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Paeds > Neonatology > Flashcards

Neonatology Flashcards

1
Q

When is surfactant produced

A

24-34 weeks gestation

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2
Q

What are the issues with neonatal hypoxia

A

Happens during normal labour and delivery

Can lead to fetal bradycardia

If ongoing, can get hypoxic-ischaemic encephalopathy

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3
Q

What are the main principles in neonatal resuscitation

A

Warm baby

Calculate APGAR score

Stimulate breathing

Inflation breaths

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4
Q

How is the APGAR score calculated

A

Appearance (colour)

Pulse

Grimace (response to stimulation)

Activity (muscle tone)

Respiration

Calculate at 1, 5, and 10 minutes

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5
Q

How is breathing stimulated during neonatal resuscitation

A

Dry vigorously with towel

Place head in neutral position

If gasping, check for obstruction

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6
Q

How are inflation breaths delivered in neonatal resuscitation

A

2 cycles of 5 inflation breaths

30 seconds ventilation breaths

Chest compressions

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7
Q

Why is delayed umbilical cord clamping used

A

Allows time for blood from cord to go into fetal circulation

Improves: Hb levels, iron stores, blood pressure

Reduces: intraventricular haemorrhage, necrotising enterocolitis

Uncompromised neonates: at least 1 minute

Compromised neonates: clamp when needed and start resuscitation

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8
Q

What conditions are screened for in the newborn heel prick test

A

On day 5, results in 6-8 weeks

Sickle cell disease

Cystic fibrosis

Congenital hypothyroidism

Phenylketonuria

MCADD

Maple syrup urine disease

Isovaleric acidaemia

Glutaric aciduria type 1

Homocysteine

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9
Q

When does the newborn examination take place

A

Within 72 hours

At 6-8 weeks (by GP)

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10
Q

What do you need to look for in the general appearance part of the newborn examination

A

Colour

Tone

Cry

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11
Q

What do you need to look for in the head part of the newborn examination

A

General appearance (size, shape, dysmorphology, cephalohaematoma)

Head circumference

Sutures

Ears (low set, asymmetry)

Eyes (epicanthic folds in Down’s, discharge in infection)

Red reflex (absent in congenital cataracts and retinoblastoma)

Mouth (cleft lip, tongue tie)

Sucking reflex and cleft palate

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12
Q

What do you need to look for in the shoulders and arms part of the newborn examination

A

Shoulder asymmetry

Arm movements

Brachial pulses

Radial pulses

Palmar creases

Digits

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13
Q

What do you need to look for in the chest part of the newborn examination

A

Observe breathing (distress, symmetry, stridor)

Heart sounds

Breath sounds

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14
Q

What do you need to look for in the abdomen part of the newborn examination

A

Observe for sex

Palpate testes and scrotum (descent, hernias, hydrocele)

Inspect penis (hypospadias, urination)

Inspect anus (check patency)

Ask about meconium

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15
Q

What do you need to look for in the legs part of the newborn examination

A

Observe legs and hips (equal movements, skin creases, tone, talipes)

Barlow and Ortolani manoeuvres (clunking, clicking, dislocation)

Count toes

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16
Q

What do you need to look for in the back part of the newborn examination

A

Inspect and palpate spine (curvatures, spina bifida, pilonidal sinus)

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17
Q

What do you need to look for in the reflexes part of the newborn examination

A

Mono reflex (arms and legs extend when tipped back quickly)

Suckling reflex (when place finger in mouth)

Rooting reflex (turn towards stimulus when tickling cheek)

Grasp reflex (grab finger if placed in palm)

Stepping reflex (make stepping movements when upright and feet touch a surface)

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18
Q

What do you need to look for in the skin findings part of the newborn examination

A

Haemangiomas

Port wine stains

Mongolian blue spot

Cradle cap

Desquamation

Erythema toxisum

Milia

Nevus simplex

Moles

Transient pustular melanosis

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19
Q

What is caput succedaneum

A

A birth injury

Oedema of scalp (outside periosteum, able to cross suture lines)

