Neonatology Flashcards
Name five components of a baby check
Top to toe
Head, face, mouth palate, eyes, colour and skin, arms, chest, heart, abdomen, genitalia, muscle tone and reflexes, back and spine, hips, feet, count toes
What should be palpated for in the head of a baby?
Fontanelle
What are fontanelle?
(colloquially, soft spot) is an anatomical feature of the infant human skull comprising soft membranous gaps (sutures) between the cranial bones that make up the calvaria of a fetus or an infant.
What are Epstein’s pearls?
Gingival cyst, also known as Epstein’s pearl, is a type of cysts of the jaws that originates from the dental lamina and is found in the mouth parts. Completely benign and commonly found in newborns
What should be assessed in the eyes?
opthalmoscope- red reflex
Why is a red reflex performed?
to exclude cataracts
Name three abnormalities in the skin of a newborn?
Pale, jaundiced
Cyanosis
Skin rash
Discolouration e.g. port wine stains
What is the name of a skin lesion in babies that can be found near the eye and may obstruct vision
Cavernous hemangioma (see in paediatric dermatology clinic SSC)
Black baby with blue skin marks along the base of spine. What is the likely cause?
Mongolian blue spots= congenital dermal melanocytosis
Name one aspect to examine in the arms?
abnormal posturing- nerve palsies if difficult delivery
Name one aspect of hand exam in baby check
palmar crease (down’s)
What should you examine during the heart assessment of baby check?
thrill/heave
listen over precordium and back
brachial and femoral pulses
Name one condition in which femoral pulses is reduced
coarctation
Name three normal reflexes found in babies
grasp
suck (place finger in mouth)
moro= infant suddenly splaying their arms and moving their legs before bringing their arms in front of their body, this is normal. If absent then worry
What is Galeazzi sign?
used to assess for hip dislocation, primarily in order to test for developmental dysplasia of the hip. It is performed by flexing an infant’s knees when they are lying down so that the feet touch the surface and the ankles touch the buttocks to assess for leg length.
Which two maneuvers are employed to determine whether the hip is disloctable?
Barlow’s- initial test
Ortolani
What does the newborn blood spot test screen for?
cystic fibrosis, sickle cell disease, congenital hypothyroidism, inherited metabolic diseases, PKU
Name one cause of conjugated hyperbilirubinaemia in neonates?
biliary atresia
What is a typical presentation of biliary atresia?
pale stool and dark urine
Why do you get dark urine dark and pale stools?
Biliary blockage causes bile to leak into systemic circulation. Since conjugated bilirubin is soluble it is excreted in the urine (making it dark). The faeces are deprived of their stercobilinogen and are pale.
What is biliary atresia?
Biliary atresia is a blockage in the tubes (ducts) that carry bile from the liver to the gallbladder. This congenital condition occurs when the bile ducts inside or outside the liver do not develop normally.
Name three causes of unconjugated hyperbilirubinaemia in neonates?
- Physiological
- Breast milk jaundice
- Haemolytic disease (Rhesus, ABO or other antibodies)
- Infection (UTI, sepsis)
- Congenital hypothyroidism (prolonged jaundice)
What is the definition of prolonged jaundice?
Prolonged jaundice is defined as visible jaundice persisting >14 days in a term
infant and >21 days in a preterm infant.
What is the most common cause of prolonged jaundice?
breast feeding
Treatment for hyperbilirubinaemia is determine by which two factors?
gestational age and bilirubin level
Name two treatment options for hyperbilirubinaemia
Phototherapy and exchange transfusion
Name two causes of respiratory distress in neonates
- Transient tachypnoea of the newborn
- Respiratory distress syndrome (surfactant deficiency)
- Meconium aspiration
- Pneumothorax
- Respiratory Infection
When does TTN arise and for how long?
first 8 hours
List two causes of cyanosis in newborn
- Any cause of respiratory distress can also cause cyanosis
- Persistent Pulmonary Hypertension of the Newborn
- Congenital cyanotic heart disease
- Tracheo-oesophageal fistula
- Diaphragmatic hernia
What is the most common cause of a collpased neonate?
neonatal sepsis
List three risk factors for neonatal sepsis
prolonged rupture of membranes, premature rupture of
membranes, maternal infection (particularly Group B strep)
Name three ways in which neonatal sepsis can present?
collapse, apnoea, respiratory distress,
seizures, jaundice, poor feeding, lethargy
Three differentials for intestinal obstruction in neonate?
- Meconium plug/ileus
- Duodenal atresia, or other small bowel atresia
- Oesophageal atresia
- Malrotation with volvulus
- Hirschsprung disease
What is hirschsprung disease?
ntestinal disorder characterized by the absence of nerves in parts of the intestine leading to constipation and obstruction
What is meconium aspiration?
