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RCPCH TAS/ AKP > Neonatology > Flashcards

Neonatology Flashcards

1
Q

Which antibody is responsible for passive immunity in newborn?

A

IgG can cross placenta and via breast milk

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2
Q

What causes RDS?

A

Ineffective / inadequate surfactant
Prematurity <32w
MAS
Hypoxia
Hypothermia
Maternal DM

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3
Q

Signs of RDS on CXR

A
  • Generalised atalectasis - ground glass appearance
  • Air bronchograms
  • Reduced lung vol
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4
Q

Define bronchopulmonary dysplasia (CLD)

A

Persistent o2 requirement after 28 days of life or 36+0 corrected

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5
Q

Risk factors for BPD

A

PREMATURITY
Infection
Ventilatory support
Male
Caucasian
IUGR
FHx asthma
PDA
Maternal smoking / HTN

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6
Q

Signs of BPD on CXR

A
  • Diffuse interstitial shadowing
  • Hyperexpansion
  • Flattening of diaphragm
  • Cysts
  • Bronchial wall thickening
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7
Q

Treatment of BPD

A
  • Prevention: AN steroids
  • Supportive - nutrition, resp. support
  • Steroids
  • Diuretics
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8
Q

Presentation of Choanal Atresia

A
  • Cyanosis / resp. distress on feeding, improves on crying
  • Minimal ventilation requirement
  • Ix - NGT into both nostrils
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9
Q

Conditions associated with Choanal Atresia

A

Down’s
Treacher Collins
CHARGE

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10
Q

Treatment of pneumothorax in neonate

A
  • Increased o2 concentration
  • Needle thoracocentesis
  • Chest drain
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11
Q

Signs of TTN on CXR

A
  • Cardiomegaly
  • Pleural effusion / fluid in horizontal fissure
  • Prominent peri-hilar interstitial markings
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12
Q

Signs of MAS on CXR

A
  • Heterogenous opacification (collapse and consolidation)
  • Over-inflation
  • Atalectasis
  • +/- Pneumothorax
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13
Q

Treatment of MAS

A
  • Intubation and ventilation ?Oscillation
  • Surfactant
  • Inotropes
  • NO
  • ECMO
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14
Q

CXR appearance in PPHN

A

Dark (reduced pulmonary blood flow)

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15
Q

Risk factors for PPHN

A

Perinatal asphyxia
MAS
RDS
EONS
Polycythaemia
Acidosis, hypothermia, hypoglycaemia
NSAIDs, SSRIs
Pulm. hypoplasia
CDH

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16
Q

Indication for ECMO in PPHN

A

Oxygenation index >30 for >4 hours
OI = (FiO2 x MAP) / Post-ductal PaO2

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17
Q

Common pathogens for congenital pnuemonia

A
  • Gram -ve: E. Coli, klebsiella, pseudomonas
  • GBS
  • Staph
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18
Q

Causes of pulmonary hypoplasia

A
  • Oligohydramnios
  • CDH
  • Decreased breathing activity - Werdnig Hoffman
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19
Q

Pulmonary hypoplasia CXR

A

Dense
Hypoinflated
“Bell shape”

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20
Q

What are VACTRL associations?

A

Vertebral defects
Anorectal malformation
Cardiac defect
TOF-OA
Renal anomalies
Limb defects
(Not genetic). Associated with maternal progesterone.

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21
Q

What is a bronchopulmonary sequestration?

A

Normal lung tissue.
Supplied by systemic circulation not pulmonary
Not connected to pulmonary tree

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22
Q

Causes of neonatal seizures

A
  • Cerebral malformation
  • HIE
  • Infection
  • Metabolic - pyridoxine def.
  • IVH
  • Hypoglycaemia / electrolyte disturbance
  • Neonatal abstinence syndrome
  • CVA
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23
Q

Treatment escalation of neonatal seizures

A
  1. Phenobarbital 20mg/kg
  2. Phenobarbital 10mg/kg
  3. Phenobarbital 10mg/kg
  4. Phenytoin 20mg/kg
  5. Clonazepam / Midazolam 100mcg/kg
  6. Lidocaine 2mg/kg
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24
Q

