Neonates Flashcards
1
Q
Why is jaundice seen in over 50% of newborns
A
Increase in breakdown of RBC as high Hb at birth
Red blood cells have shorter lifespan in neonates
Hepatic metabolism less efficient
2
Q
What is kernicterus
A
Bilirubin encephalopathy as free unconjugated bilirubin can cross the BBB
3
Q
How can kernicterus present
A
Moderate cases
- lethargy and poor feeding
Severe cases
- irritability
- increased muscle tone (oplsthotonos)
- seizures and comas
4
Q
What is oplsthonos
A
When babies lie with arched back
5
Q
What are long term effects of kernicterus
A
Choreoathetoid cerebral palsy
Sensorineural deafness
Learning disabilities
6
Q
Where does jaundice typically present in a newborn
A
The head and then spreads downwards with increasing severity
Cephalocaudal
7
Q
Referral guidelines for neonates with jaundice
A
If first showed signs within 24 hrs of life then admit to neonatal or paeds unit within 2 hours
If over 24 hours admit within 6 hours if
- first appeared at more than 7 days
- very unwell
- gestational age less than 35 weeks
- prolonged jaundice
- issues about weight
- pale stools and dark urine
If neither of these
- get transcutaneous bilirubin level with 6 hours if not refer to hospital for bilirubin level in 6 hours
8
Q
Investigations in secondary care for jaundiced baby
A
FBC and blood film
Blood group
DAT
LFTs
G6PD levels
Cultures of urine/blood to look for cause of sepsis
9
Q
What determines prolonged jaundice in neonates
A
Gestational age of 37 or more = 14 days
Gestational age of less than 37= 21 days
10
Q
Difference in solubility between unconjugated and conjugated bilirubin
A
Unconjugated- fat
Conjugated- water
11
Q
How does phototherapy work on jaundice
A
Converts uBR to lumirubin and photobilirubin but DOES NOT WORK on Conjugated bilirubin
12
Q
What is problem with transcutaneous bilirubin measurements
A
Only shows levels of unconjugated- if urgent then do blood reading which will show split between conjugated and unconjugated
13
Q
Causes of jaundice in first 24 hours of life
A
Infection
ABO or Rh incompatibility
G6PD or HS
Gilberts
Cirgler-Najjar
14
Q
Differences between Rhesus incompatibility and ABO
A
Rhesus negative mums produce ABs against Rhesus positive baby- normally does not affect first pregnancy only subsequent
ABO occurs in type O mums with naturally occuring Anti-A/B ABS- can occur in any pregnancy
Rhesus not very common but extremely serious
ABO more common but reduced morbidity/mortality
15
Q
Rfx for haemolytic disease of the newborn
A
Chorionic villous sampling
Amniocentesis
Vaginal delivery
Antenatal haemorrhage
16
Q
How to diagnose haemolytic disease of the newborn
A
Coombs test- will show positive indirect antiglobulin test showing IgG in maternal blood
17
Q
Antibodies in ABO incompatibility
A
Anti-A haemolysin IgG- more common
Anti-B haemolysin IgG
18
Q
What triggers gilberts to cause neonatal jaundice
A
Normally infection
19
Q
What is Criger-Najjar syndrome
A
Results in a complete dysfunction of the gene encoding UDP-Glucuronyl transferase
20
Q
Difference between Criger-Najjar syndrome and gilberts
A
CN results in a complete dysfunction of the gene encoding UDP-Glucuronyl transferase whereas gilberts get some activity
In CN the hyperbilirubinaemia is massive
21
Q
Treatment options for acute bilirubin encephalopathy
A
Immediate exchange transfusion
Phototherapy
Hydration
IVIG
Folic acid after to prevent anaemia
22
Q
Things to tell parent if baby undergoing phototherapy
A
Not harmful but eyes will be covered with blood samples taken regularly so know when to stop
Breastfeeding every 3 hours
Need to measure bilirubin after to check for rebound hyperbilirubinaemia
23
Q
Options for treating neonatal jaundice
A
Phototherapy
Exchange transfusion
Thresholds for determining when to
24
Q
Common causes of jaundice neonatal jaundice
A
Physiological
Breast milk jaundice
Sepsis
Feeding difficulty
25
What is biliary atresia
Progressive fibrosis and obliteration of extra and intra hepatic ducts
