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Exam > Neonatology > Flashcards

Neonatology Flashcards

1
Q

Which cells produce surfactant?

A

Type 2 alveolar cells

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2
Q

What are the 5 parts of neonatal resus?

A
  1. Warm baby
  2. Calculate APGAR
  3. Stimulate breathing
  4. Inflation breaths
  5. Chest compressions
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3
Q

What is used for inflation breaths?

A

Term babies - Air

Preterm babies - Air + oxygen

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4
Q

What are the five parts of APGAR?

A

Appearance = Blue centrally, blue peripheries, pink

Pulse = Absent, <100, >100

Grimace = Absent, little response, good response

Activity = None, flexed arms/legs, active.

Respiration = Absent, weak, good/crying

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5
Q

What is caput succudaneum?

A

Present at birth

Oedema of the scalp at the presenting part - typically the vertex

No discolouration associated

Lump crosses suture lines

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6
Q

What is cephalohaematoma?

A

Develops several hours after birth

Collection of blood between the skull and the periosteum

Lump does not cross suture lines

Jaundice may be apparent due to blood breakdown

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7
Q

What is Erb’s palsy?

A

A result of injury to C5/C6

Internally rotated shoulder

Extended elbow

Pronated wrist

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8
Q

What is the most organism responsible for neonatal sepsis?

A

GBS

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9
Q

What are features of neonatal sepsis?

A

Respiratory distress - grunting, nasal flaring, tachypnoea

Apnoeas

Fever

Reduced tone

Jaundice

Seizures

Poor feeding

Vomiting

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10
Q

How is neonatal sepsis managed?

A

IV Benzylpenicillin + Gentamicin (suspected or confirmed neonatal sepsis)

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11
Q

What are causes of persistent or severe neonatal hypoglycaemia?

A

Preterm birth

Maternal DM

IUGR

Hypothermia

Neonatal sepsis

Inborn errors of metabolism

Nesidioblastosis

Beckwith-Wiedemann syndrome

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12
Q

How can neonatal hypoglycaemia present?

A

Irritability

Tachypnoea

Pallor

Poor feedng

Drowsiness

Hypotonia

Seizures

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13
Q

How is neonatal hypoglycaemia treated?

A

Encourage normal feeding

If severe (less than 1) IV 10% dextrose

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14
Q

What is hypoxic ischaemic encephalopathy? What are the causes?

A

Damage to brain due to hypoxia during birth

Maternal shock

Intrapartum haemorrhage

Prolapsed cord

Nuchal cord (cord wrapped around neck of baby)

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15
Q

How can the risk of hypoxic ischaemic encephalopathy be reduced?

A

Therapeutic hypothermia after birth

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16
Q

When is jaundice pathological in neonates?

A

If it presents in first 24 hours of life

If it is prolonged (more than 14 days in term babies, more than 21 days in preterm babies)

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17
Q

What are causes of neonatal jaundice?

A

Can be split into causes which cause increased bilirubin production, and causes which cause decreased clearance of bilirubin

Increased production = haemolytic disease, ABO incompatibility, haemorrhage, cephalohaematoma, polycythaemia, G6PD

Decreased clearance = prematurity, breast milk jaundice, neonatal cholestasis, biliary atresia, hypothyroidism, Gilbert syndrome

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18
Q

What is classed as prolonged jaundice?

A

> 14 days in term neonates

> 21 days in preterm neonates

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19
Q

What is kernicterus? How can it present?

A

Brain damage due to excessive bilirubin - Bilirubin can cross the BBB

Floppy, drowsy baby

Poor feeding

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20
Q

What are risk factors for necrotising enterocolitis?

A

VLBW // very preterm

Formula fed

Respiratory distress

Sepsis

PDA

21
Q

How does necrotising enterocolitis present?

A

Intolerance to feeds

Green bilious vomiting

Distended, tender abdomen

Absent bowel sounds

Blood in stools

22
Q

What is seen on Abdominal XR in necrotising enterocolitis?

