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Paeds > Neonatal medicine > Flashcards

Neonatal medicine Flashcards

1
Q

Which age does TORCH infection occur?

A

In newborn

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2
Q

What does TORCH stand for?

A 
Toxoplasmosis
Other agents
Rubella
Cytomegalovirus (CMV)
Herpes simplex (HSV)
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3
Q

What is the most common congenital infection in UK?

A

CMV

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4
Q

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

A

APGAR score

Heart rate
Respiratory effort
Muscle tone
Reflex irritability
Colour
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5
Q

What can small fetus be caused by?

A

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

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6
Q

What are milia?

A

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

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7
Q

What could an absent red reflex suggest?

A

Cataracts

Retinoblastoma

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8
Q

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

A

Vitamin K

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9
Q

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

A 
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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10
Q

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

A

Serum immunoreactive trypsin

Raised immunoreactive trypsin if pancreatic duct obstruction

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11
Q

Difference between exomphalos and gastroschisis?

A

No covering sac with gastroschisis

Exomphalos associated with other congenital abnormalities

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12
Q

Define exomphalos

A

Abdo contents protrude through umbilical ring.

Covered by transparent sac formed by aminotic membrane and peritoneum.

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13
Q

Define gastroschisis

A

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

No covering sac.

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14
Q

Give causes of increased bilirubin causing jaundice in neonates

A 
Haemolytic disease of the newborn
ABO incompatibility
Haemorrhage
Intraventricular haemorrhage
Cephalo-haematoma
Polycythaemia
Sepsis and disseminated intravascular coagulation
    G6PD deficiency
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15
Q

Give causes of decreased clearance of bilirubin causing neonatal jaundice

A 
Prematurity
Breast milk jaundice
Neonatal cholestasis
Extrahepatic biliary atresia
Endocrine disorders (hypothyroid and hypopituitary)
Gilbert syndrome
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16
Q

Give causes of decreased clearance of bilirubin causing neonatal jaundice

A 
Prematurity
Breast milk jaundice
Neonatal cholestasis
Extrahepatic biliary atresia
Endocrine disorders (hypothyroid and hypopituitary)
Gilbert syndrome
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17
Q

Is jaundice <24 hours of life pathological? Why?

A

Yes - might be neonatal sepsis.

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18
Q

Give investigations for jaundice

A

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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19
Q

What are 2 different treatments for neonatal jaundice?

A

1st line: Phototherapy

2nd line: Exchange transfusion

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20
Q

What is the complication of extended hypoxia to the brain?

A

Hypoxic-ischaemic encephalopathy (HIE)

Cerebral palsy possible

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21
Q

What are important aspects in resuscitating a newborn?

A
  1. Warming baby
  2. APGAR score
  3. Stimulating breathing
  4. Inflation breaths
  5. Chest compressions
  6. (if severe) - IV drugs and intubation
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22
Q

Why delay umbilical cord clamping after birth?

A

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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23
Q

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

A

Ground-glass appearance

24
Q

What is the main cause of respiratory distress syndrome?

A

Inadequate surfactant –> high surface tension in alveoli.

–> atelectasis

–> inadequate gas exchange

–> hypoxia, hypercapnia, respiratory distress

25
Q

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

A

Dexamethasone (steroids)

26
Q

What are 2 major complications of necrotising enterocolitis?

A

Peritonitis

Shock

27
Q

What are risk factors for developing NEC?

A 
Low birth weight/premature
Formula feeds
Respiratory distress/assisted ventilation
Sepsis
PDA and other congenital heart disease
28
Q

How would a child with NEC present?

A 
Intolerant to feeds
Vomiting (esp green bile)
Generally unwell
Distended, tender abdo
Absent bowel sounds
Blood in stools

Peritonitis and shock later

29
Q

What would FBC show with NEC?

A

Thrombocytopenia and neutropenia

30
Q

What would CBG show for NEC?

A

Metabolic acidosis

31
Q

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

A

Abdominal x-ray

Dilated bowel loops
Bowel wall oedema
Gas in bowel wall
Free gas in peritoneal cavity
Gas in portal veins
32
Q

List management for NEC

A

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

33
Q

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

A

Group B strep

Found in vagina, spread to baby during labour

34
Q

List risk factors for neonatal sepsios

A 
Vaginal GBS colonisation
GBS sepsis in previous baby
Maternal sepsis or fever >38c
Prematurity
Early rupture of membrane
Prolonged rupture of membranes
35
Q

List features of neonatal sepsis

A 
Fever
Reduced tone + activity
Poor feeding
Respiratory distress/apnoea
Vomiting
Tachycardia/Bradycardia
Hypoxia
Jaundice within 24h
Seizures
Hypoglycaemia
36
Q

What are red flags when suspecting neonatal jaundice

A 
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
37
Q

Management of neonatal sepsis

A

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.

38
Q

Which 2 antibiotics can be used for neonatal sepsis?

A

Benzylpenicillin

Gentamycin

(cefotaxime in lower risk babies)

39
Q

Give the triad of features in congenital toxoplasmosis?

A

Intracranial calcification
Hydrocephalus
Chorioretinitis

40
Q

Give the triad of features in congenital cytomegalovirus?

A 
Fetal growth restriction
Microcephaly
Hearing loss
Vision loss
LD
Seizures
41
Q

What features occur in congenital varicella?

A 
Fetal growth restriction
Microcephaly, hydrocephalus and LD
Scars/skin changes (dermatomal)
Underdeveloped limbs
Cataracts and chorioretinitis
42
Q

What features occur in congenital rubella syndrome?

A

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

43
Q

What are 4 major features of Foetal Alcohol Syndrome?

A

Microcephaly
Thin upper lip
Smooth, flat philtrum
Short palpebral fissures

44
Q

What 2 conditions is gestational diabetes associated with?

A

Polyhydramnios and Pre-eclampsia

predisposes to congenital malformations, hypoglycaemia in newborn and polycythaemia

45
Q

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

A

Macrosomia - increased birth weight

  • predisposes to birthing injuries
46
Q

How is hyperthyroidism diagnosed in the fetus?

A

If mother has/had Graves,
then search for fetal tachycardia in CTG trace.

Also sometimes fetal goitre on USS

47
Q

How is transient hypoglycaemia prevented in the newborn?

A

Early feeding and close monitoring during first 24h

48
Q

What are characteristic features of listeria infection?

A 
Meconium staining of amniotic fluid
Widespread rash
Sepsis
Pneumonia
Meningitis
Death in 30%
49
Q

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

A

Elective caesarean section

Prophylactic aciclovir

50
Q

How is HSV encephalitis found in babies?

A

HSV antibodies in CSF

51
Q

Which part of the brain do HSV infections localise to?

A

Temporal lobes (bilateral or unilateral)

52
Q

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

A

Cleft palate

53
Q

How does cleft palate complicate feeding?

A

Milk goes into nose and causes coughing + choking

54
Q

What can bronchopulmonary dysplasia be caused by?

A

Delay in lung maturation

Pressure/volume trauma from artificial ventilation

O2 toxicity

Infection

55
Q

How is bronchopulmonary dysplasia managed?

A

Artificial ventilation
CPAP
Hi Flo O2

56
Q

What are risks of having bronchopulmonary dysplasia?

A

Intercurrent infection
Pulmonary HTN
Pertussis
Respiratory viral infection

Paeds (8 decks)

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