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Paediatric > Neonatal medicine > Flashcards

Neonatal medicine Flashcards

1
Q

term (early term and full term), preterm, post term

A

term- 37-42 (early 37-38 6/7, full 39-40 6/7), preterm - <36 6/7, post term- >42

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2
Q

very low birth weight, extremely low, incredibly low

A

v low <1500g
e low <1000g
i low <750g

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3
Q

immediate care post-delivery of baby

A

clear airway secretions, dry and warm baby, skin to skin contact, start breastfeed, APGAR 1min and 5min, if not breathing by 30-60sec start resus

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4
Q

resus of newly delivered baby

A

airway clear, o2 support, o2 sats for preterm 88-95%, monitor HR RR, BP, weight
ABG, FBC, UE, Lactate, blood and urine culture, glucose check
give broad spectrum antibiotic

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5
Q

Hypoxic ischaemic encephalopathy what and causes?

A

perinatal asphyxia results in cardioresp depression, reduced perfusion, resp acidosis, brain ischaemic injury
causes- placenta abruption, cord prolapse, cord compression, prolonged contractions

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6
Q

hypoxic-ischaemic encephalopathy clinical features?

A

mild- irritable, staring, impaired feeding
moderate- same and stops feeding, abnormal tone and movement, seizures
severe- prolonged seizures, no normal spontaneous movements, hypotone and hypertone fluctuates

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7
Q

RX hypoxic ischaemic encephalopathy

A

fluid restrict, treat seizure rx hypothermia, monitor hypoglycaemia, resp support

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8
Q

Respiratory distress syndrome, what? and why?

A

surfactant deficiency- higher alveolar surface tension- alveolar collapse, commoner in preterm

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9
Q

Features of respiratory distress syndrome

A

laboured breathing, grunting, recessions

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10
Q

CXR signs respiratory distress syndrome

A

diffuse granule of lungs

heart borders may be indistinct in severe

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11
Q

RX respiratory distress syndrome

A

If expecting preterm baby- give corticosteroids to mother antenatally
o2 support, 88-95% premature, surfactant therapy via tracheal tube, CPAP or raised ambient oxygen

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12
Q

Bronchopulmonary dysplasia, aka chronic lung disease? what?

A

after 36w corrected gestational age, still require oxygen, due to long use of artificial ventilation or infections.

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13
Q

CXR signs bronchopulmonary dysplasia

A

fibrosis, distended lungs, alveolar reduced surface area, widespread opacification

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14
Q

RX bronchopulmonary dysplasia

A

wean to CPAP, short course corticosteroid may help

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15
Q

Necrotising enterocolitis, what? complication?

A

bacterial infection of ischaemic bowel walls, often for preterm in first few weeks–> can lead to bowel perforation!

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16
Q

Protect against necrotising enterocolitis?

A

breast milk

cow milk formula more risky

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17
Q

features of necrotising enterocolitis

A

stops feeding, milk aspiration, bile stained vomit, fresh blood in stool, abdomen distension, shock signs

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18
Q

investigations and rx of necrotising enterocolitis

A 
AXR
stop oral feed
iv fluid resus if needed
co-amoxiclav
if perforated surgery
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19
Q

signs on AXR of necrotising enterocolitis

A

distended bowel loops, thickened bowel wall, air in portal tract

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20
Q

Jaundice causes if <24h, 24h-2w, >2w

A

<24h congenital infection, haemolysis
24h-2w physiological, haemolysis, polycythaemia
>2w unconjugated- haemolytic anaemia, UTI, physiology, hypothyroidism ,conjugated-neonatal hepatitis, bile duct obstruction

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21
Q

Features of jaundice

A

chalky stool, yellowed skin start at face and downwards, signs of cause e.g. vomit if obstruction, infection signs

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22
Q

investigations and rx of jaundice (clinical bilirubin > x?)

A

investigate- clinical bilirubin if >80micromol/L, transcutaneous bilirubin meter, or blood sample, do split bilirubin ratio, direct antibody test (COOMB’s)
rx: depending on gestational age, onset, rate of change–> phototherapy or exchange transfusion

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23
Q

complication of jaundice

A

kernicterus

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24
Q

what is kernicterus?

A

unconjugated bilirubin deposited in basal ganglia and brain stem cause permanent neurological damage

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25
Q

features of kernicterus

A

acute lethargy, poor feeding, irritable, increased tone, opisthotonos (arched back), seizures

26
Q

long term complications of kernicterus

A

learning difficulties, cerebral palsy, deafness

27
Q

rx of kernicterus

A

exchange transfusion

28
Q

meconium aspiration what?