Meconium aspiration happens when a baby is stressed and gasps while still in the womb, or soon after delivery when taking those first breaths of air. Amniotic fluid and meconium. Meconium= stool passed soon after birth before feeding. They can pass this in the womb if stressed
What is necrotising enterocolitis?
affects premature neonates where part of the bowel becomes ischaemic
What is a complication of necrotising enterocolitis?
bowel death can lead to perforation, causing shock and peritonitis
Name two injuries to neonate associated with birth?
traumatic injuries: facial paralysis, fractured clavicle, Erbs palsy (C5/C6 injury), cephalohaematoma, caput succaedaneum
Hypoxic ischemic encephaopathy can lead to which condition?
cerebral palsy
Describe two risk factors that would concern you for potential hypoxic ischaemia encephalopathy?
prolonged hypoxia
respiratory acidosis
multiorgan failure evidence
Two causes of hypoxic ischaemic encephalopathy?
Maternal shock
Intrapartum haemorrhage
Prolapsed cord, causing compression of the cord during birth
Nuchal cord, where the cord is wrapped around the neck of the baby
Baby is born and 2 hours later develops jaundice. Are you worried?
Yes, Jaundice in the first 24 hours of life is pathological. This needs urgent investigations and management. Neonatal sepsis is a common cause. Babies with jaundice within 24 hours of birth need treatment for sepsis if they have any other clinical features or risk factors.
List three causes of jaundice increased production of bilirubin
Haemolytic disease of the newborn
ABO incompatibility
Haemorrhage
Intraventricular haemorrhage
Cephalo-haematoma
Polycythaemia
Sepsis and disseminated intravascular coagulation
G6PD deficiency
List three causes of jaundice decreased clearance of bilirubin
Prematurity
Breast milk jaundice
Neonatal cholestasis
Extrahepatic biliary atresia
Endocrine disorders (hypothyroid and hypopituitary)
Gilbert syndrome
Aside from breast feeding, name two causes of prolonged jaundice
biliary atresia
G6PD deficiency
hypothyroidism
Name three outcomes/long-term effects of preterm birth
Chronic lung disease of prematurity (CLDP)
Learning and behavioural difficulties
Susceptibility to infections, particularly respiratory tract infections
Hearing and visual impairment
Cerebral palsy
What is retinopathy of prematurity?
Abnormal development of the blood vessels in the retina can lead to scarring,
What are two long term effects of retinopathy of prematurity?
retinal detachment and blindness
What is a typical feature on CXR of baby with respiratory distress syndrome?
ground glass appearance
What is the pathophysiology of respiratory distress syndrome?
Inadequate surfactant leads to high surface tension within alveoli and therefore collapse ->hypoxia, hypercapnia, respiratory distress
What do you inspect for during hip exam?
moulding, abnormal posture, leg length symmetry, hip creases symmetry, knee height
Name the two manoeuvres you perform in hip exam?
barlow and ortolani
What is the aim of the barlow manouvre?
to detect dislocation by trying to displace femoral heal posteriolaterally from the acetabulum
What is the aimof the ortolani manouvre?
to determine if dislocated hip joint is reducible after Barlow manouvre is performed
What does a ‘clicky hip’ suggest?
developmental dysplasia of the hips (DDH)
List four risk factors for DDH
1 Breech at or after 36 weeks gestation
2 Breech at delivery after 28 weeks
3 Family history of DDH in 1st degree relative
4 Associated deformities (e.g. fixed talipes or calcaneovalgus deformity) or
moulding
5 Multiple birth with risk factors or multiple birth sibling with positive examination
6 Female gender (5x risk in girls)
7 Post dates
8 babies
Birthweight >4.5kg
List three complications of DDH
Avascular necrosis
Acetabular dysplasia
Osteoarthritis
Redislocation
Multiple surgeries
How is DDH diagnosed?
ultrasound
What is the management of DDH?
Pavlik harness
Surgical reduction if late diagnosis or Rx failure
Would you be more worried in baby losing weight with formula milk or breast fed?
formula milk as this suggests pathology, whereas breast milk weight discrepancy could well be due to technical aspects
When would you perform blood tests to investigate weight loss?
concern for CAH = congenital adrenal hyperplasia
jaundice
any pathological cause
What questions should you ask in the history of a baby who has lost >13% weight?
GA, feeding?, formula or breast?, any pregnancy/delivery issues, family history, wet nappies?
Why is it important to document mongolian blue spot/congenital dermal melanocytosis?
if visit to A&E, it highly resembles bruising, therefore could be a child protection issue
Why do you check the testes in newborn males?
descended testes (this can take several days to occur, arrange follow up), hypospodias
Why might there be bleeding or discharge from baby vagina?
effect of maternal hormones
What could a sacral dimple suggest?
spina biffida or occulta
You have just helped deliver a 2 week premature baby and are asked to do a quick assessment of the current APGAR score. The baby has a slow irregular cry, is pink all over, a slight grimace, with a heart rate of 140 BPM and moving both arms and legs freely. The current APGAR score is?
This baby will score an APGAR of 8. The breakdown of points is as follows;
A - Pink all over no cyanosis - 2 points
P - Pulse rate over 100 - 2 points
G - Grimace - 1 point
A - Activity flexed arms and legs - 2 points
R - Respiration slow irregular cry - 1 point
A score of over 7 is generally accepted as normal
A score of 0-3 is very low score, between 4-6 is moderate low and between 7 - 10 means the baby is in a good state
