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Peadiatrics > Neonates > Flashcards

Neonates Flashcards

1
Q

Define term? Preterm? Neonate?

A

T- birth at 37-42 weeks gestation
P- birth before 37 weeks
Neonatal period - first month of life

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2
Q

Diabetes mellitus effect on fetus?

A

Congenital malformations - 3x more esp cardiac

Macrosomia- fetal insulin response to hyperglycaemia promotes excessive growth

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3
Q

Maternal Diabetes mellitus effect on neonate

A

Hypoglycaemia - transient due to increased insulin (avoid with early feeding)
Respiratory distress syndrome
Polycythaemia (haematocrit >0.65)

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4
Q

Which antiepileptic have effect on fetus? What is the effect ?

A

carbamazepine, valproate, phenytoin.

Mid facial hypoplasia; CNS, limb & cardiac malformations

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5
Q

Which drug used in blood has an effect on fetus and what does it do?

A

Warfarin

Interferes with cartilage formation; cerebral haemorrhages & microcephaly

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6
Q

What are the effects of amiodarone on the fetus

A

Hypothyroidism

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7
Q

Use of iodines/ propylthiouracil in pregnancy on fetus?

A

Goitre / hypothyroidism

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8
Q

Effect of lithium in pregnancy

A

Congenital heart disease

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9
Q

Use of tetracyclines in pregnancy

A

Enamel hypoplasia of the teeth

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10
Q

ACEi in pregnancy

A

Host of things including renal agenesis, CHD…..

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11
Q

Effect of alcohol on fetus

A

Growth restriction, characteristic face, cardiac defects, developmental delay

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12
Q

What are the characteristic facial features of fetal alcohol syndrome

A

Low nasal bridge, epicanthal folds, short palperbral fissure, flat mid face, short nose, indistinct philtrum, micrognathia

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13
Q

Smoking risks to fetus

A

Miscarriage & stillbirth, low birth weight, IUGR

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14
Q

Opiates effect on fetus

A

Prematurity, neonatal withdrawal, IUGR

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15
Q

Cocaine effect on fetus

A

Small placenta, prematurity, cerebral infarction, spontaneous abortion

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16
Q

Egs of congential infections causing issues

A

Rubella, cytomegalovirus, toxoplasmosis, varicella zoster, HIV

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17
Q

Effects of maternal rubella infection at different stages of pregancy

A

Before 8/40 - deafness, cardiac malformations, cataracts
13-16/40 - hearing impairment
>18/40 - minimal

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18
Q

Usual effect of CMV in pregancy

A

90% born normal

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19
Q

What are the clinical features if baby is affected by maternal CMV infection during pregnancy

A

Hepatosplenomegaly & petichae at birth

Neurodevelopmental problems - sensorineural deafness, CP, epilepsy, cognitive impairment

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20
Q

What type of organism causes toxoplasmosis? What are the effects on fetus ? Where is it found?

A

Protozoan (toxoplasma gandis)
Hydrocephalus; intracranial calcification; clorioretinitis; neurological damage.
Raw/undercooked meat, infected cat feaces

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21
Q

Usual effect on fetus with varicella zoster?

A

Unaffected

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22
Q

What can happen to fetus with maternal varicella zoster infection? What is the treatment ?

A

Congenital varicella syndrome - skin lesions, malformed digits, cataracts, CNS damage, chlorioretinitis

Varicella zoster immune globulin (VZIG) in susceptible women

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23
Q

What is the risk of transmission of HIV from mother to fetus? How is this minimised ?

A

1%

Zidovudine to mother in pregancy & labour & neonate for first 6/52 of life

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24
Q

Egs of drugs and fluids used in labour and effects on fetus

A

IV fluids - hyponatraemia in neonate
Analgesia (opioids) - respiratory suppression at birth
Sedatives (eg diazepam) - sedation, hypothermia, hypotension

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25
Q

What is the scoring system used at birth to make sure fetus is ok? What are the parts?

