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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
Q

How does kernicterus present?

A
  • lethargy
  • poor feeding
  • hypotonia
  • irritability/ hypertonia/ apnoea/ seizures/ coma/ death
  • long term: cerebral palsy, low IQ and deafness
26
Q

How might you investigate jaundice?

A

well lit - colour, hydration etc
FBC, DAT, blood group
blood gas, sepsis screen
transcutaneous bilirubinometer + plot
total bilirubin

27
Q

How might you manage jaundice in neonates?

A

phototherapy + repeat bilirubin
exchange transfusion if needed

28
Q

When might you consider hyperbilirubniaemia as physiological?

A

2-3 days after birth and resolves within 2w
- increased production of RBC, breakdown of foetal Hb, absence of gut flora

29
Q

What are some risk factors for sudden infant death syndrome?

A
  • 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
Q

How can you minimise the risk of SIDs?

A
  • 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
Q

What services can you offer to families suffering through SIDs?

A
  • 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
Q

What are some signs of RDS?

A
  • 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
Q

How does ARDS appear on XR?

A
  • BL and diffused pattern
  • reduced lung volume
  • white patches in lungs
  • ground glass pattern with air bronchograms
34
Q

How might you manage ARDS in neonate?

A

prevention - antenatal steroids if pre-term anticipated!
blood gas, O2 monitoring
mild - O2
non-invasive CPAP, invasive ventilation
surfactant replacement below 26w

35
Q

What are some complications of ARDS?

A

short term - pneumothorax, infection, apnoea, IVH
long term - CLDP

36
Q

What are the principles of Resus at birth?

A
  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
Q

What is the advantage of delayed cord clamping?

A

improved haemoglobin, iron stores, blood pressure, reduction in IVH and NEC

increased risk neonatal jaundice!!

at least 1 minute of delay recommended

38
Q

When would you suspect neonatal sepsis?

A

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
Q

How would you manage neonatal sepsis?

A
  • sepsis screen: FBC, CRP, urine culture, blood culture, LP
  • sepsis 6
  • Abx within 1h of decision - benzylpenicillin and gentamicin
40
Q

How would you reassess neonatal sepsis?

A
  • 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
Q

What are some differentials for billious vomiting in neonates?

A

duodenal atresia
malrotation
jejunal atresia
meconium ileus
NEC

Y4 Paediatrics (16 decks)

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