Due to pressure on scalp during long/traumatic/instrumental delivery

Will resolve in a few days

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20
Q

What is caphalohaematoma

A

A birth injury

Collection of blood between skull and periosteum (does not cross suture lines)

Due to pressure on scalp during long/traumatic/instrumental delivery

Discolouration of skin

Will resolve in a few months

Risk of anaemia and jaundice

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21
Q

What is Erb’s palsy

A

Injury to C5/C6 in brachial plexus

Associated with: shoulder dystocia, traumatic delivery, high birth weight

Weakness of: shoulder abduction, external rotation, arm flexion, finger extension

Get a waiter’s tip appearance

Function usually returns in a few months

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22
Q

What are clavicle fracture birth injuries

A

Associated with: shoulder dystocia, traumatic delivery, high birth weight

Picked up during newborn examination (lack of movement, asymmetry, pain)

Confirm via ultrasound or X-ray

Conservative management

Can get brachial plexus nerve palsies

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23
Q

What are the common organisms that cause neonatal sepsis

A

Group B strep

E coli

Listeria

Klebsiella

Staph aureus

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24
Q

What are the risk factors for neonatal sepsis

A

Maternal vaginal GBS

GBS in previous baby

Maternal sepsis, chorioamnionitis, or fever > 38

Prematurity

Premature rupture of membranes

Prolonged rupture of membranes

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25
Q

What are the clinical features of neonatal sepsis

A

Fever

Reduced tone and activity

Poor feeding

Respiratory distress

Vomiting

Tachycardia or bradycardia

Hypoxia

Jaundice within 24 hours

Seizures

Hypoglycaemia

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26
Q

What are the red flags for neonatal sepsis

A

Confirmed or suspected sepsis in mother

Signs of shock

Seizures

Term baby needed mechanical ventilation

Respiratory distress starting >4 hours after birth

Presumed sepsis in another baby in multiple pregnancy

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27
Q

What is the management for presumed neonatal sepsis

A

1 risk factor or clinical feature: close monitoring for 12 hours

2+ risk factors or clinical signs: start antibiotics

Any red flags: start antibiotics

Antibiotics: within 1 hour, benzylpenicillin

Consider lumbar puncture

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28
Q

What is the ongoing management for neonatal sepsis

A

Check CRP at 24 hours

Check blood culture results at 36 hours

Consider stopping antibiotics when: baby clinically well, blood cultures negative, CRP low

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29
Q

What is hypoxic-ischaemic encephalopathy

A

Occurs in neonates due to hypoxia during birth

Can lead to permanent damage (cerebral palsy)

Causes: maternal shock, intrapartum haemorrhage, prolapsed cord, nuchal cord (cord around neck)

30
Q

What are the signs of mild hypoxic-ischaemic encephalopathy

A

Poor feeding

Generally irritable

Hyper-alert

Resolves within 24 hours

31
Q

What are the signs of moderate hypoxic-ischaemic encephalopathy

A

Poor feeding

Lethargy

Hypotonia

Seizures

Can take weeks to resolve

40% develop cerebral palsy

32
Q

What are the signs of severe hypoxic-ischaemic encephalopathy

A

Reduced consciousness

Apnoea

Flaccid, absent, or reduced reflexes

Up to 50% mortality

90% develop cerebral palsy

33
Q

What is the management for hypoxic-ischaemic encephalopathy

A

Supportive care

Therapeutic hypothermia (protects brain from hypoxic injury, cool to 33-36 degrees for 72 hours, warm over 6 hours)

34
Q

What is neonatal jaundice

A

Jaundice in babies as they have high concentration of fragile red blood cells and less developed livers

Normal at 2-7 days

Pathological if within 24 hours

Prolonged if > 14 days in term babies (> 21 days in preterm babies)

35
Q

What are the causes of neonatal jaundice related to increased production of bilirubin

