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Neonatology Flashcards

1
Q

What cells produce surfactant?

A

Type II alveolar cells

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2
Q

What are the two sides to the surfactant?

A

The hydrophilic side that faces the water, and the hydrophobic side that faces the air

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3
Q

What is the action of surfactant?

A

Increases the lung compliance

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4
Q

Why would the alveoli collapse without surfactant?

A

Due to the surface tension of the water surrounding them

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5
Q

What is compliance?

A

When the surfactant reduces the force needed to expand the alveoli and therefore the lungs during inspiration

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6
Q

How does surfactant increase lung compliance?

A

Reduces the surface tension of the fluid in the lungs to keep the alveoli inflated and maximise their surface area

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7
Q

How does surfactant promote equal expansion of all alveoli?

A

As an alveolus expands, the surfactant becomes more thinly spread and therefore the surface tension increases, making it more difficult to expand further

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8
Q

At what gestation do alveolar cells become mature enough to start producing surfactant?

A

24-34 weeks gestation

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9
Q

What stimulates the first breath?

A

Birth, temperature change, sound and physical touch

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10
Q

What is released by the baby in response to the stress of labour that stimulates respiratory effort?

A

Adrenalin and cortisol

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11
Q

What happens during the first breaths the baby takes?

A

The alveoli expand for the first time, decreasing pulmonary vascular resistance

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12
Q

What changes to the cardiovascular system do the first breaths trigger?

A

Decrease in pulmonary vascular resistance causes fall in pressure in right atrium, causing left atrial pressure to be greater and the closure of the foramen ovale.

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13
Q

What changes happen to the cardiovascular system after birth?

A

Closure of foramen ovale and ductus arteriosus
Ductus venosus stops functioning
Pressure becomes greater in left atrium

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14
Q

What are the key problems that would trigger the need for neonatal resuscitation?

A

Hypoxia- placenta can’t carry out normal gaseous exchange during contractions
Hypothermia- large surface area: weight ratio and are born wet
May have aspirated meconium

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15
Q

What are the key steps in neonatal resuscitation?

A 
Warm them
Calculate APGAR score
Stimulate breathing
Inflation breaths
Chest compressions
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16
Q

How can you warm the baby?

A

Get them dry as quickly as possible
Warm delivery rooms and heat lamps
Put in plastic bag if <28 weeks

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17
Q

What is the APGAR score?

A

Used to indicate progress after the first minutes after birth

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18
Q

What does APGAR stand for?

A 
Appearance
Pulse
Grimmace (response to stimulation)
Activity
Respiration
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19
Q

How often should the APGAR score be calculated?

A

At 1, 5 and 10 minutes

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20
Q

How can you stimulate breathing immediately after birth?

A

Shake vigorously
Place head in neutral position to keep airway open
Check for airway obstruction

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21
Q

When are inflation breaths given?

A

When the neonate is gasping or not breathing despite adequate initial stimulation

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22
Q

How many inflation breaths are given?

A

Two cycles of five inflation breaths

If no response- 30 seconds of ventilation breaths

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23
Q

When performing inflation what should be used?

A

Air for term babies

Air + oxygen for pre-term babies

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24
Q

When should chest compressions be started in neonates?

A

If HR< 60 despite resuscitation and inflation breaths

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25
Q

What is HIE and what causes it?

A

Hypoxic-ischaemic encephalopathy

Caused by prolonged hypoxia

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26
Q

Why is there a delay in umbilical cord clamping?

A

There is still a large volume of fetal blood in the placenta after birth. Delaying clamping gives time for the blood to enter the fetal circulation, improving haemoglobin, iron stores and blood pressure

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27
Q

What is the one downside of delaying cord clamping?

A

Increases instance of neonatal jaundice

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28
Q

How long should cord clamping be delayed after birth?

A

At least one minute

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29
Q

What is the neonatal period?

A

The first 4 weeks of life

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30
Q

What is the care given to neonates immediately after birth?

A 
Skin to skin contact
Clamp to umbilical cord
Dry baby and keep warm
Vitamin K 
Label baby 
Measure weight and length
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31
Q

Why are babies given a vitamin K infusion?

A

Babies are born with vitamin K deficiency, and it is a normal part of blood clotting

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32
Q

How is vitamin K given to babies?

A

IM injection

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33
Q

What are the benefits of immediate skin to skin contact?

