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Neonates Flashcards

1
Q

What problem can prems get with their eyes?

A

Retinopathy of prematurity

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2
Q

what problem can prems get with their bones?

A

osteopenia of prematurity

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3
Q

what problems can prems get with their lungs? (x3)

A

Respiratory Distress Syndrome
Pneumothorax
Bronchopulmonary Dysplasia

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4
Q

what problem can prems get with their heart?

A

PDA = patent ductus arteriosis

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5
Q

what problems can prems get with their metabolism?

A

hypocalcaemia and general electrolyte imbalance

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6
Q

what problem can prems get with their liver

A

jaundice

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7
Q

what problem can prems get with their blood?

A

anaemia of prematurity

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8
Q

how much does a baby weight to class as ‘very low birth weight’ (VLBW)

A

<1500g

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9
Q

what is a baby weighing under <1000g called

A

‘extremely low birth weight’

<750g = incredibly low birth weight

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10
Q

what range do you aim to keep O2 sats within for prems? why?

A

91-95%
under 91% = risk of NEC
over 95% = risk of retinopathy

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11
Q

give me two key reasons why prems have lung problems

A
  1. not enough alveoli yet
  2. not enough surfactant yet
    (so atelectasis)
    so decreased gas exchange
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12
Q

what do you give to the mother to prevent resp distress syndrome in prems?

A

glucocorticoid

stims surfactant prod

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13
Q

Resp Distress Syndrome causes tachypnoea >60, laboured breathing, recession, nasal flaring, and WHAT SOUND on expiration?

A

expiratory grunting

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14
Q

What does CXR show in Resp Distress Syndrome?

A

ground glass

air bronchogram

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15
Q

what is air bronchogram on a CXR and when do u see it?

A

pattern of air-filled bronchi on background of airless lung

Resp Distress Syndrome

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16
Q

what is a sign that Resp Distress Syndrome has got really severe?

A

cyanosis

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17
Q

what is the treatment for Resp Distress Syndrome in prematurity?

A

surfactant therapy

+/- CPAP/ high flow o2 / mech vent

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18
Q

A chronic lung disease of prematurity. What’s it called?

A

Bronchopulmonary Dysplasia

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19
Q

What is the main complication of Resp Distress Syndrome?

A

persistent pulmonary hypertension of newborn

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20
Q

If a prem needs 02 at term (past 36wks), this is…

A

Bronchopulmonary Dysplasia

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21
Q

What causes bronchopulmonary dysplasia in prems ?

A

failure of alveolarisation :(
barotrauma from mech vent

wean them onto CPAP/nasal o2. Go home on o2.

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22
Q

In Resp Distress Syndrome, sometimes alveoli get overdistended, letting air into the pleural cavity. What’s this called?

A

Pneumothorax!

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23
Q

How do you investigate suspected pneumothorax in a prem?

A

transillumination of chest wall with fibre optic light!

CXR

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24
Q

Pneumothorax in prems can cause decreased breath sounds and decreased chest movements on affected side. What is the treatment of a tension pneumothorax?

A

chest drain

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25
Q

Why do apnoea and bradycardia occur in prems?

A

brainstem not fully myelinated

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26
Q

Sometimes prems stop breathing for 20-30 seconds. What’s this called?

A

apnoea and bradycardia (brainstem problem)

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27
Q

What investigation for interventricular haemorrhage in prem?

A

cranial ultrasound

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28
Q

Interventricular haemorrhage in prem can lead to what two sever consequences?

A
  1. hydrocephalus–> cerebral palsy

2. infarction –> hemiplegia

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29
Q

Periventricular leukomalacia = loss of white matter in prems. Cranial ultrasound show?

A

multiple bilateral cysts

can lead to spastic diplegia

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30
Q

Give me three reasons why prems are vulnerable to hypothermia

A
  1. large surface area
  2. thin skin
  3. less subcutaneous fat
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31
Q

Which problem in premature neonates is caused by HYPEROXIC insult?