26
Symptoms of biliary atresia
Pale stools
Dark urine
Mild jaundice
DONT GET VOMITING
27
Examination finding of biliary atresia
Hepatosplenomegaly
Mild jaundice
Can get cardiac murmurs
28
What are the types of biliary atresia
T1- common bile duct
T2- cystic dict
T3- fulla tresia where over 90%
29
Problems of biliary atresia
Progress to chronic liver failure in 2 years and then HCC
Faltering growth despite normal birth weight
30
Investigations for biliary atresia
USS
Lfts- elevated GGT
High conjugated CBr
TIBIDA SCAN
ERCP and biopsy
31
US finding of biliary atresia
Triangular chord sign
32
Gold standard for biliary atresia
TIBIDA isoptope scan also known as scintiligraphy
33
Confirmatory test for biliary atresia
ERCP and biopsy
34
Management of biliary atresia
1st line -Kasai hepatoportoenterostomy- involves ligating the fibrous ducts above the join with the duodenum and joining an end of the duodenum directly to the porta hepatis of the liver
If fails need liver transplant
Complication management
F Fat-soluble vitamins (levels monitored)
U Ursodeoxycholic acid promotes bile flow
P Prophylactic ABx to prevent cholangitis (co-trimoxazol
35
Causes of jaundice between 24 hours and 2 weeks
Physiological
Breastfeeding difficulty
Breastmilk jaundice
Metabolic- gilberts, HS etc
Biliary atresia
Congenital hypothyroidism
Infection
36
What causes breastfeeding jaundice
Where babies do not receive enough milk there is increased enterohepatic cycling of bilirubin
37
What is congenital hypothyroidism and why serious
A lack of thyroid hormones from birth
Lack of growth and neurological defects
38
Aetiology of congenital hypothyroidism
In order of most common
Thyroid gland defects (missing etc) (not inherited)
Thyroid hormone metabolism (TSH unresponsive) (inherited)
Transient
Hypothalamic/pituitary dysfunction (tumours, ischaemia etc)
39
What can cause transient hypothyroidism
Seen in neonates
Maternal anti-thyroid medication like carbimazole, PTU
Maternal ABs from hashimotos
40
Presentation of congenital hypothyroidism
Feeding difficulties
Lethargy
Constipation
JAUNDICE
Large fontanelles
Niche- umbilical hernia, coarse features (flattened nasal bridge), macroglossia, thin hair
41
Investigations for congenital hypothyroidism
High TSH and low T4
Measure thyroid autoantibodies ± US or radionucleotide scan
42
Management of congenital hypothyroidism
Thyroxine hormone replaced with levothyroxine OD, titrate dose to TFTs + regular monitoring
Monitor growth, milestones, development
43
Management of primary hypothyroidism in children
Thyroxine hormone replaced with levothyroxine OD, titrate dose to TFTs + regular monitoring
Monitor growth, milestones, development
44
Most common cause of acquired childhood hypothyroidism
Hashimotos
45
Rfx for hashimotos hypothyroidism
Down’s syndrome, Turner’s syndrome
Female
46
Risk of graves mums giving birth
1-2% can be born hyperthyroid due to circulating TSHr-Abs which can cross placenta
47
Signs of foetal hyperthyroidism
High CTG trace
Foetal goitre on USS
48
Signs of neonatal hyperthyroidism
Irritability
Tachycardia
Diarrhoea
Exopathalmos
HF
49
Medical managment of hyperthyroidism
Carbimazole or PTU
Can consider beta blockers if symptomatic
Other management is surgery or radioactive treatment
50
When does anterior fontanelle shut
9-18 mths
51
What does absent red reflex suggest in newborn check
Retinoblastoma
Could be congenital cataracts
52
Normal newborn head circumfrence
23-35 cm
Highest of 3 measurements
53
What is a cephalhematoma versus caput
Cephalhematoma is a bleed under the epicranial aponeuris and restricted to suture lines
Caput succundem- swelling under the skin/subcut tissue- crosses suture lines
54
What is concerning about cephalematoma
Cause may be skull fracture
55
White spots on the face of newborn
Milia
56
Management of cephalematoma
Monitor jaundice
57
What causes a bleed in sclera of eye- newborn
Subconjunctival haemorrhage
58
What is the barlow and ortolani manoever
