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Y4 Paeds > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What produces surfactant ?

A

Type 2 pneumocytes

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2
Q

How does surfactant work ?

A

Reduces the surface tension of the fluid in the lungs. It helps keep the alveoli inflated and maximises the surface area of the alveoli reducing the force needed to expand the alveoli. Surfactant increases lung compliance.

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3
Q

When is surfactant produced ?

A

24 - 34 weeks gestation

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4
Q

How can hypoxia occur in babies during labour ?

A

Normal labour and birth leads to hypoxia. When contractions happen the placenta is unable to carry out normal gaseous exchange leading to hypoxia.

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5
Q

What can extended hypoxia during birth lead to ?

A

Will lead to anaerobic respiration and a subsequent drop in fetal heart rate.
Reduced consciousness and a drop in respiratory effort.
Affects the brain leading to hypoxic-ischaemic encephalopathy which can cause cerebral palsy

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6
Q

What are some other issues in neonatal resuscitation ?

A

Babies have a large surface area to weight ratio and get cold very easily
Babies are born wet so loose heat rapidly
Babies that are born through meconium may have this in their mouth or airways

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7
Q

What are the principles of neonatal resuscitation ?

A

Warm the baby - dry them as quickly as possible
Calculate the APGAR - done at 1,5 and 10 minutes
Stimulate breathing - vigorous drying, neutral position to keep airway open
Inflation breaths - two cycles of 5 breaths can be given to stimulate breathing if neonate is not breathing
Chest compressions

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8
Q

What is measured in the APGAR score ?

A

Appearance - skin colour
Pulse
Grimmace - response to stimulation
Activity - muscle tone
Respiration

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9
Q

What is the benefit of delaying the umbilical cord clamping ?

A

After birth there is still a significant volume of foetal blood in the placenta. Delayed clamping provides more time for this blood to enter the circulation of the baby.
Recent studies show improved haemoglobin, iron stores and blood pressure and a reduction in intraventricular haemorrhage and necrotising enterocolitis.

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10
Q

What is the only negative effect of delaying the cord clamping ?

A

Neonatal jaundice requiring more phototherapy

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11
Q

What should immediately be given to the baby after birth ?

A

Skin to skin
Clamp the umbilical cord
Dry the baby
Keep the baby warm with a hat and blanket
Vitamin K
Label the baby
Measure the weight and length

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12
Q

Why is vitamin K given to babies after birth ?

A

Babies are born with a deficiency of vitamin K.
Given IM
Stimulates crying which helps open the lungs
Prevents bleeding - especially intracranial, umbilical stump and GI

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13
Q

What are the benefits of skin to skin contact ?

A

Helps warm the baby
Improves mother and baby interaction
Calms the baby
Improves breast feeding

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14
Q

What is screened for in the heel prick test ?

A

Sickle cell disease
Cystic fibrosis
Congenital hypothyroidism
Phenylketonuria
Maple syrup urine disease
Homocystinuria

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15
Q

When is the heel prick test performed ?

A

Day 5 ( day 8 at latest )

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16
Q

When is a newborn baby exam performed ?

A

Within the first 72 hours and then repeated at 6-8 weeks by the GP

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17
Q

What is it important to ask before performing a newborn baby exam ?

A

Has the baby passed meconium ?
Is the baby feeding ok ?
Is there a family history of congenital heart, eye, or hip problems ?

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18
Q

What are the steps of a new born baby exam ?

A

General appearance
Head
Shoulders and arms
Chest
Abdomen
Genitals
Legs
Back
Reflexes

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19
Q

What is looked for in the general appearance in a newborn baby exam ?

A

Colour
Tone
cry

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20
Q

What is looked for in the head step in a newborn baby exam ?

A

General appearance - Size, shape
Head circumference
Anterior and posterior fontanelles
Sutures
Ears - skin tags, low set ears
Eyes - squint
Red reflex
Mouth - cleft lip or tongue tie
Assess suckling

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21
Q

What is looked for in the shoulders and arms step in a newborn baby exam ?

A

Shoulder symmetry
Arm movement = erbs palsy
Brachial and radial pulse
Palmar crease
Digits
Sats probe

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22
Q

What is looked for in the chest step in a newborn baby exam ?

