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Finals Revision > Neonates > Flashcards

Neonates Flashcards

1
Q

At what gestation is a baby considered pre-term?

A

Before 37 weeks

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2
Q

When is a baby considered extremely pre-term?

A

Before 28 weeks

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3
Q

When is a baby considered very pre-term?

A

28-32 weeks

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4
Q

What are some risk factors for pre-term birth?

A

Multiple pregnancy, GU infections, placenta praevia, placental abruption, PPROM, cervical incompetence, pre-eclampsia, hypertension, diabetes, cigarette smoking, alcohol abuse

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5
Q

How long should cord clamping be delayed for and why?

A

At least one minute to allow blood flow to equilibriate between placenta and baby

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6
Q

How should pre-term babies be kept warm when delivered?

A

Should be placed when still wet into a suitable plastic bag and then later under a radiant heater

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7
Q

What should be the airway positioning of a newborn baby?

A

Neutral head position, jaw thrust and suction if needed for secretions

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8
Q

If respiratory support is needed in preterm infants how is this done?

A

Usually start with air and if positive pressure ventilation is needed, start at lower pressures

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9
Q

What is a complication of lung overinflation in preterm infants?

A

Overinflation leads to volu/baru trauma leading to an inflammatory cascade that predisposes to broncho-pulmonary dysplasia

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10
Q

Why is hypothermia a common problem in the preterm infant?

A

Low BMR
Minimal muscular activity
Negligable subcut fat
High surface area to body mass

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11
Q

`What should you remember to do when plotting growth charts for pre-term infants?

A

Gestational correction

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12
Q

How long should gestation correction continue?

A

If born 32-37 weeks - one year

If born before 32 weeks - 2 years

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13
Q

Why is gestational correction continued for this long?

A

As this is how long it takes for the infant to catch up with normal growth

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14
Q

What is respiratory distress syndrome?

A

Deficiency of alveolar surfactant and structural immaturity of alveoli

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15
Q

Why is surfactant important?

A

It maintains the surface tension which stops the alveoli from collapsing and therefore making breathing more difficult for the baby

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16
Q

How does RDS present?

A

Tachypnoea (>60/min), grunting, nasal flare, indrawing, cyanosis

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17
Q

When is the onset of RDS?

A

Onset from minutes to 4 hours after birth. Does NOT resolve in 24 hrs like TTN.

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18
Q

What may be seen on a CXR of an infant with RDS?

A

Ground glass appearance

Air bronchogram

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19
Q

How is RDS prevented?

A

Antenatal steroids

2 x 12 mg betamethasone 12 hours apart

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20
Q

How is RDS managed?

A

Surfactant and ventilation (intubation/CPAP)

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21
Q

What is apnoea of prematurity?

A

Breathing centres in baby’s brain not fully developed yet resulting in the baby forgetting to breathe

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22
Q

How does apnoea of prematurity present?

A

Cessation of breathing for >20secs, and/or hypoxia and bradycardia

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23
Q

How is apnoea of prematurity managed?

A

IV caffeine

Ventilation

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24
Q

What is bronchopulmonary dysplasia?

A

Long term complication of ventilation of babies due to barotrauma and oxygen toxicity

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25
Q

What signs are seen in bronchopulmonary dysplasia?

A

CXR shows hyperinflation

Histology shows necrotizing bronchitis and alveolar fibrosis

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26
Q

How does bronchopulmonary dysplasia present?

A

Hypoxia and difficulty weaning off ventilator

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27
Q

What long term consequences are there of bronchopulmonary dysplasia?

A

Decreased IQ, cerebral palsy, feeding issues

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28
Q

What is transient tachypnoea of the newborn?

A

A period of rapid breathing shortly after delivery that resolves within 24-48hrs

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29
Q

What causes TTN?

A

Amniotic fluid remaining in the fetal lungs meaning it is difficult to breathe

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30
Q

What babies are more likely to get TTN?

A

C-Section - not had pressure of SVD to push fluid out of lungs

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31
Q

How is TTN managed?

A

Supportive - oxygen, CPAP, non-oral feeds to prevent aspiration

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32
Q

What is early onset sepsis of the newborn?

A

Bacteria acquired before and during delivery (within 48hrs)

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33
Q

What is late onset sepsis?

A

Bacteria acquired after delivery (after 48hrs)

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34
Q

What organisms usually cause neonatal sepsis?

A

Early - GBS, Ecoli

Late - Listeria, staph A, strep pyogenes

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35
Q

How does neonatal sepsis present?

A

Fever, poor feeding, tachypnoea, cyanosis, stiff limbs, increased work of breathing

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36
Q

How is neonatal sepsis treated?

A

Benzylpenicillin and gentamicin

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37
Q

What is meconium aspiration syndrome?

A

Meconium is passed in utero allowing the baby to swallow it

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38
Q

Why may meconium aspiration syndrome occur?

A

Fetal distress

Post term baby

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39
Q

How does meconium aspiration present?

A 
Meconium stained amniotic fluid
Respiratory distress (hypoxia, increased effort of breathing)
40
Q

How is meconium aspiration managed?

A

Suctioning and supportive care

41
Q

What causes heart failure in newborns?

A

Infection
Chromosome abnormalities
Rhesus disease

42
Q

How does heart failure present in newborns?

A

Cyanosis, respiratory distress, pulmonary oedema, sacral/periorbital/ankle oedema, hepatosplenomegaly

43
Q

What is persistent pulmonary hypertension?

A

Failure of fetal circulation to adapt to being outwith the womb, leading to failure of pulmonary pressure to fall. Causes shunting of blood and hypoxia

44
Q

What is patent ductus arteriosis?

A

Failure of ductus arteriosis to close after birth

45
Q

What is the ductus arteriosis?