A

meconium passed before birth, foetus inhales

29
Q

features of meconium aspiration

A

meconium stained amniotic fluid, pneumonia (laboured breathing), cyanosis, tachypnoea, yellow stained umbilical cord, finger nails, skin, desaturation

30
Q

diagnosis of meconium aspiration and what you would see on xr

A

CXR hyperinflated, pleural effusion, flattened diaphragm

31
Q

rx of meconium aspiration

A

antibiotic, surfactant therapy, CPAP, sometimes suction of airways

32
Q

early onset neonatal infections- time, method of infection

A

<48h from birth,

from birth canal infect amniotic fluid, so bacteraemia or pneumonia

33
Q

RF and features of early onset neonatal infections

A

prolonged or premature rupture of membranes, maternal fever, unstable temperature of baby, respiratory distress

34
Q

investigations and treatment of early onset neonatal infections

A

blood culture, o2 sats, septic screen, CXR, check CSF if indicated
rx: amoxicillin and gentamicin, o2 support

35
Q

late onset neonatal infection time, causative agent mostly

A

> 48h

staph aureus, staph epidermis, e.coli

36
Q

treatment of late onset neonatal infection

A

flucloxacillin and gentamicin first line

37
Q

o2 sat targets for preterm

A

88-95%

38
Q

Listeria monocytogenes cause and features

A

mother taken unpasteurised milk, soft cheese

features- widespread rash, meningitis, pneumonia, meconium stained fluid

39
Q

TORCH what?

A

transplacenta or via birth canal infections
Toxaplasma gondii
Other- syphilis, parvovirus B19, listeriosis, varicella-zoster
Rubella
Cytomegalovirus
Herpes simplex virus

40
Q

HSV features and rx

A

localised lesions face eyes, can have encephalitis signs!

rx- aciclovir

41
Q

Toxoplasma gondii features and treatment and investigations (what would you see?)

A

classic triad- chorioretinitis, hydrocephalus, intracranial calcification
and petichiae purpura (blueberry muffin rash)
rx- folinic acid avoid uncooked meat, cat faeces
investigations- IgM specific, MRI ring enhanced lesions

42
Q

Syphilis- features and rx

A

features- maculopapular rash on soles and palms, nasal discharge, jaundice
rx- penicillin

43
Q

listeriosis features and rx

A

vesicular and pustula rash, meningitis,

ampicillin and gentamicin

44
Q

varicella zoster features and rx

A

cataracts, chorioretinitis, encephalitis, pneuomia,

rx- aciclovir, varicella zoster specific immunoglobulins, breastfeeding!

45
Q

parvovirus b19 features and rx

A

aplastic anaemia, fetalis hydrops

rx- if needed intrauterine blood transfusion

46
Q

rubella features

A

blueberry muffin rash petichiae purpura

sensorineural deafness, PDA, cataracts, growth restriction

47
Q

Cytomegalovirus

A

blueberry rash, sensorineural deafness, seizures, growth restriction
rx- ganiciclovir

48
Q

Cleft lip and palate- features and rx

A

can be unilateral, bilateral, partial or complete
hearing, feeding difficulty, dental problems
rx- conservative- SALT, feeding technique or surgery repair
(can be spotted prenatal 12w gestation)

49
Q

gastroschisis what and features

A

paraumbilical herniation of intestines through abdomen wall without hernia sac, due to failure of development of peritoneal cavity
features- intestines outside, malabsorption, short bowel, seen in premature infants mostly

50
Q

gastroschisis- treatment

A

surgery, wrap intestines in sterile plastic wrap

delivery- csection no advantage over vaginal

51
Q

oesophageal atresia what- and types

A

abnormal development of oesophagus- can be
A- no connection with proximal and distal oesophagus
B- Oesophagus atresia with tracheoesophagus fistula in proximal
C- most common, OA with tracheoesophagus fistual in distal oesophagus section
D- H-type, no OA but fistula present

52
Q

features of oesophagus atresia (+/- tracheoesophagus fistula)

A

poor feeding, polyhydramnios, aspiration, gastric distension

53
Q

other features associated with Oesophagus Atresia

A

VACTORL
vertebral abnormalities, anal atresia, cardiac abnormalities, tracheooesophagus fistual, oesophagus atresia, renal abnormal, limb abnormal

54
Q

treatment of oesophagus atresia

A

antibiotics, sometimes oesophagus tube for suction, surgery

55
Q

Bowel atresia what and where most common

A

sections of bowel missing so discontinuation (or narrowing)
more common in premature and multiple pregnancy,
more common at jejunum or ileum over duodenum or Large intestines

56
Q

bowel atresia features and rx

A

polyhydramnios, no meconium passed, green or yellow stained vomiting, refusal to feed, abdo distended, jaundice
surgery

57
Q

maternal diabetes risks to foetus

A

macrosomia, early foetal loss, foetal hyperglycaemia (neonoatal hypoglycaemia tho- prevent w early feeding) neonatal respiratory distress syndrome

58
Q

maternal hyperthyroidism risks to foetus

A

maternal TSH pass through placenta and stimulate thyroid
goitre, tachypnoea, diarrhoea, HF, wieght loss
rx with carbimazole to mother and monitor

59
Q

Low and v low hypoglycaemia is ? for neonates?

A

low <2.5mmol/L

v low <1.6mmol/L

60
Q

features of hypoglycaemia

A

irritable, lethargy, seizures

61
Q

treatment hypoglycaemia

A

2.5ml/kg 10% dextrose bolus

early and frequent milk feed prevents this

Paediatric (6 decks)

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