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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is kernicterus

A

Bilirubin encephalopathy as free unconjugated bilirubin can cross the BBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can kernicterus present

A

Moderate cases
- lethargy and poor feeding

Severe cases
- irritability
- increased muscle tone (oplsthotonos)
- seizures and comas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is oplsthonos

A

When babies lie with arched back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are long term effects of kernicterus

A

Choreoathetoid cerebral palsy
Sensorineural deafness
Learning disabilities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where does jaundice typically present in a newborn

A

The head and then spreads downwards with increasing severity
Cephalocaudal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Difference in solubility between unconjugated and conjugated bilirubin

A

Unconjugated- fat
Conjugated- water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does phototherapy work on jaundice

A

Converts uBR to lumirubin and photobilirubin but DOES NOT WORK on Conjugated bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of jaundice in first 24 hours of life

A

Infection
ABO or Rh incompatibility
G6PD or HS
Gilberts
Cirgler-Najjar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Rfx for haemolytic disease of the newborn

A

Chorionic villous sampling
Amniocentesis
Vaginal delivery
Antenatal haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How to diagnose haemolytic disease of the newborn

A

Coombs test- will show positive indirect antiglobulin test showing IgG in maternal blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Antibodies in ABO incompatibility

A

Anti-A haemolysin IgG- more common
Anti-B haemolysin IgG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What triggers gilberts to cause neonatal jaundice

A

Normally infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Criger-Najjar syndrome

A

Results in a complete dysfunction of the gene encoding UDP-Glucuronyl transferase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Treatment options for acute bilirubin encephalopathy

A

Immediate exchange transfusion
Phototherapy
Hydration
IVIG
Folic acid after to prevent anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Options for treating neonatal jaundice

A

Phototherapy
Exchange transfusion
Thresholds for determining when to

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Common causes of jaundice neonatal jaundice

A

Physiological
Breast milk jaundice
Sepsis
Feeding difficulty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is biliary atresia

A

Progressive fibrosis and obliteration of extra and intra hepatic ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Symptoms of biliary atresia

A

Pale stools
Dark urine
Mild jaundice
DONT GET VOMITING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Examination finding of biliary atresia

A

Hepatosplenomegaly
Mild jaundice
Can get cardiac murmurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the types of biliary atresia

A

T1- common bile duct
T2- cystic dict
T3- fulla tresia where over 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Problems of biliary atresia

A

Progress to chronic liver failure in 2 years and then HCC
Faltering growth despite normal birth weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Investigations for biliary atresia

A

USS
Lfts- elevated GGT
High conjugated CBr
TIBIDA SCAN
ERCP and biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

US finding of biliary atresia

A

Triangular chord sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Gold standard for biliary atresia

A

TIBIDA isoptope scan also known as scintiligraphy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Confirmatory test for biliary atresia

A

ERCP and biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Management of biliary atresia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Causes of jaundice between 24 hours and 2 weeks

A

Physiological
Breastfeeding difficulty
Breastmilk jaundice
Metabolic- gilberts, HS etc
Biliary atresia
Congenital hypothyroidism
Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What causes breastfeeding jaundice

A

Where babies do not receive enough milk there is increased enterohepatic cycling of bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is congenital hypothyroidism and why serious

A

A lack of thyroid hormones from birth
Lack of growth and neurological defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Aetiology of congenital hypothyroidism

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What can cause transient hypothyroidism

A

Seen in neonates
Maternal anti-thyroid medication like carbimazole, PTU
Maternal ABs from hashimotos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Presentation of congenital hypothyroidism

A

Feeding difficulties
Lethargy
Constipation
JAUNDICE
Large fontanelles
Niche- umbilical hernia, coarse features (flattened nasal bridge), macroglossia, thin hair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Investigations for congenital hypothyroidism

A

High TSH and low T4
Measure thyroid autoantibodies ± US or radionucleotide scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Management of congenital hypothyroidism

