Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What is hypoxic ischaemic encephalopathy ?

A

-> Prolonged or severe hypoxia during birth leading to ischaemic brain damage.
-> HIE can lead to permanent damage to the brain, causing cerebral palsy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Give 4 causes of HIE

A

ANYTHING CAUSING ASPHYXIA

-> Maternal shock
-> Intrapartum haemorrhage
-> Prolapsed cord : causing compression of the cord during birth
-> Nuchal cord : cord is wrapped around neck of the baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is used to grade the severity of HIE?

A

-Sarnat staging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the features of mild HIE (3)

A

-Poor feeding, generally irritable and hyper-alert
-Resolves within 24 hrs
-Normal prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the features of moderate HIE (4)

A

-Poor feeding, lethargic hypotonic and seizures
-Can take weeks to resolve
-Up to 40% develop cerebral palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the features of severe HIE (4)

A

-Reduced consciousness, apnoeas, flaccid and reduced or absent reflexes
-Up to 50% mortality
-Up to 90% develop cerebral palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can be done to reduce risk of severe damage from HIE

A

-> Therapeutic Hypothermia
-> Carefully cooling a baby in ICU to between 33 and 34 degrees, measruing with a rectal probe
-> Continued for 72 hrs, after which the baby is warmed over 6 hrs
-> Done to reduce inflammation and neuron loss after acute hypoxic injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What 5 things are scored in apgar scores

A

-HR
-Resp effort
-Muscle tone
-Reflex irritability
-Colour

0-3 = very low
4-6 = moderate low
7-10 = baby is ok

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define prematurity

A

-Born before 37 weeks

<28 wks - extreme preterm
28-32 wks - very preterm
32-37 wks - moderate to later preterm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What 2 thing can be done to try and delay birth in an USS showing cervical length of 25mm or less before 24 wks gestation

A

-Prophylactic vaginal progesterone
-Prophylactic cervical cerclage -> suture in cervix to hold shut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If preterm labour is confirmed, what can done to improve outcomes?

A

-Tocolysis with nifedipine (CCB) to suppresses labour
- Maternal corticosteroids before 35 wks
- IV magnesium sulphate before 34 wks to protect babys brain
- Delayed cord clamping or cord milking to increase circulating blood volume and Hb in the baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Give issues in early life following premature birth (10)

A

-Resp distress syndrome
-Hypothermia
-Hypoglycaemia
-Poor feeding
-Apnoea and bradycardia
-Neonatal jaundice
-Intraventricular haemorrhage
-Retinopathy of prematurity
-Necrotising enterocolitis
-Immature immune system and infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Give 5 long term effects of prematurity

A

-Chronic lung disease of prematurity
-Learning and behavioural difficulties
-Susceptibility to infections
-Hearing and visual impairment
-Cerebral palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why does respiratory distress syndrome occur in premature neonates?

A

-<32 wks there is inadequate surfactant leading to high surface tension within alveoli
-This leads to lung collapse as it is more difficult for alveoli and lungs to expand
-There is inadequate gaseous exchange, causing hypoxia, hypercapnia and resp distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the options for managing respiratory distress syndrome in premature neonates

A
  • Intubation and ventilation if severe
  • Endotracheal surfactant via endotracheal tube
  • CPAP
  • Oxygen to maintain sats between 91 and 95% in preterm neonates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What can be given to mothers with suspected or confirmed preterm labour to reduced incidence and severity of respiratory distress syndrome in the baby

A

-Antenatal steroids (I.e . dexamethasone) to increase surfactant production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Give 6 short term complications of respiratory distress syndrome

A

-Pneumothorax
-Infection
-Apnoea
-Intraventricular haemorrhage
-Pulmonary haemorrhage
-Necrotising enterocolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Give 3 long term complications of respiratory distress syndrome

A

-Chronic lung disease of prematurity
-Retinopathy of prematurity
-Neurological, hearing and visual impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is necrotising enterocolitis ?

A

-Disorder affecting premature neonates where part of the bowel becomes necrotic
-Death of bowel tissue can lead to perforation -> peritonitis -> shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Give 5 risk factors for necrotising enterocolitis

A

-Very low birth weight or very premature
-Formula feeds
-Respiratory distress and assisted ventilation
-Sepsis
-Patient ductus arteriosus and other congenital heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How can necrotising enterocolitis present ?

