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4.4. Child Health > Neonatal Presentations > Flashcards

Neonatal Presentations Flashcards

1
Q

What is meconium aspiration, how does it present and what is its DDx?

A

Meconium passes in utero = meconium stained amniotic fluid MSAF = airway obstruction, surfactant dysfunction, pulmonary vasoconstriction, infection, chem pneumonitis

S+S = Rapid or laboured breathing, chest wall recessions, grunting sounds, cyanosis, low apgar score (color, heartbeat, reflexes, muscle tone, respiration), limp body

DDx = Congenital Heart Disease with Pulmonary Hypertension, Sepsis, Surfactant Deficiency,

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2
Q

What is HDoN, how does it present and what is its DDx?

A

Rh-ve mother with Rh+ve baby, possible anti-D IgG Ab = subsequent preg these cross placenta = Rh haemolytic disease

S+S = jaundice, yellow vernix, CCF (oedema, ascites), hepatosplenomegaly progressive anaemia, bleeding, kernicterus (bilirubin brain damage)

DDx = thalassaemia, infection (CMV, toxoplasmosis), maternal DM

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3
Q

What is hypoxic-ischaemic encephalopathy, how does it present and what is its DDx?

A

Clinical syndrome of brain injury sec to hypoxic-ischaemic insult (cord prolapse, placental abruption, maternal hypoxia, inadequate postnatal cardio-pulmonary circulation)

S+S = resp depression (resus, IPPV), floppy, seizures, feeding probs, significant hypotonia, diminished deep tendon reflexes

DDx = Disorders of pyruvate metabolism, urea cycle defects, Zellweger syndrome, mitochondrial disorders

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4
Q

What is biliary atresia, how does it present and what is its DDx?

A

Biliary tree occlusion by being abnormally narrow, blocked, or absent at around 3w

S+S = jaundice, yellow urine, pale stools, splenomegaly

DDx = cholestasis, idiopathic neonatal hepatitis, neonatal hemochromatosis, toxoplasmosis, viral infections

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5
Q

What is sticky eye, how does it present and what is its DDx?

A

Commonly from a blocked tear duct (can be born with), infection

S+S = white or yellow discharge in the corner of the eye

DDx = ophthalmia neonatorum, chlamydia (swab)

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6
Q

What is are birth marks, how do they present and what a DDx?

A

Areas of discoloured and/or raised skin - pigment cells or blood vessels

VASCULAR = Infantile haemangiomas(rapid growth), capillary malformation (port-wine stain - red-pink stain on face/neck), nevus flammeus (forehead/eyelids/neck)

PIGMENTED = Café au lait spot (flat, ten), Slate grey nevus (mongolian blue spot - lower back), congenital nevus (mole)

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7
Q

What is the types of birth trauma and how do they present?

A

Caput Succedaneum = scalp bruising/oedema by vacuum/vaginal/uterus pressure (swelling)

Cephalohematoma = haematoma below the periosteum by rupture of blood vessels crossing the periosteum due to the pressure on the fetal head during birth (jaundice, swelling)

Chignon = oedema/bruising from ventouse delivery

Bruising and broken bones = tools, physical stresses of the passage through the birth canal or contact with the pelvis (not using limbs, malformations)

Subconjunctival haemorrhage = increased pressure (red eye)

Brachial plexus injury
- Erbs Palsy = C5, C6, waiters tip

Oxygen Deprivation = cord prolapse, premature loss of placenta (pale, floppy baby, CP)

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8
Q

What is a cephalohematoma, how does it present and what is its DDx?

A

Haematoma below the periosteum by rupture of blood vessels crossing the periosteum due to the pressure on the fetal head during birth

S+S = jaundice, bulges on head

DDx = forceps, vacuum

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9
Q

What is paediatric chronic lung disease, how does it present and what is its DDx?

A

Long-term breathing and lung problems in premature babies - from pressure/volume trauma from artificial ventilation, oxygen toxicity, infection

S+S = rapid breathing, flaring of the nostrils, grunting, chest retractions

Ix = CXR: ground glass

Continued need for positive pressure respiratory support or oxygen after a premature baby reaches 36 weeks of gestation

DDx = pneumonia, aspiration syndrome, SLE, CF

Mx = prophylactic palivizimab (try to prevent bronchiolitis)

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10
Q

What is erythema toxicum, how does it present and what is its DDx?

