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Obs & Gyny - Risk Factors > Neonates > Flashcards

Neonates Flashcards

1
Q

Three categories of neonatal jaundice

A

Physiological (1-14 days) Pathological (<24 hours) Prolonged (>14 days)

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2
Q

Cause of physiological jaundice

A

ABSENCE OF ANAEMIA, MODERATE BILIRUBIN AND shortened RBC lifespan Increased breakdown Low EPO

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3
Q

Pathological jaundice causes (<24 hours)

A
  • METABOLIC + Crigler Najar + Gilbert’s disease - IMMUNE + Haemolytic disease of Newborn - INFECTION + TORCH organisms + Hepatitis B - TRAUMA + Cephalhaematoma
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4
Q

Prolonged jaundice (1-14 days)

A
  • METABOLIC + Galactosaemia + Breast milk jaundice - ENDOCRINE + Hypo/hyperthyroidism
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5
Q

4 causes of conjugated hyperbilirubinaemia

A
  • Neonatal hepatitis - Sepsis - CF - Biliary atresia
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6
Q

Complication of jaundice

A

Kernicterus - EPSEs, visual problems, cognitive impairment

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7
Q

Risk factors for neonatal jaundice

A

1) Sibling with phototherapy 2) Breast fed babies 3) Mothers with diabetes

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8
Q

Other signs to look for in jaundice

A

1) Hepatosplenomegaly 2) Petechiae 3) Microcephaly

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9
Q

Investigations jaundice

A

1) Bilirubin 2) LFTs 3) Infection screen: TORCH, Swabs, Blood culture, Urine Culture 4) Direct Coombs Test in the infant

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10
Q

Management of jaundice (3)

A

Phototherapy Exchange transfusion Monitor bilirubin

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11
Q

Risk factors for IVH (2)

A

Prematurity Low birthweight

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12
Q

Signs of IVH

A

Bulging fontanelle Eye signs Diminished primitive reflexes

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13
Q

Neonatal sepsis presenting

A

Symptoms Seizures Sleeping Reduced movements Diarrhoea Poor feeding Signs Abnormal HR Bulging/depressed fontanelle Decreased/increased temp Hypoxia

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14
Q

Neonatal sepsis investigations

A

UNLESS OBVIOUS BRONCHIOLITIS in Neonate <30 days 1) FBC 2) Blood culture 3) Urinalysis 4) Lumbar puncture 5) Urine culture ALSO CXR

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15
Q

Neonatal sepsis management

A

1) IV penicillin + gentamicin

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16
Q

Neonatal sepsis causative organisms

A

1) GBS, e.coli, Haemophilus influenza 2) If late onset (4-90 days) then Staph aureus, e.coli, candida

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17
Q

What is PPROM?

A

Preterm prelabour rupture of membranes (P-PROM) is the rupture of membranes prior to the onset of labour, in a patient who is at less than 37 weeks of gestation

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18
Q

What are three risks to neonate of PPROM?

A

Prematurity Sepsis (ascending infection) Pulmonary hypoplasia

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19
Q

How should PPROM be manageD?

A

1) Steroids 2) Prophylactic antibiotics - Erythromycin or penicillin if GBS identified

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20
Q

Short-term complications of IUGR

A

1) Jaundice 2) Meconium aspiration 3) Necrotising enterocolitis

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21
Q

Late complications of IUGR

A

1) Cerebral palsy 2) Poorer scores on cognitive testing 3) Obesity

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22
Q

Definition of prematurity

A

Born <37 weeks

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23
Q

Problems of prematurity (short-term)

A

BRAIN - IVH EYES - ROP LUNGS - RDS (O2 leads to ROP) GUT - NEC LIVER - Jaundice & Kernicterus METABOLIC - Hypothermia - Hypoglycaemia

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24
Q

Problems of prematurity (long-term)

A
  • Cognitive difficulties - Obesity
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25
Q

Causes of prematurity

A

Pre(eclampsia)-M-atU(terine abnormalities)RI(UGR)TY 1) multiple pregnancy 2) Pre-eclampsia 3) IUGR 4) Uterine anomalies

26
Q

Identify

A

Stork bite

Not serious

Lesions on eyelids fade in the first year; over 95% will fade by 12 months. Back of the neck may never fade.

27
Q

Identify

A

Milia

Sebaceous cysts, very small raised pearly white or yellowish bumps on the skin.

Seen on the nose, cheeks, eyelids, forhead and chest, but can occur anywhere

Affects about half of babies

Retentions of keratin and sebaceous material in sweat glands that are not fully formed

Will clear spontaneously in weeks

28
Q

Identify

A

Erythema Toxicum

Small firm yellow or raised bumps filled with pus on top of a red area of skin, contains eosinophils.

Occur on any part of the body except the palms and soles.

Often begins on face and spreads. Appears on day 2-3 and disappears by day 10. HALF of all newborn infants.

29
Q

Identify

A

Cradle Cap

Usually occurs on the scalp but can affect face, ears, neck, nappy area or skin folds

Does not cause itch or discomfort – if scratching consider atopic eczema

Recognised by large, greasy yellow or brown scale on cap

Seborrhoeic dermatitis

Large greasy yellow or brown scales on the scalp

Massaging scalp with baby oil will help loosen flakes

30
Q

Identify

A

Cavernous Haemangioma

May be present at birth but more commonly develop in the first month. Grow for 3-4 years when they start to regress.