A

Helps warm baby
Improves mother baby interaction
Calms baby
Improves breast feeding

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34
Q

What care should happen to the neonate after mum and baby are out of delivery room?

A 
Initiate breast (or bottle) feeding
Newborn examination within 72 hours
Blood spot test
Newborn hearing test
First bath within few days
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35
Q

What is the blood spot screening test?

A

Heel prick blood spot that looks for 9 congenital conditions

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36
Q

What day does the blood spot screen occur?

A

Day 5

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37
Q

What conditions are screened for in the blood spot test?

A

Sickle cell disease
CF
Congenital hypothyroidism
Congenital metabolic disorders (6)

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38
Q

Within what time frame after birth should a NIPE be performed?

A

Within 72 hours

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39
Q

At what point is the newborn exam repeated?

A

At 6-8 weeks by GP

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40
Q

What questions should be asked at a NIPE?

A

Has meconium been passed?
Is baby feeding ok?
Family history of congenital heart, eye or hip problems?

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41
Q

What are pre and post ductal saturations?

A

Measures oxygen level before and after ductus arteriosus

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42
Q

What are normal saturations in a neonate?

A

> 96%

No more than 2% difference between pre and post ductal sats

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43
Q

Where is the ductus arteriosus located?

A

Along the arch of the aorta (connects aorta and pulmonary artery)

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44
Q

When does the ductus arteriosus usually stop functioning?

A

1-3 days after birth

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45
Q

What are duct-dependent conditions?

A

Congenital heart conditions that rely on the mixing of blood across ductus arteriosus for survival

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46
Q

How might duct dependent conditions be picked up?

A

By comparing pre and post ductal saturations

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47
Q

Where are pre-ductal saturations measured and why?

A

Baby’s right hand- receives blood from right subclavian artery which branches from the aorta before the ductus arteriosus

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48
Q

Where are post-ductal saturations measured?

A

In either foot- both receive blood from the descending aorta which occurs after the ductus arteriosus

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49
Q

What is Talipes?

A

Clubfoot- when the ankles are in the supinated position

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50
Q

What is positional talipes?

A

Where the muscles are slightly tight around the ankle but the bones are unaffected so will resolve with time

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51
Q

What is structural talipes?

A

When the bones of the foot and ankle are affected so must have referral to orthopaedic surgeon

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52
Q

What are the key injuries that can occur at birth?

A 
Caput succedaneum
Cephalohaematoma
Facial paralysis
Erbs palsy
Fractured clavicle
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53
Q

What is caput succedaneum?

A

Oedema on the scalp outside the periosteum

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54
Q

What causes caput succedaneum?

A

Pressure to a specific area of the scalp during a traumatic, prolonged or instrumental delivery

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55
Q

What is the periosteum?

A

A layer of dense connective tissue that lines the outside of the skull and doesn’t cross the sutures

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56
Q

What is a cephalohaematoma?

A

Collection of blood vessels between the skull and periosteum

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57
Q

What causes a cephalohaematoma?

A

Damage to blood vessels during a traumatic, prolonged or instrumental delivery

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58
Q

What is the difference between the lump in caput succedaneum and cephalohaematoma?

A

Crosses suture line in caput succadaneum but not cephalohaematom

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59
Q

What are the risks associated with a cephalohaematoma?

A

Risk of anaemia and jaundice (blood collects and breaks down, releasing bilirubin)

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60
Q

What is the usual cause of facial nerve injury at birth?

A

Forceps delivery

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61
Q

What is an Erbs palsy?

A

Damage to the brachial plexus leading to weakness of shoulder abduction, external rotation, arm flexion and finger extension

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62
Q

What causes Erbs palsy?

A

The result of injury to the C5/6 nerves in the brachial plexus during birth

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63
Q

How is the affected arm affected in Erbs palsy?

A 
'Waiters tip' appearance:
Internally rotated shoulder
Extended elbow
Pronated, flexed wrist
Lack of movement
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64
Q

What is Erbs palsy associated with?

A

Shoulder dystocia
Traumatic or instrumental delivery
Large birth weight

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65
Q

What are the most common causative organisms of neonatal sepsis?

A 
*Group B strep
E.coli
Listeria
Klebsiella
Staph aureus
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66
Q

Why is Group B strep the most common cause of neonatal sepsis?

