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paediatrics > neonatal medicine > Flashcards

neonatal medicine Flashcards

1
Q

what proportion of babies need intensive care?

A

1-3%

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2
Q

explain the pathophysiology of hypoxic-ischaemic encephalopathy (HIE)

A
  1. gas exchange for the fetus is compromised
  2. reduced cardiac output
  3. cardiorespiratory depression
  4. brain injury
  5. brain death
  6. disability
  7. death
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3
Q

generally, what can lead to HIE?

A

any acute hypoxic events before/during labour/delivery

  • failure of GE across placenta
  • interrupted umbilical flow
  • compromised fetal growth
  • failure to breathe at birth
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4
Q

give examples of events that could cause failure of gas exchange across the placenta

A
  • excessive/prolonged uterine contractions
  • placental abruption
  • ruptured uterus
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5
Q

give examples of events that could interrupt umbilical blood flow

A
  • cord compression
  • cord prolapse
  • shoulder dystocia (compresses cord too)
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6
Q

give examples of events that could compromise fetal growth

A
  • IUGR

- anaemia

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7
Q

what is the commonest neurodevelopmental disorder following HIE?

A

cerebral palsy

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8
Q

which nerves are injured in Erb’s palsy?

A
  • C5

- C6

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9
Q

presentation of Erb’s palsy?

A
  • affected arm lies straight
  • limp arm
  • pronated hand
  • fingers flexed (waiter’s tip position)
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10
Q

a) what is the commonest fracture following shoulder dystocia?
b) what is the treatment and prognosis of this?

A

a) clavicle fracture

b) no treatment needed, excellent prognosis

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11
Q

what causes respiratory distress syndrome?

A
  • surfactant deficiency

- reduced surface tension on the alveoli

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12
Q

what is the main risk factor for respiratory distress syndrome?

A
  • being preterm!

- the more preterm the higher the risk

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13
Q

signs of respiratory distress syndrome?

A
  • RR >60/min (tachypnoea, red flag sign!)
  • laboured breathing
  • chest wall recession
  • expiratory grunting
  • cyanosis (severe)
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14
Q

what are the 2 aims of the expiratory grunting in respiratory distress syndrome?

A
  • to create positive airway pressure during expiration

- to maintain functional residual capacity

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15
Q

CXR sign in respiratory distress syndrome?

A

ground glass appearance

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16
Q

management of respiratory distress syndrome?

A
  • raised ambient oxygen
  • surfactant therapy via tracheal tube
  • CPAP if needed
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17
Q

commonest heart defect in preterm neonate?

A

patent ductus arteriosus

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18
Q

presentation of patent ductus arteriosus in neonate?

A
  • asymptomatic, or RDS:
  • apnoea
  • bradycardia
  • low O2 sats
  • bounding pulse
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19
Q

management of a symptomatic PDA?

A
  • prostaglandin synthetase inhibitor
  • e.g. indomethacin or ibuprofen
  • surgical ligation if this fails
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20
Q

why are preterm infants at higher risk of infection?

A

IgG only crosses the placenta in the third trimester

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21
Q

complications of infection in preterm infants?

A
  • bronchopulmonary dysplasia
  • brain injury
  • later disability
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22
Q

main GI complication in preterm infants?

A
  • necrotising enterocolitis

- the more preterm they are the higher the risk is

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23
Q

which type of milk increases risk of necrotising enterocolitis?

A

cow’s milk

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24
Q

signs of necrotising enterocolitis?

A
  • feed intolerance
  • bile-stained vomit
  • distended abdomen
  • stools containing fresh blood
  • shock (end stage)
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25
Q

X-ray findings in necrotising enterocolitis?

A
  • distended bowel loops
  • thickened bowel walls
  • intramural gas
  • bowel perforation (late)
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26
Q

management of necrotising enterocolitis?

A
  • stop oral feeds
  • broad-spectrum antibiotics (ampicillin, gentamicin)
  • parenteral nutrition
  • mechanical ventilation
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27
Q

long-term complications of necrotising enterocolitis?

A
  • strictures
  • malabsorption
  • neurodevelopmental delay
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28
Q

a) risk factor for intraventricular haemorrhage?

b) when does it happen?

A

a) prematurity

b) <72h of life

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29
Q

disease progression of a large intraventricular haemorrhage?