A

Retinopathy

vascular proliferation –> fibrosis –> blindness in some cases

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32
Q

Retinopathy of prematurity leads to loss of which reflex?

A

red reflex

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33
Q

What is the treatment for retinopathy of prematurity

A

laser therapy

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34
Q

ischaemia and bacterial invasion of the bowel in prems. What’s this?

A

necrotizing enterocolitis (NEC)

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35
Q

What are the three key symptoms of necrotizing enterocolitis?

A
  1. Distended Abdo
  2. Bilious Vomit
  3. Feed Intolerance
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36
Q

Two bad consequences of necrotizing enterocolitis

A

shock

perforation

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37
Q

What does AXR show in necrotizing enterocolitis?

A

intramural gas (distended abdo)

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38
Q

What is the treatment for necrotizing enterocolitis?

A

STOP ORAL FEEDING!

total parenteral nutrition (TPN)

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39
Q

Why are prems at particular risk of infection and sepsis?

A
  • IgG doesnt go across placenta until Last Trimester!
  • Mum might have had premature labour due to infection
  • Nosocomial from mech vent / cath!
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40
Q

Neonatal jaundice is very common. Even more so in prems. At what bilirubin level is neonatal jaundice clinically visible?

A

80 umol/L

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41
Q

Two causes of jaundice <24hrs of age

A 
haemolytic disorders (e.g. rhesus disease)
congenital infections
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42
Q

Two causes of jaundice >24hrs-2wks of age

A

physiological jaundice of the newborn

breastmilk jaundice

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43
Q

Why does physiological jaundice of the newborn happen? Three reasons, you can get em :)

A
  1. high Hb conc at birth
  2. newborn rbc 70 day lifespan (instead of 120)
  3. bili metab less effective in first days
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44
Q

4 factors exacerbating jaundice between 24hrs-2wks…

A

infection
dehydration
bruising
polycythaemia

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45
Q

How to investigate jaundice of the newborn

A

transcutaneous bilirubin meter
serial serum bilirubins - plot on chart
split bili - to see if conjugated.

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46
Q

what is the usual treatment for neonatal jaundice?

A

correct dehydration, start Abx (sepsis risk)
if serial bilis meet threshold:
PHOTOTHERAPY

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47
Q

if serial bilirubins climbing dangerously high in neonatal jaundice, how do you treat?

A

EXCHANGE TRANSFUSION

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48
Q

in jaundice >2weeks of age, this may be because of conjugated or unconjugated bilirubin. Give me two causes of high unconjugated?

A

hypothyroidism
infection (esp UTI)

or just prolonged breastmilk / physiological >2wks

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49
Q

In jaundice >2wks of age, with high CONJUGATED bilirubin, what are the two key causes?

A

BILIARY ATRESIA

NEONATAL HEPATITIS

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50
Q

4 week old baby with pale stools + dark urine, hepatomegaly and growth faltering. Conjugated bilirubin is high. What are the two likely diagnosis?

A

Biliary atresia

Neonatal hepatitis

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51
Q

Bile ducts narrowed / blocked / absent. What’s this?

A

biliary atresia

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52
Q

What is the treatment for neonatal biliary atresia?

A

Kasai hepatoporoenterostomy

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53
Q

What causes neonatal hepatitis, apart from congenital infection of hepatitis?

A

Inborn errors of metabolism
a-1 anti-trypsin deficiency
cystic fibrosis

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54
Q

Unconjugated bilirubin deposits in basal ganglia and brainstem nuclei…. causing encephalopathy. What’s this?

A

Kernicterus.

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55
Q

Why is it UNconjugated bili deposits that cause kernicterus?

A

fat-sol – cross blood brain barrier

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56
Q

Neonate with lethargy, and poor feeding goes on to have opisthotonos, seizures and coma. What comes to mind?

