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Paeds > Neonates: > Flashcards

Neonates: Flashcards

1
Q

Why is vitamin K given at birth?

A

To prevent Haemorrhagic disease of newborn (low vitamin K dependent clotting factors at birth)

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2
Q

What is neonate?

A

A baby up to 28 days of age

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3
Q

What is a term baby?

A

Born between 37 and 42 weeks gestation

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4
Q

What is a preterm baby?

A

Born between 23 weeks and 36 +6 weeks gestation

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5
Q

List 6 causes of high-risk deliveries:

A
  • Preterm (<6 weeks)
  • Multiple births
  • ‘Crash’ or emergency c-sections - fetal distress, undiagnosed breech
  • Meconium stained liquor
  • Instrumental deliveries - forceps, ventouse
  • Expected problems - anomaly scans
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6
Q

What syndrome is associated with neurological and skin disorder?

A

Sturge-Weber Syndrome/neurocutaneous syndrome

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7
Q

What is Sturg-weber syndrome characterised by?

A

Proliferation of arteries of the brain -> multiple angiomas occur on same side as physical signs

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8
Q

What is Sturge-weber syndrome associated with?

A
  • Port-wine stains
  • Glaucoma
  • Seizures
  • Mental retardation
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9
Q

How is club foot treated?

A

Physio/surgery:

- Serial plaster casting

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10
Q

In congenital displasia of the hip, what signs can be elicited during examination?

A

Barlows - displacement downwards

Ortolani - to relocate hip (tests for posterior dislocation)

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11
Q

What can be given to help treat ‘Strawberry Naevus’?

A

Propanolol

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12
Q

What is associated with an unilateral absent red reflex?

A

Retinoblastoma (more commonly picked up 9-22months)

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13
Q

What is associated with a bilateral absent red reflex?

A

Congenital cataracts

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14
Q

What can failure of treatment of congenital cataracts cause?

A

Amblyopia - lazy eye

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15
Q

What is performed on all babies within the first 48hrs of birth?

A

New born baby screen

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16
Q

Outline the components of the newborn examination:

A

Head-to-toe:

  • Head - measure, feel fontanelles, any asymmetry
  • Face - dysmorphic, red reflex, jaundice sclera, palate, look at ears
  • Moro reflex
  • Heart - listen for murmurs
  • Arms/hands - count digits, palmar creases, posture, movements
  • Abdo - distention, masses, organomegaly, ‘flare’
  • Spine - scoliosis, dimples, hairy tufts
  • Groin and genitallia - femoral pulses, male/female genetalia, hypospadias
  • Bottom - anus present and correctly positioned
  • Hips/legs/feet - check for clicky/clunky hips, talipes (club foot), accessory digits
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17
Q

What should a doctor do if they find a unilateral undescended testis?

A

Recheck at 6 weeks

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18
Q

What can be the cause of bilateral undescended testis?

A

Idiopathic usually or hormonal disorders

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19
Q

List 3 risk factors for infection in neonates:

A
  • PROM
  • Group B strep. (GBS)
  • Inadequate labour prophylactic Abx
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20
Q

What can sepsis cause?

A

metabolic acidosis

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21
Q

What causes should be considered in an unwell term baby?

A
  • Sepsis - GBS, E. coli, Listeria
  • Hypoglycaemia
  • Congenital cardiac abnormality
  • Metabolic problems
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22
Q

When are antibiotics given to reduced GBS sepsis?

A

During labour - 90% risk reduction

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23
Q

What antibiotics are used in the management of sepsis in the newborn?

A

Initially - Benzylpenicillin and gentamicin until microbiology results

Benzylpenicillin -> GBS, staphs, streps

Gentamycin -> Gram -ve, E. Coli

Amoxicillin -> Listeria

24
Q

What is the Coombs Test (direct antiglobulin test) used for?

A

To diagnose Autoimmune haemolytic anaemia

25
Q

Give 2 features found in biliary atresia:

A
  • Conjugated bilirubin (serum)
  • Dark urine, pale stools

Due to no allowing conjugated bilirubin to enter the bowels = pale stools.

26
Q

What do most jaundiced babies have?

A

Physiological jaundice - liver enzymes not mature enough yet.

Onset is first 2-5 days off life

27
Q

What type of jaundice does physiological jaundice cause?

A

Unconjugated. This is due to the liver not having a high enough conjugation rate.

28
Q

How can breast milk cause jaundice and what type of jaundice does it produce?

A

Delayed establishemnt of gut flora results in increased bilirubin reabsorption. Substances in breast milk inhibit conjugation and excretion of bilirubin.