A

Thyroxine hormone replaced with levothyroxine OD, titrate dose to TFTs + regular monitoring
Monitor growth, milestones, development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Management of primary hypothyroidism in children

A

Thyroxine hormone replaced with levothyroxine OD, titrate dose to TFTs + regular monitoring
Monitor growth, milestones, development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Most common cause of acquired childhood hypothyroidism

A

Hashimotos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Rfx for hashimotos hypothyroidism

A

Down’s syndrome, Turner’s syndrome
Female

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Risk of graves mums giving birth

A

1-2% can be born hyperthyroid due to circulating TSHr-Abs which can cross placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Signs of foetal hyperthyroidism

A

High CTG trace
Foetal goitre on USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Signs of neonatal hyperthyroidism

A

Irritability
Tachycardia
Diarrhoea
Exopathalmos
HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Medical managment of hyperthyroidism

A

Carbimazole or PTU
Can consider beta blockers if symptomatic
Other management is surgery or radioactive treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

When does anterior fontanelle shut

A

9-18 mths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What does absent red reflex suggest in newborn check

A

Retinoblastoma
Could be congenital cataracts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Normal newborn head circumfrence

A

23-35 cm
Highest of 3 measurements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is a cephalhematoma versus caput

A

Cephalhematoma is a bleed under the epicranial aponeuris and restricted to suture lines
Caput succundem- swelling under the skin/subcut tissue- crosses suture lines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is concerning about cephalematoma

A

Cause may be skull fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

White spots on the face of newborn

A

Milia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Management of cephalematoma

A

Monitor jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What causes a bleed in sclera of eye- newborn

A

Subconjunctival haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the barlow and ortolani manoever

A

Dislocate femur out of hip joint- check if weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How is hydrocele of newborn managed

A

Normally self limiting within a year however if not need surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What syndrome is port and winerash associated with

A

Sturg-weber

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Signs of resp distress in children

A

Nasal flaring
Subcostal recession
Tracheal indenting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are categories of preterm infant

A

Preterm under 37
Near term 34-36
Very preterm 29-33
Extremely preterm under 29

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What causes TTN

A

Lungs still full of amniotic fluid
Transient tachypnoea of the fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What causes RDS

A

Lack of endogenous surfactant
Decreases surface tension and prevents collapse of alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Rfx for RDS

A

Maternal DM
Preterm
Hypothermia- deactivates surfactant
Elective C section
Any cause of hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is protective for RDS

A

Pre-eclampsia
Recurrent threatened preterm labour (as able to give steroids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Symptoms for RDS

A

Tachypnoea
Grunting
Cyanosis
Head bobbing
Chest wall recession

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

CXR of RDS

A

Ground glass appearance with bronchogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Risk of trophic feeds

A

Spontaneous pneumothorax
These are small volumes of mik given to stimulate bowels not for nutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What increases risk of IVH in kids

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

How are IVH graded

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

When is post haemorrhagic ventricular dilation a problem

A

Grade 3 and 4 IVH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Rfs for NEC

A

LBW
Preterm
PDA as reduces blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Symptoms of NEC

A

Quiet
Feeding intolerance
Bilious vomiting or in NG tube
Bloody stools
If really bad- distension,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

AXR of NEC

A

Pneumoperitoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Treatment of NEC

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Complications of NEC

A

Perforation
Recurrent strictures
Neuro-maldevelopment
Short gut syndrome if feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is chronic lung disease

A

Ongoing oxygen needed for 28 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Rfx of CLD

A

Ventilation injury
Infection
RDS
Fluid overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Complications of CLD and how managed

A

Very susceptible to future infection
- vaccinate against flu at 6 months
- vacciante against RSV
Wheezy for first 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is ROP

A

Retinopathy of prematurity- refractive errors or squints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Risks for ROP

A

Low birth weight
preterm
Hyperoxaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Management of ROP

A

Treated for up to 2 years
MDT approach
Photocogulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What antibiotics given in RDS

A

Benzylpenicillin and gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is main risk factor for TTN

A

C-section or preterm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Treatment for TTN

