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Year 4 - Paeds > Neonatology > Flashcards

Neonatology Flashcards

1
Q

Birth weight
- Low categories

A

Birthweights

2500g - very low

1500 - extremely low

1000 - extremely extremely low

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2
Q

IRDS
- Tx

A

IRDS
- Infant RDS

  1. Surfactant
  2. Ventilation
  3. Steroids
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3
Q

Newborn nutrition

  • Three options
A

Newborn feeds

  1. Colostrum
    - First milk
  2. Breast milk
  3. TPN
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4
Q

Macrosomia

  1. Aetiology
  2. Problems
A

Macrosomia

  • DM mother
  • Problems
    1. Shoulder dystocia
    2. Ischaemic brain injury
  • Cerebral palsy risk
  • Total body cooling (33.5º)
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5
Q

Craniosynostosis
- Pathology
- Types

A

Synostosis of the cranium

  • Pathology
    1. Early closure of a suture
    2. Pulling of the bones towards the closure

Types
1. Sagittal
- Scaphocephaly
- Long and narrow growth

  1. Coronal
    - Anterior plagiocephaly
    - Forehead flattening on closed side
  • Bicoronal synostosis
  • Flattening on both sides (broad)
  • Brachycephaly
  1. Lambdoid synostosis
    - Flattened on the back l/r
    - Posterior plagiocephaly
  2. Metopic synostosis
    - Narrow at front near frontal/metopic suture
    - Trigonocephaly (narrow front, broad back)
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6
Q

Cranial US

  1. View
  2. Pathologies
A

Cranial US

  • View
  • Pathologies
    1. Periventricular haemorrhage (PVH/IVH)
    2. Periventricular leukomalacia
    3. Ventricular dilatation
    4. Hydrocephalus
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7
Q

Intraventricular haemorrhage

  1. Epidemiology
  2. Grading
A

IVH/PVH

  • Epidemiology
    1. 15-30% <1500g
    2. First week of life
    3. Rare beyond 34 weeks
  • Grading
    1. Caudothalamic notch
    2. In ventricle
    3. Ventricular dilation
    4. In parenchyma
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8
Q

Intraventricular haemorrhage

  1. Pathophysiology
  2. Mx
A

IVH

  • Pathophysiology
    1. <34 week baby
    2. HIE reperfusion
    3. Hemorrhagic infarct
  • Mx
    1. Antenatal CSTs
    2. Antimicrobials in PRoM
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9
Q

NIPE Hydrocele

  1. Pathology
  2. Mx
A

NIPE Hydrocele

  • Pathology
    1. Patent processus vaginalis
    2. Fluid in tunica vaginalis
  • Mx
    1. Observe for 1 year
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10
Q

Gentamicin

  1. ADRs
  2. Monitoring
A

Gentamicin

  • ADRs
    1. Dysphonia
    2. Tinnitus
    3. Vomiting
    4. Nephrotoxicity (in renal impairment)
  • Monitoring
  1. Neonates
    - after 3-4 doses
    - taken before next dose ‘trough’
    - 1 hr after IM/IV ‘peak’ conc
  2. Renal function assessed before
  3. Auditory and vestibular monitored
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11
Q

NIPE
- Four main checks

A

NIPE

  1. Eyes
  2. Hips
  3. Heart
    (4. Testicles)
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12
Q

NIPE
- CHAMPION

A

NIPE

C - ranium
H - ead circumference
A - rteries (femoral)
M - oro reflex
P - osture/spine
I - nspect genetalia
O - rganomegaly
N - eurology

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13
Q

NIPE
- Hip Checks

A

NIPE Hip

  1. Barlow
    - Adduction and flexion
    - Pressure
    - Dislocation
  2. Ortolani
    - Abduction
    - Click of reduction
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14
Q

Gestation

  1. Extremely preterm
  2. Very preterm
  3. Moderately preterm
  4. Late preterm
A

Gestation

  1. <28 weeks
    - Extremely preterm
  2. 28-32 weeks
    - Very preterm
  3. 32-34 weeks
    - Moderate
  4. 35-37 weeks
    - Late preterm
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15
Q

Prematurity

  • 7 complications
A

Prematurity complications

  1. Head
    - IVH
  2. Eyes
    - RoP (retinopathy)
  3. Heart
    - PDA
  4. Lungs
    - RDS
    - CLD
  5. Gut
    - NEC
  6. Skin
    - Thermoregulation
  7. Glucose
    - Hypo and hyperglycaemia
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16
Q

Prematurity
- Head complications

A

Prematurity - Head

  1. IVH
    - Grade 1-4
  2. Intraparenchymal cystic lesions
  3. PVL
    - Peri-ventricular leukomalacia
    - Softening of white matter
17
Q

Prematurity - RoP

  1. Pathology
  2. Ix
  3. Mx
A

Retinopathy of Prematurity

-Pathology
1. <32wk/<2kg
2. Dependant on location

  • Ix
    1. 2-weekly review
  • Mx
    1. Sats 88-92%
    2. ?Prevent reperfusion injury
    3. Laser treatment
18
Q

Prematurity
- 4 causes of premature delivery

A

Prematurity causes

  1. No identifiable cause
  2. PROM
    - 30-40%
  3. Life-threatening
    - 25%
    - Pre-eclampsia
    - Renal
    - Growth restriction
  4. Emergency event
    - 25%
    - Placental abruption
    - Eclampsia
    - Severe infection
19
Q