A

It is a common harmless bacteria found in the vagina, that can be transferred to the baby during labour

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67
Q

What are the risk factors for developing neonatal sepsis?

A 
Vaginal GBS colonisation
GBS sepsis in previous baby
Maternal sepsis, chorioamnionitis or fever >38
Prematurity
PROM/ PPROM
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68
Q

What are the clinical features of neonatal sepsis?

A 
Fever
Reduced tone/ activity
Poor feeding
Respiratory distress/ apnoea
Vomiting
Tachy/ bradycardia
Hypoxia
Jaundice
Seizures 
Hypoglycaemia
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69
Q

What are the red flags to look for to suspect neonatal jaundice?

A 
Sepsis in mother
Signs of shock
Seizures
Needing mechanical ventilation
Respiratory distress
Sepsis in another baby (multiple pregnancy)
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70
Q

What should be done if there is one risk factor or clinical feature of neonatal sepsis?

A

Monitor obs and clinical condition for 12 hours

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71
Q

What should be done if there are two or more risk factors or clinical features of neonatal sepsis?

A

Start broad spectrum antibiotics

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72
Q

When should antibiotics be given in suspected neonatal sepsis?

A

If there is 1 or more red flag features

If there are two or more risk factors/ clinical features

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73
Q

What should be done before giving antibiotics in neonatal sepsis?

A

Blood cultures taken
Check baseline FBC and CRP
(Perform LP if infection strongly suspected)

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74
Q

What are the first line antibiotics used in neonatal sepsis?

A

Benzylpenicilllin and Gentamycin

or Cefotaxime

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75
Q

How do you monitor neonatal sepsis?

A

Check CRP at 24 hours

Check blood culture at 36 hours

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76
Q

When would you consider stopping antibiotics in neonatal sepsis?

A

If baby is clinically well, blood cultures are negative after 36 hours and CRP<10

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77
Q

What is HIE?

A

Hypoxic ischaemic encephalopathy

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78
Q

When does HIE occur?

A

In neonates as a result of hypoxia during birth

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79
Q

What can HIE cause?

A

Cerebral palsy

Death

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80
Q

When should you suspect HIE?

A

In neonates when there are events that could lead to hypoxia during the perinatal or intrapartum period
If there is pH<7 on umbilical artery blood gas
Poor Apgar scores
Features of HIE seen
Evidence of multiorgan failure

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81
Q

What are the common causes of HIE?

A

Maternal shock
Intrapartum haemorrhage
Prolapsed cord
Nuchal cord

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82
Q

What is nuchal cord?

A

Where the cord is wrapped around the babies neck

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83
Q

What are the different grades of HIE?

A

Mild- resolves within 24 hours
Moderate- can take weeks to resolve
Severe- Up to 50% mortality, 90% develop cerebral palsy

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84
Q

How is HIE managed?

A

MDT team:
Supportive with neonatal resuscitation and optimal ventilation, circulatory supporty, nutrition, acid base balance and seizure treatment

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85
Q

What may be considered in HIE to protect from hypoxic injury?

A

Therapeutic hypothermia

86
Q

What is therapeutic hypothermia?

A

Actively cooling the core temperature to 33/34 degrees for 72 hours to reduce inflammation and neurone loss

87
Q

What is jaundice?

A

Abnormally high levels of bilirubin in the blood

88
Q

What kind of bilirubin to RBC’s contain?

A

Unconjugated

89
Q

Why is there unconjugated bilirubin in the blood?

A

Released when RBC’s break down

90
Q

Where is unconjugated bilirubin conjugated?

A

In the liver

91
Q

How is conjugated bilirubin excreted?

A

Via the biliary system into the GI tract

Via the urine

92
Q

What is bilirubin a breakdown product of?

A

Haem from haemoglobin

93
Q

Why do fetuses have more bilirubin than adults?

A

There is a higher concentration of RBC’s in neonates
RBC’s are more fragile and break down more rapidly
Less developed liver function

94
Q

How is bilirubin excreted in a fetus?

A

Via the placenta

95
Q

Why is there a normal rise in bilirubin shortly after birth?

A

The baby can no longer rely on the placenta to excrete it

96
Q

When does physiological jaundice usually present and how long does it usually take to resolve?

