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Y3 paediatrics > neonatology > Flashcards

neonatology Flashcards

1
Q

categories of term admission

A

sepsis
resp
cardio
hypoglycaemia
hypothermia
jaundice
birth asphyxia
surgical problems
neonatal abstinence syndrome

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2
Q

symptoms of sepsis in the neonate

A
  • pyrexia or hypothermia
  • poor feeding
  • lethargy or irritable
  • early jaundice
  • tachypnoea
  • hypo/hyperglycaemia
  • floppy
  • asymptomatic
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3
Q

risk factors for sepsis in the neonate

A

premature rupture of membranes

maternal pyrexia

maternal GBS carriage

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4
Q

management of presumed neonatal sepsis

A
  • admit NNU
  • partial septic screen - FBC, CRP, blood cultures and blood gas
  • consider CXR, LP
  • IV penicillin and gentamicin 1st line
  • add medronidazole if surgical/abdo concerns
  • fluid management and treat acidosis
  • monitor vital signs and support resp and CVS system as required
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5
Q

commonest causes of neonatal sepsis

A
  1. group B strep
  2. e coli
  3. listeria
  4. coag -ve staphylococci (if lines in situ)
  5. haemophilus influenzae
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6
Q

onset of GBS sepsis

A

early onset: birth - 1wk

late onset/recurrence - up to 3mths

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7
Q

difficulties w/ GBS sepsis

A

may be non-specific sepsis

may have no risk factors

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8
Q

complications of GBS sepsis

A

meningitis

DIC

pneumonia and resp collape

hypotension and shock

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9
Q

causes of congenital infection - TORCH

A

toxoplasmosis

other - syphilis, VZV

rubella

CMV

HSV

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10
Q

what is a congenital infection

A

infections acquired transplacentally or in utero

typically occurs when a woman contracts an infection w/ one of the responsible organisms for the 1st time during pregnancy and the foetus then becomes affected

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11
Q

what can congenital infections result in

A

IUGR

brain calcifications

neurodevelopmental delay

visual impairment

recurrent infections

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12
Q

signs and symptoms associated w/ congenital infection

A
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13
Q

how common is resp distress in neonates

A

one of the most common reasons for admission to NNU

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14
Q

causes of resp problems in neonates

A

sepsis

TTN - transient tachypnoea of the newborn

meconium aspiration

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15
Q

how common is TTN

A

self limiting and commonest cause of resp distress in term neonate

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16
Q

presentation of TTN

A

presents within 1st few hrs of life

grunting, tachypnoea, oxygen requirement, normal gases

17
Q

pathophysiology of TTN

A

delay in clearance of foetal lung fluids

  • normally at birth a small amount of fluids are expelled from the mouth, majority is absorbed by lung epithelium (influenced by catecholamines)
18
Q

management of TTN

A

supportive

abx - make sure to exclude other serious causes

fluids

O2

airway support

19
Q

what is associated w/ TTN

A

C section

lower concentration of catecholamines to help clear lung fluids

absence of physical pressure squeezing on the chest

20
Q

what is seen here

A

TTN

  • wet lungs
  • prominent vascular markings
  • horizontal fissure (separating right upper lobe from middle lobw)
21
Q

what is meconium

A

first stool passed by a newborn

10% of neonates pass it during labour

22
Q

risk factors for meconium aspiration

A

post dates

maternal HT

maternal DM

difficult labour

23
Q

symptoms of meconium aspiration

A

cyanosis

increased work of breathing

grunting

apnoea

floppiness

24
Q

investigations for meconium aspiration

A

blood gas

septic screen

CXR

25
Q

why is meconium aspiration important

A

thick meconium inhaled can cause obstruction and air trapping

increased risk of pneumothorax or air leaks

irritant properties - chemical pneumonitis

reduces effectiveness of surfactant and predisposes to chest infections

25
Q

why is meconium aspiration important

A

thick meconium inhaled can cause obstruction and air trapping

increased risk of pneumothorax or air leaks

irritant properties - chemical pneumonitis

reduces effectiveness of surfactant and predisposes to chest infections

26
Q

what can be seen here

A

meconium aspiration

  • flattened diaphragm
  • hyperinflation of the chest
  • coarse opacities w/ patchy areas of collapse and areas of overinflation
27
Q

treatment for meconium aspiration

A

suction below cords

airway support - intubation and ventilation

fluids and IV abx

surfactant

NO or ECMO

28
Q

prognosis for meconium aspiration

A

most do well

some develop PPHN - persistent pulmonary hypertension of the newborn

associated mortality

29
Q

what happens to the circulation in PPHN

A

R → L shunt across PFO/PDA

(persistence of foetal circulation)

failure to oxygenate and pulmonary HT

30
Q

things to remember about cardiac conditions in neonates

A
  • most murmurs aren’t significant and don’t need NNU admission
  • blue baby = urgent treatment
  • sepsis and resp causes are more common than cardiac
31
Q

investigation of the blue baby

A

hx and exam

sepsis screen

blood gas and blood glucose

CXR

pulse oximetry

ECG

echo

hyperoxia test

32
Q

what is a hyperoxia test

A

try to differentiate cardiac from resp disease

  • administer 100% O2 for short time period

lung disease - improved pp O2 on blood gas

cyanotic heart disease - healthy lungs already oxygenating as much as possible, no difference on blood gas

33
Q

DDx - cardiac diagnoses for the blue baby

A

TGA

TOF

TAPVD

hypoplastic L heart syndrome

tricuspid atresia

truncus arteriosus

pulmonary atresia

34
Q

5 Ts of cyanotic congenital cardiac disease

A
  1. Truncus arteriosus (one vessel)
  2. TGA (2 major vessels are switched)
  3. TRIcuspid atresia
  4. TOF (4 defects)
  5. TAPVD (total anomalous pulmonary venous drainage)
35
Q

defects in TOF

A

pulmonary stenosis

VSD

overriding aorta

RVH

Y3 paediatrics (45 decks)

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