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Y4 Paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What is a neonate?

A

a child under 28 days of age, high risk of dying

*term = > 37weeks

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2
Q

What is important to consider when taking a neonatal history?

A
  • age and gestational age
  • birth weight
  • pregnancy complications
  • delivery mode, complications
  • antenatal screening
  • previous pregnancies
  • feeding hx
  • social screening: smoke, alcohol
  • mothers mood
  • twins?
  • mothers concerns
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3
Q

What is the earliest accepted gestation in the UK?

A

22-24 w

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4
Q

When is surfactant produced?

A

liquid produced by type 2 alveolar cells to reduce surface tension
*24-34 weeks

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5
Q

When is a baby considered premature?

A

any baby under 37w

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6
Q

What are some RF for prematurity?

A
  • Social deprivation
  • Smoking, Alcohol, Drugs
  • Overweight or underweight mother
  • Maternal co-morbidities
  • Twins - multiple pregnancy
  • Personal or family history of prematurity
  • early pregnancy - within 6m of previous
  • infection, diabetes, hypertension
  • trauma
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7
Q

What are some early complications of prematurity?

A

ARDS, hypothermia, hypoglycaemia, poor feeding
neonatal jaundice
retinopathy of prematurity
NEC

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8
Q

What are some long term complications of prematurity?

A

chronic lung disease of prematurity
learning and behavioural difficulties
susceptibility to infectons
hearing and visual impairment
cerebral palsy

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9
Q

What is hypoxic-iscaemic encephalopathy?

A

occurs in neonates as a result of hypoxia leading to ischaemic brain damage –> CP or death
*neuronal damage from ischaemia or reperfusion injury

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10
Q

When can HIE occur?

A

placental abruption
ruptured uterus
cord compression
nuchal cord wrapped around neck
maternal hypotension or hypertension
compromised foetus
intra-partum haemorrhage

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11
Q

how might HIE be picked up on examination?

A

mild - poor feeding, irritable, hyper alert *24h resolve

moderate - poor feed, lethargic, hypotonic, seizures *40% CP

severe - reduced consciousness, apnoeas, flaccid, reduced or absent reflexes *90% CP, 50% mortality

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12
Q

How do you investigate HIE?

A

umbilical artery ABG
APGAR
amplitude-integrated EEG - abnormal brain activity

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13
Q

How do you manage HIE?

A

resus + ventilation
therapeutic hypothermia
- using cooling blanket and hat
- 33-34c target, for 72h, warmed to normal over 6h

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14
Q

What is the aim of therapeutic hypothermia?

A

reduces inflammation and neurone loss after acute hypoxic injury, risk of cerebral palsy, developmental delay, learning disability, blindness and death

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15
Q

What is necrotising enterocolitis?

A

disorder in premature neonates where part of bowel becomes necrotic –> risk of perforation, peritonitis, shock and death

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16
Q

What are some RF for NEC?

A

low birth weight
formula feeds
ARDS + assisted ventilation
sepsis
PDA

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17
Q

How might NEC present?

A

feeding intolerance
vomiting - bile or blood stained
abdominal distention
haematochezia

progression - abdominal tenderness, abdominal oedema, erythema and palpable bowel loop
systemic sx!!

18
Q

What are some complications of NEC?

A

peritonitis
shock
long term - intestinal stricture, short bowel syndrome, neuro-developmental disorder and recurrence

19
Q

How do you investigate NEC?

A

*bell scoring system used
FBC, CRP, U&E, CBG (metabolic acidosis), cultures
AXR - dilated bowel loops, bowel oedema, pneumoperitoneum

20
Q

How do you manage NEC?

A

*NBM, IVF, Abx
total parenteral nutrition - 10 to 14 days
NGT

Systemic support - ventilatory support, fluid resuscitation, inotropic support, correction of acid-base balance coagulopathy

surgery!! -> intestinal resection, stoma, clip and drop

21
Q

What are some differentials for jaundice in a neonate within 24h?

A
  • sepsis - impaired organ function
  • rhesus incompatibility
  • ABO incompatibility
  • red cell abnormalities - spherocytosis, elliptocytosis
  • haemolytic disease of the newborn
22
Q

What are some differentials for prolonged jaundice?