A

kernicterus

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57
Q

Try your best to give me three complications of kernicterus.

A

dyskinetic cerebral palsy
learning difficulties
sensorineural deafness

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58
Q

premature babies are usually fed with TPN. whats this

A

total parenteral nutrition

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59
Q

why do you not build up feeds too quickly in prems?

A

risk of NEC

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60
Q

What would you give for pulmonary hypertension in newborn?

A

sildenafil

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61
Q

Give me four complications of intubation of premature babies. (Acronym: DOPE)

A

Displaced tube
Obstructed tube
Pneumothorax
Equipment problem

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62
Q

What is often one of the first clinical signs of neonatal jaundice

A

YELLOW SCLERAE

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63
Q

If a newborn has jaundice with pale stools and dark urine, what should you be worried about?

A

Biliary atresia

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64
Q

What is biliary atresia

A

Bile ducts narrowed / blocked / absent.

65
Q

How do you investigate biliary atresia?

A

radio-isotope scan, then liver biopsy

66
Q

What kind of cerebral palsy can kernicterus result in?

A

dyskinetic cerebral palsy

67
Q

Albert is a 10 day old neonate. He has just his heelprick bloodspot (biochemical screening). The lab phone up to say is TSH is very high. What’s the problem?

A

high TSH = congenital hypothyroidism

bc high TSH means not enough T4

68
Q

What is the average birthweight ?

A

3.5kg (7.7 lbs)

69
Q

What is the normal range for birth weight?

A

2.7 - 4.1kg

70
Q

What counts as low birth weight?

71
Q

What counts as high birth weight?

72
Q

What is the commonest cause of congenital hypothyroidism WORLDWIDE?

A

iodine deficiency

73
Q

What are the commonest causes of congenital hypothyroidism IN THE UK? (x2)

A
  • maldescent of thyroid

- athyrosis

74
Q

What is maldescent of the thyroid? (cause of congenital hypothyroidism)

A

the thyroid stays sublingual - at the base of the tongue!

75
Q

What is athyrosis? (cause of congenital hypothyroidism)

A

the thyroid fails to develop

76
Q

What is the commonest cause of congenital hypothyroidism in CONSANGUINEOUS COUPLES?

A

dyshormonogenesis (error of T3/4 synthesis)

77
Q

Congenital hypothyroidism is usually asymptomatic or picked up neonatal biochemical screening. If symptomatic, it can present with…. (x7) (in order from head to toe)

A
  • delayed development
  • growth problems
  • coarse facies
  • hoarse cry
  • feeding problems
  • constipation
  • prolonged jaundice >2wks
78
Q

What is treatment for congenital hypothyroidism?

A

oral thyroxine lifelong!!

79
Q

Newborn screening consists of three main screens…

A

newborn BloodSpot
newborn hearing screening
6-8wk baby check

80
Q

How many conditions screened for in newborn BloodSpot (Guthrie)?

81
Q

What conditions are screened for in newborn BloodSpot?

A

sickle cell
CF
congenital hypothyroidism
6 x inherited metabolic disorders

82
Q

Give 2 examples of the 6 inherited metabolic disorders screened for in newborn BloodSpot.

A

phenylketonuria
maple syrup disease
homocysteniuria
MCADD

83
Q

For newborn BloodSpot, heel prick blood test is done at 5days old. If positive, what do you do?

A

repeat.

refer to specialist.

84
Q

You do baby check (NIPE) at ____ and then again at 6-8wks.

85
Q

What do you check in 6-8wk baby check?

A

eye
heart
hips
testes

86
Q

6-8wk baby check: what do u check in eyes

87
Q

6-8wk baby check: what do u check in testes

A

undescended

88
Q

When do u do newborn hearing screening?

A

before leave hosp

89
Q

what’s the special name for newborn hearing screening

A

automated otoautoacoustic emission

90
Q

If newborn hearing screening positive, what next

A

refer for audiology assessment

91
Q

How common is sickle cell?

