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Med Finals - Paediatrics > Neonates > Flashcards

Neonates Flashcards

1
Q

Main principles of neonatal resuscitation

A

Warm the baby
Calculate APGAR scores
Stimulate breathing
Inflation breaths
Chest compression

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2
Q

What is assessed in APGAR score

A

Appearance
Pulse
Grimmace
Activity
Respiration

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3
Q

APGAR score A1

A

Appearance
0 - blue/pale centrally
1 - Blue extremities
2 - Pink

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4
Q

APGAR score P

A

Pulse
0 - Absent
1 - <100
2 - >100

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5
Q

APGAR score G

A

Grimmace
0 - No response
1 - Little response
2 - Good response

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6
Q

APGAR score A2

A

Activity
0 - Floppy
1 - Flexed arms and legs
2 - Active

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7
Q

APGAR score R

A

Respiration
0 - Absent
1 - slow irregular
2 - strong/crying

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8
Q

What is assessed in blood spot screening

A

9 congenital condition
Sickle cell disease
Cystic fibrosis
Congenital hypothyroidism
Phenylketonuria
MCADD
MSUD
IVA
GA1
Homcystin

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9
Q

Define port wine stain

A

Pink patches of skin often on the face caused by abnormalities of the capillaries - they dont fade and often turn a darker red or purple.
Rarely related to sturge-weber syndrome

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10
Q

Define caput succedaneum

A

Fluid collection on the scalp outside the periosteum - results from a traumatic, prolonged or instrumental delivery
Fluid is ably to cross the suture lines and theses are benign with no treatment required

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11
Q

Define cephalohaematoma

A

Collection of blood between the skull and periosteum - lump does not cross suture line
Slight risk of anaemia or jaundice but should resolve without intervention

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12
Q

Define Erbs palst

A

Results from injury to C5/C6 nerves during birth
Associated with shoulder dystocia, traumatic or instrumental delivery
Waiters tip appearance - internally reotated, extended elbow, flexed wrist facing backwards, lack of movement

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13
Q

Define neonal sepsis

A

Sepsis caused by an infection in the neonatal period

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14
Q

Common causative organisms in neonatal sepsis

A

Group B streptococcus!!!
E. coli
Listeria
Klebsiella
Staphylococcus aureus

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15
Q

Risk factors for neonatal sepsis

A

Vaginal GBS
GBS in previous baby
Maternal sepsis
Prematurity
Early rupture of membrane
Prolonged rupture of membrane

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16
Q

Presentation of sepsis

A

Fever
Reduce tone and activity
Poor feeding
Respiratory distress
Vomiting
Tachycardia or brady cardia
Hypoxia
Jaundice
Seizures
Hypoglycaemia

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17
Q

Red flags of sepsis

A

Confirmed or suspected sepsis in mother
Signs of shock
Seizures
Term baby needing mechanical ventilation
Respiratory distress starting more than 4 hours after birth
Presumed sepsis in another baby in multiple pregnancy

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18
Q

Management of sepsis

A

Antibiotics - benzylpenicillin
Blood cultures
FBC and CRP
Lumbar puncture

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19
Q

Define hypoxic ischaemic encephaopathy

A

Occurs in neonates as a result of hypoxia during birth - can lead to damage to the brain causing cerebral palsy

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20
Q

Causes of hypoxic ischaemic encephalopathy

A

Maternal shock
Intrapartum haemorrhage
Prolapsed cord
Nuchal cord - around neck

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21
Q

Management of hypoxic ischaemic encephalopathy

A

Supportive neonatal resuscitation
Therapeutic hypothermia
Lots of follow up!

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22
Q

Define physiological jaundice

A

Due to high levels of fetal haemoglobin there is high turnover of RBCs resulting in lots of bilirubin leading to mild yellowing of skin and sclera - presents at 2-7 days. Normally resolves within 10 days

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23
Q

When is jaundice pathological

A

When presenting within the first 24 hours of life

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24
Q

When does physiological jaundice present

A

2-7 days of life

25
Q

Causes of jaundice - increased bilirubin

A

Haemolytic disease of the newborn
ABO incompatibility
Haemorrhage
Intraventricular haemorrhage
Cephalo-haematoma
Polycythaemia
Sepsis and DIC
G6PD deficiency

26
Q

Causes of jaundice - decreased clearance

A

Prematurity
Breast milk jaundice
Neonatal cholestasis
Extrahepatic biliary atresia
Endocrine - hypothyroid, hypopituitary
Gilbert syndrome

27
Q

Define breast milk jaundice

A

Components of breast milk inhibit processing of bilirubin, more likely to become dehydrated by inadequate feeding, poor feeding leads to slow stools worsening excretion of bilirubin

28
Q

Define haemolytic disease of the newbord

A

Caused by incompatibility between the rhesus antigens on the surface of the red blood cells of the mother and fetus.

