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Paediatrics > Neonates > Flashcards

Neonates Flashcards

1
Q

What is early onset neonatal sepsis?

A

Sepsis occurring within the first 48-72 hours of life?

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2
Q

What is the most frequent cause of severe neonatal infection?

A

Group B strep

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3
Q

What is group B strep?

A

Gram positive coccus in chains

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4
Q

What are some risk factors for early onset neonatal sepsis?

A

Invasive group B strep infection in previous baby, maternal GBS in current pregnancy, prelabour rupture of membranes, preterm birth, intrapartum fever higher than 38, suspected chorioamniotiis

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5
Q

What are some clinical indicators suggestive of early onset neonatal sepsis?

A

Respiratory distress starting >4 hours after birth, seizures, signs of shock,, feeding difficulties, tachycardia or bradycardia, hypoxia, jaundice within 24 hours of birth, apnoea, temperature abnormalities

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6
Q

What are some differentials of early onset neonatal sepsis?

A

Transient tachypnoea of the new born, respiratory distress syndrome, meconium aspiration, haemolytic disease of the newborn

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7
Q

How is early onset neonatal sepsis managed?

A

IV benzylpenicillin with gentamicin

Continue for 7-10 days if blood cultures are positive or up to 14 days if CSF is also positive

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8
Q

How is early onset neonatal sepsis investigated?

A

FBC, CRP, blood cultures, LP

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9
Q

What causes physiological neonatal jaundice?

A

Due to increased red blood cell breakdown and immature liver not able to process high bilirubin concentrations

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10
Q

What is the natural history of physiological neonatal jaundice?

A

Starts at day 2-3, peaks at day 5 and usually resolves by day 10

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11
Q

What are the causes of pathological neonatal jaundice?

A

Haemolytic disease of the newborn, G6PD deficiency, dehydration, infection, breast milk jaundice, biliary atresia

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12
Q

What are some risk factors for pathological hyperbilirubinaemia?

A

Prematurity, low birth weight, previous sibling required phototherapy, exclusively breast fed, jaundice <24 hours, infant of diabetic mother

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13
Q

How could pathological neonatal jaundice present?

A

Yellowing of skin and sclera, drowsy, altered muscle tone, poor urine output

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14
Q

How is neonatal jaundice investigated?

A

Transcutaneous bilirubinometer, serum bilirubin, blood group, DCT, FBC, U+Es, infection screen, LFTs, TFTs

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15
Q

How can neonatal jaundice be managed?

A

Phototherapy, exchange transfusion, IVIG

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16
Q

What complication can arise from neonatal jaundice?

A

Kernicterus - bilirubin is neurotoxic and can accumulate in CNS gram matter causing irreversible neurological damange

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17
Q

What is the definition of extreme preterm?

A

Before 28 weeks

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18
Q

What is the definition of very preterm?

A

28 to 32 weeks

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19
Q

What is the definition of moderate to late preterm?

A

32 to 37 weeks

20
Q

What are some reasons for prematurity?

A

Pre-eclampsia, severe IUGR, PPROM, placental abruption, severe infection, no identifiable cause

21
Q

What are some risk factors for premature delivery?

A

Previous preterm delivery, multiple pregnancy, smoking, infections, diabetes, hypertension, physical injury, being underweight or overweight during pregnancy

22
Q

How is a premature baby investigated?

A

FBC, U+Es, blood cultures, CRP, blood group and DAT, blood gas, CXR, AXR, CrUSS

23
Q

How can RDS in a neonate be managed?

A

Exogenous surfactant administration, endotracheal intubation and mechanical ventilation, CPAP, NIPPV, high flow oxygen, caffeine administration for apnoeas

24
Q

What medication can be given to close a PDA?

A

Indomethacin or ibuprofen

25
Q

How can retinopathy of prematurity be managed?