A

Mild yellowing of skin/ sclera from 2-7 days, but usually resolves by 10 days

97
Q

What are the two overlying causes of neonatal jaundice?

A

Increased production of bilirubin or

Decreased clearance of bilirubin

98
Q

What are the causes of increased production of bilirubin in the neonate?

A 
Haemolytic disease of the newborn
ABO incompatibility 
Haemorrhage
Intravascular haemorrhage
Cephalo-haematoma
Polycythaemia
Sepsis/ DIC
G6PD deficieny
99
Q

What are the causes of decreased clearance of bilirubin in the neonate?

A 
Prematurity
Breast milk jaundice
Neonatal cholestasis
Extrahepatic biliary atresia
Endocrine disorders
Gilbert syndrome
100
Q

When is jaundice pathalogical?

A

In the first 24 hours of life

101
Q

Why are premature babies more likely to get jaundice?

A

Process of physiological jaundice is exaggerated due to immature liver

102
Q

What is the key complication of neonatal jaundice?

A

Kernicterus

103
Q

What is kernicterus?

A

Brain damage due to high bilirubin levels

104
Q

What is breast milk jaundice?

A

When babies that are breast fed are more likely to have neonatal jaundice

105
Q

Why are breastfed babies more likely to have neonatal jaundice?

A

Components in breast milk inhibit ability of liver to process bilirubin
Breastfed babies more likely to be dehydrated if not feeding adequately, which can lead to slow passage of stools and increased absorption of bilirubin in intestines

106
Q

What is haemolytic disease of the newborn?

A

Disease where there is premature haemolysis of neonatal RBC’s

107
Q

What causes haemolytic disease of the newborn?

A

Rhesus disease
ABO incompatibility
G6PD deficiency
Spherocytosis

108
Q

How does rhesus haemolytic disease occur?

A

When a rhesus negative D mother has a rhesus positive child, the blood will mix and the mother will produce antibodies against the rhesus D antigen (sensitised). In the second pregnancy, the anti-D antibodies can cross the placenta and cause haemolysis, anaemia and high bilirubin levels in the fetus or newborn

109
Q

What is ABO incompatibility?

A

When group O mothers have an IgG anti-A-haemolysin antibody that can cross the placenta and haemolyse the red cells of a group A infant

110
Q

When does jaundice for ABO incompatibility peak and is it worse or better than rhesus disease?

A

Less severe than rhesus disease

Peaks in first 12-72 hours

111
Q

What is G6PD deficiency?

A

Genetic disorder where body doesn’t produce enough of G6PD enzyme which helps RBCs work

112
Q

Who is most affected G6PD deficiency?

A

Males

Mediterranean, middle-eastern and african-americans

113
Q

When is jaundice classified as prolonged?

A

> 14 days in term babies

>21 days in prem babies

114
Q

What investigations are done to look into jaundice?

A 
FBC and Blood film
Conjugated bilirubin lvels
Blood type testing (ABO/ Rhesus)
Direct Coombs test
TFTs
Blood/ urine cultures
G6PD levels
115
Q

What is the Coombs test?

A

Direct antiglobulin test for haemolysis

116
Q

How is neonatal jaundice managed?

A

Plot bilirubin levels on treatment threshold chart
Phototherapy
Exchange transfusion

117
Q

What is the action of phototherapy?

A

Converts unconjugated bilirubin into isomers that can be excreted in the bile and urine without conjugation in the liver

118
Q

What does phototherapy involve?

A

Removing all clothing and putting on eye patches to protect eyes. Light box shines blue light on baby’s skin.

119
Q

What is the main reason we treat neonatal jaundice?

A

To prevent kernicterus

120
Q

How does kernicterus present?

A

Less responsive
Floppy
Drowsy
Poor feeding

121
Q

What are the main causes of jaundice starting <24 hours?

A 
Congenital infection
Haemolytic disorders: 
-Rhesus incompatibility
-ABO incompatibility
-G6PD deficiency
-Spherocytosis
122
Q

What are the causes of jaundice at 24 hrs- 2 weeks?

A 
Physiological
Breast milk
Infection
Haeomlysis
Bruising
Polycythaemia
123
Q

What are the causes conjugated of jaundice at >2 weeks?

A

Bile duct obstruction

Neonatal hepatitis

124
Q

What are the causes of unconjugated jaundice at > 2 weeks?

