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Year 3 Paeds > Neonates > Flashcards

Neonates Flashcards

1
Q

Briefly describe the foetal circulation

A

oxygenated blood via umbilical vein
ductus venosus
foramen ovale –> LA - LV to aorta
right ventricle –> PA to PDA and to aorta

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2
Q

Sa02 in foetal body

A

60-70%

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3
Q

What does ductus arteriosus protect against?

A

lungs against circulatory overload

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4
Q

What does ductus arteriosus allow?

A

right ventricle to strengthen

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5
Q

ductus arteriosus - oxygenated or deoxygenated blood?

A

deoxygenated

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6
Q

What does ductus venosus connect?

A

umbilical vein to IVC

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7
Q

How is blood flow in ductus venosus regulated and does it carry oxygenated or deoxygenated blood?

A

sphincter

oxygenated

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8
Q

What happens with baby first breath?

A

foramen ovale closes

many embryological structures become ligaments

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9
Q

breathing in new born

A

30-60/min

periodical

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10
Q

HR in newborn

A

120-160bpm
<100 = bradycardia
>160bpm = tachycardia

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11
Q

thermoregulation in newborn

A

lack shivering thermogenesis

brown fat - sympathetic neurons

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12
Q

Non invasive ways to measure new born breathing

A

blood gas

trans cutaneous

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13
Q

Invasive ways to measure new born breathing

A

capnography
tidal volume
minute ventilation
flow volume loop

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14
Q

is it normal not to pass urine for first 24 hours?

A

yes

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15
Q

Fluid balance in premature infants

A

less fat
slow GFR, reduce Na reabsorption
increased insensible water loss

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16
Q

low birth weight

A

<2500g

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17
Q

SGA and IUGR

A 
SGA = neonatal 
IUGR = obstetric
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18
Q

hypotrophy

A

below the 10th centile

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19
Q

Reasons for babies small for dates

A 
maternal = smoking, PET
genetic eg trisomy 18
infection eg CMV
placental abruption 
twins
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20
Q

Common problems for small for date babies

A 
hypoglycaemia
perinatal hypoxia 
hypothermia 
thrombocytopenia
polycythaemia
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21
Q

Long term problems for babies small for date

A

hypertension
reduced growth
obesity
IHD

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22
Q

% of pregnancies premature

A

10

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23
Q

Under what weeks is premature?

A

37

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24
Q

When is extremely premature?