A

Avoid excessive oxygen exposure, screening for ROP by ophthalmology team, laser treatment if indicated

26
Q

Describe the results of the EPICure 2 study

A

Infants born at 22 weeks - 1/3rd will have no or mild disability

By 26 weeks - 75% have no or mild disability

27
Q

What are some complications of prematurity

A

Retinopathy of prematurity

Respiratory distress syndrome which can lead to chronic lung disease

Neonatal sepsis

Intraventricular haemorrhage

Necrotising enterocolitis

Hypoglycaemia and electrolyte abnormalities

28
Q

What should be covered in the NIPE?

A

General condition - colour, how they handle, birth marks etc

Head - shape, circumference, fontanelles

Mouth - sucking reflex, tongue, palate, cyanosis

Count fingers and toes, look at palmar creases

Genitals and anal patency

Eyes - red reflex

Check heart sounds and femoral pulses

Palpate testes

Check hips - Barlow (posterior force, adduct) and ortolans (push anteriorly and abduct)

29
Q

What conditions are looked for on the blood spot test?

A

Congenital hypothyroidism, sickle cell disease, cystic fibrosis (measures trypsin), metabolic disorders (maple syrup urine disease, homocystinuria, phenylketonuria etc)

30
Q

How and when are hearing problems screened in babies?

A

Ideally hearing tested in the first 4-5 weeks, can be done up to 3 months

Automated otoacoustic emission or auditory evoked brainstem response

31
Q

What future condition is kernicterus associated with?

A

Athetoid cerebral palsy

32
Q

How does phototherapy work for jaundice?

A

Blue-green 450-460nm fluorescent light converts bilirubin to soluble

33
Q

What murmur is heard in PDA?

A

Continuous machinery murmur

34
Q

What are the acyanotic congenital heart defects?

A

VSD, ASD, PDA, coarctation of the aorta

35
Q

What are some cyanotic congenital heart defects?

A

Tetralogy of Fallot, transposition of the great arteries, hypo plastic left heart syndrome

36
Q

What are some clinical features of NEC?

A

Crying too much or silent, fever, bruised, distended abdomen, feed intolerance, vomiting, haematochezia

37
Q

What will be seen on the CXR in NEC?

A

Pneumatosis intestinalis (intramural gas)

38
Q

How is NEC managed?

A

NBM, antibiotics, NG free drainage, IV fluids, maybe surgery

39
Q

When do alveoli form?

A

32 weeks

40
Q

What are some signs of respiratory distress in the newborn?

A

Cyanosis, high RR, tracheal tug, intercostal and subphrenic recessions, head bobbing

41
Q

What will be seen on the CXR in respiratory distress syndrome?

A

Ground glass appearance, air bronchogram

42
Q

When should a newborn be back to it’s birth weight?

A

By 3 weeks (should not lose >10% of BW)

43
Q

What are the neonatal fluid requirements?

A

Birth to day 1 - 50-60ml/kg/day

Day 2 - 70-80ml/kg/day

Day 3 - 80-100ml/kg/day

Day 4 - 100-120ml/kg/day

Day 5-28 - 120-150ml/kg/day

44
Q

What are the fluid requirements of a baby after 28 days?

A

0-10kg - 100ml/kg/day

10-20kg - 50ml/kg/day

> 20kg - 20ml/kg/day

45
Q

What is the pathophysiology of respiratory distress syndrome?

A

Deficiency of alveolar surfactant which leads to atelectasis and possible respiratory failure

46
Q

What is bronchopulmonary dysplasia?

A

Defined as a persistent oxygen requirement after 28 postnatal days or 36 weeks corrected gestational age (whichever is later)

47
Q

What are some early and late sequelae of bronchopulmonary dysplasia?

A

Early - ventilator dependence, pulmonary hypertension, tracheobronchomalacia, feeding problems, GORD

Late - lower IQ, cerebral palsy, asthma and exercise limitation

Paediatrics (7 decks)

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