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Written exam > Neonates > Flashcards

Neonates Flashcards

1
Q

Risks to newborn of maternal DM with insulin

A

2-3x greater risk of congenital abnormality
- Sacral agenesis (caudal regression syndrome)
- Situs inversus
- Holoprosencephaly
- Congenital heart disease

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2
Q

Risks to newborn of maternal HTN

A

Before 20/40: miscarriage
After 20/40:
- IUGR
- placental insufficiency
- placental abruption or previa

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3
Q

Risk to newborn of maternal hyperthermia

A

Days 14-30 after conception increases the risk of NTDs

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4
Q

Risk to newborn of SLE

A

Before 20/40: miscarriage
After 20/40:
- still birth
- prematurity
- congenital heart block

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5
Q

Risk of maternal parvovirus B19 (causes erythema infectiosum - 5th disease)

A

Infection btwn 10 & 24 wks can result in 10% risk of foetal severe anaemia, heart failure, hydrops fetalis, and death

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6
Q

Risk of maternal varicella

A

Infection during 1st trimester (8-20wks) can result in 1-2% risk of limb reduction defects, IUGR, microphthalmia, chorioretinitis, skin scarring, DD, microcephaly

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7
Q

Risk of maternal CMV

A

Before 27 wks, 5% risk of symmetric IUGR, microcephaly, periventricular calcifications, intellectual disability, hearing loss

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8
Q

Risk of maternal rubella

A

0-8 wks - deafness (85%)
9-12 wks - cataracts (52%)
12-30 wks - heart defects (16%)

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9
Q

Toxoplasmosis

A

Increasing risk as GA increases
- Hydrocephalus
- Blindness
- Intellectual disability

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10
Q

Maternal syphilis -> congenital syphilis

A

Esp after 5 mths GA
- Abnormal teeth and bones
- Intellectual disability
- Proteinuria

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11
Q

Maternal HSV -> neonatal HSV

A

Local infection - skin, eyes, mouth
CNS - HSV encephalitis
Both local and CNS

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12
Q

TORCH

A

Toxoplasmosis
Other (syphilis, parvovirus)
Rubella
CMV
HSV

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13
Q

Most common causes of neonatal sepsis

A

GBS, E Coli

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14
Q

Clinical features of neonatal sepsis

A

APGARS <6
Temperature instability
Resp distress
Lethargy
Irritability
Poor feeding
Tachycardia
Bradycardia - uncommon

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15
Q

Describe TTN

A

In late pre-term infants 34-37 wks
Inadequate clearance of lung fluid at birth
Present with tachypnoea, grunting, nasal flaring, mild intercostal/subcostal recessions, cyanosis
OE: chest clear
CXR: prominent pulmonary vasculature, fluid in the fissures, flattening of the diaphragms (from overaeration), plural fluid
NO air bronchograms or reticular granularity (present in RDS)

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16
Q

CXR TTN

A

Prominent pulmonary vasculature, fluid in the fissures, flattening of the diaphragms (from overaeration), plural fluid
NO air bronchograms or reticular granularity (present in RDS)

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17
Q

Incidence of RDS

A

Inversely proportional to gestational age
White males > F

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18
Q

Describe RDS

A

Due to surfactant deficiency and immature alveoli
Surfactant reduces alveolar surface tension, which decreases the pressure which is required to keep alveoli inflated
Alveoli don’t expand adequately -> atelectsis, less functional RC, inadequate ventilation of the lungs, hypercapnia, hypoxaemia

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19
Q

Surfactant constituents and production

A

1) Lecithin (65%)(dipalmitoylphosphatidylcholine)
2) Surfactant proteins SP-A, -B, -C, -D (phosphatidylglycerol, apoproteins)
3) Cholesterol
As GA increases, more surfactant is synthesised and stored in Type II alveolar cells.
Mature levels at >35 wks GA

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20
Q

CXR RDS

A

Low lung volumes
Air bronchograms
Diffuse, fine, reticulogranular ground glass haziness

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21
Q

DDx RDS

A

In setting of hypoxia, hypercapnia and metabolic acidosis -
GBS sepsis
Congenital heart disease

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22
Q

Ante and perinatal corticosteroid treatment to prevent RDS

A

Given at 23-24 wks if risk of preterm labour
+/- 34-36 wks - betamethasone or dexamethasone
Intratracheal surfactant therapy within 30-60 mins of delivery

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23
Q

Indications for prophylactic abx for GBS

A
  • Positive 36 wk vaginal/rectal culture
  • Prior infant with GBS
  • GBS bacteruria during pregnancy
  • Unknown culture in setting of fever, preterm labour or PROM
24
Q

Neonatal resp syndromes

A

TTN - wet lungs
RDS - surfactant def.
GBS
PPHN
Apnoea - CNS/ob/mixed
MAS
CDH
PTX
Pneumomediastinum
BPD
Pulm haemorrhage

25
Q

Describe PPHN

A

Pulmonary vascular resistance remains elevated after birth, causing pulm-systemic (R-L) shunting of blood via fetal circulatory pathways (aka PDA or PFO).
Causes severe hypoxia refractory to O2 administration

26
Q

PPHN - O2 requirements

A

O2 requirements vary widely within a relatively short period of time as PVR frequently oscillates. Observed clinically as SpO2 lability.