A

under 28 weeks

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25
low, very low and extremely low birth weight
low = <2500g very low <1500g extremely low <1000g
26
Problems with the premature baby include..
RDS Necrotising entero-colitis IVH pot haemorrhagic hydrocephalus
27
How to prevent RDS
antenatal steroids
28
early treatment for RDS
surfactant and extubation | N-CPAP
29
Preventing and treating IVH
steroids antenatally | Drain?
30
Pressure aorta > pulmonary artery = what kind of shunt?
left to right
31
Patent ductus arteriosus - what happens?
lung oedema | systemic ischaemia
32
Symptoms of sepsis
hypothermia/pyrexia poor feeding and lethargy early jaundice hypo or hyperglycaemia
33
Risk factors for sepsis
prolonged rupture of membranes maternal pyrexia maternal group B strep carriage
34
managing presumed sepsis
``` admit septic screen - FBC, CRP, blood cultures and blood gas CXR, LP IV penicillin and gentamicin metronidazole if abdo ```
35
Commonest causes of neonatal sepsis
E coli Group B strep Listeria H influenzae
36
Group B strep sepsis
early onset | complications eg meningitis, pneumonia, DIC
37
ToRCH congenital infection
Toxoplasmosis rubella CMV herpes
38
What may congenital infections result in?
IUGR brain calcifications neurodevelopmental delay recurrent infections
39
causes of respiratory distress
sepsis TTN meconium aspiration
40
TTN - clinical presentation, cause and management
grunting, tachypnoea, O2 delay in clearing foetal lung fluids supportive, antibiotics, O2 and fluids
41
What is meconium?
earliest stool of a baby
42
meconium aspiration risk factors
post dates - aged placenta maternal diabetes maternal HTN
43
symptoms of meconium aspiration
``` cyanosis increased work of breathing grunting apnoea floppiness ```
44
Investigating meconium aspiration
blood gas sepsis screen CXR
45
Treating meconium aspiration
``` suction below cords airway support - intubate fluids and IV antibiotics surfactant NO or ECMO ```
46
When does cyanosis occur?
deoxygenated haemoglobin >5g/dl
47
Investigating the blue baby
sepsis screen blood gas and glucose CXR, ECG, echo pulse oximetry, hyperoxia test
48
blue baby - cardiac
transposition of great arteries | tetralogy of fallot
49
Managing hypoglycaemia
monitor blood glucose IV 10% glucose glucagon hydrocortisone
50
Managing hypothermia
incubator sepsis screen + antibiotics thyroid function monitor blood glucose
51
birth asphyxia
lack of oxygen at or around birth
52
Causes of birth asphyxia
``` Placenta problem long labour umbilical cord rupture infection neonatal airway problem ```
53
1st stage of birth asphyxia
within minutes with no 02 | cell damage
54
2nd stage of birth asphyxia
reperfusion injury days or weeks toxins released from damaged cells
55
classifying birth asphyxia
mild moderate severe
56
Managing birth asphyxia
treat seizures support therapeutic hypothermia fluid restriction
57
causes of failure to pass stool
``` constipation imperforate anus +/- fistula large bowel atresia hirschsprungs disease meconium ileus ```
58
What to think of with meconium ileus?
CF
59
diaphragmatic hernia presentation
90% on left males pulmonary hypoplasia
60
Energy triangle
hypothermia hypoglycaemia hypoxia/anoxia
61
Cause of plethora
polycythaemia
62
Mongolian blue spots
blue-grey pigment lower back and buttocks races with pigmented skin
63
Other name for stork marks
naevus simplex
64
What is naevus simplex?
light colour capillary dilatation back of neck midline of face gradually fades
65
Babies at risk of hypoglycaemia
``` premature babies perinatal stress hyperinsulinaemia small and large babies sepsis hypothermia ```
66
Symptoms of hypoglycaemia
``` jitteriness hypothermia temperature instability lethargy hypotonia apnoea poor feeding vomiting seizures ```
67
When can bedside testing for hypoglycaemia be inaccurate?
poor perfusion | polycythaemia
68
hypoglycaemia
blood sugar <2.6mmol/l
69
Vulnerable babies to hypothermia
low birth weight | requiring prolonged resus
70
Resuscitation and cold stress
``` dry quickly remove wet linens use warm blankets provide radiant warmer heat use heated/humidified oxygen ```
71
tongue ties
short, thick frenulum attached anterior - base of tongue sometimes - frenotomy
72
Evaluating respiratory problems
resp rate increased effort - grunting, nasal flare colour oxygen sats
73
4 areas to assess for retractions
substernal suprasternal subcostal intercostal
74
unilateral cleft lip
left
75
issues with cleft lip/palate
``` feeding issues - special bottles and teats can still attempt breast feeding airway problems associated anomalies - echo, hearing ```
76
Ophthalmology
cataracts - remove and artificial lens | retinoblastoma
77
Spinal dimples can reveal what?
spine/spinal cord eg spina bifida | kidney problems
78
cephalohaematoma
localised swelling limited by cranial bones haemorrhage beneath pericranium can cause jaundice
79
Caput succedaneum
subcutaneous fluid presenting part on dilating cervix scalp swelling across midline
80
treatment of fixed talipes
vigorous manipulation strapping casting possible surgery
81
What may babies with significant talipes also have?
DDH
82
treating DDH
relocate head of femur to acetabulum Pavlik harness surgical reduction
83
trisomy 21 features
``` low set ears single palmar crease learning difficulties cardiac defects thyroid problems hypotonia ```

Year 3 Paeds (14 decks)

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