Dislocate femur out of hip joint- check if weakness
59
How is hydrocele of newborn managed
Normally self limiting within a year however if not need surgery
60
What syndrome is port and winerash associated with
Sturg-weber
61
Signs of resp distress in children
Nasal flaring
Subcostal recession
Tracheal indenting
62
What are categories of preterm infant
Preterm under 37
Near term 34-36
Very preterm 29-33
Extremely preterm under 29
63
What causes TTN
Lungs still full of amniotic fluid
Transient tachypnoea of the fluid
64
What causes RDS
Lack of endogenous surfactant
Decreases surface tension and prevents collapse of alveoli
65
Rfx for RDS
Maternal DM
Preterm
Hypothermia- deactivates surfactant
Elective C section
Any cause of hypoxia
66
What is protective for RDS
Pre-eclampsia
Recurrent threatened preterm labour (as able to give steroids)
67
Symptoms for RDS
Tachypnoea
Grunting
Cyanosis
Head bobbing
Chest wall recession
68
CXR of RDS
Ground glass appearance with bronchogram
69
Risk of trophic feeds
Spontaneous pneumothorax
These are small volumes of mik given to stimulate bowels not for nutrition
70
What increases risk of IVH in kids
CSF produced in choroid plexus which are very fragile and vascular. As mature get more supported with connective tissue- until this is risk of rupture into
71
How are IVH graded
1- bleeding only in germinal matrix
2- bleeding can occur into ventricles
3- grade 2 but blocked ventricles and theyre now dilated
4- ventricles so dilated it compresses surrounding venous
72
When is post haemorrhagic ventricular dilation a problem
Grade 3 and 4 IVH
73
Rfs for NEC
LBW
Preterm
PDA as reduces blood flow
74
Symptoms of NEC
Quiet
Feeding intolerance
Bilious vomiting or in NG tube
Bloody stools
If really bad- distension,
75
AXR of NEC
Pneumoperitoneum
76
Treatment of NEC
Stop enteral feeds and medications
- give TPN if feeds stopped for over 24 hours
- if confirmed NEC stop feeds for 1 weeks
NG tube on free drain
Abx- cefotaxime and vancomycin
Resp support if abdo distended
Fluids- may need ionotropes
Surgery if perforation
77
Complications of NEC
Perforation
Recurrent strictures
Neuro-maldevelopment
Short gut syndrome if feeding
78
What is chronic lung disease
Ongoing oxygen needed for 28 days
79
Rfx of CLD
Ventilation injury
Infection
RDS
Fluid overload
80
Complications of CLD and how managed
Very susceptible to future infection
- vaccinate against flu at 6 months
- vacciante against RSV
Wheezy for first 3 months
81
What is ROP
Retinopathy of prematurity- refractive errors or squints
82
Risks for ROP
Low birth weight
preterm
Hyperoxaemia
83
Management of ROP
Treated for up to 2 years
MDT approach
Photocogulation
84
What antibiotics given in RDS
Benzylpenicillin and gentamicin
85
What is main risk factor for TTN
C-section or preterm
86
Treatment for TTN
Oxygen if needed
87
Treatment for CLD
Manage oxygen therapy- wean off if necessarty or give what necessary
Caffeine citrate
Nitric oxide if pulmonary hypoplasia or pulmonary HTN
88
CXR finding of CLD
Widespread opacification
Can be atelectasis, multicystic appearance, emphysema or pulmonary scarring
89
Management of NEC
Resp support and potential cardio
Stop enteral feeding and medications- switch to parenteral
NG tube left on free drain
Abx with good cover- cefotaxime and vancomycin
Surgery if needed
90
What is used to diagnose vesicoureteric reflex
Micturating cytourethrogram
91
Pathophysiology of vesicoureteric reflux
Where urine backlows from bladder into the ureters and kidney
Normally due to ureters entering bladder perpendicularly -> shorter intramural course -> VUR
92
How can vesicoureteric reflux present
antenatal period: hydronephrosis on ultrasound
recurrent childhood urinary tract infections
reflux nephropathy
93
What is a reflux nephropathy
term used to describe chronic pyelonephritis secondary to VUR which commonest cause of chronic pyelonephritis
94
How can reflux nephropathy affect blood pressure