A

Oxygen if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Treatment for CLD

A

Manage oxygen therapy- wean off if necessarty or give what necessary
Caffeine citrate
Nitric oxide if pulmonary hypoplasia or pulmonary HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

CXR finding of CLD

A

Widespread opacification
Can be atelectasis, multicystic appearance, emphysema or pulmonary scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Management of NEC

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is used to diagnose vesicoureteric reflex

A

Micturating cytourethrogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Pathophysiology of vesicoureteric reflux

A

Where urine backlows from bladder into the ureters and kidney
Normally due to ureters entering bladder perpendicularly -> shorter intramural course -> VUR

92
Q

How can vesicoureteric reflux present

A

antenatal period: hydronephrosis on ultrasound
recurrent childhood urinary tract infections
reflux nephropathy

93
Q

What is a reflux nephropathy

A

term used to describe chronic pyelonephritis secondary to VUR which commonest cause of chronic pyelonephritis

94
Q

How can reflux nephropathy affect blood pressure

A

A renal scar can produce increased quantity of renin

95
Q

Complications of VUR

A

Renal scar (35%)
HTN from renal scar
Renal osteodystrophy

96
Q

How is renal scar visualised

A

DMSA
A DMSA scan is a radionuclide scan that uses dimercaptosuccinic acid in assessing renal morphology, structure and function

97
Q

How is HIE graded

A

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
Q

Prognosis of mild, moderate and severe HIE

A

Mild- expect full recovery
Moderate- recovery in 2 weeks good prognosis, if not not good
Severe- 80% cerebral palsy, 40% mortality

99
Q

Criteria for therapeutic cooling

A

Must be over 36 weeks
Over 1800g
Moderate or severe HIE

100
Q

What virus during pregnancy presents with limb defects

A

Acute varicella

101
Q

What virus during pregnancy presents with cerebral palsy

A

Acute CMV

102
Q

What virus during pregnancy presents with cataracts

A

Rubella

103
Q

What infection during pregnancy presents with choroidoretinitis

A

Toxoplasmosis

104
Q

How is PV19 virus diagnosed

A

Parvovirus B19 serology

105
Q

What are 4 main things to check in newborn examination

A

Heart
Hip
Eyes
Testes

106
Q

What are the types of cleft lip and palate

A

Most common =combined
cleft palate alone
cleft lip

107
Q

Risk factors for cleft lip and palate

A

Maternal antiepileptic and BDZ use

108
Q

What does cleft palate and lip increase risk of

A

Secretory otitis media

109
Q

Management of cleft lip and palate

A

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
Q

Causes of pulmonary hypoplasia

A

Congenital diaphragmatic hernia- most common
Oligohydramnios
Tetralogy of fallot
Osteogenesis imperfecta
Diaphram agenesis

111
Q

Who is palivizumab often given to

A

Premature infants
Infants with lung or heart abnormalities
Immunocompromised

112
Q

How long does caput succedaneum take to resolve versus cephalaematoma

A

CS- days
Cephalhematoma- months

113
Q

How does CF present in neo-nates

A

Meconium ileus with SBO

114
Q

Antiobitcs for listeria infection in child

A

Amoxicillin and gentamicin if blood cultures or CSF comes back as positive

115
Q

How does listeria monocytogenes present

A

Widespread rash
Pneumonia or meningitis
Meconium stained amniotic fluid

116
Q

What can present with meconium stained amniotic fluid in preterms

A

Listeria infection

117
Q

How does erythema toxicum present

A

Often combination of erythematous patches, papules or pustules
Starts on face and spreads down
Will disappear in a few days without treatment

118
Q

Differentials for neonate with breathing difficulty

A

Common
- TTN
- Pneumonia
- Sepsis

Uncommon
- meconium aspiration
- pneumothorax
- congenital abnormality like diaphragmatic hernia

119
Q

Management of congenital diaphragmatic hernia

A

First line- NG tube drip and suck
If cyanosed use ventilation
Manage pulmonary hypertension with inhaled NO or ECMO
Surgery to repair