A 
Physiological
Breast milk
Infection
Hypothyroidism
Haemolytic
High GI obstruction
125
Q

What gestation is classified as prematurity?

A

Birth before 37 weeks gestation

126
Q

What are the different classifications of prematurity?

A

Extreme preterm= <28 weeks
Very preterm= 28-32 weeks
Moderate- late preterm= 32-37 weeks

127
Q

What are the risk factors for premature birth?

A 
Social deprivation
Smoking
Alcohol
Drugs
Over/ underweight mother
Maternal comorbidities
Twins
Personal/ family history
128
Q

Why is there an attempt to delay birth as long as possible in premature pregnancies?

A

There is a dramatic improvement in prognosis with each additional week of gestation

129
Q

What are the two options of trying to delay birth before 24 weeks gestation?

A

Prophylactic vaginal progesterone

Prophylactic cervical cerclage

130
Q

What is prophylactic cervical cerclage?

A

Putting a suture in the cervix to hold it closed

131
Q

What options are available for improving outcomes in suspected preterm labour?

A

Tocolysis with nifedipine
Maternal corticosteroids
IV magnesium sulphate
Delayed cord clamping

132
Q

What is tocolysis?

A

Using mediation (nifedipine) to suppress labour

133
Q

What are the key issues that can occur in early life as a result of premature delivery?

A 
Respiratory distress syndrome
Hypothermia
Hypoglycaemia
Poor feeding
Apnoea and bradycardia
Neonatal jaundice
Intraventricular haemorrhage
Retinopathy
Necrotising enterocolitis
Immature immune system--> Infection
134
Q

What are the long term effects of premature birth?

A 
Chronic lung disease of prematurity
Learning/ behavioural difficulties
Susceptibility to infections
Hearing/ visual impairment
Cerebral palsy
135
Q

What is apnoea?

A

Periods where breathing stops spontaneously for > 20 seconds OR for >10 seconds with oxygen desaturation or bradycardia

136
Q

What is apnoea often accompanied by?

A

A period of bradycardia

137
Q

In which babies is apnoea very common?

A

Premature neonates (almost all <28 weeks gestation)

138
Q

What causes apnoea in neonates?

A

Immaturity of the autonomic nervous system that controls respiration and heart rate

139
Q

What may apnoea be a sign of?

A 
Developing illness:
Infection
Anaemia
Airway obstruction
CNS pathology
GORD
Neonatal abstinence syndreom
140
Q

How is apnoea of prematurity managed?

A

Attach apnoea monitors, which make a sound when apnoea is occuring
Tactile stimulation can then be used to prompt the baby to restart breathing

141
Q

What can be used in babies to prevent apnoea and bradycardia?

A

IV caffiene

142
Q

What is retinopathy of prematurity?

A

Abnormal development of blood vessels in the retina of premature babies, leading to scarring, retinal detachment and blindness

143
Q

At what point in development does blood vessel development usually start?

A

Around 16 weeks

144
Q

At what gestation is retinal blood vessel development usually complete?

A

37-40 weeks

145
Q

What stimulates retinal blood vessel formation?

A

Hypoxia (normal state of the retina during pregnancy)

146
Q

Why does being born prematurely increase the risk of retinopathy?

A

Premature exposure to higher oxygen levels removes the stimulant for normal blood vessel development. When hypoxic environment recurs, retina responds by producing excessive blood vessels and scar tissue which may regress and cause retinal detachment

147
Q

What are the 3 zones of the retina?

A

Zone 1= optic nerve + macula
Zone 2= between zone 1 and ora serrata
Zone 3= outside ora serrata

148
Q

When are babies screened for premature retinopathy?

A

30-31 weeks GA in babies born <27 weeks

4-5 weeks in babies born after 27 weeks

149
Q

What babies should be screened for ROP?

A

Those born before 32 weeks

<1/5kg

150
Q

How frequently should retinopathy screening be performed in premature babies and when can it stop?

A

Every 2 weeks

Can stop once retinal vessels enter zone 3

151
Q

How are babies screened for retinopathy?

A

Opthalmologist monitors retinal vessels as they develop and looks for additional findings (Plus disease)

152
Q

How is retinopathy of prematurity treated?

A

Systemic targeting of the retina to stop new blood vessels developing with transpupillary laser photocoagulation

153
Q

Who are most affected by respiratory distress syndrome and why?