A renal scar can produce increased quantity of renin
95
Complications of VUR
Renal scar (35%)
HTN from renal scar
Renal osteodystrophy
96
How is renal scar visualised
DMSA
A DMSA scan is a radionuclide scan that uses dimercaptosuccinic acid in assessing renal morphology, structure and function
97
How is HIE graded
Depends on response within first 48 hours
Mild- irritable infant, responds excessively to stimulation, staring eyes, hypertonia
Moderate- abnormailities of movement, hypotonic, seizures, cant feed
Severe- no normal movement, does not respond to pain, tone in limbs fluctuate, hypo to hypertonic, seizures
98
Prognosis of mild, moderate and severe HIE
Mild- expect full recovery
Moderate- recovery in 2 weeks good prognosis, if not not good
Severe- 80% cerebral palsy, 40% mortality
99
Criteria for therapeutic cooling
Must be over 36 weeks
Over 1800g
Moderate or severe HIE
100
What virus during pregnancy presents with limb defects
Acute varicella
101
What virus during pregnancy presents with cerebral palsy
Acute CMV
102
What virus during pregnancy presents with cataracts
Rubella
103
What infection during pregnancy presents with choroidoretinitis
Toxoplasmosis
104
How is PV19 virus diagnosed
Parvovirus B19 serology
105
What are 4 main things to check in newborn examination
Heart
Hip
Eyes
Testes
106
What are the types of cleft lip and palate
Most common =combined
cleft palate alone
cleft lip
107
Risk factors for cleft lip and palate
Maternal antiepileptic and BDZ use
108
What does cleft palate and lip increase risk of
Secretory otitis media
109
Management of cleft lip and palate
MDT- surgeons, ENT, orthodontist, SALT, feeding team
Orthodontic devices may be needed if feeding difficult
Speech and language therapy
Cleft lip repaired in first 3 months of life
Cleft palate between 6-12 months of life
110
Causes of pulmonary hypoplasia
Congenital diaphragmatic hernia- most common
Oligohydramnios
Tetralogy of fallot
Osteogenesis imperfecta
Diaphram agenesis
111
Who is palivizumab often given to
Premature infants
Infants with lung or heart abnormalities
Immunocompromised
112
How long does caput succedaneum take to resolve versus cephalaematoma
CS- days
Cephalhematoma- months
113
How does CF present in neo-nates
Meconium ileus with SBO
114
Antiobitcs for listeria infection in child
Amoxicillin and gentamicin if blood cultures or CSF comes back as positive
115
How does listeria monocytogenes present
Widespread rash
Pneumonia or meningitis
Meconium stained amniotic fluid
116
What can present with meconium stained amniotic fluid in preterms
Listeria infection
117
How does erythema toxicum present
Often combination of erythematous patches, papules or pustules
Starts on face and spreads down
Will disappear in a few days without treatment
118
Differentials for neonate with breathing difficulty
Common
- TTN
- Pneumonia
- Sepsis
Uncommon
- meconium aspiration
- pneumothorax
- congenital abnormality like diaphragmatic hernia
119
Management of congenital diaphragmatic hernia
First line- NG tube drip and suck
If cyanosed use ventilation
Manage pulmonary hypertension with inhaled NO or ECMO
Surgery to repair
120
Management of bacterial conjunctivitis in the neonate
Same day referral to opthalmologist
Mild- chloramphenicol eye drops
Moderate-severe- give systemic abx according to organism
Chlamydia- oral erythomycin
Gonoccocal- single dose parenteral ceftriaxone
Pseudomonal- gentamicin eye drops with systemic abx
121
Management of viral opthalmia neonatorum
Topical antihistamine with artificial tears
122
What is biphasic presentation of group b streptococcus
Newborn- pneumonia or meningitis-> both often causes sepsis
3 months- meningitis or osteomyelitis/septic arthritis
123
What is given to babies with signs of group b strep infection
Penicillin and gentamicin
If CSF positive then swithc to benzylpenicllin and gentamicin
124
Risk factors for group b strep infection
Maternal fever during delivery
Choriamniitis
Previous GBS infection in pregnancy
Preterm
