Neonates Flashcards
Ways to reduce the risk of SIDS
Breastfeeding Ensuring babies are not too hot Use of dummies "Back to sleep" "Feet to foot" - ensuring the baby's feet touch the end of the cot
Preterm infants require Fe supplementation T/F
True - iron stores are laid down in the third trimester
In a neonate at about what age do the blood vessels reach the peripheral retina?
1 month
What is the classic presentation of renal vein thrombosis in a neonate secondary to dehydration?
Triad of:
gross haematuria
thrombocytopenia
enlarged kidneys
Note: usually anticoag is not used in treatment of unilateral thrombosis but it might be used in bilateral
In a full term male infant with undescended testes after how long is spon descent rare?
Spon descent is rare after 6 months
In preterm infants 70% of undescended testes are on the left T/F
F - 70% on the right
Risk factors for neonatal death and still birth
Low SES African race Male infant Nullip or multip (3rd and subsequent) Non singleton
Classic finding for Hirschprung disease on contrast enema in neonate?
Transition zone typically in the sigmoid colon
Developmental dysplasia of the hip is more common in males or females? Which hip is more commonly affected?
More common in females 6:1
More common in left hip
Both hips affected in 1/3 of cases
Treatment of haemorrhagic disease of the newborn (vit K def) with active bleeding?
IV vit K + FFP
Note: IV vit K works faster than IM. FFP is given as even IV vit K does not work fast enough
When does haemorrhagic disease of newborn usually present and how? RFs?
2- 7 days of life (can be later in those with malabs)
GI bleed, bleeding from umbilical stump and bruising
Those who did not receive vit K + breastfeed are most at risk
What is the main protein in breast milk?
Whey
Note: is is more digestible than cow’s milk protein, casein. Breast milk contains low levels of vitamins K but higher levels of vitamins A, C and E (compared to cow’s milk)
A rate of increase of bilirubin above 6.5 micro mol/L per hour is a RF for kernicterus T/F
F - above 8.5
Other RFs:
Bili > 340 in infant with GA > 37 wks
Clinical features of acute bilirubin encephalopathy
2 day old infants with rhythmic focal myoclonic jerks at a rate of 1-3/sec what pathology
Early onset hypocalcaemia
Note: may be followed by a generalised seizure
Acetylsalicylic acid is C/I in when breastfeeding T/F
T - AKA aspirin
Due to risk of Reye’s and may inhibit plt fxn in infant
How many calories are found in mature breast milk
70kcal/100ml
In which congenital infection are the eye defects unilateral?
Varicella zoster - can have unilateral microphthalmia, chorioretinitis, cataract - development in involved dermatome
Other features - skin scarring in a dermatomal distribution, limb hypoplasia, microcephaly, developmental delay, dysfunction of the bowel and bladder sphincters
Ideal weight increase of a newborn / day
15g/kg/day
What is the most common cause of hydrops fetalis?
Fetomaternal haemorrhage
Other causes: paroxysmal SVT, Turner syndrome, congenital infections
A rubella non immune mother contracts the disease at 30 weeks, what is the % risk of congenital rubella?
0%
Note: 8-10 weeks - 90%; 11 -16 weeks - 10 -20%; > 16 weeks- nearly nil
By how many weeks gestation is surfactant produced?
22 - 24 weeks
By how many weeks gestation does complete alveolisation occur?
28 weeks
Note: lung development is not complete until 7 yrs old
Indications for operative intervention in acute NEC?
Absolute: pneumoperitoneum; failure of medical mgmt with worsening of clinical situation 48 hours into the onset of disese
Relative: peritonism; palapable mass; discolouration of abdo; fixed abdo loops on serial radiographs
Typical presentation of bilateral choanal atresia
Infant will develop resp distress as it is an obligate nose breather, cyanosis at rest but will regain colour when they cry as they open their mouth
IVH without ventricular dilatation is grade 2 T/F
True
Grade 1: ependymal (germinal matrix)
Grade 2: IVH w/o dilatation
Grade 3: IVH w dilatation
Grade 4: parenchymal
Prognosis of grade 1 and 2 IVH is good T/F
True - likely no long term side effects
Grade 3: possible impairment on the contralateral side depending on degree of dilatation
Grade 4: likely motor impairment on contralateral side
What is the most common bone to fracture during labour and delivery?