A

Apgar score
Heart rate, respiratory effort, muscle tone, reflex response to stimulation (crying), colour (blue/just- extremities, pink)

All score 0,1 or 2 (2 is best )

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26
Q

What do you do if baby is not breathing / there is a poor respiratory effort? What if there is no improvement?

A

Stimulate, open and clear airway - bag and mask

No improvement + HR

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27
Q

Egs of benign lesions in newborn

A

Neonatal urticaria (erytherma toxicum)
Miliaria
Mangolian blue spots
Positional talipes

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28
Q

What is neonatal urticaria

A

Common rash at 2-3/7
white, pin point papules at centre of erythermatous base
(Fluid contains eosinophils; lesions concentrated on trunk but can come and go all over)

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29
Q

What are miliaria

A

White pimples on the nose and cheeks from retention of keratin and sebaceous material

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30
Q

What are Mongolian blue spots ? Who are they found in usually?

A

Blue / black macular discolouration at lower spine / buttocks

Asian / Afro Caribbean

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31
Q

What are positional talipes

A

Unlike true talipes equinovarus, the foot can be fully dorsiflexed to touch shin (just due to positioning in womb)

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32
Q

What are the two categories (and egs) for causes of IUGR

A

Intrinsic fetal problem - chromosomal disorders, congenital infections, small normal fetus

Placental insufficiency (asymmetrical small growth - brain sparring effect) - pre eclampsia, multiple pregancy, sickle cell disease

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33
Q

Where can a fetus bleed / Bruise due to birth injuries ? What are they called ? How to differentiate ?

A

Look at image for help / card 136
Caput succadaneum - brusing/ odema over presenting part (Extends OVER skull margins)
Cephal haematoma - subperiosteal haematoma (Doenst cross skull margins)
Subaponeurotic haemorrhage - diffuse swelling of scalp with ++ blood loss (rare)

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34
Q

Egs of nerve palsy coming from brachial plexus ? What causes these palsys

A

Erb’s, Klumpke’s

Damage due to traction of nerve roots from breech presentation / shoulder dystocia

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35
Q

Which nerve roots affected in Erb’s palsy? Features?

A

Upper never roots C5/6

Straight arm with hand pronated and fingers flexed (“waiters tip”)

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36
Q

Which nerve roots are affected in Klumpke’s palsy ? Features?

A

Lower nerve root damage c8/t1

Supinated forearm with wrists and fingers flexed “claw hand”

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37
Q

What causes facial nerve palsy? What are the features

A

Foceps or pressing against ischial spine of mother

Unilateral facial weakness

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38
Q

Prognosis of nerve palsys

A

90% resolve in 2 years

39
Q

Causes of respiratory distress syndrome

A

SURFACTANT DEFICIENCY, hyaline membrane disease

40
Q

What does surfactant do

A

Lowers alveolar surface tension & prevents collapse on expiration

41
Q

Who commonly gets RDS

A

Infants born before 28 weeks

42
Q

Features of RDS

A

Tachypnea (

43
Q

What investigation can be done in RDS? What does it shoe?

A

Chest X-ray - defuse granular “ground glass” appearance

44
Q

Management of lack of surfactant -> RDS

A

Before birth - glucocorticoids -> stimulate surfactant production
After birth - surfactant therapy, oxygen (+/- CPAP intubation)

45
Q

What does CPAP intubation stand for

A

Continuous positive airway pressure

46
Q

Complications of intubation for RDS

A

Pneumothorax - increased WOB, decreased breath sounds & movement on affected side, transilluminates

47
Q

Treatment of pneumothorax

A

Chest drain and try to avoid by ventilating with lowest pressures possible

48
Q

Who commonly gets apnoea attacks ? How long do they last? What is the cause ? Predisposing factors?

A

Very low birthweight (

49
Q

Treatment for apnea attacks ? If they are frequent?