A

Haemolytic disease of newborn

ABO incompatibility

Haemorrhage

Intraventricular haemorrhage

Cephalo-haematoma

Polycythaemia

Sepsis

DIC

G6PD deficiency

36
Q

What are the causes of neonatal jaundice related to decreased clearance of bilirubin

A

Prematurity

Breast milk jaundice

Neonatal cholestasis

Extrahepatic biliary atresia

Endocrine disorders

Gilbert syndrome

37
Q

What are the investigations for neonatal jaundice

A

FBC

Blood film

Conjugated bilirubin

Blood type testing

Direct Coombs test (for haemolysis)

Thyroid function tests

Blood culture

Urine culture

G6PD

38
Q

What is the management for neonatal jaundice

A

Plot bilirubin levels on treatment threshold chart (specific to gestational age of baby at birth)

Phototherapy (converts unconjugated bilirubin to isomers which can be excreted)

Exchange transfusion

39
Q

What factors are associated with prematurity

A

Social deprivation

Smoking

Alcohol

Drugs

Over/underweight mother

Twins

Personal or family history

40
Q

What is the management for prematurity before/at birth

A

Tocolysis (nifedipine, suppresses labour)

Maternal corticosteroids (if < 35 weeks)

IV magnesium sulphate (protect baby’s brain, if < 34 weeks)

Delayed cord clamping and cord milking

41
Q

What are the issues of prematurity in early life

A

Respiratory distress syndrome

Hypothermia

Hypoglycaemia

Poor feeding

Apnoea

Bradycardia

Neonatal jaundice

Intraventricular haemorrhage

Retinopathy of prematurity

Necrotising enterocolitis

Immature immune system

42
Q

What are the long term effects of prematurity

A

Chronic lung disease of prematurity

Learning disability

Susceptibility to infection

Hearing and visual impairment

Cerebral palsy

43
Q

What is apnoea of prematurity

A

Breathing stops spontaneously for more than 20 seconds

Often with bradycardia

Very common in neonates born at < 28 weeks

Incidence decreases with increasing gestational age

44
Q

What are the causes of apnoea of prematurity

A

Due to immaturity of autonomic nervous system

Often a sign of developing illness (infection, anaemia, airway obstruction, CNS pathology, GOR, neonatal abstinence syndrome)

45
Q

What is the management for apnoea of prematurity

A

Attach apnoea monitors

Tactile stimulation (prompt baby to restart breathing)

IV caffeine (stimulate respiratory drive)

Episodes settle as baby grows and develops

46
Q

What is retinopathy of prematurity

A

Abnormal development of blood vessels in retina, leading to scarring, retinal detachment, blindness

Retinal blood vessels start developing at 16 weeks (finish at 37 weeks), form under hypoxic conditions

If have hypoxic episode after birth, get production of excessive blood vessels (neovascularisation)

When hypoxic episode ends, blood vessels can regress, causing retinal detachment

47
Q

When is retinopathy of prematurity screened for

A

For babies born at < 32 weeks or < 1.5 kg

At 30-31 weeks gestational age for babies born before 27 weeks

At 4-5 weeks of age for babies born after 27 weeks

Monitor every 2 weeks

48
Q

What is the management for retinopathy of prematurity

A

Transpupillary laser photocoagulation (halt and reverse neovascularisation)

Cryotherapy

Inject intravitreal VEGF inhibitors

Surgery (for retinal detachment)