92
Q

How common is CF?

93
Q

How common is congenital hyopthyroid?

94
Q

Normal physiology of thyroid hormones after birth?

A

not much thyroxine transferred from mum to foetus. foetus makes inactive T3

after birth, surge in TSH and T3/4, which normalises within a week

95
Q

What counts as early onset neonatal sepsis?

A

<48hrs after birth

96
Q

What counts as late onset neonatal sepsis?

A

> 48hrs after birth

97
Q

Give me a key cause of late onset neonatal sepsis.

A

staph epidermidis

often from indwelling cath, parenteral nutrition

98
Q

Give me some examples of when early onset neonatal sepsis is caused by bac ascending via birth canal, infecting foetus VIA AMNIOTIC FLUID.

A

prolonged ROM, chorioamnionitis

99
Q

Give me some examples of when early onset neonatal sepsis is caused by infection VIA PLACENTA.

A

congenital viral or Listeria monocytogenes

100
Q

Give four causes of early onset neonatal sepsis.

A

prolonged ROM, chorioamnionitis

congenital viral or Listeria monocytogenes

101
Q

What is treatment for early onset neonatal sepsis?

A

BenPen or gentamycin

102
Q

What is treatment for late onset neonatal sepsis?

A

flucloxacillin or gentamycin

103
Q

What antibiotic is good for staph epidermidis

A

vancomycin

104
Q

Broad spec Abx for late onset neonatal sepsis if fluclox/gentamycin don’t work?

105
Q

Why do you repeat CRPs in early onset neonatal sepsis?

A

takes 12-24hrs to rise - repeat CRP

106
Q

What grams does gentamycin get?

A

gram negatives

107
Q

Prolonged Abx for neonatal sepsis can cause….

108
Q

Give me some non-specific clinical features of neonatal sepsis…

A 
temp instability (fever --- hypothermia)
resp distress
poor feeding
vomiting
irritability, lethargy
seizures
jaundice, 
hyper/hypoglycaemia
109
Q

Investigations for neonatal sepsis

A

FBC
CRP
cultures - if pos, LP
CXR

110
Q

3 serious sequalae of neonatal meningitis.

A

cerebral abscess
hydrocephalus
hearing loss

111
Q

2 signs of neonatal meningitis

A

bulging fontanelle

opisthotonos

112
Q

Treatment for neonatal meningitis?

A

IV cefotaxime

113
Q

Does GBS cause early or late onset neonatal sepsis?

114
Q

What percent of women are carriers of GBS?

115
Q

<48hrs of birth, how does GBS present?

A

early - resp distress and pneumonia - sepsis

116
Q

> 48hrs of birth, how does GBS present?

A

late - meningitis!

occasionally osteomyelitis / septic arthritis

117
Q

Listeria monocytogenes can cause pneumonia and meningitis in neonates. True or false?

118
Q

are sticky eyes common in neonates?

119
Q

Normal sticky eyes in neonate - how treat?

A

clean w saline

120
Q

Staph/strep conjunctivitis - how to treat?

A

chloramphenicol

121
Q

Gonorrhoea conjunctivitis - how to treat?

A

IV cefuroxime

122
Q

Chlamydia conjunctivitis - how to treat?

A

oral erythromycin

123
Q

Neonate with purulent discharge, conjunctiva injection, and eyelid swelling. Likely diagnosis?

A

gonorrhoea or chlamydia conjunctivitis

124
Q

Mum test for Hep B?

A

HBsAg
(surface antigen e = more risky for chronic)

if pos - neonate should get vaccination

125
Q

I want EIGHT causes of neonatal seizures.

Rule out meningitis and hypoglycaemia ASAP.

A
  • HIE.
  • meningitis
  • hypoglycaemia
  • hypoNa, Ca, Mg
  • inborn errors of metabolism
  • neonatal abstinence syndrome
  • congenital infection
  • kernicterus
126
Q

hypo whats can cause neonatal seizures?