27
Q

PPHN - risk factors

A

MAS, RDS, CDH
Pulmonary infections
Pulm hypoplasia
Hyperviscosity or polycythaemia
Birth asphyxia
Sepsis
Hypoglycaemia
Hypothermia
Maternal NSAID or SSRI use
In utero closure of ductus arteriosus

28
Q

PPHN - CVS signs

A

Prominent precordial pulse
Tricuspid regurg (harsh systolic murmur LLSB)
Loud, narrowly split 2nd heart sound (P2)

29
Q

PPHN - ECHO findings

A

Elevated pulm artery pressure
Atrial septal flattening
R-L shunting of blood across DA or FO

30
Q

Neonatal apnoea causes

A

Most frequent - sleep associated hypoxaemia and GOR
Also - infections, CNS, metabolic, cardiac, drug, environmental and anatomic

31
Q

Newborn periodic breathing

A

Respiratory pauses of 5-10 secs with < 20 secs of resp btwn pauses
Normal in premature infants and resolves with age

32
Q

Apnoea of prematurity

A

Periodic breathing WITH apnoea (> 20 secs), occurs in preterms.
Usually resolves by 37 wks

33
Q

Side effects of caffeine (used to stimulate resp drive)

A

Jitteriness
Tachycardia
GI distress
Feeding intolerance

34
Q

MAS - factors that cause in utero passage of meconium

A

Placental insufficiency
Maternal HTN
Oligohydramnios
Maternal substance use
Chorioamnionitits
Fetal distress/hypoxia

35
Q

CXR MAS

A

Patchy infiltrates
Later progress to hyperinflation with flattening of the diaphragm
PTX and air leaks are common due to ball valve effect of mec plugs

36
Q

Most common type of oesophageal atresia?

A

Type C (blind pouch + distal tracheal oesophageal fistula)

37
Q

Presentations at birth that warrant screening for CMV

A

IUGR and prematurity
Jaundice
Thrombocytopaenia
Microcephaly

38
Q

Components of APGAR score

A

Appearance (colour)
Pulse
Grimace (reflex irritability)
Activity (tone)
Respirations

39
Q

Causes HIGH maternal alpha fetoprotein

A

Neural tube defects (e.g., spina bifida, anencephaly)
GI: Omphalocele, gastroschisis
Sacrococcygeal teratoma
Placental abnormalities
Cystic hygroma
Renal: polycystic kidney or absent kidney, urinary obstruction, congenital nephrosis
Osteogenesis imperfecta
Threatened abortion
Decreased maternal wt
IUGR

40
Q

Causes low AFP

A

Down syndrome
Increased maternal weight
Fetal demise
Hydatidiform mole
Trisomy 18 (Edward Syndrome)
Incorrect gestational age (older than calculated)

41
Q

Acute bilirubin encephalopathy and kernicterus pathophysiology

A

Bilirubin deposition in the basal ganglia and certain brainstem nuclei

42
Q

Acute bilirubin encephalopathy and kernicterus signs

A

Hypertonia
Retrocollis (neck ext)
Opisthotonos
Recurrent apnoea

43
Q

Acute bilirubin encephalopathy and kernicterus sequelae

A

Athetoid CP
SN deafness
Seizures
Developmental delay
Neuro-cognitive impairment
Oculomotor dysfunction

44
Q

TSB escalation of care threshold

A

34 umol/L below the exchange transfusion threshold

45
Q

DDx hyperbilirubinaemia

A

Isoimmune haemolytic disease (Rh disease)

46
Q

What’s a subgaleal haemorrahge?

A

Haemorrhage btwn the aponeurosis and periostium

47
Q

What’s a caput succedaneum?

A

Fluid btwn the periosteum and the scalp

48
Q

What’s a cephalohaematoma?

A

Haemorrhage between the periosteum and the skull

49
Q

What is sodium valproate used for?

A

GTC, absence, myoclonic, partial, akinetic

50
Q

Carbamazepine

A

GTC, partial

51
Q

Clonazepam

A

Absence, myoclonic, infantile spasms, partial, Lnnox-Gastaut, akinetic

52
Q

Phenytoin

A

GTC, partial, status

53
Q

Vigabatrin

A

Infantile spasms (with steroids), TS (no steroids)

54
Q

1st line AED for absence seizures?

A

Sodium valproate

55
Q
A

Written exam (14 decks)

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