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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
Q

low, very low and extremely low birth weight

A

low = <2500g
very low <1500g
extremely low <1000g

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26
Q

Problems with the premature baby include..

A

RDS
Necrotising entero-colitis
IVH
pot haemorrhagic hydrocephalus

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27
Q

How to prevent RDS

A

antenatal steroids

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28
Q

early treatment for RDS

A

surfactant and extubation

N-CPAP

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29
Q

Preventing and treating IVH

A

steroids antenatally

Drain?

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30
Q

Pressure aorta > pulmonary artery = what kind of shunt?

A

left to right

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31
Q

Patent ductus arteriosus - what happens?

A

lung oedema

systemic ischaemia

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32
Q

Symptoms of sepsis

A

hypothermia/pyrexia
poor feeding and lethargy
early jaundice
hypo or hyperglycaemia

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33
Q

Risk factors for sepsis

A

prolonged rupture of membranes
maternal pyrexia
maternal group B strep carriage

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34
Q

managing presumed sepsis

A 
admit
septic screen - FBC, CRP, blood cultures and blood gas
CXR, LP
IV penicillin and gentamicin
metronidazole if abdo
35
Q

Commonest causes of neonatal sepsis

A

E coli
Group B strep
Listeria
H influenzae

36
Q

Group B strep sepsis

A

early onset

complications eg meningitis, pneumonia, DIC

37
Q

ToRCH congenital infection

A

Toxoplasmosis
rubella
CMV
herpes

38
Q

What may congenital infections result in?

A

IUGR
brain calcifications
neurodevelopmental delay
recurrent infections

39
Q

causes of respiratory distress

A

sepsis
TTN
meconium aspiration

40
Q

TTN - clinical presentation, cause and management

A

grunting, tachypnoea, O2
delay in clearing foetal lung fluids
supportive, antibiotics, O2 and fluids

41
Q

What is meconium?

A

earliest stool of a baby

42
Q

meconium aspiration risk factors

A

post dates - aged placenta
maternal diabetes
maternal HTN

43
Q

symptoms of meconium aspiration

A 
cyanosis 
increased work of breathing
grunting 
apnoea 
floppiness
44
Q

Investigating meconium aspiration

A

blood gas
sepsis screen
CXR

45
Q

Treating meconium aspiration

A 
suction below cords
airway support - intubate
fluids and IV antibiotics 
surfactant 
NO or ECMO
46
Q

When does cyanosis occur?

A

deoxygenated haemoglobin >5g/dl

47
Q

Investigating the blue baby

A

sepsis screen
blood gas and glucose
CXR, ECG, echo
pulse oximetry, hyperoxia test

48
Q

blue baby - cardiac

A

transposition of great arteries

tetralogy of fallot

49
Q

Managing hypoglycaemia

A

monitor blood glucose
IV 10% glucose
glucagon
hydrocortisone

50
Q

Managing hypothermia

A

incubator
sepsis screen + antibiotics
thyroid function
monitor blood glucose

51
Q

birth asphyxia

A

lack of oxygen at or around birth

52
Q

Causes of birth asphyxia

A 
Placenta problem 
long labour 
umbilical cord rupture
infection 
neonatal airway problem
53
Q

1st stage of birth asphyxia

A

within minutes with no 02

cell damage

54
Q

2nd stage of birth asphyxia

A

reperfusion injury
days or weeks
toxins released from damaged cells

55
Q

classifying birth asphyxia

A

mild
moderate
severe

56
Q

Managing birth asphyxia

A

treat seizures
support
therapeutic hypothermia
fluid restriction

57
Q

causes of failure to pass stool

A 
constipation 
imperforate anus +/- fistula
large bowel atresia 
hirschsprungs disease
meconium ileus
58
Q

What to think of with meconium ileus?

A

CF

59
Q

diaphragmatic hernia presentation

A

90% on left
males
pulmonary hypoplasia

60
Q

Energy triangle

A

hypothermia
hypoglycaemia
hypoxia/anoxia

61
Q

Cause of plethora

A

polycythaemia

62
Q

Mongolian blue spots

A

blue-grey pigment
lower back and buttocks
races with pigmented skin

63
Q

Other name for stork marks

A

naevus simplex

64
Q

What is naevus simplex?

A

light colour capillary dilatation
back of neck
midline of face
gradually fades

65
Q

Babies at risk of hypoglycaemia

A 
premature babies 
perinatal stress 
hyperinsulinaemia 
small and large babies
sepsis 
hypothermia
66
Q

Symptoms of hypoglycaemia

A 
jitteriness 
hypothermia 
temperature instability 
lethargy 
hypotonia 
apnoea 
poor feeding 
vomiting 
seizures
67
Q

When can bedside testing for hypoglycaemia be inaccurate?

A

poor perfusion

polycythaemia

68
Q

hypoglycaemia

A

blood sugar <2.6mmol/l

69
Q

Vulnerable babies to hypothermia

A

low birth weight

requiring prolonged resus

70
Q

Resuscitation and cold stress

A 
dry quickly 
remove wet linens 
use warm blankets
provide radiant warmer heat 
use heated/humidified oxygen
71
Q

tongue ties

A

short, thick frenulum
attached anterior - base of tongue
sometimes - frenotomy

72
Q

Evaluating respiratory problems

A

resp rate
increased effort - grunting, nasal flare
colour
oxygen sats

73
Q

4 areas to assess for retractions

A

substernal
suprasternal
subcostal
intercostal

74
Q

unilateral cleft lip

A

left

75
Q

issues with cleft lip/palate

A 
feeding issues 
- special bottles and teats
can still attempt breast feeding
airway problems 
associated anomalies 
- echo, hearing
76
Q

Ophthalmology

A

cataracts - remove and artificial lens

retinoblastoma

77
Q

Spinal dimples can reveal what?

A

spine/spinal cord eg spina bifida

kidney problems

78
Q

cephalohaematoma

A

localised swelling limited by cranial bones
haemorrhage beneath pericranium
can cause jaundice

79
Q

Caput succedaneum

A

subcutaneous fluid
presenting part on dilating cervix
scalp swelling across midline

80
Q

treatment of fixed talipes

A

vigorous manipulation
strapping
casting
possible surgery

81
Q

What may babies with significant talipes also have?

A

DDH

82
Q

treating DDH

A

relocate head of femur to acetabulum
Pavlik harness
surgical reduction

83
Q

trisomy 21 features

A 
low set ears
single palmar crease 
learning difficulties 
cardiac defects
thyroid problems 
hypotonia

Year 3 Paeds (14 decks)

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