120
Q

Management of bacterial conjunctivitis in the neonate

A

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
Q

Management of viral opthalmia neonatorum

A

Topical antihistamine with artificial tears

122
Q

What is biphasic presentation of group b streptococcus

A

Newborn- pneumonia or meningitis-> both often causes sepsis
3 months- meningitis or osteomyelitis/septic arthritis

123
Q

What is given to babies with signs of group b strep infection

A

Penicillin and gentamicin
If CSF positive then swithc to benzylpenicllin and gentamicin

124
Q

Risk factors for group b strep infection

A

Maternal fever during delivery
Choriamniitis
Previous GBS infection in pregnancy
Preterm

125
Q

How is HIE graded

A

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
Q

Management of HIE for all patients

A

Resus
- consider early ventilation
- ionotropic support
- maintain BP with dobutamine
- fluids (40ml/kg)

127
Q

Extra management of moderate HIE

A

Treat complications
- seizures and consider EEG
- maintain normoglycaemia
- treat hypocalcaemia
- measure LFTs and coagulation (IM phytomenadione)
- withold feeding as increased risk of NEC

128
Q

Complications of HIE acute

A

Liver injury
Hypoglycaemia
Hypocalcemia
Hypotension
Resp failure

129
Q

How can intraventricular haemorrhage present

A

Silent picked up on routine US
Symptomatic
- altered consciousness

  • hypotonia
  • abnormal eye movements
    Catastrophic deteriation
  • coma
  • irregular respirations
  • apnoea
  • flaccid weakness
  • seizures
130
Q

Pathophysiology of retinopathy of prematurity

A

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
Q

Who is ROP screened for

A

In babies under 1500g Birth weight
Under 32 weeks gestation
Opathalmoscope will show abnormal retinal vessel proliferation

132
Q

Complications of IVH

A

Clots in grade 3 and 4 can lead to hydrocephalus
If haemorrhagic IVH leads to cerebral palsy 50% of cases

133
Q

Management of IVH

A

Fluids replacement
Treat seizures
Shunt if hydrocephalus or raised ICP

134
Q

Neonatal hypoglycaemia management

A

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
Q

What to do if persistent neonatal hypoglycaemia

A

Refer to endo for further investigation

136
Q

What to do if secondary hyperinsulinaemia causing hypoglycaemia in neonates

A

Either
- glucagon infusion
- diazoxide and chlorthiazide
- somatostatin analogue

137
Q

How should neonatal hypoglycaemia be prevented

A

Encourage feeding 30 mins after birth

138
Q

Cyanosis after birth with absent heart murmurs and signs of HF

A

Persistent pulmonary hypertension

139
Q

Exam findnigs of CLD

A

Scattered rales
Expiratory wheeze

140
Q

What defines CLD

A

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
Q

Pathophysiology of pulmonary hypertension of the newborn

A

Pulmonary vascular resistance doesnt decrease after birth which can cause right to left shunting via PDA or patent foramen ovale

142
Q

Causes of persistent pulmonary hypertension of the newborn

A

Idiopathic
OR
Secondary to neonatal pulmonary conditions
- meconium aspiration
- ttn
- congenital diaphragmatic hernia
- RDS

143
Q

How can whether a childs condition is duct dependant be assessed

A

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
Q

How can persitent pulmonary hypertension of the newborn be investigated

A

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
Q

Management of persistent pulmonary hypertension

A

Oxygen
Intubate for ventilation
Surfactant
Suction of secretions
Fluids and ionotropes
Inhaled nitric oxide

146
Q

What can be used for oxygenation in neonates with PPHN where no improvement with normal ventiation

A

High frequency oscillatory ventilation

147
Q

When insert chest drain for pneumothorax

A

Tension pneumothoraces
Ventialted or preterm infants with non-tension pneumothoraces who deteriorate