29
Q

Outline the management of jaundice in neonates:

A
  • Adequate hydration through continued feeding
  • Phototherapy breaks down bilirubin into easily excreted isomers.
  • Very high levels - Exchange blood transfusion
  • Extreme hyperbilirubinaemia - kenicterus may occur = form of dystonic cerebral palsy
30
Q

List 4 complications of preterm delivery:

A

Respiratory: respiratory distress syndrome

Cardiovascular: Patent ductus arteriosus

Gastroenterological: Necrotizing enterocolitis

Neurological: Intraventricular haemorrhage (due to capillary bed immaturity)

31
Q

Why is respiratory distress more likely in preterm delivery?

A

Usually as a result of surfactant deficiency. Production typically begins between 24-28 weeks and is adequate by 35 weeks

32
Q

What intervention is performed to reduce the chances of respiratory distress in preterm babies?

A

Antenatal steroids help promote production in threatened pre-term labour

33
Q

What CXR findings are present in a baby with respiratory distress syndrome?

A
  • Ground- glass shadowing

- Air bronchograms

34
Q

What respiratory support can be given in those with RDS?

A
  • CPAP - (continuous positive airway pressure) prevents alveolar collapse during expiration
  • Surfactant (‘curosurf’) via endotracheal tube
35
Q

What is necrotizing enterocolitis (NEC)?

A

Bowel ischaemia, inflammation, necrosis and even performation.

36
Q

List 3 symptoms of NEC:

A
  • Poor feed tolerance
  • Abdominal distension
  • Bloody stools
37
Q

What can be seen on AXR in a child with NEC?

A
  • Distended bowel loops
  • Wall thickening
  • Riglers sign (double walled sign)
38
Q

When does NEC typically present?

A

2nd-3rd week of life.

39
Q

What is a good measure of the severity of NEC?

A

Platelets <100x10^9 = severe

40
Q

What is the management of NEC?

A
  • Bowel rest (NBM)
  • Total parenteral nutrition (TPN)
  • Antibiotics
  • Surgery to remove perforated or necrotic bowel
41
Q

What is a stillbirth?

A

Baby delivered with no sign of life after 24 weeks

42
Q

What is early neonatal death?

A

Baby dies within 7 days of delivery

43
Q

What is late neonatal death?

A

Baby dies within 7-28 days of delivery

44
Q

Outline what low birth weight (LBW), VeryLBW and ExtremelyLBW are:

A 
LBW = <2000g
VLBW = <1500g
ELBW = <1000g
45
Q

Outline newborn resuscitation in terms of when to give breaths and chest compressions:

A

If no respiratory effort and HR <100bpm, give 5 inflation breaths.

If HR does not increase after inflation breaths, check position and try again.

If not success, start chest compressions at 3:1 ratio.

46
Q

What is produced as part of haemolysis?

A

Unconjugated bilirubin

47
Q

What can excessive haemolysis cause?

A

Unconjugated jaundice

48
Q

What can cause excessive haemolyis in newborns?

A
  • Sepsis
  • Immune destruction: blood group ABO incompatibility, rhesus incompatibility
  • Congenital RBC defects - hereditary spherocytosis, G6PD deficiency
49
Q

What two features suggest haemolytic jaundice?

A
  • Positive Coombs test (direct antiglobulin test)

- Unconjugated hyperbilirubinaemia

50
Q

If severe what does haemolytic jaundice necessitate?

A

Exchange transfusion.

51
Q

What are the common serious congenital infections?

A 
(TORCH)
T - toxoplasmosis
O - other (HIV, measles, parvovirus, hepatitis)
R - Rubella
C - Cytomegalovirus (CMV)
H - Herpes simplex
52
Q

What is biliary atresia?

A

Congenital abnormality of the bile ducts (blockage/absence). Untreated it can result is progressive liver failure.

53
Q

List 4 signs in biliary atresia:

A
  • Jaundice
  • Pale stools
  • Dark urine
  • Abdominal distention 2ndry to hepatomegaly
54
Q

What is done to diagnose biliary atresia?

A
  • USS

- LFTs

55
Q

What is the surgical management of biliary atresia?

A
  • Kasai hepatoportoenterostomy (if only external bile duct involved)
  • Liver transplant (if intra-hepatic duct involved)
56
Q

What medical management can be used in those with biliary atresia?

A
  • Abx - prevent choleangitis
  • Ursodeoxycholic acid (to encourage bile flow)
  • ADEK fat soluble vitamins

Paeds (13 decks)

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