A

Breathing usually restarts with *physical stimulation *

Freq with no underlying cause - oral caffine (+CPAP if severe)

50
Q

How does caffeine work ?

A

Phosphodiesterase inhibitor

51
Q

Who commonly gets PDA? Features? Treatment?

A

Preterm esp. With RDS
Bounding pulse, hyper dynamic precordium + systolic murmur
Usually closes spontaneously but prostaglandin inhibitors (eg ibuprofen ) if it doesn’t

52
Q

What is necrotising enterocolitis (NEC) ? Risk factors?

A

Necrosis of bowel secondary to infection & ischemia.

Rapid oral feeding with cows milk formula; prematurity; asphyxia; PDA

53
Q

What are the features of NEC

A

Distended abdomen, vomiting (can be bilious), bloody stools

54
Q

What’s seen on abdo X-ray of NEC ?

A

Distended loops of bowel with mural thickening and intramural gas

55
Q

Initial Treatment for NEC ? What can be done for necrosed segment?

A

Stop oral feeds, gastric aspiration & parenteral nutrition (TPN)
Broad spectrum Abx - penicillin, gentamicin & metronidazole
Ventilation & circulatory support often required

Surgical resection

56
Q

When does the suck reflex develop?

A

32-34/40

57
Q

Where does intracranial haemorrhage usually occur ? What is the effect?

A

Germinal matrix / ventricles
Small - no sequale
Large - risk of cerebral palsy

58
Q

What can happen with a large ventricular haemorrhage

A

Decrease CSF absorption -> hydrocephalus

59
Q

What are the causes of periventricular white matter injury ? How can it be seen?

A

Follow ischemia / inflammation (with/out haemorrhage)

Appear as ‘flare’ of echo density in brain parenchyma on cranial USS

60
Q

What is it called if there is multiple bilateral cysts on the periventricular white matter? What is this a risk for?

A

periventricular leukomalacia

80% risk of spastic diplegia

61
Q

Risk factors for intracranial haemorrhage / periventricular White matter injury? What is important here?

A

Pneumothorax, asphyxia, hypotension, hypoxia

They are all complications of RDS

62
Q

What is retinopathy of prematurity also called? What is it? What can it lead to? What are the risk factors?

A

Retrolentral fibroplasia - disease of blood vessels at junction of vascular & non-vascular retina -> vascular proliferation -> retinal detachment, fibrosis & blindness.
hyperoxia (PaO2 > 12kPa); ver low birth weight;

63
Q

What is chronic lung disease of prematurity also called? What is it?

A

Bronchiopulmonary dysplasia - oxygen requirement beyond 36/40 (or 28 days old if that occurs first)

64
Q

What causes BPD

A

Pressure and volume trauma from artificial ventilation, oxygen toxicity & infection

65
Q

Treatment of BPD ? Risk of with this?

A

Continued respiratory support + corticosteroids (dexamethasone) to try and wean off
Neurodevelopmental problems

66
Q

What’s seen on chest X-ray of BPD

A

Widespread opaque often with cystic changes

67
Q

What concentration of serum bilirubin to appear jaundiced ?

A

Over 80-120umol/L

68
Q

If there is jaundice in first 24 hours of life what type of bilirubin is it? Due to? Egs?

A

Always pathological - unconjugated usually due to haemolysis
1 - haemolytic disease of the newborn - Rh / ABO incompatibility
2- intrinsic RBC defects: sphereocytosis, G6PD deficiency

69
Q

When do you get Rh incompatibility

A

Rh -ve mother with Rh +ve baby

70
Q

When do you get ABO incompatibility with baby? What does this cause ?

A

Group O mother with group A (sometimes B) baby

Competitively weak anti-A (or B) haemolysins -> mild anaemia, no organomegally, weakly +ve Coombs test

71
Q

Jaundice at 2days - 3 weeks causes? Type of bilirubin ?

