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Y5 Paediatrics > Neonatal medicine > Flashcards

Neonatal medicine Flashcards

1
Q

What is hypoxic ischaemic encepalopathy?

A

Reduced cardiac output / oxygen delivery causing hypoxic-ischaemic injury to brain and other organs

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2
Q

What are causes of HIE?

A
  • Failure of gas exchange across placenta (prolonged contractions, placental abruption)
  • interruption of umbilical blood flow (cord compression)
  • inadequate maternal placental perfusion
  • compromised foetus
  • failure of cardioresp adaptation at birth
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3
Q

When do clinical manifestations of HIE start?

A

Up to 48 h after injury

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4
Q

What is HIE grading like?

A

Mild
Moderate
Severe

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5
Q

What is mild HIE ?

A 
irritable 
excessive response to stimulation
staring eyes 
hyperventi,ation 
impaired feed
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6
Q

What is moderate HIE

A

marked abnormalities in tone and movement
cannot feed
seizures

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7
Q

severe HIE

A

no spontaneous movement
no response to pain
seizures
multi organ failure

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8
Q

What is HIE prognosis ?

A 
good if mild / moderate 
high mortality (40%) if severe + neuro disabilities (cerebral palsy)
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9
Q

What are soft tissue injuries that can occur to the foetus?

A

caput succedaneum (brusing + oedema of presenting part)

Cephalhaematoma (bleeding below the periosteum, wtihin margins of skill sutures)

Chignon (from ventouse)
Bruising (face/buttock)

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10
Q

What is the most common brachial plexus injury ?

A

Erb’s palsy (C5, C6)

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11
Q

What is management for brachial plexus palsies

A

most will resolve completely

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12
Q

What is the most likely cause of a clavicle fracture?

A

shoulder dystocia

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13
Q

What is skin like in a pre term baby=

A

very thin

dark red colour

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14
Q

What is genitalia like in a pre term baby?

A

smooth scrotusm, no testes

prominent clitoris, wide labia major, protruding labia minor

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15
Q

What kind of feeding do pre term babies need

A

TPN, then tube feeding

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16
Q

What is respiratory distress syndrome

A

deficiency of surfactant

causes widespread alveolar collapse and inadequate gas exchange

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17
Q

What are RF for RDS?

A

pre term foetus

maternal diabetes

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18
Q

Whaqt are clincial signs of RDS?

A

WITHIN 4 H of birth

tachypnoea
laboured breathing with chest wall recession (sternal, subcostal indrawing) and nasal flare
expiratory grunting
cyanosis

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19
Q

How do you manage RDS?

A

oxygen, ventilation (CPAP/artificial ventilation)

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20
Q

How does pneumothorax present in a newbord?

A

increased oxyfgen demand
reduced breath sounds
chest expansion

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21
Q

How can you demonstrate newbord pneumothorax?

A

transillumination

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22
Q

How do you manage newborn pneomothorax

A

immediate decompression
oxygen therapy
chest drain if tension

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23
Q

What are causes of newborn pneumothorax

A

spontaneous
meconium aspiration
resp distress syndrome

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24
Q

Why do foetuses have more difficult temp control

A

large surface area to volume ration
thin skin, heat permeable
little subcut fat
often nursed naked

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25
Q

How does a patent ductus arteriosus present?

A

apnoea, bradycardia
increased oxygen requirement
difficulty weaning infant off ventilation
bounding pulse

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26
Q

how do you manage patent ductus arteriosus

A

IV indomethacin
ibuprofen
surgical ligation

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27
Q

How old are babies when they can start sucking and swallowing?

A

34 weeks

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28
Q

How does feeding occur for infants who cannot suck and swallow?

A

via orogastric / nasogastric tube

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29
Q

When does breast milk need to be supplemented

A

In very preterm infants

with phosphate, protein, calciu, calories

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30
Q

What does cows milk increase risk of

A

Necrotoising enterocolitis

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31
Q

What tool can be used to identify brain haemorrhage in very low birthweight infant?

A

USS

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32
Q

How can a brain haemorrage lead to hydrocephalus0

A

very large hemorrage
impairs drainage and reabsorption of CSF
causes CSF accumulation
may progress to hydrocephalys

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33
Q

How do you treat hydrocephalys?

A

venticuloperitoneal shunt

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34
Q

What is a likely consequence of post-haemorrhagic ventricular dilatation?

A

cerebral palsy

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35
Q

What is paraventricular leukomalacia

A

presence of multiple cystic lesions that occur due to periventricular white matter injur

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36
Q

What is necrotising enterocolitis

A

bacterial infection of ischaemic bowel wall

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37
Q

What are clinical features of NE

A
  • stop tolerating feeds-
  • milk aspirated from stomach
  • vomiting (bile stained)
  • abdo distension
  • rectal bleeding
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38
Q

What are. x ray fts of NE

A

distended loops of bowel
thickening of bowel wall
intramural. gas
gas in portal tract

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39
Q

what is the risk of NE

A

progression to bowel perforation

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40
Q

How do you manage NE

A

STOP feeding
broad spec antibioticsa
surgery if bowel perforation / necrosis
parenteral nutrition, artificial ventilation

41
Q

What are consequences of NE

A

development of strictures

malabsortpion

42
Q

What is broncopulmonary dysplasia

A

chronic lung disease

when infants still havc an oxygen requirement. after 36 wks

43
Q

How many infants become visibly jaundiced

A

50%

44
Q

What is RBC span like in newborns

A

70 days

instead of 120

45
Q

What is the level of bilirubin above which it becomes clinical jaundice

A

80mmol/L

46
Q

What is kernicterus?

A

encepalopathy caused by deposition of unconjugated bilirubin in basal ganglia and brainstem

47
Q

When does kernicterus occur?

A

when level of unconjugated bilirubin exceeds albumin binding capacity
Bilirubin is fat soluble, so it crosses the blood brain barrier
bilirubin has neurotoxic effects

48
Q

\What are manifestations of kernicterus=?

A 
irritability 
lethargy, poor feeding
increased muscle tone 
baby lies with arched back (opisthotonos) 
seizures 
coma
49
Q

What is opisthotonos?

A

baby lying with arched back

due to increased muscle tone in kernicterus

50
Q

what do infants who survive kernicterus develop?

A

choreoathetoid cerebral palsy
learning difficulties
sensorineural deafness

51
Q

how can we classify jaundice in neonates?

A

conjugated vs unconj

<24h
2 days to 2 weeks
>2 weeks

52
Q

What are causes of jaundice <24h

A

HAEMOLYSIS:

  • rhesus haemolytic disease
  • ABO incompatibility
  • G6PD deficiency
  • Spherocytosis

OR CONGENITAL INFECTION

53
Q

How do you detect jaundice secondary to ABO incompatibility?

A

Coombs test (direct antibody test) +

54
Q

What are causes of jaundice 2 days - 2 weeks

A
  • Physiological jaundice
  • Breast milk jaundice
  • dehydration
  • infection
  • Crigler-Najjar syndrome
55
Q

What are causes of jaundice >2 weeks

A

unconjugated:
- breast milk jaundice
- infection
- congenital hypothyroidism

conjugated:
- BILIARY ATRESIA
- neonatal hepatitis syndrome

56
Q

What other sx occur with obstructive jaundice?

A

pale stools
dark urine
hepatomegaly
poor weight gain

57
Q

Where does jaundice start and where does it spread?

A

starts on neck and face

spreads to trunk and limbs

58
Q

How do you assess for neonatal jaundice?

A
  • Inspect baby in natural light
  • Measure bilirubin
      • serum bilirubin (<35 weeks OR jaundice developed in 24h)
    • -transcutaneous bilirubin (>35 weeks OR jaundice developed >24h)
  • Assess kernicterus risk
  • Measure serum bilirubin every 6 hours
59
Q

When can you stop measuring serum bilirubin every 6h=

A

Once it drops below treatment threshold or becomes stable / falling

60
Q

When is someone at increased risk of kernicterus?

A
  • serum bilirubin >340 mcmol/L in babies >37 weeks
  • rapidly rising bilirubin > 8.5 mcmil/L per hour
  • clinical its of acute bilirubin encepalopathy
61
Q

How do you investigate underlying cause for neonatal jaundice

A 
Htc 
Blood group of mother and baby 
DAT test (Coomb's) 
Consider: 
- FBC and blood film (e.g. hereditary spherocytosis) 
- Blood G6PD levels 
- microbio cultures of blood, urine, CSF
62
Q

How do you treat neonatal jaundice

A

Phototherapy
Exchange transfusion
IVIG

63
Q

What must you check for after phototherapy?

A

REBOUND bilirubinaemia

by measuring serum bilirubin 12-18 hours after stopping

64
Q

What kind of dx is transient tachypnoea of the newborn?

A

Dx of EXCLUSION

65
Q

What is the cause of transient tachypnoea of the newborn?

A

delay in reabsorption of liquid

66
Q

What increases risk of transient tachypnoea of the newborn?=

A

C section

because liquid is not squeezed out of the lung

67
Q

How do you manage transient tachypnoea of the newborn?