A
  • impairs drainage + reabsorption of CSF
  • CSF builds up under pressure
  • may resolve spontaneously
  • OR progress to hydrocephalus
  • anterior fontanelle gets tense
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30
Q

management of an intraventricular haemorrhage?

A
  • symptomatic relief by removing CSF with LP

- ventriculoperitoneal shunt

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31
Q

long term complication of untreated intraventricular haemorrhage?

A

cerebral palsy

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32
Q

main cause of retinopathy of prematurity?

A

high conc of O2 administered

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33
Q

biggest risk factor of retinopathy of prematurity?

A

very low birthweight (<1500g)

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34
Q

management of retinopathy of prematurity?

A
  • laser therapy

- intravitreal anti-VEFG therapy

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35
Q

define bronchopulmonary dysplasia

A

infants who still have an oxygen requirement aged 36 weeks

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36
Q

causes of bronchopulmonary dysplasia?

A
  • delayed lung maturation
  • artificial ventilation
  • oxygen toxicity
  • infection
37
Q

CXR signs in bronchopulmonary dysplasia?

A
  • areas of opacification

- cystic changes

38
Q

management of bronchopulmonary dysplasia?

A
  • CPAP or high-flow nasal cannula O2

- additional ambient O2 for months afterwards

39
Q

which pathogens cause serious chest infection after bronchopulmonary dysplasia?

A
  • RSV

- rhinovirus

40
Q

cause of osteopenia of prematurity?

A

phosphate deficiency

41
Q

explain why most newborns get jaundice

A
  • marked release of Hb from broken down RBCs
  • RBC lifespan in first few days is 70 days (vs 120 for us)
  • hepatic metabolism of bilirubin not very efficient
42
Q

underlying causes of neonatal jaundice?

A
  • haemolytic anaemia
  • infection
  • inborn error of metabolism
  • liver disease
43
Q

how does kernicterus happen?

A
  • unconjugated bilirubin gets deposited in basal ganglia

- causes encephalopathy

44
Q

signs of kernicterus?

A
  • lethargy
  • poor feeding
  • irritability
  • increased muscle tone leading to arched back on lying down
  • seizures
  • coma
  • death
45
Q

complications post-kernicterus?

A
  • choreoathetoid cerebral palsy
  • learning difficulties
  • sensorineural deafness
46
Q

causes of haemolysis resulting in jaundiced neonate <24 hrs?

A
  • rhesus haemolytic disease
  • ABO incompatibility
  • G6PD deficiency
47
Q

causes of jaundice <2 weeks?

A
  • physiological
  • breast milk jaundice
  • UTI
  • haemolysis
  • bruising
  • polycythaemia
48
Q

causes of unconjugated jaundice >2 weeks?

A
  • physiological
  • breast milk jaundice
  • UTI
  • haemolytic anaemia
  • hypothyroidism
  • pyloric stenosis
49
Q

causes of conjugated jaundice >2 weeks?

A
  • bile duct obstruction

- hepatitis

50
Q

demographic for G6PD deficiency?

A

Mediterranean, Middle/Far Eastern or African babies

51
Q

where is jaundice often missed?

A
  • dark-skinned babies

- preterm babies

52
Q

management of moderate jaundice in neonate?

A
  • phototherapy
  • blue-green light converts unconjugated bilirubin into harmless soluble stuff
  • gets passed in urine
  • given intensively where bilirubin is very high
53
Q

side effects of phototherapy?

A
  • hypothermia (undressed baby)
  • bronzed skin
  • macular rash
54
Q

management of severe jaundice in neonate?

A
  • exchange transfusion
  • blood removed by aliquots via arterial line / umbilical vein
  • replaced with donor blood via umbilical vein
55
Q

key differential for jaundice in neonate >2 weeks old?

A
  • biliary atresia
  • bilirubin here is CONJUGATED
  • needs to be managed promptly
56
Q

when should breast milk jaundice be cleared up by?

A

4-5 weeks of age

57
Q

signs of respiratory distress?

A
  • tachypnoea >60 breaths/min
  • laboured breathing with recession
  • nasal flaring
  • expiratory grunting
  • head bobbing (severe)
  • cyanosis (severe)
58
Q

pulmonary causes of respiratory distress in term infant?