148
Q

Risk of ventilation in children

A

Pneumothorax
- keep pressure as low as possible

149
Q

Complications of meconium aspiration

A

Atelectasis
Infection
PPHN
Pneumothorax
Pneumomediastinum

150
Q

Risk factors for meconium aspiration

A

Post term delivery
Prolonged rupture of membranes
Chorioamnionitis
Oligohydramnios

151
Q

Investigations for meconium aspiration

A

CXR- shows atelectasis, hyperinflation and patchy consolidation
Culture

152
Q

Antibiotics for meconium aspiration

A

IV ampicillin and gentamicin

153
Q

Symptoms of meconium ileus

A

Not passed meconium
Bilious vomiting
Can even vomit the meconium

154
Q

Associations of meconium ileus

A

Biliary atresia
CF

155
Q

Management of meconium ileus

A

1st line - gastrograffin enema
2nd line- surgery

156
Q

Ddx for bilious vomiting in neonate

A

NEC
Duodenal atresia <6hrs
Jejunal or ileal atrsia <24 hrs
Meconium ileus 24-48 hrs
Malrotation volvulus 3-7 days

157
Q

AXR of duodenal atresia

A

Double bubble sign

158
Q

AXR of jejunal and ileal atresia

A

Air fluid levels

159
Q

CXR finding of meconium aspiration

A

Hyperinflation
Atelelctasis
Consolidation
Pneumothorax
Pneumomediastium

160
Q

Complications of diaphragmatic hernia

A

RDS
Stomach volvulus
Intestinal obstruction

161
Q

How do diaphragmatic hernias present

A

Concave chest
Resp distress at birth

162
Q

What goes into the apgar score and how is it rated

A

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
Q

Neonatal resus

A
  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
Q

What to do if saturation very low in first few minutes after birth

A

Very normal for cyanosis after birth as adjusting- reassess in a few minutes

165
Q

Investigation for cranial swelling

A

CRUSS if anterior fontanelle not shut, if has then do MRI

166
Q

What is neurological finding seen in shoulder dystocia

A

Erb-duchenne palsy from damage to the brachial plexus

167
Q

Abnormalities in erb palsy

A

Arm medially rotated and adducted
Extension at elbow

168
Q

Classical presentation of congenital syphillis

A

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
Q

Triad for congenital toxoplasmosis

A

Hydrocephalus
Microcalcifications
Choroidretinitis
Can also present with liver issues and jaundice

170
Q

Most common cause of congenital infection

A

CMV

171
Q

Congenital infections acronym

A

TORCH
Toxoplasmosis
Other (syphilis)
Rubella
CMV
H- HIV,HBV

172
Q

Most likely cause of hydrops fetalis

A

Parovirus
Could also be CMV

173
Q

How are cephalhaematomas differentiated from subgaleal bleeds

A

Subgaleal bleeds cross fontanelles

174
Q

How can congenital herpes present

A

3 main presentations
- skin eye mouth disease
- CNS disease
- disseminated systemic disease

175
Q

Presentation of choledochal cyst

A

Abdo pain
Abdo mass
Jaundice

176
Q

Investigation for choledochal cyst

A

USS

177
Q

Management of choledochal cyst

A

Surgical excision with roux en y anastamosis to biliary duct

178
Q

What is infection of the umbilicus

A

Omphalitis- normally s.aureus

179
Q

How is omphalitis managed

A

Sepsis 6

180
Q

What is it when urine passes through the umbilicus

A

Urachus

181
Q

What is it when mass of red/grey tissue by the umbilicus

A

Umbilical hernia
Caused by umbilicus recovering post birth

182
Q

Complications of breech presentation

A

DDH
Femur fractures
Erb palsy

183
Q

Causes of HIE

A

Anything which reduces oxygenated blood flow around birth

184
Q

Immediate management of a neonate

A

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
Q

When is only time treat IVH

A

Hydrocephalus or raised ICP
Put shunt in

186
Q

Risks of drinking in pregnancy

A

Learning difficulties
Microcephaly
Growth retardation
Cardiac malformations
Epicanthic folds
Sooth philtrum (area between nose and mouth)
Small palpebral fissue