A

Oxygen sats
Observe breathing
Heart sounds
Breath sounds

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23
Q

What is looked for in the abdomen step in a newborn baby exam ?

A

Observe the shape
Umbilical stump
Palpate for organomegaly

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24
Q

What is looked for in the genitals step in a newborn baby exam ?

A

Observe for sex
Palpate testes and scrotum
Inspect penis
Inspect anus
Ask about meconium

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25
Q

What is looked for in the legs step in a newborn baby exam ?

A

Observe the legs and hips for equal movement, skin creases and tone
Barlow and ortolani manoeuvres
Count the toes

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26
Q

What is looked for in the back step in a newborn baby exam ?

A

Inspect and palpate the spine - curvature, spina bifida

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27
Q

What is looked for in the reflexes step in a newborn baby exam ?

A

Moro reflex - when rapidly tipped backwards the arms and legs will extend
Suckling reflex - placing a finger in the mouth will prompt them to suck
Rooting reflex - tickling the cheek will cause the baby to look towards the stimulus
Grasp reflex - placing a finger in the palm will cause the baby to grasp
Stepping reflex - when held upright and the feet touch a surface they will make a stepping motion

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28
Q

What is talipes ?

A

Clubfoot where the ankles are in a supinated position rolled inwards.

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29
Q

What are the 2 types of talipes ?

A

Positional talipes - the muscles are slightly tight but no bones affected - referral to physiotherapy
Structural talipes - involves the bones of the foot and ankle - referral to orthopaedic

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30
Q

What are port wine stains ?

A

Pink patches of skin often on the face caused by abnormalities affecting the capillaries.

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31
Q

What are some common issues identified during the newborn baby examination ?

A

Talipes
Undescended testes
Skin findings
Haemoangioma
Port wine stain
Clicky and clunky hips
Cephalohaematoma
Bones injuries
Soft systolic murmurs

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32
Q

What is Caput succedaneum ?

A

Involves fluid collecting on the scalp outside the periosteum.

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33
Q

What is cephalohaematoma ?

A

Collection of blood between the skull and the periosteum. It is caused by damage to blood vessels during a traumatic, prolonged or instrumental delivery.

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34
Q

How do you distinguish between a succedaneum and cephalohaematoma ?

A

The blood in the cephalohaematoma is below the periosteum therefore the lump does not cross the suture lines of the skull.

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35
Q

What is Erb’s palsy ?

A

The result from an injury to the C5/C6 nerves in the brachial plexus.
It is associated with shoulder dystocia, traumatic or instrumental delivery and large birth weight.

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36
Q

How does Erbs palsy present ?

A

Waiter’s tip
- internally rotated shoulder
- Extended elbow
- Flexed wrist facing backwards - pronated
Lack of movement in the affected arm

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37
Q

What are some birth injuries ?

A

Caput succedaneum
Cephalohaematoma
Facial paralysis
Erbs palsy
Fractured clavicle

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38
Q

What are the common organisms that cause neonatal sepsis ?

A

Group B strep
Ecoli
Listeria
Klebsiella
Staph aureus

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39
Q

What are some risk factors for neonatal sepsis ?

A

Vaginal GBS colonisation
GBS sepsis in a previous baby
Maternal sepsis, chorioamnionitis or fever over 38 degrees
Prematurity
Early rupture of the membrane
Prolonged rupture of membranes

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40
Q

What are the clinical features of neonatal sepsis ?

A

Fever
Reduced tone and activity
Poor feeding
Resp distress
Vomiting
Tachycardia
Hypoxia
Jaundice
Seizures
Hypoglycaemia

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41
Q

What are the red flags for neonatal sepsis ?

A

Confirmed or suspected sepsis in mother
Signs of shock
Seizures
Term baby needing mechanical ventilation
Resp distress

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42
Q

What should be performed when suspecting neonatal sepsis ?

A

FBC
Crp
LP
Blood cultures

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43
Q

What is the antibiotic of choice in treating neonatal sepsis ?

A

Benzylpenicillin and gentamycin

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44
Q

What is the ongoing management for neonatal sepsis after abx ?

A

Check CRP again at 24 hours
Check blood culture at 36 hours
Check CRP again at 5 days if still on treatment

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45
Q

What are some causes of hypoxic-ischaemic encephalopathy ?

