Neonatology Flashcards
What are the features of congenital rubella syndrome?
Absent red reflex
Widespread pupiric rash (ITP)
Sensoryneural hearing loss
PDA.
What is the treatment for hypoxic ischaemic encephalopathy?
Therapeutic hypothermia
Describe the process of therapeutic hypothermia for treatement of HIE
Reduction of core body temperature to 33.5°C for 72 hours followed by a slow rewarming phase (0.5°C/hour increase) over 6 hours.
Start within 6 hours of birth!
What does RDS and a scaphoid abdomen suggest?
congenital diaphragmatic hernia
What is the first line anti-convulsant medication in neonates?
Phenobarbitol
What is pathagnomic x-ray finding for necrotising enteroclitiis and what does it look like?
Pneumatosis intestinalis.
Gas within bowel wall, dark lines around bowel loops
(also may have air under diaphragm)
What are the potential causes of sudden new O2 requirment in intubated and ventialted neonate?
Displaced ET tube
Obstructed ET tube
Pneumothorax
Equipment failure
What does bruising and oedema on neonates head, above the periosteum and over the suture lines, but well demarcated suggest?
Caput Succedaneum
A/W Ventouse delivery
What does swelling of neonates head confined to suture lines suggest?
Cephalohaematoma
When should premature babies recieve vaccinations?
Same as all babies.
If born <28 weeks gestation requires in hosptial vaccination and 48-72 hour monitoring as increased risk of apnoea
What population of babies are at greater risk of RDS secondary to surfactant deficiency disease?
Babies of mothers with poorly controlled diabetes.
Define Potters Syndrome
Caused by Oligohydraminos + subsequent compression of foetus
P-Pulmonary hypoplasia
O -Oligohydramnios
T -Twisted skin (wrinkly skin)
T -Twisted face (Potter facies: flattened ‘parrot-beaked’ nose, low-set cartilage-deficient ears, retrognathia, hypertelorism)
E -Extremity deformities (limb deformities: club hands and feet, joint contractures)
R -Renal abnormalities (bilateral renal agenesis, obstructive uropathy, autosomal-recessive polycystic kidney disease or dysplastic kidneys)
When is hypospadias corrected?
What do parents need to know?
6-12 months
do NOT circumcise
How would you investigate Brachial nerve palsy?
chest x-ray to r/o a clavicle or humeral fracture or diaphragmatic palsy
What are the 3 types of brachial nerve palsy? What berve roots are effected?
Erb’s palsy = C5, C6, +/- T1
Klumpke’s palsy = C8, T1
Total palsy C5-T1
What is the difference in clinical presentation of Erb’s and Kumpke’s palsy?
Erbs: arm is adducted and internally rotated with elbow extended, forearm is in pronation and wrist is flexed
Klumpke: Claw hand. a/w horners
What is first line treatment of Erb’s Palsy?
Rest and careful hadnling for 1-2 weeks, then physiotherapy.
70-80% resolution in 6 weeks.
Which pregnant ladies are offered antenatal steroids?
All women between 24+0 and 33+6 weeks of pregnancy who are at risk of preterm delivery within 7 days. Deliver 1-7 days after administration
What are the features of a haemodynamically significant PDA?
pansystolic and pandiastolic murmur -machinery type mumur
acitve pericordium with a wide pulse pressure
Cardiac failure symptoms
What are the characteristic clinical findings of NEC?
Abdominal distension, bilious aspirates and blood with mucus in the stool are all characteristic findings
Define Grade 1 IVH
germinal matrix haemorrhage with or without IVH (less than 10% of ventricle filled with blood)
Define Grade 2 IVH
IVH (10%–50% of ventricle filled with blood), typically without ventricular dilation.
Define Grade 3 IVH
IVH (greater than 50% of ventricle filled with blood) typically with ventricular dilation
Define Grade 4 IVH
periventricular haemorrhagic infarction.
Which babies get screened for ROP?
<32 weeks gestational age or < 1501 g birth weight
What is treatment for ROP?
Laser ablation
Intraocular injections of anti-VEGF agents such as bevacizumab for central ROP
How is the clinical severity of PPHN calculated?
Using the oxygenation index
Fi O2 x Mean arterial pressure / post-ductal PaO2
How do you manage hypoglycaemic neonate with blood glucose < 1?
IV bolus 10 % dextrose
Also: blood glucose, insulin, cortisol, growth hormone, fatty acids, ketone bodies, carnitine, acylcarnitine profile, amino acids, ammonia, lactate.
urine ketones and organic acids
How do you mange hypoglycaemic yet asymptomatic baby with Blood glucose of 2.5?
Help to establish feeding
How do you manage hypoglycaemic yet asymptomatic baby with blood glucose 1- 1.9?
Buccal dextrose gel.
Help to establish feeding.
How do you manage hypoglycaemic neonate with BM > 1 yet is symptomatic?
IV bolus 10 % dextrose
Also: blood glucose, insulin, cortisol, growth hormone, fatty acids, ketone bodies, carnitine, acylcarnitine profile, amino acids, ammonia, lactate.
urine ketones and organic acids
What is second line treatment for neonatal seizures?
Phenytoin
At what level of thrombocytopenia would you consider platelet transfusion in neonate?
25x 10^(9)/l
In neonate with absent thymic shadow, what do you need to consider?
Di George Syndrome!
Where do you measure pre-ductal sats?
Right hand
What can cause persistent pulmonary hypertension of the neonate?
meconium aspiration syndrome
severe sepsis
congenital pneumonia
respiratory distress syndrome
congenital diaphragmatic hernia
What suggests PPHN?
Evidence of somethign that can cause PPHN
Big pre and post ductal saturation difference
Low O2 sat and normal CO2
Cardiac echo
How do you treat PPHN?
Inhaled nitric oxide 20 ppm
ECMO
What is investigation of choice for malrotation + volvulous?
Upper Gi contrast study
What artery is most likely occluded in maltoration?
Superior messenteric artery