187
Q

What is the palpebral fissue

A

Distance between outside of eye and inside

188
Q

Risks of smoking in pregnancy

A

IUGR and LBW
Preterm
Miscarriage

189
Q

What congenital infection will present with an asymptomatic mother

A

Toxoplasmosis

190
Q

How does TTN appear on CXR

A

Hyperinflated
Fluid in horizontal fissue

191
Q

What worried about in acute macrocephaly

A

Raised ICP
- hydrocephalus etc

192
Q

What is craniosyntiosis

A

When sutures of the brain fuse prematurely

193
Q

What are the 2 types of craniosyntiosis

A

Sagittal (AP suture)- long flat head
Lamdoidal synostosis (posteriorly, goes laterally)- appears like plagiocephaly

194
Q

What tends to cause sagittal craniosyntosis

A

Premature infants lying on their sides

195
Q

Management of duodenal atresia

A

A-E
NG tube for decompression
Duodenoduodenostomy- anastamosis between non-obstructed parts of duodenum

196
Q

What is difference between low and high anorectal anomalies

A

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
Q

What are retractile testes

A

Testes which have descended but then go in and out of scrotum

198
Q

Management of retractile testes

A

Reassurance and follow-up annually

199
Q

Surgical management of undescended testes

A

If in inguinal canal- orchidopexy
If anywhere else- laparoscopy

200
Q

Difference between early and late onset sepsis

A

Within 72 hours of birth is early

201
Q

What needs to be done if have port and wine rash

A

MRI to rule out intracranial haemangioma

202
Q

If have patient with TTN what need to do

A

Septic screen as impossible to differentiate- can give abx in meantime

203
Q

What determines what bilirubin measuring device used

A

Within 24 hours of life or born under 35 weeks- serum reading
After 24 hours- transcutaneous bilirubinometer

204
Q

What is cutoff on transcutaneous bilirubinometer to do serum reading

A

250

205
Q

Most common cause of opthalmia neonatorum

A

Chlamydia

206
Q

Management of chlamydia opthalmia neonatorum

A

Oral erythomycin

207
Q

Management of gonococcal opthalmia neonatorum

A

IV cefotaxime single dose

208
Q

Newborn baby with isolated skin disease. Widespread vesicles and pustules on face with salmon patch on left eyelid. what TORCH

A

HSV

209
Q

What is a chignon

A

A swelling on head from where vetnouse was attached

210
Q

How do umbilical granulomas present

A

Red lump leaking clear fluid

211
Q

What is main problem if bottle feed over 6 months

A

Vitamin D deficiency

212
Q

What is periventricular leukomalacia

A

Where get hypoxic injury to white tissue making it very soft

213
Q

What is potter sequence

A

It is the result of the force from oligohydramnios

214
Q

What is presentation of potter sequence

A

Pulmonary hypoplasia
Renal agenesis
Clubbed feet
Low set ears
Flattened nose
Downwards epicanthal folds

215
Q

How often is bilirubin checked in phototherapy

A

Every 4-6 hours

216
Q

What is chorioretinitis

A

Posterior uveitis

217
Q

What is main risk factor for contracting congenital toxoplasmosis

A

Maternal exposure to cat faeces

218
Q

Investigation for meconeum ileus

A

AXR

219
Q

‘bubbly’ appearance of the intestine with a lack of air-fluid levels

A

Meconeum ileus

220
Q

What does yellow amniotic fluid suggest

A

Haemolysis

221
Q

Signs of haemolysis on newborn examination

A

Yellow amniotic fluid
Hepatosplenomegaly
Hydrops fetalis

222
Q

With phototherapy what bilirubin level aim for

A

50 micromoles below target

223
Q

Management of phototherapy in neonate

A

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
Q

Management of meconium aspiration

A

Attempt to suction meconium from mouth
Transfer to NICU
Administer oxygen
Gentamicin and ampicillin

225
Q

How does mycoplasma pneumonia present

A

Insidious onset compared to normal pneumonia