A

-Intolerance to feeds
-Vomiting, usually green bile
-Generally unwell
-Distended, tender abdomen
-Absent bowel sounds
-Blood in stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the investigation of choice for diagnosing necrotising enterocolitis ?

A

-Abdo X-ray
-Done front on in supine position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What will an abdo x-ray show in necrotising enterocolitis ?

A

-Dilated loops of bowel
-Bowel wall oedema
-Gas in the bowel wall (pneumatosis intestinalis)
- Gas in portal veins

24
Q

What will be seen on bloods in necrotising enterocolitis ?

A

-FBC : thrombocytopenia and neutropenia
-CRP : raised
-Capillary blood gas -> metabolic acidosis
-Blood culture for sepsis

25
Q

How is necrotising enterocolitis managed ?

A
  • NBM
    -Total parenteral nutrition (TPN), IV fluids and antibiotics to stabilise
  • Nasogastric tube to drain fluid and gas from stomach and intestines
26
Q

Give 8 complications of necrotising enterocolitis

A

-Perforation and peritonitis
-Sepsis
-Death
-Strictures
-Abscess formation
-Recurrence
-Long term stoma
-Short bowel syndrome after surgery

27
Q

What is a common cause of neonatal sepsis ?

A

Group B streptococcus

28
Q

Give 6 RF for neonatal sepsis

A
  • Vaginal GBS colonisation
  • GBS sepsis in a previous baby
  • Maternal sepsis, chorioamnionitis or fever > 38ºC
  • Prematurity (less than 37 weeks)
  • Early (premature) rupture of membrane
  • Prolonged rupture of membranes (PROM)
29
Q

Give 10 features of neonatal sepsis

A
  • Fever
  • Reduced tone and activity
  • Poor feeding
  • Respiratory distress or apnoea
  • Vomiting
  • Tachycardia or bradycardia
  • Hypoxia
  • Jaundice within 24 hours
  • Seizures
  • Hypoglycaemia
30
Q

Give 6 red flags for neonatal sepsis

A
  • Confirmed or suspected sepsis in the mother
  • Signs of shock
  • Seizures
  • Term baby needing mechanical ventilation
  • Respiratory distress starting more than 4 hours after birth
  • Presumed sepsis in another baby in a multiple pregnancy
31
Q

what is the management steps of presumed neonatal sepsis

A
  • Check local policy and consult paediatrician
  • If there is one risk factor or clinical feature, monitor the observations and clinical condition for at least 12 hours
  • If there are two or more risk factors or clinical feature of neonatal sepsis start antibiotics
  • Antibiotics should be started if there is a single red flag
  • Antibiotics should be given within 1 hour of making the decision to start them
  • Blood cultures should be taken before antibiotics are given
  • Check a baseline FBC and CRP
  • Perform a lumbar puncture if infection is strongly suspected or there are features of meningitis (e.g. seizures)
32
Q

what antibiotics are recommended first line for neonatal sepsis ?

A

IV Benzylpenicillin and gentamycin

33
Q

What is the ongoing management of neonatal sepsis

A
  • Check CRP at 24 hrs and check blood culture results at 36 hrs :

(Abx can be stopped IF baby is clinically well, blood cultures are -ve and CRP is <10)

34
Q

What are the 8 increased bilirubin production causes of jaundice in neonates

A
  1. Haemolytic disease of newborn -> rhesus incompatibility
  2. ABO incompatibility
  3. Haemorrhage
  4. Intraventricular haemorrhage
  5. Cephalo-haematoma
  6. Polycythaemia
  7. Sepsis and DIC
  8. G6PD deficiency
35
Q

what is a common cause of jaundice in the 1st 24 hrs of life

A
  • Neonatal sepsis
  • Jaundice in first 24 hrs = pathological
36
Q

what are 6 decreased bilirubin clearance causes of neonatal jaundice

A
  1. Prematurity
  2. Breast milk jaundice
  3. Neonatal cholestasis
  4. Gilberts
  5. Biliary atresia
  6. Endocrine disorders (hypothyroid, hypopituitary)
37
Q

what is physiological jaundice

A

-Neonate = high conc of fragile RBCs & less developed liver function
-These RBCs break down rapidly
-There is a normal rise in bilirubin shortly after birth with mild yellowing of skin and sclera from 2-7 days of age
- Usually resolves at 10 days.

38
Q

What is deemed as prolonged jaundice in a neonate ?