A

Therapy - hypersensitivity reaction

Common benign self-limiting, small papule/pustule surrounded by erythematous wheel

S+S = small papule/pustule surrounded by erythematous wheel

DDx = sepsis, staphylococcal folliculitis, acne neonatorum, pyoderma, congenital candidiasis, herpes simplex

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11
Q

What is paediatric failure to feed, how does it present and what is its DDx?

A

Causes = cleft lip/palate, premature suckling reflex

S+S = little interest in feeding, failure to thrive

DDx = congenital hypothyroidism, infant botulism, DS, diarrhoea, ear infections, coughs and colds, teething

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12
Q

What is a Hep B infection, how does it present and what is its DDx?

A

S+S = anorexia, nausea, malaise, vomiting, arthralgias, myalgias, headache, photophobia, pharyngitis, cough, coryza, jaundice, dark urine, clay-colored or light stools, and abdominal pain

DDx = autoimmune Hepatitis, paediatric Cytomegalovirus Infection, paediatric Hepatitis A, paediatric Hepatitis C, paediatric Herpes Simplex Virus Infection

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13
Q

What is paediatric hypothermia, how does it present and what is its DDx?

A

Body temp <36.5 = not drying, lack of skin-to-skin, lack of wrapping, cold delivery environment, no aftercare of newborn

S+S = weak cry, low energy level, lethargic, reddish cold skin, cool extremities and abdo, poor feeding, hypoglycaemia

DDx = haemorrhagic shock, medications (benzodiazepine, opioid, alcohol), carbon monoxide toxicity

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14
Q

What is Meconium delay, how does it present and what is its DDx?

A

Failure of the newborn to pass meconium within 24-48 hours

S+S = no meconium, poor feeding, lethargy, vomiting, diarrhoea, bloody stools, and constipation

DDx = Hirschsprung disease, meconium plug syndrome, meconium ileus, anorectal malformation,

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15
Q

What is Neonatal apnoea, how does it present and what is its DDx?

A

Unexplained episode of cessation of breathing for >20s

S+S = >20s, cyanosis, bradycardia

DDx = bacteraemia, bronchiolitis, bronchopulmonary dysplasia, croup, CHF, influenza, asthma, bacterial meningitis, head trauma, pneumonia, Guillain–Barré syndrome, prematurity, WPW syndrome

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16
Q

What is Neonatal collapse, how does it present and what is its DDx?

A

S+S = apnoea, limp child, pallor, bradycardia, cyanosis, collapse, cardiac/resp failure

DDx = congenital heart disease, sepsis, metabolic/endocrine disorders, head injury, hypothermia, intussusception, pneumothorax, pulmonary HTN, pneumonia, seizures, toxins

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17
Q

What is neonatal hypoglycaemia, how does it present and what is its DDx?

A

30 mg/dL (1.65 mmol/L) in the first 24 hours of life and less than 45 mg/dL (2.5 mmol/L) thereafter

Likely in = IGR, preterm (poor glycogen stores), mother with DM (hyperplasia of islet cells = increased insulin), large for dates, hypothermic, polycythaemia, illness

S+S = jitteriness, hypothermia, irritability, tremor, twitching, hypotonia, seizures, coma, irregular RR, apnoea

DDx = malnutrition, diarrhoea, glucagon deficiency, enzyme defects, congenital hyperinsulinism

Glucose intravenous infusion 10%

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18
Q

What is ABO/Rh incompatibility, how does it present and what is its DDx?

A

Mother’s immune system reacts and make Ab against her baby’s RBCs

S+S = blood in urine, fever/chills, SOB, tachy, vomiting , jaundice

DDx = acute anaemia, parvovirus B19 Infection, CMV, Hydrops Fetalis, toxoplasmosis

19
Q

Outline ambiguous genitalia

A

Infant’s external genitals don’t appear to be clearly either male or female caused by atypical development of chromosomal, gonadal, or anatomical sex

Includes syndromes such as Turner syndrome (45,X with one absent sex chromosome) and Klinefelter syndrome (XXY with one additional X chromosome).

Mosaicism occurs when more than one type of chromosomal arrangement is present (45,X/46, XY)

46,XX DSD are conditions characterised by excess exposure to androgens. Over 95% of causes of ambiguous genitalia with a 46,XX genotype are due to congenital adrenal hyperplasia secondary to 21 hydroxylase deficiency.

46,XY DSD can be due to several aetiologies and usually requires a more extensive diagnostic evaluation.

20
Q

Outline congenital adrenal hyperplasia

A

Caused by a defect in 21-hydroxylase in the steroid hormone synthesis pathway in the adrenal gland - leads to excess amounts of male hormones being produced by the adrenal glands

Causes females to be masculinized - large clitoris, fused labia

Autosomal recessive

Involves a deficiency of an enzyme involved in the synthesis of cortisol, aldosterone, or both

21
Q

Outline inborn errors of metabolism

A

Types = PKU, ornithine transcarbamylase deficiency, methylmalonicaciduria, medium-chain acyl-CoA dehydrogenase (MCAD) deficiency, galactosemia, and Gaucher’s disease, G6PD def

Many congenital metabolic diseases are now detectable by newborn screening tests

Mx = restrictive diet, enzyme replacement, gene therapy, organ transplantation

22
Q

Discuss neonatal HIV

A

Antenatal screening for HIV is offered at antenatal booking appts

The majority is from mother-to-child transmission (MTCT)

  • VL <50 = vaginal delivery
  • VL >50 = prelabour Caesarean section (PLCS)

In children over 1 year of age, treatment is based on the child’s age, CD4 cell count, viral load, and symptoms.

To prevent transmission of infection, neonates born to HIV +ve mothers should be given post-exposure prophylaxis as soon as possible after birth, but starting no later than 72 hours after birth

Exclusive formula feeding

23
Q

Outline neonatal intraventricular haemorrhage

A

Bleeding into the ventricles in the brain, from the choroid plexus under the ventricles

Condition occurs most often in babies that are born premature - under devel blood vessels, cant regulate own BP

Ix = cranial USS

S+S = apnoea, brady, cyanosis, high-pitched cry, bulging fontanelles, lethargy

Comp = clotting, RICP, parenchymal bleed (cortical damage = CP)

24
Q

Discuss retinopathy of prematurity

A

Blood vessels grow abnormally and randomly in the eye, these tend to leak or bleed, leading to scarring of the retina

Link to over-oxygenation

When the scars shrink, they pull on the retina, detaching it from the back of the eye = blindness

25
Q

Outline neonatal talipes

A

Clubfoot = birth defect that can affect one or both feet, entire foot inverted, supinated, forefoot adducted, heel rotated inwards, plantar flexion

Idiopathic

Ponsetti method = (passive) manipulating the foot into a better position, then putting it into a cast. This is repeated every week for ~5-8w. After the last cast comes off, most need a minor operation to loosen the Achilles tendon

26
Q

What is neonatal jaundice, its causes and presentation?

A

Jaundice of the white part of the eyes and skin in a newborn baby due to high bilirubin levels

Hx = feeding (type, well weight loss), nappies, birth gestation, sepsis, antiD use, FH: anaemia, HDoN, HA, hypothryoid

Causes =

  • Physiological: never first 24h, D2-14 (breakdown of fetal Hb as it is replaced with adult Hb, relatively immature metabolic pathways of the liver)
  • Early: first 24h, haemolytic disease, congenital infection, ABO incompatibility, Rh disease
  • Prolonged: >2w in term baby, >21d preterm, UTI, hypothyroidism, biliary atresia
  • Conjugated hyperbilirubinemia: infection, CF, biliary atresia (pale stools, dark urine)

S+S = yellow skin/sclera (blanch the nose), excess sleepiness, poor feeding, altered muscle tone

27
Q

How should neonatal jaundice be Ix?

A

Bilirubinometer = serum bilirubin

Direct coombs test, blood group, LFTs, FBC, blood film, enzyme def (G6P-D), sepsis investigations, split bilirubin (conjugated vs non), TFT, urine analysis, U+Es, INR

USS = biliary atresia

28
Q

How should neonatal jaundice be Mx?

A

More frequent feeding (monitor nappies) = more bowel movements, which helps to eliminate excess bilirubin

Refer bilirubin chart

  • Phototherapy = 24-48h, light is absorbed by the skin and helps break down the bilirubin
  • Exchange transfusions via umbilical artery or vein

Other = IV access, Abx (cover sepsis), surgery (biliary atresia)

29
Q

What are the possible complications of neonatal jaundice?

A

Seizures

CP

Kernicterus = unconjugated bili can cross BBB, bilirubin-induced encephalopathy (fever, seizures, high-pitched crying) - effects basal ganglia, brainstem CN nuclei, hippocampus

30
Q

What is the definition of prematurity and its RF?

A

Delivery before 37w gestation

RF =

  • Multiple pregnancy
  • Smoking and illicit drug use in pregnancy
  • Being under or overweight in pregnancy
  • Early Pregnancy (within 6m of previous pregnancy)
  • Problems involving cervix, uterus, placenta, including infection
  • Certain chronic conditions such as DM and HTN
  • Physical injury/trauma
31
Q

How is prematurity managed?