A
  • transient tachypnoea of the newborn (common)
  • meconium aspiration
  • pneumonia
  • RDS
  • pneumothorax
  • milk aspiration
  • airway obstruction
  • diaphragmatic hernia
59
Q

non-pulmonary causes of respiratory distress in term infant?

A
  • congenital heart disease
  • HIE
  • severe anaemia
  • metabolic acidosis
60
Q

when does meconium pass?

A
  • 20% pass it before birth

- others pass it during delivery

61
Q

how is meconium aspirated?

A

asphyxiated newborn could choke on it when gasping for air

62
Q

risk factors for neonatal pneumonia?

A
  • PROM
  • chorioamnionitis
  • low BW
63
Q

risk factors for milk aspiration?

A
  • preterm babies
  • GOR (often follows bronchopulmonary dysplasia)
  • cleft palate
  • neuro disorder
64
Q

presentation of diaphragmatic hernia?

A
  • many are picked up on antenatal USS
  • respiratory distress
  • not responsive to resuscitation
65
Q

CXR in diaphragmatic hernia?

A
  • most are left-sided

- left bowel loops up in the thorax

66
Q

management of diaphragmatic hernia?

A
  • large nasogastric tube
  • suction applied (stops the lifted bowel from getting any bigger)
  • then surgery
67
Q

main underlying cause of diaphragmatic hernia?

A

pulmonary hypoplasia (high mortality if true)

68
Q

features of neonatal sepsis?

A
  • fever OR hypothermia
  • poor feeding
  • vomiting
  • apnoea
  • bradycardia
  • respiratory distress
  • abdominal distension
  • jaundice
  • neutropenia
  • hypoglycaemia OR hyperglycaemia
  • shock
  • irritability
  • seizures
  • lethargy
69
Q

added signs of sepsis seen only in meningitis?

A
  • tense, bulging fontanelles

- head retraction

70
Q

commonest pathogen in neonatal infection >48h of life?

A

staph epidermis

71
Q

sources of infection >48h of life?

A

usually environmental:

  • indwelling central catheters (TPN)
  • tracheal tubes
  • any other invasive stuff
  • poor hand hygiene of others handling baby
72
Q

what % of pregnant women carry GBS?

A

10-30%

73
Q

risk factors for GBS infection in newborn?

A
  • preterm birth
  • PROM
  • maternal fever during labour
  • chorioamnionitis
  • past Hx of infected infant
74
Q

prophylaxis of GBS infection?

A

mothers at risk of GBS are offered IV antibiotics

75
Q

age of presentation with GBS infection?

A
  • early onset = straight after birth

- late onset = 3m old

76
Q

which foods may contain listeria?

A
  • unpasteurised milk
  • soft cheese
  • undercooked meat
  • pate (veg or non veg!)
77
Q

presentation of listeria infection in mother?

A
  • mild flu-like illness

- caused by the bacteraemia

78
Q

features of listeria infection in the neonate?

A
  • meconium staining the liquor
  • widespread rash
  • septicaemia
  • pneumonia
  • meningitis
79
Q

signs of gonococcal eye infection in neonate?

A
  • purulent discharge
  • conjunctivitis
  • swollen eyelids
  • presents <48h of life
  • blindness (late)
80
Q

urgent investigation in gonococcal eye infection?

A

gram stain the discharge

81
Q

main difference between gonococcal and chlamydia eye infection?

A

chlamydia usually presents a bit later (1-2 weeks old)

82
Q

investigation in chlamydia eye infection?

A

immunofluorescent staining

83
Q

management of chlamydia eye infection?

A

2 weeks of oral erythromycin

84
Q

presentation of neonatal herpes?

A
  • lesions on skin or eye

- encephalitis

85
Q

prophylaxis for infant born to hep-B positive mother?

A

immediate vaccination against it to stop vertical transmission

86
Q

risk factors for hypoglycaemia <24h of life?

A
  • IUGR
  • maternal DM
  • large for gestational age
  • hypothermic
  • polycythaemic
87
Q

symptoms of neonatal hypoglycaemia?

A
  • jitteriness
  • irritability
  • apnoea
  • lethargy
  • drowsiness
  • seizures
88
Q

prevention of hypoglycaemia?

A
  • early and frequent feeding

- regular blood glucose monitoring for at-risk babies

89
Q

definition of hypoglycaemia in neonate?

A

blood glucose <2.6 mmol/l

paediatrics (10 decks)

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