125
How is HIE graded
Mild (everything excessive)
- hyper alert
- hypertonia
- increased reflexes
- weak such reflex
- tachycardia
- no seizures
Moderate (dampened down)
- lethargic
- mild hypotonia
- strong distal flexion
- weak reflexes
- pinpoint eyes
- bradycardia
- focal seizures
Severe
- comatose
- absent reflexes
- difficult to control seizures
- unequal and unreactive pupils
- flaccid posture
126
Management of HIE for all patients
Resus
- consider early ventilation
- ionotropic support
- maintain BP with dobutamine
- fluids (40ml/kg)
127
Extra management of moderate HIE
Treat complications
- seizures and consider EEG
- maintain normoglycaemia
- treat hypocalcaemia
- measure LFTs and coagulation (IM phytomenadione)
- withold feeding as increased risk of NEC
128
Complications of HIE acute
Liver injury
Hypoglycaemia
Hypocalcemia
Hypotension
Resp failure
129
How can intraventricular haemorrhage present
Silent picked up on routine US
Symptomatic
- altered consciousness
- hypotonia
- abnormal eye movements
Catastrophic deteriation
- coma
- irregular respirations
- apnoea
- flaccid weakness
- seizures
130
Pathophysiology of retinopathy of prematurity
Vascular development of retina begins at 15-18 weeks and continues until term
If baby is born preterm then vascular development continues after birth and sometimes this is abnormal
131
Who is ROP screened for
In babies under 1500g Birth weight
Under 32 weeks gestation
Opathalmoscope will show abnormal retinal vessel proliferation
132
Complications of IVH
Clots in grade 3 and 4 can lead to hydrocephalus
If haemorrhagic IVH leads to cerebral palsy 50% of cases
133
Management of IVH
Fluids replacement
Treat seizures
Shunt if hydrocephalus or raised ICP
134
Neonatal hypoglycaemia management
Less than 1.5
- admit to neonatal unit
- confirm with lab blood glucose assay
- IV 10% glucose 2ml/kg bolus
- followed by infusion of 3.6ml/kg/hr
- monitor regularly
Between 1.5 and 2.5
- feed immediately
- recheck glucose after 30 mins and if still low consider admitting and starting IV glucose
135
What to do if persistent neonatal hypoglycaemia
Refer to endo for further investigation
136
What to do if secondary hyperinsulinaemia causing hypoglycaemia in neonates
Either
- glucagon infusion
- diazoxide and chlorthiazide
- somatostatin analogue
137
How should neonatal hypoglycaemia be prevented
Encourage feeding 30 mins after birth
138
Cyanosis after birth with absent heart murmurs and signs of HF
Persistent pulmonary hypertension
139
Exam findnigs of CLD
Scattered rales
Expiratory wheeze
140
What defines CLD
Need for oxygen supplementation after 36 weeks postmenstrual age
Can be also seen as sats dropping below 90% after an hour on room air
141
Pathophysiology of pulmonary hypertension of the newborn
Pulmonary vascular resistance doesnt decrease after birth which can cause right to left shunting via PDA or patent foramen ovale
142
Causes of persistent pulmonary hypertension of the newborn
Idiopathic
OR
Secondary to neonatal pulmonary conditions
- meconium aspiration
- ttn
- congenital diaphragmatic hernia
- RDS
143
How can whether a childs condition is duct dependant be assessed
Pre and post ductal blood saturations
Saturations taken from the right hand and foot
If duct dependant then saturations will be lower in the foot as this is after the duct
144
How can persitent pulmonary hypertension of the newborn be investigated
Pre and post ductal saturations will show lower saturations in the feet than in the right arm
Echo will show increased pressure in the pulmonary artery
145
Management of persistent pulmonary hypertension
Oxygen
Intubate for ventilation
Surfactant
Suction of secretions
Fluids and ionotropes
Inhaled nitric oxide
146
What can be used for oxygenation in neonates with PPHN where no improvement with normal ventiation
High frequency oscillatory ventilation
147
When insert chest drain for pneumothorax
Tension pneumothoraces
Ventialted or preterm infants with non-tension pneumothoraces who deteriorate