A

Premature neonates (<32 weeks) born before the lungs start producing adequate surfactant

154
Q

What is seen on CXR of respiratory distress syndrome?

A

‘Ground glass appearance’

155
Q

What causes respiratory distress syndrome in preterm neonates?

A

Inadequate surfactant leads to high surface tension within alveoli, leading to lung collapse as they find it harder to expand. This leads to hypoxia, hypercapnia and respiratory distress

156
Q

What is given to mothers with suspected preterm labour and why?

A

Antenatal steroids to increase production of surfactant and reduce incidence or RDS

157
Q

How is RDS managed?

A

Intubation and ventilation
Endotracheal surfactant
CPAP
Supplementary oxygen

158
Q

What is CPAP?

A

Continuous positive airway pressure (via nasal mask to keep lungs inflated)

159
Q

What are the short term complications of respiratory distress syndrome?

A 
Pneumothorax
Infection
Apnoea
Intraventricular haemorrhage
Pulmonary haemorrhage
Necrotising enterocolitis
160
Q

What are the long term complications of respiratory distress syndrome?

A

Chronic lung disease of prematurity
Retinopathy of prematurity
Neurological, hearing and visual impairment

161
Q

What are the clinical signs of respiratory distress syndrome?

A

Tachypnoea >60

Increased work of breathing (Chest wall recession, nasal flaring etc)

162
Q

What is necrotising enterocolitis?

A

Disorder affecting premature neonates where part of the bowel becomes necrotic

163
Q

Why is necrotising enterocolitis a life threatening emergency?

A

Death of the bowel tissue can lead to bowel perforation, leading to peritonitis and shock

164
Q

What are the risk factors for developing necrotising enterocolitis?

A 
Very low birth weight
Prematurity
Formula feeds
Respiratory distress/ assisted ventilation
Sepsis
Congenital heart disease
165
Q

How does necrotising enterocolitis present?

A 
Intolerance to feeds
Vomiting with green bile
Generally unwell
Distended, tender abdomen
Absent bowl sounds
Blood in stools
166
Q

What investigations can be done into necrotising enterocolitis?

A

Blood tests

Abdominal Xray

167
Q

What blood tests are done to diagnose necrotising enterocolitis?

A

FBC
CRP
Capillary blood gas
Blood culture

168
Q

What may abdo Xray show with necrotising enterocolitis?

A

Dilated loops of bowel
Bowel wall oedema
Pneumatosis intestinalis
Pneumoperitoneum

169
Q

What is pneumatosis intestinalis?

A

Gas in the bowel wall

170
Q

What is pneumoperitoneum?

A

Free gas in the peritoneal cavity

171
Q

How is necrotising enterocolitis managed>

A

Nil by mouth with IV fluids, TPN and antibiotics.

Immediate surgical referral

172
Q

What is TPN?

A

Total parenteral nutrition= method of feeding that bypasses the GI tract by giving formula straight into veins

173
Q

What are the key complications of necrotising enterocolitis?

A 
Perforation and peritonitis
Sepsis
Death
Strictures
Abscess formation
Recurrence
Long term stoma
Short bowel syndrome
174
Q

What is neonatal abstinence syndrome?

A

Withdrawal symptoms that happen in neonates of mothers that used substances in pregnancy

175
Q

What substances cause neonatal abstinence syndrome?

A 
Opiates
Methadone
Benzodiazepines
Cocaine
Amphetamines
Nicotine or cannabis
Alcohol
SSRI antidepressants
176
Q

When after birth does withdrawal usually begin?

A

3-72 hours

177
Q

What are the signs and symptoms of substance withdrawal in the neonate?

A 
Irritability
Increased tone
High pitched cry
Not settling
Tremors
Seizures
Yawning
Sweating
Unstable temperature and pyrexia
Tachypnoea (fast breathing)
Poor feeding
Regurgitation or vomiting
Hypoglycaemia
Loose stools with a sore nappy area
178
Q

How is substance abuse managed before delivery

A

Mothers encouraged and supported to cut back/ stop

Alert in notes so neonate can have extra monitoring and management

179
Q

How are babies with abstinence syndrome managed?

A

Monitor on NAS chart for at least 3 days
Urine sample to test for substances
Medical treatment if severe

180
Q

What medical treatment options are available for: 1. Opiate withdrawal?
2. Non-opiate withdrawal?