Clavicle
What proportion of still births are attributable to congenital abnormalities?
Less than 10%
Initial investigation in a infant with suspected fetal alcohol syndrome?
CMA - want to rule out other aetiologies
How does protein and carb content vary in colostrum compared to mature breast milk?
Colostrum has high protein and lower carbs
Compare the timing of neonatal vs perinatal deaths?
Neonatal - death within first 28 days of life
Perinatal - still births plus death within 1st 7 days of life
Note: still birth = in utero death after 24 weeks gestation
How to differentiate neonatal alloimmune thrombocytopenia from neonatal autoimmune thrombocytopenia?
In allo immune the maternal plts will be normal and infants will be low
In auto immune both the maternal and infant plts will be low
Note: alloantibodies are against a certain foetal platelet antigen that the baby inherits from the father but is absent in the mother. In autoimmune it is the mother who has the autoimmune disease.
Up until what age can a newborn hearing screen be carried out?
12 weeks
What is the earliest age at which weaning from formula/breast milk can start?
17 weeks
In an infant with congenital heart block what is the most likely antibodies that crossed the placenta from the mother?
Anti Ro/Anti La
In persistent pulmonary hypertension in neonates signs of heart failure are often present T/F
F - signs of heart failure are often absent
Pulmonary hypertension can be associated with birth asphyxia and sepsis T/F
T
Defn of polycythemia in neonate and when it needs to be treated?
Venous blood haematocrit > 65% is diagnostic
Should be treated if > 70% or symptomatic
Lab abnormalities in IUGR baby
Hypoglycaemia
Neutropenia
Thrombocytopenia
Polycythaemia (secondary to chronic hypoxia)
What type of IG are rheusus antibodies?
IgG
Note: these are the only antibodies that can Go across the placenta
When is amniocentesis and chorionic villus sampling typically done?
Amniocentesis from 15 weeks onwards
Chorionic villus sampling from 11 - 13 6/7 weeks
What is the best way to measure blood pressure in an infant?
Doppler auscultation
What is the definition of broncho pulmonary dysplasia?
Need for resp support > 28 days or past 36 weeks gestation
Most infants who are born SGA will achieve catch up growth T/F
T - 80% will
Facial nerve palsy is common in neonates due to birth trauma, what is the mgmt?
Usually requires no treatment and will resolve on it’s own in 2 months
For how long is an infant’s creatinine indicative of the maternal creatinine?
First 2 days of life
What are the two most important aims of mgmt in a baby born with gastroschisis?
Prevention of fluid and heat loss –> wrap the defect in cling film
Survival rates of babies born at 21, 22 and 23, 24, 26 weeks respectively
21 - 0% 22 - 10% 23 - 40% 24 - 60% 26 - 80%
Most common cause of subgalael haematoma?
Ventouse extraction
Bleed between the peri osteum and scalp aponeurosis is called
subgalael haematoma
General develop between 12 hours to 3 days after birth
Subcutaneous fat necrosis of the newborn is usually present at birth T/F
F - usually develops in the weeks following delivery and resolves by 6 - 8 weeks of age
Presents as a firm tender subcut nodule with an overlying dusky purple discolouration
Complication of subcut far necrosis of the newborn?
Hypercalcaemia
Cephalohaematoma or caput crosses suture lines?
Caput crosses
Which takes longer to resolve caput or cephalohaematoma?
cephalohaematoma - weeks to months
caput - days
How long does the grasp reflex last?
Hands - until about 5-6 months
Feet - 9-12 months
Advanced maternal age is a risk factor for SIDS T/F
F - maternal age < 20 yrs is a major maternal risk factor for SIDS. The 2nd major maternal factor is smoking
Note: other pregnancy complications that increase risk placenta previa, placental abruption, premature ROM and elevated maternal alpha feet protein
The majority of natal teeth are due to premature eruption of the primary deciduous teeth - T/F
T - more than 90%
Note: they should only be removed if they are supernumerary (this needs to be confirmed by X-ray)
Natal tooth eruption is a common finding in newborns T/F
F
What type of hyperbiliruninaemia is often present in infants of diabetic mothers?