A
  • Biliary atresia
  • hyperthyroidism
  • increased production of bilirubin in G6PD
  • ABO incompatibility
  • infection
23
Q

What are some RF for developing jaundice?

A

delayed cord clamping
assisted delivery
prematurity
bruising after instrumental delivery
siblings hx

24
Q

What is kernicterus?

A

permanent neurological sequelae of high BLB and BLB encephalopathy caused by free flow through blood brain barrier due to it being poorly developed

25
How does kernicterus present?
- lethargy - poor feeding - hypotonia - irritability/ hypertonia/ apnoea/ seizures/ coma/ death - long term: cerebral palsy, low IQ and deafness
26
How might you investigate jaundice?
well lit - colour, hydration etc FBC, DAT, blood group blood gas, sepsis screen transcutaneous bilirubinometer + plot total bilirubin
27
How might you manage jaundice in neonates?
phototherapy + repeat bilirubin exchange transfusion if needed
28
When might you consider hyperbilirubniaemia as physiological?
2-3 days after birth and resolves within 2w - increased production of RBC, breakdown of foetal Hb, absence of gut flora
29
What are some risk factors for sudden infant death syndrome?
- Prematurity - Low birth weight - Smoking during pregnancy - Male baby (only slightly increased risk) - young teen mothers - sleeping with baby in bed - using a lot of blankets - male baby - high temperatures in room - previous sibling with same
30
How can you minimise the risk of SIDs?
- Put the baby on their back when not directly supervised - Keep their head uncovered - Place their feet at the foot of the bed to prevent them sliding down and under the blanket - Keep the cot clear of lots of toys and blankets - Maintain a comfortable room temperature (16 – 20 ºC) - Avoid smoking - Avoid co-sleeping, particularly on a sofa or chair - If co-sleeping avoid alcohol, drugs, smoking, sleeping tablets or deep sleepers
31
What services can you offer to families suffering through SIDs?
- Lullaby trust for families affected, bereavement support and counselling - **Care of Next Infant (CONI)** supports parents with next infant after a sudden infant death. home visits, resuscitation training, access to equipment like monitors and alarms in case of apnoea
32
What are some signs of RDS?
- tachypnoea over 60 breaths/min - colour change with bluish tinge around mouth - grunting - nose flaring - tracheal tug - chest retractions and recessions (intercostal or subcostal)
33
How does ARDS appear on XR?
- BL and diffused pattern - reduced lung volume - white patches in lungs - ground glass pattern with air bronchograms
34
How might you manage ARDS in neonate?
prevention - antenatal steroids if pre-term anticipated! blood gas, O2 monitoring mild - O2 non-invasive CPAP, invasive ventilation surfactant replacement below 26w
35
What are some complications of ARDS?
short term - pneumothorax, infection, apnoea, IVH long term - CLDP
36
What are the principles of Resus at birth?
1. warm baby - dry, lamp 2. APGAR - at 1, 5, 10 min 3. stimulate breathing 4. inflation breaths 5. chest compressions 6. IV drugs, intubation, therapeutic hypothermia
37
What is the advantage of delayed cord clamping?
improved haemoglobin, iron stores, blood pressure, reduction in IVH and NEC increased risk neonatal jaundice!! at least 1 minute of delay recommended
38
When would you suspect neonatal sepsis?
fever reduced tone, activity, floppy tachy or Brady hypoxia jaundice within 24h seizures, hypoglycaemia poor feeding maternal infection *ill appearance, mottled, grunting, apnoea, increased o2 requirement, pulse <60, drowsy, temp SIRS
39
How would you manage neonatal sepsis?
- sepsis screen: FBC, CRP, urine culture, blood culture, LP - sepsis 6 - Abx within 1h of decision - benzylpenicillin and gentamicin
40
How would you reassess neonatal sepsis?
- CRP at 24h and blood cultures at 36h - consider stopping Abx if clinically well, cultures negative 36h after and both CRP less than 10 - CRP again in 5 days if still on treatment - consider stopping if clinically well, LP, blood cultures negative and CRP normal at 5 days - consider LP if any CRP more than 10!! - blood cultures before Abx, FBC, CRP, LP if meningitis suspected!
41
What are some differentials for billious vomiting in neonates?
duodenal atresia malrotation jejunal atresia meconium ileus NEC

Y4 Paediatrics (16 decks)

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