A

hypoglycaemia

hypoNa, Ca, Mg

127
Q

Investigations for neonatal seizures?

A 
BM 
bloods
cultures (if pos - LP)
cerebral US
aEEG
128
Q 
BM
bloods
cultures (if pos - LP)
cerebral US
aEEG

These are investigations for?

A

neonatal seizures

129
Q

Basic treatment for neonatal seizures?

A

treat cause. anticonvulsants.

130
Q

Neonatal hypoglycaemia = < …?

131
Q

3 causes for neonatal hypoglycaemia

A

diabetic mum
preterm / IUGR
ill

132
Q

What’s the mechanism behind hypoglycaemia in neonates with diabetic mums?

A

high insulin levels

133
Q

What’s the mechanism behind hypoglycaemia in neonates who are preterm / IUGR?

A

poor glycogen stores

134
Q

Give me some symptoms of neonatal hypoglycaemia.

A

drowsiness, irritability, seizures, sweating, pallor

135
Q

Prolonged hypoglycaemia in neonate can cause permanent neurodisability. True or false?

136
Q

Treatment for neonatal hypoglycaemia??

A

IV glucose via central venous cath
(10% bolus, 10% infusion)

don’t respond / seizures? - IM glucagon

137
Q

To treat neonatal hypoglycaemia you give IV glucose via central venous cath (10% bolus, 10% infusion). When would you give IM glucagon?

A

if having seizures / not responding

138
Q

What blood glucose level would you aim for when treating neonatal hypoglycaemia?

139
Q

Investigations for neonatal hypoglycaemia?

A

confirm w lab blood glucose
serum insulin, GH, cortisol, C-peptide
urine: organic acids

140
Q

When investigating neonatal hypoglycaemia, you want to confirm with lab the blood glucose. You want to check the urine for organic acids. You also want to check the serum for what FOUR things?

A

insulin
GH
cortisol
C-peptide

141
Q

Failure of fusion of frontonasal and maxillary processes. What’s this?

142
Q

Failure of fusion of palatine processes and nasal septum. What’s this?

A

cleft palate

143
Q

When does cleft lip present?

144
Q

When does cleft palate present?

A

6-12 months

145
Q

3 symptoms of cleft palate?

A

feeding difficulties
cough/choking
secondary otitis media

146
Q

Treatment for cleft lip / palate?

A

surgical repair

147
Q

Micrognathia (small jaw) and cleft palate combo makes you think of

A

Pierre Robin sequence (airway obstruction)

148
Q

This condition causes salivation, choking and aspiration. If chronic it can cause GORD and cough.

A

oesophageal atresia

149
Q

Investigations and treatment for oesophageal atresia?

A

pass tube and x ray it

surgery

150
Q

Persistent green vomiting and delayed meconium can be signs of small bowel obstruction. Give me FOUR causes of this in neonates :)

A

duodenal atresia
malrotation /volvulus
CF - meconium ileus
meconium plug, passes spontaneously!

151
Q

What condition is duodenal atresia common in ?

152
Q

FOUR causes of LARGE bowel obstruction in neonates ? :)

A

Hirschsprung
rectal atresia
exomphalos
gastroschisis

153
Q

Which sticky outy guts through umbilicus is covered with sac?

A

exomphalos

154
Q

Treatment for exomphalos?

A

dry with heater and it closes up

155
Q

Treatment for gastroschisis?

A

NG tube, fluids, wrap it in SILO silastic sack.

156
Q

What condition is a SILO silastic sack for.

A

gastroschisis

157
Q

What happens in exomphalos / gastroschisis?

A

abdo contents through umbilicus

158
Q

Abdo contents through umbilicus. What’s this?

A

exomphalos / gastroschisis

Paediatrics (14 decks)

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