movement/response to pain, limbs fluctuate between hyper and hypotonia, prolonged seizures, multiple organ failure
What is the difference between caput succedaneum and cephalohaematoma?
They are both bleeding/oedema that typically follows prolonged difficult delivery and are managed conservatively
Caput succedaneum - Develops immediately after birth, extends past the suture line, resolves after a few days
Cephalohaematoma - Develops several hours after birth, does not cross the suture line, resolves after months, bleeding under periosteum
What are the typical causes of nerve pulsies?
Breech delivery
Shoulder dystocia
Results in brachial plexus injury, leading to Erb’s palsy or Klumpke’s palsy
Typically resolves on its own
What are the features and management of respiratory distress syndrome?
Caused by a lack of surfactant in neonates, typically due to preterm or diabetic mother
Tachypnoea (> 60 breaths per minute) Chest wall recession Nasal flaring Grunting Cyanosis
Ground glass appearance on x-ray
Managed antenatally with glucocorticoids if likely to be preterm. Postnatally, treated with oxygen with potential need for tracheal tube for ventilation. May also give artificial surfactant
What are the features of necrotising enterocolitis?
Conditions affecting preterm infants who are fed cow’s-milk formula
Infection of ischaemic bowel walls
* Vomiting * Refuse feeding * Abdominal distension * Milk aspiration * May develop shock
On CXR:
• Distended loops of bowel
• Free fluid
• Gas in portal tract
What is the management of necrotising enterocolitis?
- Stop oral feeding
- Broad spectrum antibiotics
- Parenteral feeding
- Surgery if bowel perforation/necrosis
What are the features and management of meconium aspiration?
Typically occurs in post-term babies and those with prolonged rupture of membranes
* Mechanical obstruction in lungs * Pneumonitis * Persistent pulmonary hypertension * Pneumothorax
Management:
• May need ventilation
• If meconium-stained amniotic fluid, observation recommended
• If signs of infection, give IV ampicillin and gentamicin
What are the causes of management of pneumonia?
Prolonged rupture of membranes, chorioamnionitis, low birthweight
Treat with broad spectrum antibiotics before investigations