A

Dilated loops of bowel

Bowel wall oedema

Pneumatosis intestinalis (gas in bowel wall)

Pneumoperitoneum (free gas in peritoneal cavity)

Football sign = air outlining the falciform ligament

Rigler sign = air both inside and outside of the bowel

23
Q

How is NEC managed?

A

NBM

IV Fluids

TPN

Surgery

24
Q

What are causes of bilious vomiting in neonates?

A

Necrotising enterocolitis

Duodenal atresia

Meconium ileus

25
Q

Neonate will double bubble sign on abdominal XR?

A

Duodenal atresia

Double bubble sign = dilation of both the duodenum and the stomach.

26
Q

Bilious vomiting in a neonate with CF?

A

Meconium ileus

27
Q

Neonate with persistent salivation/drooling?

A

Oesophageal atresia

28
Q

What are features of fetal alcohol syndrome?

A

Microcephaly

Thin upper lip

Smooth, flat philtre

Short palpebral fissure

Learning disability

Behavioural difficulties

Hearing + vision problems

Cerebral palsy

29
Q

What are features of congenital rubella syndrome?

A

Congenital cataracts

Congenital heart disease

Learning disability

Hearing loss

30
Q

What are features of congenital varicella syndrome?

A

Fetal growth restriction

Microcephaly

Hydrocephalus

Learning difficulty

Limb hypoplasia

Scarring/skin changes in the dematomes

Cataracts

31
Q

What is Exomphalos/Omphalocele and Gastroschisis?

A

Exomphalos/Omphacele = abdominal contents protrude through the umbilical ring - covered with a transparent sac

Gastoschisis = abdomianl contents protrude through defect in anterior abdominal wall - no covering sac

32
Q

What are causes of jaundice presenting within the first 24 hours of life? How should it be investigated?

A

Investigate with a blood film analysis

Rhesus haemolytic disease (RHD)

ABO incompatibility

Glucose-6-phosphate dehydrogenase (G6PD) deficiency

hereditary spherocytosis

33
Q

How does malrotation present?

A

Bilious vomiting

Haemodynamic instability

34
Q

What is seen on abdominal XR in meconium ileus?

A

Air-fluid levels

35
Q

How does meconium ileus present?

A

Failure to pass meconium within 48hrs

Billous vomiting

Abdominal distension

36
Q

How does meconium aspiration syndrome present?

A

Respiratory distress

Patchy infiltrates on CXR

37
Q

What is transient tachypnoea of the newborn and how does it present?

A

Most common cause of respiratory distress in the newborn period
Delayed resorption of fluid in the lungs
Low oxygen sats at birth
Resolves within a couple of days

38
Q

What is seen on CXR in transient tachypnoea of the newborn?

A

Hyperinflation of the lungs

Fluid in the horizontal fissure

39
Q

Duodenal atresia vs. Malrotation

A

Both present with billous vomiting

Duodenal atresia = few hours after birth
Malrotation = 3-7 days after birth + signs of haemodynamical instability

40
Q

How is malrotation managed?

A

Ladd’s procedure

41
Q

How does the abdomen feel in duodenal atresia?

A

Soft, distended

42
Q

How does meconium aspiration syndrome present?

A

Respiratory distress

Patchy infiltrates on CXR

43
Q

What is transient tachypnoea of the newborn and how does it present?

A

Most common cause of respiratory distress in the newborn period
Delayed resorption of fluid in the lungs
Low oxygen sats at birth
Resolves within a couple of days

44
Q

What is seen on CXR in transient tachypnoea of the newborn?

A

Hyperinflation of the lungs

Fluid in the horizontal fissure

45
Q

Congenital infection: Sensorineural deafness + congenital cataracts + congenital heart disease (E.g. PDA)?

A

Rubella

46
Q

Congenital infection: Cerebral calcification + Chorioretinitis + Hydrocephalus

A

Toxoplasmosis

47
Q

Congenital infection: Growth retardation. + Purpuric skin lesions

A

Cytomegalovirus

48
Q

What does neonatal resp distress + fluid in the horizontal fissure suggest?

A

Transient tachypnoea of the newborn

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