A

Assessment =

  • blood gas (resp, metabolic state)
  • FBC ( infection, thrombocytopenia, anaemia)
  • U+E (renal)
  • blood group/Direct Antiglobulin Test (blood transfusion)
  • CXR (?resp support)
  • AXR (?necrotising enterocolitis)
  • Cranial ultrasound scan (?neurological insults from haemorrhagic, ischaemic and infective)

Antenatal steroids

Magnesium sulphate - neuroprotective

32
Q

What are the possible complications of prematurity?

A

Resp = Respiratory distress syndrome, Surfactant deficient lung disease, Chronic lung disease/ Bronchopulmonary dysplasia, recurrent apnoea

CVS = hypotension, perfusion abnormalities, PDA

Neuro = IVH, seizures, post haemorrhagic ventricular dilatation, neurodevelopmental delay, CP

GI = Immature gut causing feed intolerance, necrotising enterocolitis (NEC)

Renal = immature renal function

Metabolic = jaundice, hyperglycaemia, hypoglycaemia, Inborn errors of metabolism

Immune = sepsis, increased risk of infection due to central lines and multiple procedures

Eyes = retinopathy of prematurity

33
Q

What is IUGR and its causes?

A

Baby is smaller than it should be because it is not growing at a normal rate inside the womb

Weight below the 10th percentile

Aetiology =

  • MATERNAL: DM, HTN, heart disease, rubella, cytomegalovirus, toxoplasmosis, syphilis, kidney disease or lung disease, malnutrition, anaemia, smoking, drinking alcohol, or abusing drugs, placental insufficiency
  • FETAL: congenital, antiphospholid Syndrome
34
Q

How should IUGR be investigated?

A

Serial USS, fetal karyotype for chromosomal abnormalities, maternal infection including TORCH (Toxoplasma, others, rubella, cytomegalovirus, and herpes), syphilis, detailed fetal anatomical survey, TIFFA scan (targeted imaging for fetal anomaly) and uterine artery Doppler, by a fetal medicine specialist if severe SGA is identified at the 18–20 week scan

35
Q

How should IUGR be Mx?

A

Regular scans

CTG monitoring

Early delivery

36
Q

How does neonatal group B strep infection present?

A

One in three women carry group B streptococci vaginally, which can infect the amniotic fluid even if the membranes are intact, or can infect the baby during delivery, causing sepsis, pneumonia, or meningitis.

S+S = fussy, very sleepy, respiratory distress, tachypnoea, grunting, seizure, sepsis, pneumonia

37
Q

How is neonatal group B strep infection Mx?

A

Maternal IV Abx during labour

Newborn intensive care unit (NICU)

IV Abx = benzylpenicillin with gentamicin

7-14d Abx if meningitis present

38
Q

How is suspected neonatal GBS infection Ix?

A

Blood/CSF culture

BP

BM

39
Q

What are the possible neonatal infection?

A 
Congenital rubella
Syphilis
Toxoplasmosis
CMV
Herpes simplex viruses
HIV
Hepatitis B
Group B streptococci
Enteric gram-negative organisms (primarily E. coli)
Listeria monocytogenes
Gonococci
Chlamydia

At increased risk as IgG transferred across placenta in the last trimester

40
Q

How does a neonatal infection present?

A

vomiting or poor feeding, increased sleepiness or lethargy, fever or hypothermia, tachypnea, rashes, diarrhea, abdominal distention

41
Q

How does a neonatal infection present?

A

Vomiting or poor feeding, increased sleepiness or lethargy, fever or hypothermia, tachypnea, rashes, diarrhea, abdominal distention

42
Q

How is a neonatal infection Dx?

A

Blood culture

43
Q

Outline neonatal RDS

A

Surfactant prod after 30w

Prematurity = decreased reduction in surface tension = alveoli collapse = increased energy required for efficient respiration. Pulmonary oedema devel, further reducing lung compliance

= hypoxia, CO2 retention, acidosis

S+S =grunting, accessory muscles, nasal flaring, tachypnoea

Tx = maternal dexamethasone, endotracheal surfactant, CPAP, Abx

44
Q

Outline respiratory distress

A

Terminal bronchioles is where you start making T2 pneumocytes

Premature = undevel/not developed yet

S+S = tachypnoea, ICR, SCR, tracheal tug, SOB, end stage: cyanosis, apnoea

Mother given 2 doses steroids

Tx = surfactant via ET tube

4.4. Child Health (37 decks)

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