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Paediatrics > Neonates > Flashcards

Neonates Flashcards

1
Q

What is the most common cause of neonatal apnoeas?

A

Apnoea of prematurity

  • Immaturity of the brain’s respiratory centre*
  • Onset from days 2-7*
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2
Q

Why are some neonates given caffeine citrate?

A

Prevention of apnoea

All infants < 30 weeks and symptomatic infants 30-34 weeks

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3
Q

What is the leading cause of perinatal death in infants in Australia?

A

Congenital anomalies

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4
Q

How is development dysplasia of the hip treated in children < 6 months?

A

Bracing with a Pavlik harness

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5
Q

Which tests are used on the hips during a newborn examination?

A

Barlow’s test

Ortolani maneuver

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6
Q

What is Barlow’s test?

A

Attempting to dislocate a neonate’s hip, assessing for DDH

Adduct the hip while applying posterior pressure

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7
Q

What is Ortolani’s maneuver?

A

Testing whether the hip has been dislocated with the Barlow test

Abduct the leg and feel for a clunk as the femoral head relocated into the acetabulum

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8
Q

What is the minimal age for recieving the Fluvax?

A

6 months

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9
Q

What is the definition of extreme prematurity?

A

< 26 weeks

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10
Q

What are the significant morbidities associated with extreme prematurity?

A

IVH

Periventricular leukomalacia

Necrotising enterocolitis

Bronchopulmonary dysplasia

Retinopathy of prematurity

Infection

Neurodevelopmental impairment

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11
Q

What is the Guthrie test?

A

Newborn heel prick

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12
Q

What is periventricular leukomalacia?

A

A white matter injury or periventricular necrosis followed by cyst formation

Leads to spastic diplegia

Caused by ischaemic insult

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13
Q

How are neonates with a subluxable hip managed?

A

US at 6 weeks

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14
Q

How are children with a dislocatable hip managed?

A

Paediatric orthopaedic referral

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15
Q

Which gender is at a greater risk of DDH?

A

Female (4x)

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16
Q

How common is hip instability at birth?

A

1:100

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17
Q

How common is a dislocated hip at birth?

A

1:1000

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18
Q

Which hip is more commonly affected by DDH?

A

Left (75%)

Due to the position of the hip in relation to the mother’s spine

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19
Q

What are the two most significant risk factors for DDH?

A
  1. Breech presentation
  2. Family history
    * 6 week US for all infants in the above categories*
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20
Q

Which screening tests are used for DDH in infants older than 3 months?

A
  1. Restricted abduction (most sensitive)
  2. Leg length discrepancy
  3. Asymmetric thigh and gluteal skin folds
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21
Q

What are each of the APGAR score points given for?

A

A - Appearance (skin colour)

P - Pulse

G - Grimace (reflex irritability)

A - Activity (muscle tone)

R - Respiration

22
Q

Why might infants of diabetic mothers have polycythemia?

A

Hyperglycaemia → stimulates EPO production

Also causes mortality and metabolic acidosis

23
Q

What vitamin is administered at birth?

A

Vitamin K

To prevent vitamin K deficiency bleeding/haemorrhagic disease of the newborn

24
Q

Why do newborns have low vitamin K?

A

Newborn livers do not effectively utilise vitamin K

Low vitamin K in breastmilk

Poor placental transfer

25
Q

What is the definition of neonatal hypoglycemia?

A

BSL < 2.6 mmol/L

26
Q

What is the significance of a base deficit in a cord gas?

A

Suggests a metabolic component in a child with acidosis

May suggest longer term/more severe acidosis

27
Q

In between which layers of the scalp does a cephalohematoma occur?

A

Below the periosteum, above the skull

28
Q

In between which layers of the scalp does a subgaleal haematoma occur?

A

In between the periosteum of the skull and the aponeurosis

29
Q

How are cephalohaematomas and subgaleal haematomas clinically distinguished?

A

Subgaleal haematomas cross suture lines

30
Q

Up to what gestational age are antenatal corticosteroids given?

A

< 35 weeks

When birth is expected in the next 7 days, or even within 24 hours

31
Q

What is the definition of low birth weight?

A

< 2500g

Low: < 2500
Very low: < 1500
Extremely low: < 1000

32
Q

What is the definition of very low birth weight?

A

< 1500 g

Low: < 2500
Very low: < 1500
Extremely low: < 1000

33
Q

What is the definition of extremely low birth weight?

A

< 1000 g

Low: < 2500
Very low: < 1500
Extremely low: < 1000

34
Q

What is the definition of extreme prematurity?

A

< 28 weeks

35
Q

What is the primary pathogenic mechanism of anaemia of prematurity?

A

Poor EPO production

36
Q

What is the most common cause of early-onset neonatal pneumonia?

37
Q

How might an infant with NEC present?

A

Feed intolerance

Bilious vomiting/high gastric aspirates

Bloody stools

Abdominal distension and/or tenderness

Ileus/decreased bowel sounds

Temperature instability

Apnoea and bradycardia

Shock

38
Q

What are the most common complications of NEC?

A

Intestinal strictures

Short gut syndrome

39
Q

How is colostrum different to breast milk?

A

2x protein

Lower in fat and carbohydrate

Less energy dense

40
Q

What is the pathophysiology of breastfeeding jaundice?

A

Insufficient breast milk intake → lack of calories and inadequate quantities of bowel movements to remove bilirubin from the body → increased enterohepatic circulation → increased reabsorption of bilirubin from the intestines

41
Q

What is the pathophysiology of breast milk jaundice?

A

Increased concentration of B-glucuronidase in breast milk → increased deconjugation and reabsorption of bilirubin → persistence of physiologic jaundice

Continue feeds and use phototherapy if required

42
Q

What is a staccato cough characteristic of?

A

Neonatal chlamydia infection

Low sensitivity

43
Q

Is conjugated or unconjugated jaundice associated with kernicterus?

A

Unconjugated

Unconjugated bilirubin crosses the BBB

44
Q

An inability to conjugate bilirubin describes which condition?

A

Crigler-Najjar

Deficiency of UDP-glucuronosyltransferase (UGT1A1)

45
Q

An inability to move conjugated bilirubin from the hepatocyte to the bile cannaliculi describes which condition?

A

Dubin-Johnson syndrome

Defective MRP2 transporter

46
Q

What is the target SpO2 after birth?

A

1 minute: 60-70%

5 minute: 80-90%

10 minute: 85-90%

47
Q

Why might neonates have head-bobbing with respiratory distress?

A

Recruitment of the SCM pulls on the head

48
Q

What are some absolute contraindications to breastfeeding?

A

Maternal HIV, active TB or active herpes lesions on breast

Ilicit drug use

Maternal chemotherapy or radiotherapy

Galactosemia

49
Q

What are the effects of intrapartum opioid use on the neonate?

A

Respiratory depression and drowsiness that can last several days

50
Q

What is Klumpke’s palsy?

A

Brachial plexus injury to C7-T1

Claw hand, absent palmar grasp reflex, Horner’s syndrome

51
Q

Jaundice that persists beyond how long in a neonate needs an escalation of management?

A

Term: 14 days

Preterm: 21 days

Paediatrics (24 decks)

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