Neonatology Flashcards
spastic diplegia
more commonly associated with preterm delivery or prolonged moderate-intensity hypoxic events resulting in periventricular leukomalacia and diffuse white matter injury,
athetoid/dyskinetic CP
basal ganglia + thalamic injuries - seen in brief but severe hypoxic insults
more commonly in term bubs
also assicted with kernicterus
periventricular leucomalacia
Occurs in very prem infants <32 weeks
The predominant etiology of PIVH is the fragility of the vessels in the germinal matrix and the immature cerebral autoregulation mechanism in the preterm neonate. Spontaneous rupture of the germinal matrix vessels may occur from hypoxia as a consequence of fluctuation in cerebral blood flow.[6][15] The germinal matrix is more prone to hemorrhage in premature infants during the first 48 to 72 hours of life. The structural fragility of the germinal matrix is what leads to PIVH.occurs when vessels of the germinal matrix in the periventricular area rupture and extend into the intraventricular space
commonly results in CP- spastic diplegia and visual/hearing impairment
Feeding in babies with PKU
Babies can still breastfeed but it is recommended that 75% of feeds should be phenylalanine-free formula. If mothers wish to breastfeed, they should be supported by an experienced metabolic dietician.
which conditions are not tested for in neonatal screening
urea cycle defects - eg OTC deficiency
lysosomal storage disroders
neoantal chlamydia conjunctivitis
Chlamydia trachomatis- intracellular coccobacillus
the incubation period is usually 5-14 days (presents later than gonorrhoea).
Clinical findings of conjunctivitis range from mild swelling with a watery eye discharge, which becomes mucopurulent, to marked swelling of the eyelids with red and thickened conjunctivae.
can lead to pneumonia between 4-12 weeks of age
Rx: azithromycin (ceftriaxone for gonorrheoa)
- azitromycin increases risk of pyloric stenosis
co infection with gonorrhoea (intracellular diplococcus) vey common so always check for both
incontinenia pigmenti
neurocutaneous disease
X linked dominant- lethal in males
erythematous vesicular rash following the Blashko lines in the body (lines of embryonic cell migration – along the legs, arms and side of the torso).- looks like herpatic infection (but mum and sisters will likely also have hyper or hypopigmented lesions)
CNS effects in up to 40%, most commonly seizures, dev delya, spasticity, peg shaped teeth, nail changes
Classically, skin lesions evolve through four stages: vesicobullous eruption, verrucous lesions, hyperpigmented and hypopigmentation macules.
1. vesicobullous- typically occurs in the first 2 weeks of life with erythematous streaks, plaques, pustules or vesicles linearly distributed on the extremities, trunk and scalp, following Blaschko’s lines, 2. hyperkeratotic verrucous lesions on an erythematous base affects the distal extremities.
3. hyperpigmentation, the hallmark of IP, usually appears between 3 and 6 months of age, characterised by hyperpigmented lesions asymmetrically distributed along Blaschko’s lines.
4. hypopigmentation may start from childhood to adolescence, is permanent and consists of hairless, anhidrotic patches and streaks, with or without atrophy, on the flexor surface of the lower legs
oxygenation index
The oxygenation index is calculated by the following equation:
[FiO2 (%) x Mean airway pressure (mmHg)] / PaO2 (mmHg)
Oxygenation index is useful for objectifying the intensity of ventilation required and the severity of hypoxaemia. Over 25 is regarded as “high” and correlates with severe type 1 respiratory failure.
which recreational drug causes most birth defects
cocaine
- placental abruption, miscarriage prematurity, fetal death
-cardiac and GU abnormalities
exam findings with congenital diaphragmatic hernia
respiratory distress
dullness to percussion and displaced apex beat to the right (80% are left sided)
Scaphoid abdomen