A
  • > 14 days in full term babies
  • > 21 days in premature babies
39
Q

How is neonatal jaundice managed ?

A
  • Plot bilirubin on treatment threshold chart
  • If threshold reached = phototherapy
    (converets unconjugated bilirubin -> isomers that can be excreted in bile and urine)
40
Q

what is kernicterus, who is at a greater risk and what are it’s complications ?

A
  • Brain damaged caused by excessive bilirubin levels as it can cross BBB.
  • Premature babies at greater risk due to immature liver
  • Cerebral palsy, LD and deafness
41
Q

when is screening involved for retinopathy of prematurity ?

A
  • Babies born before 32 wks
  • Done every 2 wks and can cease when retinal vessels enter zone 3.
  • Screening starts at :
  • > 30 – 31 weeks gestational age in babies born before 27 weeks
  • > 4 – 5 weeks of age in babies born after 27 weeks
42
Q

what is the management of ROP ?

A
  • Transpupillary laser photocoagulation to stop and reverse neovascularisation
43
Q

what are the medical treatment options for moderate to severe symptoms of neonatal abstinence syndrome ?

A
  • Oral morphine sulphate for opiate withdrawal
  • Oral phenobarbitone for non-opiate withdrawal
44
Q

Give 4 RF for SIDS

A
  • Prematurity
  • Low birth weight
  • Smoking during pregnancy
  • Male baby (only slightly increased risk)
45
Q

what can be done to minimise the risk of SIDS ?

A
  • Put baby on 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 handling the baby after smoking
  • Avoid co-sleeping, particularly on a sofa or chair
  • If co-sleeping avoid alcohol, drugs, smoking, sleeping tablets or deep sleepers
46
Q

-Traumatic, prolonged or instrumental delivery (e.g.ventouse)
-Soft, puffy occipital swelling that crosses suture lines
-No treatment needed, will resolve in a few days

A

Caput seccedaneum : fluid collecting on the scalp OUTSIDE the periosteum and caused by pressure

47
Q

-Traumatic, prolonged, instrumental delivery.
-Lump on the skull, that DOES NOT CROSS suture lines
-Discolouration of the skin in the affected area

A

-Cephalohaematoma : collection of blood between skull and periosteum. As it is BELOW the periosteum it does not cross suture lines

48
Q

Normal vaginal delivery
Convulsion within 48 hrs
No head trauma or swellings

A

Intra-ventricular haemorrhage -> in premature neonates can occur spontaneously

49
Q

what causes an erb’s palsy

A
  • Injury to C5/C6 during birth
  • Is associated with shoulder dystocia, traumatic or instrumental delivery and large birth weight
50
Q

How does Erb’s palsy present

A
  • Internally rotated shoulder
  • Elbow extended
  • Flexed wrist facing backwards (pronated)
  • Lack of movement in affected arm

‘waiters tip”

51
Q

what is gastroschisis and its managed

A
  • Congenital defect in the anterior abdo wall LATERAL to the umbilical cord.
  • Management : vaginal delivery, take newborn to theatre within 4 hrs
52
Q

what is exomphalos (omphalocoele) and its management

A
  • Abdominal contents protrude through abdo wall but are covered by amniotic sac
  • C section to protect the sac from rupture with staged repair
53
Q

How is neonatal hypoglycaemia managed if asymptomatic

A
  • Encourage normal feeding
  • Monitor blood glucose
54
Q

How is neonatal hypoglycaemia managed if symptomatic / very low blood glucose

A
  • Admit
  • IV 10% dextrose
55
Q

What can increase the risk of cleft lip and palate

A
  • Maternal antiepileptic use
56
Q

Give the 5 steps of neonatal resus

A
  1. Warm the baby by getting them dry.
  2. Calculate APGAR score.
  3. Stimulate breathing : head in neutral position, dry vigourously.
  4. Inflation breathes : 2 cycles of 5 breathes lasting 3 seconds each.If no response, 30 secs of ventilation breathes.
  5. Chest compressions if HR remains below 60 bpm -> 3:1 ratio with ventilation breaths.
57
Q

Features of neonatal hypoglycaemia

A
  • ‘jitteriness’, irritable, tachypnoea, pallor
  • Neuroglycopenic : poor feeding/sucking, weak cry, drowsy, hypotonia, seizures
  • Other : apnoea, hypothermia

Finals (92 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions