Neonatal medicine Flashcards by V S

Which age does TORCH infection occur?

In newborn

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What does TORCH stand for?

Toxoplasmosis
Other agents
Rubella
Cytomegalovirus (CMV)
Herpes simplex (HSV)

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What is the most common congenital infection in UK?

CMV

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What score can screen newborns health? List the abbreviation and what each letter means.

APGAR score

Heart rate
Respiratory effort
Muscle tone
Reflex irritability
Colour

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What can small fetus be caused by?

Fetal chromosomal disorder/sydrome
Congenital infection
Maternal drug/alcohol abuse
Malnutrition

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What are milia?

White pimples on nose and cheeks, from keratin and sebaceous material in follicles

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What could an absent red reflex suggest?

Cataracts

Retinoblastoma

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What is given to all newborn infants to prevent haemorrhagic disease of the newborn?

Vitamin K

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What does the newborn screening (Guthrie test) pick up? (9 conditions)

Congenital hypothyroidism
Haemoglobinopathies (sickle cell and thalassemia)
Cystic fibrosis
Six inherited metabolic diseases:
Phenylketonuria
MCAD
Maple syrup urine disaese
Isovaleric acidaemia
Glutaric aciduria type 1
Homocystinuria

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What specific lab test scans for CF in newborn? How does that test work?

Serum immunoreactive trypsin

Raised immunoreactive trypsin if pancreatic duct obstruction

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Difference between exomphalos and gastroschisis?

No covering sac with gastroschisis

Exomphalos associated with other congenital abnormalities

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Define exomphalos

Abdo contents protrude through umbilical ring.

Covered by transparent sac formed by aminotic membrane and peritoneum.

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Define gastroschisis

Bowel protrudes trhrough defect in anterior abdo wall adjacent to umbilicus.

No covering sac.

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Give causes of increased bilirubin causing jaundice in neonates

Haemolytic disease of the newborn
ABO incompatibility
Haemorrhage
Intraventricular haemorrhage
Cephalo-haematoma
Polycythaemia
Sepsis and disseminated intravascular coagulation
    G6PD deficiency

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Give causes of decreased clearance of bilirubin causing neonatal jaundice

Prematurity
Breast milk jaundice
Neonatal cholestasis
Extrahepatic biliary atresia
Endocrine disorders (hypothyroid and hypopituitary)
Gilbert syndrome

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Give causes of decreased clearance of bilirubin causing neonatal jaundice

Prematurity
Breast milk jaundice
Neonatal cholestasis
Extrahepatic biliary atresia
Endocrine disorders (hypothyroid and hypopituitary)
Gilbert syndrome

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Is jaundice <24 hours of life pathological? Why?

Yes - might be neonatal sepsis.

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Give investigations for jaundice

Full blood count and blood film for polycythaemia or anaemia

Conjugated bilirubin: elevated levels indicate a hepatobiliary cause

Blood type testing of mother and baby for ABO or rhesus incompatibility

Direct Coombs Test (direct antiglobulin test) for haemolysis

Thyroid function, particularly for hypothyroid

Blood and urine cultures if infection is suspected. Suspected sepsis needs treatment with antibiotics.

Glucose-6-phosphate-dehydrogenase (G6PD) levels for G6PD deficiency

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What are 2 different treatments for neonatal jaundice?

1st line: Phototherapy

2nd line: Exchange transfusion

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What is the complication of extended hypoxia to the brain?

Hypoxic-ischaemic encephalopathy (HIE)

Cerebral palsy possible

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What are important aspects in resuscitating a newborn?

Warming baby
APGAR score
Stimulating breathing
Inflation breaths
Chest compressions
(if severe) - IV drugs and intubation

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Why delay umbilical cord clamping after birth?

Allows blood to enter circulation of baby from placenta.

Increases Hb, iron and BP.

Reduces IVH and NEC.

However, increases neonatal jaundice.

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What is the characteristic feature of an X-ray of newborn with respiratory syndrome?

Ground-glass appearance

What is the main cause of respiratory distress syndrome?

Inadequate surfactant –> high surface tension in alveoli.

–> atelectasis

–> inadequate gas exchange

–> hypoxia, hypercapnia, respiratory distress

What drug can be used antenatally to prevent respiratory distress by increasing surfactant?

Dexamethasone (steroids)

What are 2 major complications of necrotising enterocolitis?