Commonest tumour in infancy affecting 5-10% of Caucasian babies. More common with low birthweight, prematurity and multiple gestations

Increases in size until 3-15 months and then regresses

No treatment unless interferes with vision or the airway

Can be external, internal (liver, heart, brain) or both

31
Q

Identify

A

A vascular malformation of developmental origin with ectasia of superficial dermal capillaries

Face, nape of neck and upper trunk

Pink to deep red or purple patches; often unilateral with distinct cut-off

Lesions tend to persist, darken and thicken with age

Disfiguring lesions can be improved with laser therapy

Occasionally associated with congenital glaucoma, sturge

weber syndrome (Portwine + hemiparesis + epilepsy + vascular headache) and klippel-trenauny-weber syndrome (portwine + giant limb)

32
Q

Identify

A

Blue/black discolouration at the base of the spine or on the buttocks

Occasionally occurs on the legs or any other part of the body

Usually, although not invariably, on afro-carribean or Asian babies

Fade slowly over the years

33
Q

Identify

A

Satellite lesions are common

Fungal infection manifest by widespread vivid sharply bordered erythema with satellite pauples or vesicles.

Frequently found in anterior perineum, perianal and folds

Systemic antibiotic treatment is a common trigger

Antifungal agents like nystatin or miconazole can be used in association with gentle cleansing of the perineum. May need oral nystatin.

34
Q

Identify

A

‘W’ shape of lesion – affecting convex areas and sparing folds

Worsening of lesions with baby wipes and cloth diapers also suggest diagnosis, because that kind of diaper has diminished power of absorption. Baby wipes make worse so advise against.

Other causative are increasing skin h, local humidity, coverage and friction

Treated with zinc oxide

35
Q

Meconium aspiration syndrome definition

A

AS is defined as a respiratory distress that develops shortly after birth, with radiographic evidence of aspiration pneumonitis and presence of meconium-stained amniotic fluid.

36
Q

Risk factors for Meconium Aspiration Syndrome

A

Pre-eclampsia

Oligohydramnios

Smoking

37
Q

Meconium Aspiration Syndrome Investigations

A

FBC

CXR

Brain imaging

ECG

38
Q

Meconium Aspiration Syndrome Management

A

Suction

Oxygen

Ventilatory support

Surfactant replacemetn

39
Q

Respiratory Distress Risk Factors

A

Prematurity

C-section

Maternal diabetes

40
Q

Respiratory distress presentation

A

Tachypnoea

Grunting

Flaring of nostrils

Subcostal recession

41
Q

Respiratory Distress Management

A

Surfactant Replacement Therapy

Oxygen therapy

Gentle management

42
Q

Respiratory Distress Chronic Complications

A

Bronchopulmonary dysplasia

Retionpathy of prematurity

Neurological impairment

43
Q

Determining level of gestation

A

Dubowitz/Ballard Examination

44
Q

Investigation for IVH

A

Cranial Ultrasound Scan

45
Q

Investigations for premature infants

A

Blood gas

FBC

U&E

Blood culture

CRP

Blood group & direct coombs test

46
Q

What should obstetricians offer women likely to give birth to premature babies? (2)

A

Antenatal steroids

Magnesium sulphate

47
Q

NEC Symptoms

A

Bloating

Off feeds

Altered stool pattern

Bloody mucoid stool

Billious vomiting

48
Q

NEC investigations

A

Abdominal x-ray

FBC, U&E, Blood gas

49
Q

NEC Management

A

Nil by mouth

IV fluids, TPN, IV antibiotics (Ampicillin & Gentamicin)

50
Q

NEC Prevention

A

Feed with human milk

Slow-feeds

51
Q

What is this?

A

Ground glass shadowing indicated respiratory distress

52
Q

What is this?

A

NEC

53
Q

What does condition does a meconium ileus indicate?

A

Cystic Fibrosis

54
Q

When should meconium be passed by?

A

24 hours

55
Q

Bilious vomiting: five causes

A

1) Meconium ileus
2) hirschprung’s disease
3) Duodenal atresia
4) Imperforate anus
5) Necrotizing entercolitis

56
Q

Cephalhaematoma vs Caput Succenadeum

A

Cephalhaematoma - between periosteum and skull, limited by suture lines

Caput Succenadeum - Between scalp and periosteum , spreads over suture lines

Subgaleal - scalp galea aponeurosis and periosteum. Lots of associated head trauma.

57
Q

Name three overarching newborn screening tests

A

1) Newborn and 6-8 week physical examination
2) Newborn hearing screen
3) Newborn blood spot test

58
Q

Give five conditions tested for by newborn bloodspot test

A

1) PKU
2) Congenital hypothyroidism

3) Sickle cell disease
4) Cystic fibrosis
5) Maple syrup urine disease
6) MCAD
7) Homocysteinuria

59
Q

Give four conditions picked up by newborn physical examinations

A

1) Cataracts
2) Congenital heart disease
3) Undescended testes
4) Developmental dysplasia of the hip

60
Q

Two bits of newborn hearing test

A

1) Automated otoacoustic emission
2) Autmated auditory brainstem response

61
Q

Neonatal sepsis red flags (5)

A

1) Seizures
2) Shock
3) Resp distress >4 hours after birth
4) Suspected or confirmed infection in twin
5) Systemic abx given to mother intrapartum

62
Q

When to stop ABx in babies with neonatal sepsis?

A

the blood culture is negative, and

the initial clinical suspicion of infection was not strong, and

the baby’s clinical condition is reassuring with no clinical indicators of possible infection, and

the levels and trends of C-reactive protein concentration are reassuring.

Obs & Gyny - Risk Factors (18 decks)

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