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FOP/TAS > neonates > Flashcards

neonates Flashcards

1
Q

describe vitellointestinal duct remnant

A

two loops of bowel can intertusscept at the duct to cause ‘rams horn’ appearance

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2
Q

presentation of choanal atresia

A

cyanotic when feeding - improve when crying
unable to pass NG tube
part of CHARGE syndrome

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3
Q

embryological cause of CDH

A

failure of pleuroperitoneal canals to close

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4
Q

newborn problems born to gestational diabetic mums

A
  1. hypoglycaemia
  2. resp distress syndrome - delayed maturation, due to IGF-1
  3. hypertrophic cardiomyopathy
  4. polycythaemia
  5. macrosomia
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5
Q

how to manage hypo in newborns

A
  1. bolus 2.5mls/kg 10% dextrose
  2. fluid maintenance 60mls/kg 10% dex
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6
Q

features of maternal use of phenytoin in baby

A

flat nasal bridge
strabismus
ptosis
neck webbing
VSD + ASD

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7
Q

features of maternal warfarin use in pregnancy

A

short limbs
microcephaly
cerebral haemorrhages
nasal hypoplasia

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8
Q

features of ACE- I use in pregnancy

A

renal tubular agenesis
oligohydramnios
neonatal anuria
IUGR

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9
Q

causes of polyhydramnios

A
  1. idiopathic
  2. duodenal atresia, oesophageal atresia, CDH
  3. myotonic dystrophy, SMA
  4. Barters syndrome
    5, maternal diabetes
  5. trisomy
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10
Q

features of rubella infection in pregnancy

A
  1. cardiac - pulmonary stensosis, PDA, cardiomegaly
  2. ocular - cataracts, retinitis
  3. hearing defects - deafness
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11
Q

features of cytomegalovirus infection in pregnancy

A
  1. intraventricular calcifications
  2. sensorineural hearing loss
  3. IUGR
  4. microcephaly
    5.cataracts
  5. purpuric rash
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12
Q

test for CMV in prgenancy

A

CMV PCR

AVOID TODDLER URINE

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13
Q

Features of toxoplasmosis in pregnancy

A
  1. hydrocephalus - macrocephaly
  2. cerebral calcifications
  3. acute fundal chorioretinitis - hyperpigmented lesions around macula, leukocoria
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14
Q

features of varicella zoster infection in pregnancy

A

severe scarring of the skin
cataracts / corneal clouding
limb/ digital dysplasia/ hypoplasia
vesicular rash
high rate of mortality

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15
Q

features of syphilis infection in pregnancy

A

rash/ peeling hands and feet
jaundice
sepsis
IUGR

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16
Q

guthrie heelprick test for which conditions

A
  1. PKU
  2. hypothyroidism - most common
  3. maple syrup urine
  4. galactossaemia
  5. MCADD - high false +ve
  6. cystic fibrosis
  7. isovaleric acidaemia
  8. glutaric aciduria type 1
  9. homocystinuria

repeat test on day 28 if born < 32/40

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17
Q

how is maple syrup urine disease tested

A

high leucine levels

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18
Q

how is MCADD tested in heel prick test

A

high otctanolycarnitine

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19
Q

signs of vit K deficiency

A

bruising
malaena
prolonged bleeding
intracranial haemorrhage

present 1-8 weeks of life (usually day 3-7)

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20
Q

drugs that impair vit K

A

rifampicin
anti epileptics
warfarin

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21
Q

management if bleeding and no vit K at birth

A
  1. IV vit K
  2. fresh frozen plasma
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22
Q

test results for vit K deficiency

A
  1. prolonged PT
  2. prolonged APTT
  3. fibrinogen and thrombin time normal
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23
Q

what is erythema toxicum

A

white pin point palpules with red base in first 2-3 days of life

fluid contains EOSINOPHILS

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24
Q

newborn hearing test

A

otoacoustic emission testing

if fails, auditory brainstem response

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25
Q

what does breast milk contain

A
  1. 90% water
  2. carbohydrate - lactose *
  3. lipid - cholesterol, omega 3, long chain, 50% total energy for grey matter development and myelination
  4. protein - 0.9g/dl, whey protein *, lactoferrin
  5. igA
  6. vit A rich
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26
Q

what is colostrum

A

thick sticky fluid 3-4 days after delivery
increase gut motility and reduced neonatal jaundice
1st immunisation

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27
Q

disadvantages of BF

A

low in vit D
cannot breast feed if HIV +ve
complications - mastitis, engorgement, sore
contraindicated in PKU and galactosaemia

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28
Q

advantages of BF

A

immunity and protection
36% reduction in SIDS
protects against severe eczema
+ve effect of intelligence
reduces obesity
protects against T2DM
reduced prevalence of NEC

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29
Q

antibodies to rhesus antigens

A

IgG

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30
Q

antibodies to AB blood groups

A

IgM

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31
Q

diagnosis of polycythaemia

A

venous blood haematocrit > 65%

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32
Q

management of polycythaemia

A

if neonate symtpomatic or haematocrit >70% : partial exchange transfusion (remove blood and replace with 0.9% saline and aim haematocrit 50%)

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33
Q

common causes of early onset neonatal sepsis

A
  1. group B strep !!
  2. E.coli - common in preterm, low BW
  3. listeria - granulomatous rash (pale nodules), mec liquor
  4. h.influenza
  5. herpes
  6. enterovirus
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34
Q

common causes of late onset neonatal sepsis (>72 hours - 90 days of life)

A
  1. coag neg staph -(staph epidermidis) common cause of line infections
  2. e.coli
  3. klebsiella
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35
Q

red flags for neonatal sepsis

A
  1. suspected or confirmed infection in another baby
  2. apnoea
  3. seizures
  4. need for CPR
  5. need for mechanical ventilation
  6. signs of shock
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36
Q

risk factors for neonatal sepsis

A
  1. PROM >18 HOURS in pre term or >24 hours in term
  2. preterm < 37 weeks
  3. GBS in previous or current pregnancy
  4. chorioamnionitis
  5. altered behaviour/ floppy
  6. intrapartum fever
  7. feeding difficulties
  8. signs of resp distress
  9. jaundice within 24 hours
  10. temp abnormality
  11. metabolic acidosis
  12. altered glucose regulation
37
Q

management of early onset neonatal sepsis

A

benzylpenicillin + gentamicin

+ CRP, lumbar puncture and blood cultures

38
Q

presentation of meckels diverticulum

A

lower GI bleeding
intussusception
small bowel volvulus

39
Q

test for meckels diverticulum

A

technetium 99m scan

40
Q

cause of duodenal atresia

A

failure of vacuolation and recanalisation of duodenum at 7 weeks

41
Q

risk factors for duodenal atresia

A

trisomy 21
CF
prader willi
congenital heart disease
diaphragmatic hernia
oesophageal fistula

42
Q

duodenal atresia signs antenatal

A

polyhydramnios
double bubble sign

43
Q

presentation of duodenal atresia

A
  1. bilious vomiting in 1st few dayd of life (20% non bilious if before ampulla of vater)
  2. abdo distension
44
Q

management of duodenal atresia

A
  1. XR - double bubble
  2. NG tube to decompress stomach
  3. open laparotomy surgery
45
Q

risk factors for NEC

A
  1. preterm
  2. low birth weight
  3. smoking
  4. formula feeding / enteral feeds
  5. placental insufficiency/ abruption
  6. hypoxia, shock
  7. anaemia
46
Q

presentation of NEC

A
  1. shocked baby
  2. blood in stool
  3. abdo distension
  4. bilious vomiting and diarrhoea
47
Q

x ray findings in NEC

A

pneumoperitoneum * - perforation
bowel wall oedema
intramural gas
portal venous gas

48
Q

management of NEC

A
  1. bloods (metabolic acidosis, high lactate), cultures, prolonged PT/APTT
  2. NG tube and NBM
  3. IV fluids
  4. antibiotics for 14 days
  5. surgery if perforate or medical treatment not working
49
Q

describe hirschsprungs disease

A

failure of neural crest cells from neuroectoderm to migrate and populate distal colon causign absence of ganglion cells.

50
Q

presentation of hirschsprungs disease

A
  1. failure to pass meconium in first 48 hours
  2. abdo distension
  3. vomiting
  4. poor geeding
51
Q

management of hirschsprungs disease

A
  1. abdo x ray - contrast enema shows transition zone
  2. rectal suction biopsy
52
Q

presentation of HIE

A
  1. MILD - irritable, hyperventilation, hypertonia, impaired feeding
  2. MODERATE - hypotonic, difficulty feeding, seizures
  3. SEVERE - hypotonoa, prolonged seizures
53
Q

coolin criteria for hIE

A

SECTION A
APGARS <5 at 10 mins
resus >10 mins
acidosis < 7 within 60mins
BE >1 WITHIN 60 mins

SECTION B
hypotonia
altered state of consciousness
abnormal primitive reflexes

54
Q

presentation of tracheo-oesophageal fistula

A

resp distress
abdo distension
unable to pass NG tube
excessive salivation
vomiting and choking on feeds

55
Q

antenatal signs of tracheo-oesophageal fistula

A

polyhydramnios
absence of fetal bubble
‘large for dates’

56
Q

causes of neonatal seizures

A
  1. HIE (40%)
  2. intracranial haemorrhage - usually 1st 24 hours of life
  3. hydrocephalus
  4. biochemical - hypoglycaemia, hypocalcaemia, hyponatraemia
  5. inborn errors of metabolism
  6. drug withdrawal
57
Q

1st line management for neonatal seizures

A

phenobarbital - activates GABA-A receptor (side effect = apnoea)

58
Q

cause of spinal muscular dystrophy

A

autosomal recessive
deletion/ mutation of SMN1 gene on chromosome 5
degeneration of alpha motor neurones in anterior horn of spinal cord

59
Q

presentation. of type 1 spinal muscular dystrophy (werdnig hoffman disease)

A

die before < 2 y/o
profound hypotonia and muscle weakness
symmetrical flaccid paralysis
resp distress
poor feeding

60
Q

presentation of type 3 and 4 spinal muscular dystrophy

A

> 18 months old
proximal muscle weakness
absent tendon reflexes

61
Q

describe the common problems of brain injury in preterms

A
  1. haemorrhage (20%) - due to incompletely developed cerebral blood vessels and rupture of germinal matrix. occurs within 72 hours of life
  2. periventricular leukomalacia (3%) - ischaemic white matter injury, high risk of cerebral palsy
  3. ventricular dilatation
62
Q

classification of preterm

A

late preterm: 34- 36+6
moderately preterm: 32 - 33+6
very preterm: 28+0 - 31+6
extremely preterm: < 28 weeks

63
Q

when does retinal blood flow develop

A

retinal blood growth from 28 weeks until 2-4 weeks after birth

64
Q

risk factors for retinopathy of prematurity

A
  1. oxygen therapy
  2. < 31/40 gestation
  3. birth weight < 1.5kg
65
Q

describe retinopathy of prematurity

A

vascular proliferation of retina causing retinal detachment, fibrosis and blindness

66
Q

screening for ROP

A

4-5 weeks post natal age + then every 2 weeks

67
Q

management of ROP

A

laser therapy + intravitreal anti VEGF

68
Q

cause of resp distress syndrome (hyaline membrane disease)

A

insufficient type 2 alveolar cells to produce adequate surfactant (lipoprotein)

69
Q

when is surfactant produced

A

from 24 weeks gestation
maintains alveolar pressure by reducing surface tension and increases functional residual capacity
epithelium - stored in lamellar bodies in type 2 pneumocytes

70
Q

components of surfactant

A

largest component = phosphatidylcholine
SP-B and SP-C

71
Q

x ray of RDS

A

ground glass appearance

72
Q

management of RDS

A
  1. resp support - CPAP maintains end expiratory pressure
  2. surfactant < 1 hour of birth - give < 34 weeks gestation via endotracheal tube
  3. caffeine - increase resp drive
73
Q

resp problems in preterm babies

A
  1. RDS
  2. pneumothorax
  3. apnoea of prematurity
  4. bronchopulmonary dysplasia / chronic lung disease - oxygen requirement > 37 weeks gestation/ 28 days old
  5. pulmonary haemorrhage
74
Q

RF for chronic lung disease

A

prolonged ventilation
high ventilation pressures

75
Q

factors keeping PDA open

A

hypoxia
high blood flow
prostaglandin E2

76
Q

management of closing PDA

A

1st line= ibuprofen (less side effects than indomethacin)

77
Q

when is epidermal maturation complete by

A

34 weeks gestation

78
Q

risk factors for prematurity

A
  1. maternal age < 17 and >35 y/o
  2. lower socio economic class
  3. poor nutritional status, low BMI
  4. substance abuse e.g. smoking, cocaine
  5. previous preterm delivery
  6. infections
  7. chromosomal anomalies
79
Q

when are antenatal steroids given

A

if impending delivery < 35 weeks gestation
betamethasone 12mg x 2 doses 24 hours apart or dexamethasone 6mg X4 12 hours apart

80
Q

calculate minute ventilation

A

tidal volume x rate

determines PCO2

81
Q

types of congenital diaphragmatic hernia

A
  1. bochdalek hernia -> left sided
  2. morgani hernia -> right sided
  3. hiatus hernia
82
Q

cause of CDH

A

maldevelopment of pleuroperitoneal canal
causes pulmonary hypoplasia

83
Q

presentation of CDH

A

severe resp distress
displacement of heart sound / reduced breath sounds
scaphoid anterior abdomen

84
Q

management fo CDH

A
  1. intubate and ventilate (avoid CPAP and face mask Oxygen)
  2. NG tube
  3. iVF
  4. surgery !!!
85
Q

side effect of IV chloramphenicol in babies

A

‘grey baby syndrome’ - cV shcok and collapse due to reduced hepatic glutathione metabolism

86
Q

congenital herpes simplex virus

A

hepatosplenomegaly
cranial USS - oedema
petechial rash and vesicular lesions

87
Q

oxygen requirement for preterm babies

A

Boost II study shows sats 91-95% best for preterm babies

88
Q

muscles of soft palate

A

tensor veli palatini - innervated by medial pterygoid nerve

other 4 muscles innervated by vagus nerve

FOP/TAS (12 decks)

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