IRDS

  • Mx
A

IRDS

  1. Surfactant to 32 weeks
    - ET
    - Catheter
  2. Ventilation
    - CPAP
    - PEEP
20
Q

CLD
1. Definition
2. Mx

A

Chronic lung disease

  1. Oxygen requirement at 36 weeks
    - Evolving CLD at 34-35
  2. Nasal cannula/home oxygen therapy
21
Q

NEC
- Timing
- Mx

A

NEC

  • Timing
    1. 3rd week of life
    2. 21 days
  • Management
    1. Triple ABx
  • Cefotaxime
  • Gentamicin
  • Metronidazole
  1. Complications
    - eg. Strictures
22
Q

Prematurity glucose

  1. Hypos and Hypers
  2. Management
A

Prematurity glucose regulation

  • Challenge
  1. High energy demand
    - No brown fat reserves
  2. High stress level
    - High cortisol
  • Management
    1. Fluids
    2. NG feeding
  • Breast milk fortifier
  • Nutri-prem
23
Q

Prematurity
- Discharge requirements

A

Preterm discharge

  1. Temperature self-regulation
  2. Gaining weight
    - 50-80g/week
    - Feeding 2 hourly
  3. Only one of:
    - Tube fed
    - On oxygen
24
Q

Neonatal weight change
1. Parameters
2. Recovery

A

Neonatal weight change

  1. 10% loss by day 5 is a concern
  2. Regain by 2-3 weeks
25
Q

Pregnancy
- Two effects of smoking

A

Smoking during Pregnancy

  1. Placental insufficiency
  2. Low birth weight
26
Q

PDA
1. Prevalence
2. Mx

A

PDA
- Prevalence
1. 1/2000 term
2. 20-60% preterm

  • Mx
    1. NSAIDs
  • Ibuprofen
  • Indomethacin
  1. CHD maintenance of PDA
    - Alprostadil (PGE1)
    - Dinoprostone (PGE2)
27
Q

Neonatal infection
- Two concerning pathogen groups

A

Neonatal infection

  1. ESBL
    - Extended-spectrum-beta-lactamases
    - Treated by meropenem/tazocin/amikacin
  2. Ureaplasma
    - Hydrolyse urea to make ATP
    - 40-80% of healthy vaginal flora
    - Macrolide 10 days (erythromycin)
28
Q

Neonatal Caffeine
- Indication
- Regimen

A

Neonatal caffeine

  • Indications
    1. Apnoea/desaturation
    2. Need for IPPV
    3. Extubation
  • Regimen
    1. 20mg/kg LD
    2. 5-20mg/kg maintenance
29
Q

MBD
- Pathology
- Mx

A

Metabolic bone disease/Osteopenia of P

  • Pathology
    1. <1500g/<32 weeks
  • Placenta converts VitD to Calcitriol (1,25DHChoCal)
    2. Fractures from routine handling
  • Mx
    1. Monitor
  • Ca, P, ALP
  • Vit D, PTH
    2. Fortified EBM
    3. Vit D
30
Q

NIPE
- Penis abnormalities

A

NIPE Penises

  • Chordae (1/200)
    1. Penile torsion
    2. Skin tethering
    3. Penoscrotal web
    4. Dorsal preputial hood
  • Hypospadias
  • Associated with chordae
    1st degree
  • Glanular
  • Coronal
    2nd degree
  • Subcoronal
  • Penile (prox/mid/dist)
    3rd degree
  • Penoscrotal
  • Scrotal
  • Perineal
31
Q

HIE
- Causes

A

HIE

  • Causes (asphyxia)
    1. Maternal shock
    2. Intrapartum haemorrhage
    3. Prolapsed cord
    4. Nuchal cord (wrapping)
32
Q

HIE
- Grading

A

HIE Grading

  1. Mild
    - Poor feeding
    - Resolves within 24 hours
  2. Moderate
    - Lethargic, hypotonic
    - 40% CP
  3. Severe
    - Reduced AVPU, apnoeas, flaccid
    - 50% mortality
    - 90% CP
33
Q

HIE
- Mx

A

HIE Mx.

  1. Supportive
    - Resus
    - Ventilation
    - Nutrition
  2. Therapeutic hypothermia
    - 33.5º
    - 72 hours
    - Reduced inflammation and neuron loss
  3. MDT
34
Q

Neonatal hypoglycaemia

  • RFs
  • S&S
  • Mx
A

Neonatal hypoglycaemia

  • RFs
    1. IUGR/SGA
  • Decreased glycogen/adipose stores
  • Increased requirements
    2. Maternal DM/Macrosomia
  • Hyper insulinism
    1. Late-preterm
    2. Distressed
  • Eclampsia
  • Sepsis
  • Hypothermia
  • CHD
  • S&S
    1. Apnoea
    2. Iritability
    3. Lethargy
    4. Seizures
  • Mx
    1.Early feeding (1st hour)
  • High frequency
    2. Early monitoring
    3. Buccal dextrose
  1. NICU
  2. 10% IV dextrose
  3. CSTs/IM Glucagon

Year 4 - Paeds (11 decks)

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