Peritonitis Shock

What are risk factors for developing NEC?

``` Low birth weight/premature Formula feeds Respiratory distress/assisted ventilation Sepsis PDA and other congenital heart disease ```

How would a child with NEC present?

``` Intolerant to feeds Vomiting (esp green bile) Generally unwell Distended, tender abdo Absent bowel sounds Blood in stools ``` Peritonitis and shock later

What would FBC show with NEC?

Thrombocytopenia and neutropenia

What would CBG show for NEC?

Metabolic acidosis

What is the gold standard investigation for NEC? What would it show?

Abdominal x-ray ``` Dilated bowel loops Bowel wall oedema Gas in bowel wall Free gas in peritoneal cavity Gas in portal veins ```

List management for NEC

NBM with IV fluids TPN Antibiotics NG tube to drain fluid and gas from stomach and intestines Surgical resection of dead bowel + temporary stoma

What is the main pathogen for neonatal sepsis and where is it found?

Group B strep Found in vagina, spread to baby during labour

List risk factors for neonatal sepsios

``` Vaginal GBS colonisation GBS sepsis in previous baby Maternal sepsis or fever >38c Prematurity Early rupture of membrane Prolonged rupture of membranes ```

List features of neonatal sepsis

``` Fever Reduced tone + activity Poor feeding Respiratory distress/apnoea Vomiting Tachycardia/Bradycardia Hypoxia Jaundice within 24h Seizures Hypoglycaemia ```

What are red flags when suspecting neonatal jaundice

``` Confirmed/suspected sepsis in mother Signs of shock Seizures Term baby needing mechanical ventilation Respiratory distress >4h after birth Presumed sepsis in another baby in multiple pregnancy ```

Management of neonatal sepsis

If 2 or more risk factors/features, start antibiotics within 1 hour Blood cultures BEFORE antibiotics Baseline FBC and CRP LP if meningitis features (seizures) or strong suspicion of infection Recheck CRP again at 24h Recheck blood culture at 36h Recheck CRP again at 5 days if still on treatment Consider stopping abx if clinical well, LP/bloods negative and CRP normal.

Which 2 antibiotics can be used for neonatal sepsis?

Benzylpenicillin Gentamycin (cefotaxime in lower risk babies)

Give the triad of features in congenital toxoplasmosis?

Intracranial calcification Hydrocephalus Chorioretinitis

Give the triad of features in congenital cytomegalovirus?

``` Fetal growth restriction Microcephaly Hearing loss Vision loss LD Seizures ```

What features occur in congenital varicella?

``` Fetal growth restriction Microcephaly, hydrocephalus and LD Scars/skin changes (dermatomal) Underdeveloped limbs Cataracts and chorioretinitis ```

What features occur in congenital rubella syndrome?

Cataracts Heart disease (PDA and aortic stenosis) LD Hearing loss

What are 4 major features of Foetal Alcohol Syndrome?

Microcephaly Thin upper lip Smooth, flat philtrum Short palpebral fissures

What 2 conditions is gestational diabetes associated with?

Polyhydramnios and Pre-eclampsia predisposes to congenital malformations, hypoglycaemia in newborn and polycythaemia

What happens to the birth weight of children of mothers with gestational diabetes?

Macrosomia - increased birth weight - predisposes to birthing injuries

How is hyperthyroidism diagnosed in the fetus?

If mother has/had Graves, then search for fetal tachycardia in CTG trace. Also sometimes fetal goitre on USS

How is transient hypoglycaemia prevented in the newborn?

Early feeding and close monitoring during first 24h

What are characteristic features of listeria infection?

``` Meconium staining of amniotic fluid Widespread rash Sepsis Pneumonia Meningitis Death in 30% ```

If a mother has primary HSV or herpetic lesions, what can be done to manage this?

Elective caesarean section Prophylactic aciclovir

How is HSV encephalitis found in babies?

HSV antibodies in CSF

Which part of the brain do HSV infections localise to?

Temporal lobes (bilateral or unilateral)

Failure of fusion of frontonasal and maxillary processes results in __________.

Cleft palate

How does cleft palate complicate feeding?

Milk goes into nose and causes coughing + choking

What can bronchopulmonary dysplasia be caused by?

Delay in lung maturation Pressure/volume trauma from artificial ventilation O2 toxicity Infection

How is bronchopulmonary dysplasia managed?

Artificial ventilation CPAP Hi Flo O2

What are risks of having bronchopulmonary dysplasia?

Intercurrent infection Pulmonary HTN Pertussis Respiratory viral infection