A

A communication between the left pulmonary artery and descending aorta that allows blood to bypass the fluid filled fetal lungs

46
Q

How does PDA present?

A

Failure to thrive, CCF, bounding pulse, continuous machine like murmur

47
Q

How is PDA treated?

A

Indomethacin

Surgical management

48
Q

How does intraventricular haemorrhage start?

A

Bleeding in the germinal matrix due to lack of structural integrity

49
Q

What is intraventricular haemorrhage associated with?

A

Difficult/fast labour
Instrumental delivery
Breech
Prematurity

50
Q

How does intraventricular haemorrhage present?

A

Can be clinically silent, or with intermittant or catastrophic deteriorations

51
Q

How is IVH prevented?

A

Antenatal Steroids

2 x 12 mg betamethasone 12 hours apart

52
Q

What is necrotizing enterocolitis?

A

Inflammatory widespread necrosis of small and large bowel

53
Q

What is the biggest risk factor for NEC?

A

Prematurity

54
Q

How does NEC present?

A

Poor feeding, lethargy, abdominal distention, bloody stool, shock & DIC if perforation

55
Q

What may be seen on AXR in NEC?

A 
Asymmetrical dilated loops of bowel
Pneumatosis intestinalis (gas on gut wall)
56
Q

How is NEC managed?

A

Stop oral feeding, supportive care and antibiotics.

Surgery to resect dead bowel and prevent perforation

57
Q

What is neonatal hypoglycaemia defined as?

A

<2.6 mmol

58
Q

Why may neonatal hypoglycaemia occur?

A

Maternal diabetes
Low birth weight/pre term
Complex metabolic disorder

59
Q

What is haemorrhagic disease of the newborn?

A

Vitamin K deficiency related bleeding

60
Q

When does haemorrhagic disease of the newborn occur?

A

2-7 days post partum with bleeding and bruising

61
Q

How is haemorrhagic disease of the newborn managed?

A

Vitamin K injection (given by midwife at birth to prevent)

62
Q

When does physiological jaundice occur?

A

> 24 hours after birth

63
Q

What causes physiological jaundice?

A

Accumulation of bilirubin due to increased RBC breakdown and reduced ability of liver to conjugate bile and gut to excrete it

64
Q

What is pathological jaundice?

A

Jaundice occuring <24 hours after birth

65
Q

What are some causes of pathological jaundice?

A

Sepsis
Haemorrhagic disease of the newborn
Red cell incompatibility
Inherited conditions (e.g. G6PD, spherocytosis)

66
Q

What is prolonged jaundice?

A

Any jaundice lasting longer than 14 days

67
Q

What are some causes of prolonged jaundice?

A

Hypothyroidism
Infection (UTI, TORCH)
Biliary atresia
CF

68
Q

How is jaundice management decided?

A

Babies age and bilirubin levels plotted on a graph to help them choose between management options

69
Q

What are the two management options for jaundice?

A

Phototherapy

Exchange transfusion

70
Q

How does phototherapy work in jaundice?

A

UV light source breaks down bilirubin to products that don’t require conjugation for release

71
Q

Which babies get an exchange transfusion for jaundice?

A

Those with higher bilirubin levels

72
Q

What is kernicterus?

A

Bilirubin induced encephalopathy

73
Q

How does kernicterus present?

A

Jaundice, poor feeding, shrill cry, hypertonicity

74
Q

How is kernicterus managed?

A

Exchange transfusion and phototherapy

75
Q

What are some long term outcomes of kernicterus?

A

Deafness, reduced IQ

76
Q

What is gastroschisis?

A

Extrusion of abdominal viscera

77
Q

What is Hirschsprungs disease?

A

Lack of colonic ganglion and autonomic innervation meaning it cannot function

78
Q

How does Hirschsprungs disease present?

A

Constipation, faeces felt on palpation, explosive discharge of stool, wind on PR

79
Q

What is oesophageal atresia (+/- trachea-oesophageal fistula)?

A

Spectrum of disease - narrowing of oeseophagus and formation of fistula with the trachea

80
Q

How does trache-oesophageal fistula present and what is it associated with?

A

Frothy secretions, drooling and difficulty passing catheter into the stomach
Polyhydramnios

81
Q

What is jejunal atresia?

A

Congenital anomaly of small bowel where jejunum does not form a continuous tube but instead two blind ended sacks

82
Q

How does jejunal atresia present?

A

Vomiting and failure to pass meconium

83
Q

What is perinatal mortality?

A

24 weeks to 1 week post partum

84
Q

What is neonatal mortality?

A

Birth - 4 weeks post partum

85
Q

What is postnatal mortality?

A

4 weeks - 1 year

86
Q

What is infant mortality?

A

Birth - 1 year

87
Q

What is extremely low birth weight?

A

<1000g

88
Q

What is very low birth weight?

A

<1500g

89
Q

What is low birth weight?

A

<2500g

90
Q

What is normal birth weight?

A

2500-4000g

91
Q

What is large birth weight?

A

> 4000g

92
Q

What is erythema toxicum?

A

Harmless rash occurring in babies aged 2-5 days. Erythematous maculopapular discrete lesions with white centre, becomes widespread and confluent

93
Q

What is mongolian blue spot?

A

Bluish/black macule on lumbar/sacral area - important NAI differential

94
Q

What is a salmon patch/stork mark?

A

Erythematous vascular marks on eyelids, face and nape of neck

95
Q

What is a strawberry naevi?

A

Haemagioma - rapid proliferation between 4 and 9 months then involutes

96
Q

What is a port wine stain?

A

Naevus flammus - capillary vascular malformation. Can be treated with lasers

Finals Revision (22 decks)

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