148
Risk of ventilation in children
Pneumothorax
- keep pressure as low as possible
149
Complications of meconium aspiration
Atelectasis
Infection
PPHN
Pneumothorax
Pneumomediastinum
150
Risk factors for meconium aspiration
Post term delivery
Prolonged rupture of membranes
Chorioamnionitis
Oligohydramnios
151
Investigations for meconium aspiration
CXR- shows atelectasis, hyperinflation and patchy consolidation
Culture
152
Antibiotics for meconium aspiration
IV ampicillin and gentamicin
153
Symptoms of meconium ileus
Not passed meconium
Bilious vomiting
Can even vomit the meconium
154
Associations of meconium ileus
Biliary atresia
CF
155
Management of meconium ileus
1st line - gastrograffin enema
2nd line- surgery
156
Ddx for bilious vomiting in neonate
NEC
Duodenal atresia <6hrs
Jejunal or ileal atrsia <24 hrs
Meconium ileus 24-48 hrs
Malrotation volvulus 3-7 days
157
AXR of duodenal atresia
Double bubble sign
158
AXR of jejunal and ileal atresia
Air fluid levels
159
CXR finding of meconium aspiration
Hyperinflation
Atelelctasis
Consolidation
Pneumothorax
Pneumomediastium
160
Complications of diaphragmatic hernia
RDS
Stomach volvulus
Intestinal obstruction
161
How do diaphragmatic hernias present
Concave chest
Resp distress at birth
162
What goes into the apgar score and how is it rated
A- apearance (colour)
P- pulse
G- grimace (reflex irritability)
A- activity (tone)
R- respiration
Done between 1st and 5th minute of life- the higher the better
If low then repeat at 10 minutes
163
Neonatal resus
1. Dry baby
2. Assess tone, resp rate, HR
3. If gasping or not breathing 5 INFLATION breaths
4. Reassess
5. If HR less than 60 bpm start chest compression and VENTILATION breaths at rate of 3:1
164
What to do if saturation very low in first few minutes after birth
Very normal for cyanosis after birth as adjusting- reassess in a few minutes
165
Investigation for cranial swelling
CRUSS if anterior fontanelle not shut, if has then do MRI
166
What is neurological finding seen in shoulder dystocia
Erb-duchenne palsy from damage to the brachial plexus
167
Abnormalities in erb palsy
Arm medially rotated and adducted
Extension at elbow
168
Classical presentation of congenital syphillis
Rash on palms and soles
Blood stained rhinitis
Hepatosplenomegaly
Glomerulnephritis
Meningitis
Bossing of forehead
Small widely spaced teeth (Hutchinsons teeth)
Saddle nose deformity
Anterior bowing of shins (Saber shins)
Symmetrical knee swelling (cluttons joints)
169
Triad for congenital toxoplasmosis
Hydrocephalus
Microcalcifications
Choroidretinitis
Can also present with liver issues and jaundice
170
Most common cause of congenital infection
CMV
171
Congenital infections acronym
TORCH
Toxoplasmosis
Other (syphilis)
Rubella
CMV
H- HIV,HBV
172
Most likely cause of hydrops fetalis
Parovirus
Could also be CMV
173
How are cephalhaematomas differentiated from subgaleal bleeds
Subgaleal bleeds cross fontanelles
174
How can congenital herpes present
3 main presentations
- skin eye mouth disease
- CNS disease
- disseminated systemic disease
175
Presentation of choledochal cyst
Abdo pain
Abdo mass
Jaundice
176
Investigation for choledochal cyst
USS
177
Management of choledochal cyst
Surgical excision with roux en y anastamosis to biliary duct
178
What is infection of the umbilicus
Omphalitis- normally s.aureus
179
How is omphalitis managed
Sepsis 6
180
What is it when urine passes through the umbilicus
Urachus
181
What is it when mass of red/grey tissue by the umbilicus
Umbilical hernia
Caused by umbilicus recovering post birth
182
Complications of breech presentation
DDH
Femur fractures
Erb palsy
183
Causes of HIE
Anything which reduces oxygenated blood flow around birth
184
Immediate management of a neonate
Immediately- dry baby, note time and start clock
Within 30 seconds- assess tone, breathing effort and HR
Within 60 seconds- if gasping not breathing give 5 inflation breaths
185
When is only time treat IVH
