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Paedriatrics > Neonates > Flashcards

Neonates Flashcards

1
Q

What are causes of jaundice in the 1st 24hrs?

A

Haemolytic

TORCH - congenital infection

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2
Q

What are causes of jaundice from the 2nd day-3rd wk?

A 
Physiological (gone after 1st wk)
Breast milk
Sepsis
Polycythemia
Cephalhaematoma
Crigler-Najjar syndrome
Haemolytic disorders
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3
Q

What are causes of jaundice after the 3rd wk?

A

Breast milk
Hypothyroidism
Pyloric stenosis
Cholestasis

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4
Q

What is the treatment for jaundice?

A 
Treat underlying cause
Hydrate
Phototherapy
Exchange transfusion
Immunoglobin
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5
Q

What % of normal term neonates get erythema toxicum?

A

30-70%

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6
Q

What is erythema toxicum is?

A

Maculo-papular rash

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7
Q

What happens usually to erythema toxicum?

A

Fade by end 1st wk

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8
Q

What are Mongolian blue spots?

A

Blue-grey pigmentations

Accumulation of melanocytes

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9
Q

When do Mongolian blue spots usually present?

A

Lower back and buttocks

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10
Q

What happens to Mongolian blue spots?

A

Normally disappears three to five years after birth

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11
Q

What are stork marks?

A

Naevus simplex

Light colour capillary dilatation

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12
Q

Where are stork marks normally found?

A

Back of neck

Midline of face

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13
Q

What happens to stork marks?

A

Disappear within 1st 2yrs

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14
Q

What are examples of capillary vascular malformations?

A

Stork marks

Port wine stain

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15
Q

What is port wine stain?

A

Naevus flammeus
Present at birth, flat or slightly raised
Caused by dilated, mature capillaries in the superficial dermis

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16
Q

Do port wine stains go away?

A

Do not regress

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17
Q

What is an example of a capillary haemangioma?

A

Strawberry naevus

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18
Q

What is strawberry naevus?

A

Cluster of dilated capillaries which appears within first month after birth
Raised and bright red, with discrete edges, any part of body

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19
Q

What happens to strawberry naevus?

A

Usually regresss after one yr

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20
Q

What babies are at risk of limited glucose supply?

A

Premature babies

Perinatal stress

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21
Q

What babies are at risk of hyperinsulinism?

A

Infants of diabetic mothers

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22
Q

What babies are at risk of increased glucose use?

A

Hypothermia

Sepsis

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23
Q

What is the definition of hypoglycaemia in babies?

A

<2.0mmol/l blood sugar

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24
Q

When can bedside testing for hypoglycaemia be inaccurate?

A

At low/high levels
When poor perfusion
When polycythaemia

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25
Q

What are symptoms of hypoglycaemia in babies?

A 
Jitteriness
Temperature instability
Lethargy
Hypotonia
Apnoea, irregular respirations
Poor suck/feeding
Vomiting
High pitched or weak cry
Seizures
Asymptomatic
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26
Q

What ways can babies become hypothermic?

A

Evaporation (wet skin)
Conduction (cold towels)
Convection (open windows)
Radiation (cold objects nearby)

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27
Q

What is the management of babies with hypothermia?

A 
Dry quickly
Remove wet linens
Use warm blankets
Provide radiant warmer heat
Use heated/humidified oxygen
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28
Q

What is tongue ties?

A

Short +/- thickened frenulum

Attached anteriorly -> base of tongue

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29
Q

When should you do a frenotomy for tongue tied ness?

A

Restriction of tongue protrusion beyond alveolar margins AND feeding affected

30
Q

What types of GI problems can babies have?

A 
Vomiting
Posseting
Mucous vomits
Gastro-oesphageal reflux
Cows milk protein intolerance
Bilious vomiting
Failure to pass meconium
Bloody stools
Bloody vomit
31
Q

How can you assess respiratory function in babies?

A

RR
Increased effort: grunting, retractions, nasal flaring
Colour
O2 sats

32
Q

What areas should you assess for retractions?

A

Substernal
Subcostal
Intercostal
Suprasternal

33
Q

What % of cleft lip also have cleft palate?

A

70%

34
Q

What are the types of cleft lip?

A

Complete - small gap in lip

Incomplete - continue into nose

35
Q

Why does cleft lip occur embryonically?

A

Maxillary and medial nasal processes fail to merge

Usually 5wks gestation

36
Q

What can cleft lip/palate issues be?

A

Feedings issues
Airway problems
Associated anomalies: hearing/heart/trisomies

37
Q

What ophthalmological defects should you check for in babies?

A

Red reflexes
Cataracts
Retinoblastoma

38
Q

What can spinal dimples suggest?

A

Spina bifida +/- tethered cord

39
Q

What is a cephalohaematoma?