A

Maternal shock
Intrapartum haemorrhage
Prolapsed cord,
Nuchal cord where the cord is wrapped around the neck of the baby

46
Q

What can hypoxic-ischaemic encephalopathy lead to ?

A

cerebral palsy

47
Q

What is the management of hypoxic-ischaemic encephalopathy ?

A

Supportive care - ongoing optimal ventilation, circulatory support, nutrition, acid base balance and treatment of seizures.
Therapeutic hypothermia

48
Q

What is therapeutic hypothermia ?

A

Involves actively calling the core temperature of the baby according to strict protocol.
The temperature is carefully monitored with a target between 33-34 degrees.

49
Q

What is the intention of therapeutic hypothermia ?

A

Reduce inflammation and neurone loss after the acute hypoxic injury.
It reduces the risk of cerebral palsy, delevopmental delay, learning disability, blindness and death.

50
Q

What is jaundice ?

A

It describes the condition of abnormally high levels of bilirubin in the blood.

51
Q

What is physiological jaundice in a neonate ?

A

There is a high concentration of red blood cells in the foetus and neonate. These are more fragile than normal red blood cells.
The foetus and neonates have a less developed liver function.
Normally the bilirubin is excreted via the placenta.

52
Q

What are some causes of neonatal jaundice due to increased production of bilirubin ?

A

Haemolytic disease of the newborn
ABO incompatibility
Haemorrhage
Intraventricular haemorrhage
Cephalo-haematoma
Polycythaemia
Sepsis and disseminated intravascular coagulation
G6PD deficiency

53
Q

What are some causes of neonatal jaundice due to decreased clearance of bilirubin ?

A

Prematurity
Breast milk jaundice
Neonatal cholestasis
Extrahepatic biliary atresia
Endocrine disorder - hypothyroid and hypopituitary
Gilbert syndrome

54
Q

What is kernicterus ?

A

Brain damage due to high bilirubin levels which needs to be monitored

55
Q

What is breast milk jaundice ?

A

Babies that are breastfed are more likely to have neonatal jaundice.
Some components of breast milk inhibit the ability of the liver to process bilirubin.

56
Q

What is haemolytic disease of the newborn ?

A

A cause of haemolysis and jaundice in neonates.
Caused by incompatibility between the rhesus antigens on the surface of the red blood cells of the mother and foetus.

57
Q

What antibodies on the mother and foetus cause haemolytic anaemia of the newborn ?

A

When the mother has rhesus D negative and the child has rhesus D positive from the father.
First child not affected secondary child is.

58
Q

How long does jaundice need to be to be considered prolonged ?

A

More than 14 days in full term babies
More than 21 days in premature babies

59
Q

What are some investigations of neonatal jaundice ?

A

FBC and blood film
Conjugated bilirubin
Blood type testing
Direct Coombs test
Thyroid function
Blood and urine culture
Glucose-6-phosphate-dehydrogenase levels

60
Q

What is the management of neonatal jaundice ?

A

Phototherapy
Extremely high levels may require an exchange transfusion.

61
Q

What is phototherapy ?

A

A light box shines blue light on the baby’s skin.
Converts unconjugated bilirubin into isomers that can be excreted in the bile and urine without requiring conjugation in the liver.

62
Q

What is prematurity defined as ?

A

Before 37 weeks gestation.

63
Q

What are some associations of prematurity ?

A

Social deprivation
Smoking
Alcohol
Drugs
Overweight or underweight mother
Maternal co-morbidities
Twins
Personal or family history of prematurity

64
Q

What are some options for delaying the birth when there is suspected prematurity ?

A

Prophylactic vaginal progesterone
Prophylactic cervical cerclage

65
Q

What are some treatment options for improving the outcome of prematurity ?

A

Tocolysis with nifedipine
Maternal corticosteroid
IV magnesium sulphate
Delayed court clamping or cold milking

66
Q

What are some issues associated prematurity in early life ?

A

Respiratory distress syndrome
Hypothermia
Hypoglycaemia
Poor feeding
Apnoea and bradycardia
Neonatal jaundice
Necrotising enterocolitis

67
Q

What are some long term effects of prematurity ?