Hydrocephalus or raised ICP
Put shunt in
186
Risks of drinking in pregnancy
Learning difficulties
Microcephaly
Growth retardation
Cardiac malformations
Epicanthic folds
Sooth philtrum (area between nose and mouth)
Small palpebral fissue
187
What is the palpebral fissue
Distance between outside of eye and inside
188
Risks of smoking in pregnancy
IUGR and LBW
Preterm
Miscarriage
189
What congenital infection will present with an asymptomatic mother
Toxoplasmosis
190
How does TTN appear on CXR
Hyperinflated
Fluid in horizontal fissue
191
What worried about in acute macrocephaly
Raised ICP
- hydrocephalus etc
192
What is craniosyntiosis
When sutures of the brain fuse prematurely
193
What are the 2 types of craniosyntiosis
Sagittal (AP suture)- long flat head
Lamdoidal synostosis (posteriorly, goes laterally)- appears like plagiocephaly
194
What tends to cause sagittal craniosyntosis
Premature infants lying on their sides
195
Management of duodenal atresia
A-E
NG tube for decompression
Duodenoduodenostomy- anastamosis between non-obstructed parts of duodenum
196
What is difference between low and high anorectal anomalies
Low- at level of anus it has close in, may be a fistula to the surrounding skin
High- bowel has closed off higher up, associated with fistulas to bladder etc
197
What are retractile testes
Testes which have descended but then go in and out of scrotum
198
Management of retractile testes
Reassurance and follow-up annually
199
Surgical management of undescended testes
If in inguinal canal- orchidopexy
If anywhere else- laparoscopy
200
Difference between early and late onset sepsis
Within 72 hours of birth is early
201
What needs to be done if have port and wine rash
MRI to rule out intracranial haemangioma
202
If have patient with TTN what need to do
Septic screen as impossible to differentiate- can give abx in meantime
203
What determines what bilirubin measuring device used
Within 24 hours of life or born under 35 weeks- serum reading
After 24 hours- transcutaneous bilirubinometer
204
What is cutoff on transcutaneous bilirubinometer to do serum reading
250
205
Most common cause of opthalmia neonatorum
Chlamydia
206
Management of chlamydia opthalmia neonatorum
Oral erythomycin
207
Management of gonococcal opthalmia neonatorum
IV cefotaxime single dose
208
Newborn baby with isolated skin disease. Widespread vesicles and pustules on face with salmon patch on left eyelid. what TORCH
HSV
209
What is a chignon
A swelling on head from where vetnouse was attached
210
How do umbilical granulomas present
Red lump leaking clear fluid
211
What is main problem if bottle feed over 6 months
Vitamin D deficiency
212
What is periventricular leukomalacia
Where get hypoxic injury to white tissue making it very soft
213
What is potter sequence
It is the result of the force from oligohydramnios
214
What is presentation of potter sequence
Pulmonary hypoplasia
Renal agenesis
Clubbed feet
Low set ears
Flattened nose
Downwards epicanthal folds
215
How often is bilirubin checked in phototherapy
Every 4-6 hours
216
What is chorioretinitis
Posterior uveitis
217
What is main risk factor for contracting congenital toxoplasmosis
Maternal exposure to cat faeces
218
Investigation for meconeum ileus
AXR
219
'bubbly' appearance of the intestine with a lack of air-fluid levels
Meconeum ileus
220
What does yellow amniotic fluid suggest
Haemolysis
221
Signs of haemolysis on newborn examination
Yellow amniotic fluid
Hepatosplenomegaly
Hydrops fetalis
222
With phototherapy what bilirubin level aim for
50 micromoles below target
223
Management of phototherapy in neonate
Once 50 micromoles below can stop then re measure in 12-18 hours
If this is 50 below then no further measurement required
If less than 50 below remeasure in 12 hours
224
Management of meconium aspiration
Attempt to suction meconium from mouth
Transfer to NICU
Administer oxygen
Gentamicin and ampicillin
225
How does mycoplasma pneumonia present
Insidious onset compared to normal pneumonia