A

Localised swelling over one or both sides of head, becomes maximal in size by 3rd/4th day of life
Soft, non translucent swelling

40
Q

What is the treatment for cephalohaematomas?

A

No treatment required, usually resolution in 3-4wks

41
Q

What happens if cephalohaematoma very large?

A

Increased haemolysis can occur = increased/prolonged neonatal jaundice

42
Q

What are talipes?

A

Medial (varus) or lateral (valgus) deviation of foot

43
Q

What is the treatment for Medial (varus) or lateral (valgus) deviation of foot?

A

Often positional, so just physio

44
Q

What is the treatment for fixed talipes?

A

Strapping, casting or possibly surgery

45
Q

What is a complication of talipes?

A

Developmental dysplasia of the hips

46
Q

What are the tests for developmental dysplasia of the hip (DDH)?

A

Barlow test

Ortolani test

47
Q

What are the treatment options for DDH?

A

Pavlik harness

Surgical reduction

48
Q

What are the features of trisomy 21/DS?

A 
Dysmorphism - low set ears, downward slanting palpebral tissues, epicanthic folds, single palmar creases, wide sandal gap
Hypotonia
Cardiac defects
Learning problems
Haematological problems
Thyroid problems
49
Q

What are the symptoms of sepsis in neonates?

A 
Baby pyrexia/hypothermia
Poor feeding
Lethargy or irritable
Early jaundice
Tachypnoea
Hypo or hyperglycaemia
Floppy
50
Q

What are risk factors for sepsis in neonates?

A

PROM (premature rupture of membranes)
Maternal pyrexia
Maternal Group B Strep carriage

51
Q

What is the management of presumed sepsis in neonates?

A 
Admit NNU
Partial septic screen
Consider CXR, LP
IV penicillin and gentamicin - 1st line
IV vancomycin and gentamicin - 2nd line
Add metronidazole if surgical concerns
Fluid management
Treat acidosis
Monitor vital signs
Support resp/CVS systems
52
Q

What are the commonest causes of neonatal sepsis?

A 
Group B strep
E.coli
Listeria
Coag-neg staph
Haemophilus influenzae
53
Q

What are the complications of GBS sepsis?

A 
Meningitis
DIC
Pneumonia
Resp collapse
Hypotension and shock
54
Q

What are the TORCH infections in neonates?

A

Toxoplasmosis
Rubella
CMV
Herpes

55
Q

What are causes of respiratory distress in neonates?

A

Sepsis
TTN - transient tachypnoea of the newborn
Meconium aspiration

56
Q

What are the symptoms of TTN (transient tachypnoea of the newborn)?

A

Grunting, tachypnoea, O2 requirement, normal gases

57
Q

What causes TTN (transient tachypnoea of the newborn)?

A

Delay in clearance of foetal lung fluids

58
Q

When does TTN present?

A

First few hours of life

59
Q

What are the risk factors for meconium aspiration?

A

Post dates
Maternal diabetes
Hypertension
Difficult labour

60
Q

What are the symptoms of meconium aspiration?

A 
Cyanosis
Increased work of breathing
Grunting
Apnoea
Floppiness
61
Q

What investigations should be done for meconium aspiration?

A

Blood gas
Septic screen
CXR

62
Q

What is the treatment for meconium aspiration?

A 
Suction below cords
Airway support
Fluids
Antibiotics IV
Surfactant
NO or ECMO
63
Q

What are investigations for a ‘blue baby’?

A 
Exam and history
Sepsis screen
Blood gas and glucose
CXR
Pulse oximetry
ECG
ECHO
Hyperoxia test
64
Q

What are differentials a ‘blue baby’?

A 
TGA
ToF
TAPVD
Hypoplastic left heart syndrome
Tricuspid atresia
Truncus arteriosus
Pulmonary atresia
65
Q

What is the treatment for hypoglycaemia?

A 
Monitor blood glucose
IV 10% glucose
Increase fluids
Increase glucose conc
Glucagon
Hydrocortisone
66
Q

What is birth asphyxia?

A

Lack of O2 at or around birth leading to multi organ dysfunction

67
Q

What are causes of birth asphyxia?

A 
Placental problems
Long, difficult delivery
Umbilical cord prolapse
Infection
Neonatal airway problem
Neonatal anaemia
68
Q

What are the 2 stages of birth asphyxia?

A
  1. Within minutes without O2, cell damage occurs with lack of blood flow and O2
  2. Reperfusion injury, can last days/wks, toxins released from damaged cells
69
Q

What are causes of failure to pass stool?

A 
Constipation
Large bowel atresia
Imperforate anus +/- fistula
Hirshsprungs disease
Meconium ileum (think CF)
70
Q

What are abdominal wall defects?

A

Diaphragmatic hernia

71
Q

Which side does a diaphragmatic hernia usually affect?

A

Left

Paedriatrics (19 decks)

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