A

additional ambient oxygen

usually settles within first day of life

68
Q

What is meconium?

A

dark green substance forming first faeces of newborn infant

69
Q

How many babies pass meconium in utero ?

A

10-20%

70
Q

What is meconium passed in response to?

A

GI maturation

foetal hypoxia

71
Q

What is the issue with passing meconium in utero for foetus that is apnoea?

A

foetus starts gasping

it will aspirate on the meconium

72
Q

What are the issues with aspirating on meconium ?

A

lung irritant
causes mechanical obstruction and chemical pneumonitis
lungs become overinflated, have patches of collapse and onsolitation
pneumothorax

73
Q

How do you treat meconium aspiration?

A

Observation if no hx of GBS
Antibiotics (ampicillin/gent) if possible infection
Oxygen therapy and non-invasive ventilation (CPAP=

74
Q

What is persistent pulmonary HTN of the newborn caused by?

A

Primary

Secondary, due to:

  • birth asphyxia
  • meconium aspiration
  • septicaemia
  • RDS
75
Q

What does persistent pulmonary HTN of the newborn lead to

A

cyanosis soon after birth

due to increased vascular resistance causing L to R shunting of blood

76
Q

How do you manage persistent pulmonary HTN of the newborn

A

Mechanical ventilation and circulatory support
Inhaled nitric oxide
Sildenafil (vasodilator)
High frequency (oscillatory) ventilation
ECMO

77
Q

What is a diaphragmatic hernia caused by’

A

left sided herniation of abdominal contents through the diaphragm
This causes apex beat to be displaced to the right and poor air entry to the left

78
Q

How do you confirm a diaphragmatic hernia

A

X ray

79
Q

How do you manage a diaphragmatic hernia

A

large NG tube passed
suction applied to prevent distension of intrathoracic bowel
once stabilised, surgical repair

80
Q

What are causes for early onset neonatal infection?

A
  • ascending maternal infection

- through placenta (listeria, congenital viral)=

81
Q

What are risk factors for early onset neonatal infection’

A

prolonged, premature rupture of membranes

chorioamnionitis

82
Q

What antibiotics are started in early neonatal infection while awaiting culture?

A

benzylpenicillin

gentamicin

83
Q

what are causes of late onset neonatal infection?

A

usually from surroundings e.g. indwelling catheters, invasive procedures

84
Q

what are the paediatric sepsis 6

A

Give

  • oxygen
  • IV fluids
  • antibiotics

Take:

  • blood cultures, blood glucose, ABG/VBG
  • experienced senior clinician involvement
  • consider inotropes
85
Q

What percentage of women are GBS carriers?

A

10%

86
Q

How do you manage GBS infection in neonate?

A

IV benzylpenicillin

OR

ampicillin

87
Q

How is listeria monocytogenes infection transmitted?

A

To the mother through food (unpasteurised milk, soft cheese, undercooked poultry)

Cause mild flu like sx to mother

Passes to foetus through placenta

Maternal infection could lead to abortion / preterm delivery / foetal sepsis

88
Q

How do you manage listeria monocytogenes in pregnancy=

A

amoxicillin or co-trimoxazole

89
Q

what are common causes of conjunctivitis and how do they present?

A

Common - wash with saline and water

Staph / strep - discharge and redness

gonococcal - purulent discharge, swelling of eyelids

chlamydia - purulent, swe.ling pof euyelid

90
Q

What is cleft lip caused by?

A

Failure of fusion of frontonasal and maxillary processes

91
Q

What is cleft palate caused by?

A

failure of fusion of palatine process / nasal septum

92
Q

What is management for cleft lip / palate=?

A

specialist feeding advice
watch out for airway problem
pre surgical lip tapping to narrow the cleft
surgery for definitive repair

93
Q

What is the Pierre robin sequence?

A

TRIAD

  • microgniathia
  • glossoptosis
  • midline cleft of soft palate
94
Q

What does Pierre Robin Sequence result in’

A

Feeding difficulty > failure to thrive

95
Q

What does failure to thrive mean?

A

weight for age below the 5th percentile on multiple occasions

OR

weight deceleration that crosses 2 major percentile lines on growth chart

96
Q

How should children lie in Pierre Robin sequence

on

A

On their front

due to risk of airway opnstricton

97
Q

What is Hirschprung disease?

A

absence of myenteric plexus in the rectum

may extend along colon

98
Q

What is rectal atresia?

A

absence of the anus at the normal site

99
Q

what can you look for in a breastfeeding assessment

A
  • inspect for tempioralis contraction

- ascultate sucking in cheek

Y5 Paediatrics (30 decks)

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