Un conjugated
In the absence of any clinical findings all females born breech should under go hip ultrasound at 6 weeks T/F
T - risk if hip dysplasia in breech females is 12%
Risk factors for renal vein thrombosis?
Perinatal asphyxia Septic shock Dehydration Congenital hypercoag states Maternal DM
Caudal regression syndrome is associated with what maternal condition?
Maternal DM
Note: a spectrum of structural defects of the sacral region
What commonly causes diaphragmatic paralysis? What other injury is it commonly associated with ?
Injury to C3-5 nerve roots
Brachial plexus injury is associated in 90%
Infant born with murmur consistent with VSD and meningomyelocele, what antiHTN medication did the mother take?
ACEi
They are also associated with renal and limb anomalies and pulm hypoplasia
In an infant born with a single umbilical artery what is the recommended initial investigation?
A thorough physical exam recognising an increased risk of congenital anomalies
Note: 25% of infants with single umbilical artery have anomalies : 20% of anomalies are renal however USS kidney is no longer routinely recommended
Non blanching bluish fluctuant swelling in the mouth lateral to the midline which displaces the tongue. What pathology and what treatment?
Ranula
Tx: complete surgical excision in continuity with the associated glands
Bohn nodules typically location and appearance?
Alveolar ridge in neonate
Whitish/clear inclusion cysts
Where are mucoceles typically located?
Buccal mucosa along the occlusal plane
Harlequin color change in common in normal healthy neonates T/F
T - occurs in approx 10% of healthy newborns
What medications are associated with gastroschisis?
Vasoactive substances - cocaine, nicotine, pseudoephedrine
Note: pasthophys - vascular accident involving the right umbilical vein or right omphalomesenteric artery that leads to ischaemic necrosis or the abdominal wall, allowing bowel to enter into the amniotic cavity
What differentiates Apert from Crouzon syndrome clinically?
Apert have limb abnormality (syndactyly) and Crouzon do not
Note: both have craniosynostosi and ocular proptosis
Saethre-Chotzen syndrome is another craniosynostosis syndrome with syndactyly
Preterm birth is a risk factor for hip dysplasia. T/F
F - they have a decreased risk
Features of neonatal behavioural syndrome due to maternal SSRI use?
Hypothermia + hypoglycaemia Emesis + frequent stools Feeding difficulty Poor sleep Agitated/jittery Abnormal tone Seizures
Jaundice within the first 24 hours of life is normal T/F
F - jaundice before 48 hours is pathologic and requires a work up
Which infant in twin twin transfusion is at highest risk of hyperbilirubinaemia?
The larger (recipient) twin - due to an increased haemoglobin load
In twin twin transfusion fetal hydrops can occur in both infants T/F
T - in the donor due to anaemia and in the recipient due to polycythaemia
Indications for surgery for an umbilical hernia?
- Symptomatic
- Still present at 5-6 yrs of age
- Increases in size between 1-2 yrs old
When can a mother with Hep B initiate breast feeding?
Immediately
Do not need to wait until after vaccines
What is often the first clinical finding in a pt with congenital hypothyroidism?
Prolonged physiologic jaundice
Note: due to delayed maturation of glucuronide conjugation.
Other features: umbilical hernia, poor feeding, wide open fontanelle
Findings in child > 8 -10 weeks with developmental hip dysplasia?
+ Galeazzi sign ( asymmetry in the height of the knees)
Limited abduction of hip
+ Trendelenburg (in ambulatory child)
Indications for GBS prophylaxis in a mother with unknown carrier status?
One of
< 37 weeks gestation
ROM > 18 hours
Intrapartum temp > 100.4 (38)
Note: if prophylaxis was indicated but not received or inadequate and infant is term with ROM > 18 hours, limited eval (bcx and CBC) with 48 hours monitoring is recommended
What drugs are associated with early onset haemorrhage disease of newborn?
AEDs - phenytoin, barbiturates, carbamazepine
AntiTB - rifampin, isoniazid
Vit K antagonists - warfarin
Infants who are IUGR are at risk for what pathology as adults?
Metabolic syndrome
Hypertension
Non alcoholic fatty liver (but not cirrhosis)
Reduced cognitive executive functioning
What is the most common presentation of cerebral infarction?
Seizures within the first 3-4 days of life
Note: hypotonia and resp irregularities may be seen in the days to weeks