A

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

68
Q

What is apnoea ?

A

Defined as periods where breathing stops spontaneously for more than 20 seconds or shorter periods with oxygen desaturation or bradycardia.

69
Q

What are some causes of apnoea in neonates ?

A

Immaturity of the autonomic nervous system
Infection
Anaemia
Airway obstruction
CNS pathology
GORD

70
Q

What is the management of apnoea in neonates ?

A

Tactile stimulation to prompt the baby to restart breathing
IV caffeine

71
Q

What is retinopathy of prematurity ?

A

Abnormal development of the blood vessels in the retina can lead to scarring, retinal detachment and blindness.

72
Q

What is the pathophysiology of retinopathy of prematurity ?

A

Retinal blood vessel development starts at around 16 weeks and is complete by 37-40 weeks gestation.
This vessel formation is stimulated by hypoxia which is normal during pregnancy.
When the retina is exposed to higher o2 concentrations the stimulant is removed.
When the hypoxic environment recurs the retina by producing excessive blood vessels as well as scar tissue.

73
Q

When should a baby be screened for retinopathy of prematurity ?

A

30-31 weeks gestational age in babies born before 27 weeks
4 - 5 weeks of age in babies born after 27 weeks

74
Q

What is the treatment for retinopathy of prematurity ?

A

First line - transpupillary laser photocoagulation
Other options - cryotherapy

75
Q

What does respiratory distress syndrome look like on a chest X-ray ?

A

Ground glass appearance

76
Q

What is the pathophysiology of respiratory distress syndrome ?

A

Inadequate surfactant leads to high surface tension with alveoli. This leads to atelectasis as it is more difficult for the alveoli and the lungs to expand. This leads to inadequate gaseous exchange resulting in hypoxia, hypercapnia and respiratory distress.

77
Q

What is the management of respiratory distress syndrome ?

A

Antenatal steroids - Dexamethasone given to mothers
Intubation and ventilation
Endotracheal surfactant
CPAP
Supplementary oxygen

78
Q

What are some short term complications of respiratory distress syndrome ?

A

Pneumothorax
Infection
Apnoea
Intraventricular haemorrhage
Pulmonary haemorrhage
Necrotising enterocolitis

79
Q

What are some long term complications of respiratory distress syndrome ?

A

Chronic lung disease of prematurity
Retinopathy of prematurity occurs
Neurological, hearing land visual impairment

80
Q

What is necrotising enterocolitis ?

A

A disorder affecting premature neonates where part of the bowel becomes necrotic.
Life-threatening
Death of the bowel tissue can lead to bowel perforation which can cause peritonitis and shock.

81
Q

What are some risk factors for necrotising enterocolitis ?

A

Very low birth weight or very premature
Formula feeds
Respiratory distress and assisted ventilation
Sepsis

82
Q

How does necrotising enterocolitis present ?

A

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

83
Q

What are some investigations for necrotising enterocolitis ?

A

FBC
CRP
Capillary blood gas
Blood culture
Abdominal X-ray

84
Q

How does necrotising enterocolitis present on X-ray ?

A

Dilated loops of bowel
Bowel wall oedema
Pneumatosis intestinalis
Pneumoperitoneum
Gas in the portal veins

85
Q

What is the management of necrotising enterocolitis ?

A

Nil by mouth
Iv fluids
TPN
Antibiotics
NG tube
Surgical emergency

86
Q

What are some complications of necrotising enterocolitis ?

A

Perforation and peritonitis
Sepsis
Death
Strictures
Abscess formation
Recurrence long term stoma
Short bowel syndrome

87
Q

What is neonatal abstinence syndrome ?

A

Refers to the withdrawal symptoms that happens in neonates of mothers that used substances in pregnancy

88
Q

What are some substances that cause neonatal abstinence syndrome ?

A

Opiates
Methadone
Benzodiazepines
Cocaine
Amphetamines
Nicotine or cannabis
Alcohol
SSRI antidepressants

89
Q

What are some CNS symptoms of neonatal abstinence syndrome ?

A

Irritability
Increased tone
High pitched cry
Not settling
Tremors
Seizures

90
Q

What are some vasomotor and respiratory symptoms of neonatal abstinence syndrome ?