29
Q

Investigations in jaundice

A

FBC and film
Bilirubin
Blood typing
Direct coombs test
Thyroid function
Blood and urine cultures
G6PD deficiency

30
Q

Management of jaundice

A

Treatment graphs
Phototherapy
Exchange transfudion

31
Q

When should bilirubin be measured following phototherapy

A

12-18 hours after stopping

32
Q

What is associated with preterm birth

A

Social deprivation
Smoking
Alcohol
Drugs
Over or under weight
Maternal co-morbidities
Twins
Personal or FH

33
Q

Short term complications of preterm delivery

A

Respiratory distress
Hypothermia
Hypoglycaemia
Poor feeding
Apnoea
Bradycardia
Neonatal jaundice
Intraventricular haemorrhage
Retinopathy or prematurity
Necrotising enterocolitis
Immature immune system and infection

34
Q

Long term complications of premature delivery

A

Chronic lung disease of prematurity
Learning and behavioural difficulties
Susceptibility to infections - particularly resp
Hearing and visual impairment
Cerebral palsy

35
Q

Define apnoea of prematurity

A

Define as period where breathing stops spontaneously for more than 20 seconds or shorter periods with oxygen desaturation or bradycardia.

36
Q

Causes of apnoea or prematurity

A

Immature autonomic nervous system
Infection
Anaemia
Airway obstruction
CNS pathology
Gastro-oesophageal reflux
Neonatal abstinence

37
Q

Management of apnoea of prematurity

A

Monitoring
Tactile stimulation
Intravenous caffiene
Settle as development happens

38
Q

Define retinopathy of prematurity

A

Condition affecting preterm babies - abnormal development of blood vessels in the retina can lead to scarring, retinal detachment and blindness.

39
Q

Management of retinopathy of prematurity

A

Systematically targeting areas of the retina to stop new blood vessels developing
Transpupillary laser photocoagulation
Cryotherapy
Injections of VEGF inhibitors
Surgery for complications

40
Q

Define necrotising enterocolitis

A

NEC is a disorder affecting premature neonates, where part of the bowel becomes necrotic leading to perforation, peritonitis and shock.

41
Q

Risk factors for NEC

A

Very low birth weight
Very premature
Formula feeds
Respiratory distress
Assisted ventilation
Sepsis
Patent ductus arteriosus

42
Q

Presentation of NEC

A

Intolerance to feeds
Vomiting - green bile
Generally unwell
Distended tender abdomen
Absent bowel sounds
Blood in stools
Peritonitis and shock

43
Q

Investigations in NEC

A

Bloods - FBC, CRP, gas, culture
Abdo xray

44
Q

What is seen on xray in NEC

A

Dilated loops of bowel
Bowel wall oedema
Pnumatosis intestinalis - gas in bowel wall
Pneumoperitoneum - perforation
Gas in portal veins

45
Q

Management of NEC

A

Nil by mouth
IV fluids
TPN
Antibiotics
NG to remove gas
Surgical emergency - removal of dead bowel

46
Q

Complications of NEC

A

Perforation
Peritonitis
Sepsis
Death
Strictures
Abscess formation
Recurrence
Long term stoma
Short bowel syndrome

47
Q

Define neonatal abstinence syndrome

A

Withdrawal symptoms that happen in neonates of mothers that used substances during pregnancy

48
Q

Substances causing neonatal abstinence syndrome

A

Opiates
Methadone
Benzodiazepines
Cocaine
Amphetamines
Nicotine or cannabis
Alcohol
SSRI

49
Q

Clinical signs of abstinence syndrome

A

Irritability
Icreased tone
High pitched cry
Not settling
Tremors
Seizures
Yawning
Sweating
Unstable temp
Tachypnoea
Poor feeding
Regurgitating
Hypoglycaemia
Loose stools
Sore nappy area

50
Q

Management of abstinence syndrome

A

Lots of monitoring
replacement of substance - morphine

51
Q

Define fetal alcohol syndrome

A

Certain effects and characteristics that are found in children of mothers that consumed significant amounts of alcohol during pregnancy

52
Q

Features of fetal alcohol syndrome

A

Microcephaly
Thin upper lip
Smooth flat philtrum
Short palpebral fissure
Learning disability
Behavioural difficulties
Hearing and vision problems
Cerebral palsy

53
Q

Features of congenital rubella syndrome

A

Cataracts
Congenital heart disease
Learning disability
Hearing loss

54
Q

Features of congenital varicella syndrome

A

Severe - pneumonitis, hepatitis or encephalitis
Fetal varicella syndrome
Neonatal varicela
Fetal growht restriction
Microcephaly
Hydrocephalus
Learning dificulties
Scars and skin changes - following dermatomes
Limb hypoplasia
Cataracts and inflammation in eye

55
Q

Features of congenital cytomegalovirus

A

Fetal growth restriction
Microcephaly
Hearing loss
Vision loss
Learning disability
Seizures

56
Q

Clasic triad in congenital toxoplasmosis

A

Intracranial calcification
Hydrocephalus
Chorioetinitis

57
Q

Define sudden infant death syndrome

A

A sudden unexplained death in an infant - cot death, uaually within the first six months

58
Q

Risk factors for SIDS

A

Prematurity
Low birth weight
Smoking during pregnancy
Male baby

59
Q

How to minimise risk of SIDS

A

Put baby on back when not supervised
Keep head uncovered
Place feet at foot of bed to prevent sliding down under blanket
Keep cot clear of toys and blankets
Maintain comfortable room temperature - 16-20
Avoid smoking - dont handle after smoking
Avoid sleeping in the same bed - especially if drinking alcohol, drugs smoking sleeping tablets or sleep disorders

Med Finals - Paediatrics (17 decks)

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