A

Infection (esp UTI)
‘Breast milk’ jaundice
Physiological - diagnosis of exclusion

Unconjugated

72
Q

When does the term ‘persistent neonatal jaundice’ get used? What is the usual type of bilirubin?

A

Over 3 weeks
Unconjugated
Can tell conjugated as dark urine & pale stools, hepatomegally & poor weight gain may be present

73
Q

Causes of conjugated bilirubaemia at over 3 weeks ?

A

Neonatal hepatitis syndrome

biliary atresia

74
Q

Which bilirubin can cross the brain and cause kernicterus ?

A

Unconjugated

75
Q

Management of neonatal jaundice ? Indications for more aggressive option?

A

Phototherapy - light in blue/green band breaks down unconjugated bilirubin

Exchange transfusion - indicated if bilirubin +++, associated anaemia or if serum albumin is low

76
Q

What wavelength of blue/green light

A

450nm

77
Q

What are the long term risk of neonatal jaundice

A

dyskinetic CP, sensorineural deafness, learning difficulties

78
Q

Egs of respiratory distress / causes in term infants

A

Transient tachypnea of newborn
Meconium aspiration
Diaphragmatic hernia
Persistent pulmonary hypertension of the newborn

79
Q

What causes transient tachypnea of the newborn? What’s seen on chest X-ray? Treatment and prognosis?

A

Delay in reabsorbtion of the fetal lung fluid (more common in c-section)
Prominent pulmonary vasculature with fluid in horizontal fissure
Additional oxygen if required - can take several days to resolve

80
Q

When do you get meconium aspiration ? What happens ?

A

Fetal distress -> meconium being passed into amniotic fluid and inhaled by infant.
Lungs are overinflated with patches of collapse and consolidation

81
Q

What happens in a diaphragmatic hernia? When is it usually diagnosed? What’s seen on X-ray ? Treatment?

A

Abdo contents enter through hole in diaphragm (usually on left side)
Antenatal USS
Mediastinum shifted to right
Surgery

82
Q

What is persistent pulmonary hypertension of newborn? What is it also called?

A

Persistent fetal circulation

Failure of fetal circulation to switch to normal (less to lungs)

83
Q

What often occurs with persistent fetal circulation?

A

Birth asphyxia, RDS, meconium aspiration, septicaemia

84
Q

What happens in persistent fetal circulation

A

Increased pulmonary vascular resistance leads to R->L shunting and sever cyanosis

85
Q

What’s seen on chest X-ray of persistency fetal circulation ?

A

Heart normal size, pulmonary oligaemia (decreased blood flow)

86
Q

Why is an echo done in persistent fetal circulation

A

To exclude CHD

87
Q

Treatment of persistent fetal circulation

A

Assisted ventilation
Inhaled nitric oxide (vasodilation)
Sidenafil (viagra)

88
Q

2 craniofacial abnormalities needing surgery?

A

Cleft lip/palate

Pierre-robin sequence

89
Q

What happens in Pierre robin sequence?

A

Micrognathia (small jaw); posterior displacement of tongue; midline cleft/soft palate

90
Q

What often occurs with oesophageal atresia ? What are the features if not diagnosed at birth

A

TOF & polyhydroaminos

Persistent salivation & drooling with coughing / choking & cyanotic episodes (esp after feeding)

91
Q

What’s common with oesophageal atresia ?

A

50% have other malformations VACTERL association

Vertebral, Anorectal, Cardiac, TracheoEsophageal, Renal & Limb

92
Q

What is exomphalos

A

Abdo contents protude through umbilicus covered in transparent sac formed by amniotic membrane and peritoneum

93
Q

What is gastroschisis

A

Bowel protrudes through anterior abdo wall adjacent to umbilicus with no covering sac

94
Q

Treatment for exomphalos / gastroschisis?

A

Wrap in cling film to decrease fluid and head loss

Supportive therapy and surgery may be needed

Peadiatrics (14 decks)

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