A

Yawning
Sweating
Unstable temperature and pyrexia
Tachypnoea

91
Q

What are some metabolic and GI symptoms of neonatal abstinence syndrome ?

A

Poor feeding
Regurgitation or vomiting
Hypoglycaemia
Loose stools with a sore nappy area

92
Q

What is the medial treatment for neonatal abstinence syndrome ?

A

Oral morphine sulphate for opiate withdrawal
Oral phenobarbitone for non-opiate withdrawal

93
Q

What are some additional considerations for neonatal abstinence syndrome ?

A

Testing for hepatitis B and C and HIV
Safeguarding and social services
Safety netting
Follow up from paeds, social services, health visitors and the GP
Support for mother

94
Q

What is sudden infant death syndrome ?

A

Sudden unexplained death in an infant.
Cot death
Usually in first 6 months of life

95
Q

What are some risk factors for sudden infant death syndrome ?

A

Prematurity
Low birth weight
Smoking during pregnancy
Male baby

96
Q

What minimises the risk of sudden infant death syndrome ?

A

Put the baby on their back
Keep their head uncovered
Keep cot clear of toys and blankets
Maintain a comfortable room temp ( 16 - 20 )
Avoid smoking
Avoid co-sleeping

97
Q

What are some conditions that arise during pregnancy ?

A

Foetal alcohol syndrome
Congenital rubella syndrome
Congenital varicella syndrome
Congenital cytomegalovirus
Congenital toxoplasmosis
Congenital Zika syndrome

98
Q

What can alcohol in early pregnancy lead to ?

A

Miscarriage
Small for dates
Preterm delivery

99
Q

How can foetal alcohol syndrome present ?

A

Microcephaly
Thin upper limb
Smooth flat philtrum ( the groove between the nose and upper lip )
Short palpebral fissure
Learning disability
Behavioural difficulties
Hearing and vision problems
Cerebral palsy

100
Q

What are some features of congenital rubella syndrome ?

A

Congenital cataracts
Congenital heart disease
Learning disability
Hearing loss

101
Q

What causes congenital rubella syndrome ?

A

Caused by maternal infection with the rubella virus during pregnancy.
The MMR vaccination should be avoided in pregnancy as the MMR vaccine is live.

102
Q

What can chickenpox in pregnancy lead to ?

A

varicella pneumonitis
Varicella hepatitis
Varicella encephalitis
Foetal varicella syndrome
Severe neonatal varicella infection

103
Q

If a chicken pox rash starts in pregnancy what treatment should be given ?

A

Oral aciclovir if they present within 24 hours and are more than 20 weeks gestation.

104
Q

When does congenital varicella syndrome develop ?

A

Occurs when there is infection in the first 28 weeks of gestation.

105
Q

What are some typical features of congenital varicella syndrome ?

A

Foetal growth restriction
Microcephaly, hydrocephalus and learning disability
Scars and significant skin changes
Limb hypoplasia
Cataracts and inflammation in the eye

106
Q

What causes congenital cytomegalovirus ?

A

Occurs due to maternal CMV infection during pregnancy.
Mostly spread via the infected saliva or urine of asymptomatic children.

107
Q

What are some features of congenital cytomegalovirus ?

A

Foetal growth restriction
Microcephaly
Hearing loss
Vision loss
Learning disability
Seizures

108
Q

What are the features of the classic triad of congenital toxoplasmosis ?

A

Intracranial calcification
Hydrocephalus
Chorioretinitis

109
Q

What causes congenital toxoplasmosis ?

A

Infection with the toxoplasma gondii parasite is usually asymptomatic.
It is primarily spread by contamination with faeces from a cat that is a host of the parasite.

110
Q

What causes congenital zika syndrome ?

A

Zika virus spread by the host Aedes mosquitoes in areas of the world where the virus is prevalent.
It can also be spread by sex with someone infected with the virus .

111
Q

How can congenital Zika syndrome present ?

A

Microcephaly
Foetal growth restriction
Other intracranial abnormalities such as ventriculomegaly and cerebellar atrophy

112
Q

If a pregnant woman contracted the Zika virus what test should be organised ?

A

Viral PCR
Antibodies to the Zika virus

Y4 Paeds (14 decks)

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