A
  1. Morphine sulphate

2. Phonebarbitone

181
Q

What are the main conditions arising in pregnancy?

A 
Fetal alcohol syndrome
Congenital rubella syndrome
Congenital varicella syndrome
Congenital cytomegalovirus
Congenitla taxoplasmosis
Congenital zika syndrome
182
Q

In what period of pregnancy does alcohol consumption have the greatest effect?

A

First 3 months

183
Q

What does drinking alcohol in early pregnancy lead to?

A

Miscarriage
Small for dates
Preterm delivery

184
Q

What is fetal alcohol syndrome?

A

Specific effects and characteristics found in children of mothers that consumed significant alcohol during pregnancy

185
Q

What are the common characteristics of fetal alcohol syndrome?

A 
Microcephaly 
Thin upper lip
Smooth flat philtrum 
Short palpebral fissure
Learning/ behavioural difficulties
Hearing/ vision problems
Cerebral palsy
186
Q

What causes congenital rubella syndrome and when is pregnancy is riskiest?

A

Maternal infection with rubella during pregnancy (particularly first 3 months)

187
Q

What should be given to prevent congenital rubella syndrome?

A

MMR vaccine (NOT during pregnancy)

188
Q

What are the features of congenital rubella syndrome?

A

Congenital cataracts
Congenital heart disease (PDA, pulmonary stenosis)
Learning disability
Hearing loss

189
Q

Why is chickenpox infection dangerous in pregnancy?

A

Can lead to varicella pneumonitis, hepatitis or encephalitis, fetal varicella syndrome or severe neonatal varicella infection

190
Q

What should be done if a woman id exposed to chickenpox in pregnancy?

A

If had prev chickenpox, they’re safe
If unsure about immunity, test VZV IgG levels
If no immune, treat with IV varicella immunoglobulins

191
Q

What should be done if a women presents with chickenpox rash in pregnancy?

A

Treat with oral aciclovir if >20 weeks gestation

192
Q

In what percentage of pregnancy chickenpox cases does congenital varicella syndrome develop?

A

Around 1%

193
Q

What are the typical features of congenital varicella syndrome?

A 
FGR
Microcephaly
Hydrocephalus
Learning disability
Scars/ skin changes on dermatomes
Limb hypoplasia
Cataracts and eye inflammation
194
Q

What is the cause of congenital cytomegalovirus?

A

CMV infection during pregnancy

195
Q

What are the features of congenital CMV?

A 
FGR
Microcephaly
Hearing loss
Vision loss
Learning disability
Seizures
196
Q

What is toxoplasma gondii?

A

A parasite

197
Q

What causes toxoplasmosis infection?

A

Spread by contamination with faeces from a cat that is a host of the parasite

198
Q

What are the classic triad of features in congenital toxoplasmosis?

A

Intracranial calcification
Hydrocephalus
Chorioretinitis

199
Q

How is the zika virus spread?

A

By host Aedes mosquitos

Sex with someone infected

200
Q

What are the features of congenital zika syndrome?

A

Microcephaly
FGR
Intracranial abnormalities

201
Q

What is SIDS?

A

Sudden infant death syndrome

202
Q

When does SIDS usually occur?

A

Within first 6 months of life

203
Q

What are the risk factors for SIDS?

A

Prematurity
Low birth weight
Smoking during pregnancy
Male baby

204
Q

What measures can be taken to minimise the risk of SIDS?

A 
Put baby on back when unsupervised
Keep head uncovered
Keep cot clear 
Maintain comfortable room temp
Avoid smoking
Avoid co-sleeping
205
Q

What is classified as a neonate?

A

Infant <28 days

206
Q

What is classified as an infant?

A

From birth to 1 year

207
Q

What is classified as a low birth weight?

A

<2500 g

208
Q

What is classified as a very low birthweight?

A

<1500g

209
Q

What is classified as extremely low birth weight?

A

<1000g

210
Q

Why is a C-section more likely to cause transient tachypnoea of the newborn?

A

Because the infants chest has not been squeezed through the birth canal, so the lung liquid is not drained so it take several hours for the fluid to be completely absorbed

211
Q

What can be given to infants with continued respiratory depression due to mothers opiate analgesia?

A

Naloxone

Paeds (18 decks)

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