49
Q

What is respiratory distress syndrome

A

Common in babies born before 32 weeks

Get ground glass appearance on chest X-ray

50
Q

What is the management for respiratory distress syndrome

A

Antenatal steroids for mother

Intubation and ventilation

Endotracheal surfactant

CPAP

Oxygen

51
Q

What are the short term complications of respiratory distress syndrome

A

Pneumothorax

Infection

Apnoea

Intraventricular haemorrhage

Pulmonary haemorrhage

Necrotising enterocolitis

52
Q

What are the long term complications of respiratory distress syndrome

A

Chronic lung disease of prematurity

Retinopathy of prematurity

Neurological impairment

Hearing impairment

Visual impairment

53
Q

What is necrotising enterocolitis

A

Part of bowel becomes necrotic in premature neonates

Life threatening emergency

Can get bowel perforation

54
Q

What are the risk factors for necrotising enterocolitis

A

Very low birth weight

Very premature

Formula feeding

Respiratory distress or assisted ventilation

Sepsis

Patent ductus arteriosus

55
Q

How might a patient with necrotising enterocolitis present

A

Intolerant to feeds

Vomiting with green bile

Generally unwell

Distended, tender abdomen

Absent bowel sounds

Blood in stool

56
Q

What are the investigations for necrotising enterocolitis

A

Bloods

Capillary blood gas

Blood cultures

Abdominal X-ray (dilated bowel loops, bowel wall oedema, pneumatosis intestinalis, pneumoperitoneum)

57
Q

What is the management for necrotising enterocolitis

A

Nil by mouth

IV fluids

Total parenteral nutrition

Antibiotics

A surgical emergency

58
Q

What are the complications of necrotising enterocolitis

A

Perforation and peritonitis

Sepsis

Death

Strictures

Abscess formation

Recurrence

Long term stoma

Short bowel syndrome

59
Q

What is neonatal abstinence syndrome

A

Withdrawal symptoms in neonates of mothers using substances during pregnancy

60
Q

What are the common substances that cause neonatal abstinence syndrome

A

Opiates

Methadone

Benzodiazepines

Cocaine

Amphetamine

Nicotine

Cannabis

Alcohol

SSRIs

61
Q

How might a patient with neonatal abstinence syndrome present

A

Usually between 3 and 72 hours

CNS signs: irritability, increased tone, high pitched cry, not settling, tremors

Vasomotor and respiratory signs: yawning, sweating, unstable temperature, tachypnoea

Metabolic and gastrointestinal signs: poor feeding, regurgitation, vomiting, hypoglycaemia, loose stools

62
Q

What is the management for neonatal abstinence syndrome

A

Monitor in hospital for at least 3 days

Urine test for substances

Neonate in quiet, dim room

Oral morphine for opiate withdrawal

Oral phenobarbitone for non-opiate withdrawal

Test for Hep B, Hep C, HIV

Safeguarding

Support mother to stop using

Check suitability for breast feeding

63
Q

What are the effects of fetal alcohol syndrome on the baby

A

Microcephaly

Thin upper lip

Smooth, flat philtrum

Short palpebral fissure (horizontal distance from one eye to the other)

Learning disability

Hearing and vision problems

Cerebral palsy

64
Q

What are the effects of congenital rubella syndrome on the baby

A

Congenital cataracts

Congenital heart disease

Learning disability

Hearing loss

Ensure mothers have had MMR vaccine

65
Q

What are the effects of congenital varicella syndrome on the baby

A

If within first 28 weeks of gestation

Fetal growth restriction

Microcephaly

Hydrocephaly

Learning disabilities

Scars and significant skin changes

Limb hypoplasia

Cataracts

Chorioretinitis

66
Q

What are the effects of congenital cytomegalovirus on the baby

A

Fetal growth restriction

Microcephaly

Hearing loss

Vision loss

Learning disability

Seizures

67
Q

What are the effects of congenital toxoplasmosis on the baby

A

Intracranial calcification

Hydrocephalus

Chorioretinitis

68
Q

What is sudden infant death syndrome

A

Cot death

Usually within first 6 months

69
Q

What are the risk factors for sudden infant death syndrome

A

Prematurity

Low birth weight

Smoking during pregnancy

Male

70
Q

How can the risk of sudden infant death syndrome be minimised

A

Put baby on back when not directly supervised

Keep head uncovered

Place feet at end of bed

Keep toys and blankets out of cot

Maintain comfortable temperature

Avoid smoking

Avoid co-sleeping

Paeds (17 decks)

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