3 types of perinatal stroke

A
  1. Arterial ischaemic stroke (most MCA)
  2. Haemorrhage
  3. Cerebral sinovenous thrombus
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25
Q

Grading of IVH

A
  1. Bleeding in germinal matrix
  2. 1+ bleeding into ventricle
  3. 2+ ventricular dilatation
  4. 3+ Bleeding extending beyond ventricles
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26
Q

Most likely site of IVH in pre-term and term babies

A
  • Pre-term = Germinal matrix
  • Term = Choroid plexus
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27
Q

Criteria for Dx of HIE

A
  1. Evidence of intrapartum asphyxia
  2. Respiratory depression at delivery
  3. Encephalopathy in the immediate postnatal period
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28
Q

Indicators of Mod - Severe HIE

A

Early onset seizures
Unresponsive
Hypotonic
Abnormal primitive reflexes
Abnormal EEG

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29
Q

Risk factors for ROP

A

BW <1kg (screen <1.5kg)
Gestation <32 weeks
Hyperoxygenation
Acidosis
–> screening <32/40 or <1kg

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30
Q

Treatment ROP

A

Anti-VEGF injections
Laser ablation in severe ROP

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31
Q

Presentation of PDA

A

Systolic machinery murmur LUSE –> back
Bounding pulses
Heart failure
Pulmonary haemorrhage
Hypotension (wide pulse pressure)
Poor growth, feeding difficulty
Risk: IVH, NEC

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32
Q

Treatment PDA

A

Conservative (2/3 close spont)
Fluid restriction / diuretics
Paracetamol ( reduced prostaglandins)
Ibuprofen (COX inhibitor)
Surgical ligation

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33
Q

Presentation of NEC

A

More in preterm
Tender, distended abdo
Bilious vomiting
Bloody stool

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34
Q

Sign of NEC on AXR

A

Pneumatosis (intramural nitrogen + hydrogen)

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35
Q

Risk factors for NEC

A

Prematurity
IUGR (esp absent EDF)
Hypoxia
Polycythaemia
Exchange Tx
Rapid increase in feeds
Low IgA levels (more in breast milk)

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36
Q

NEC histology

A
  • Necrosis and microthrombus
  • Patchy mucosal ulceration
  • Oedema and haemorrhage
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37
Q

NEC treatment

A
  1. NBM 10-14d
  2. Triple Abx - BenPen, Gent, Met
  3. Systemic support
  4. ?Surgical intervention - deterioration, perforation, obstruction
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38
Q

Risk factors for transient hypoglycaemia in newborn

A
  1. Hyperinsulinism in utero - maternal DM, LGA
  2. Low glycogen stores - LBW, IUGR
  3. Increased requirements - sepsis, hypothermia, Rh disease
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39
Q

Causes of refractory hypoglycaemia in neonate

A

CAH
Inborn erros of metabolism
Glycogen deficiency
Hypopituitarism
Hyperinsulinism
Beckwith-wiedemann
Rh haemolytic disease

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40
Q

Treatment of persistent neonatal hypoglycaemia

A
  1. Reduced insulin secretion - diazoxide, octreotide, (pancreatic resection)
  2. Increase glucose delivery - fluids, glucagon.
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41
Q

Cause of metabolic bone disease in neonates

A

Substrate deficiency (PO4-, Ca2+, Vit D) –> poor bone mineralisation

RF: Prolonged TPN/ diuretics, breastfed

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42
Q

Diagnosing metabolic bone disease

A

Low phosphate
High calcium
High Alk Phos
X-rays - Cupping, osteoporosis, fractures
Sx: Reduced linear growth, fractures

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43
Q

Treatment metabolic bone disease

A

PO Phosphate
TPN - 2 mmol/kg/day calcium, 2.5 mmol/kg/day phosphate
Prevent with PO Vit D

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44
Q

What is Haemorrhagic disease of the newborn?

A

Life threatening bleeding in newborn.
Due to low levels of Vit K dependent clotting factors at birth (II, VII, IX, X)

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45
Q

Treatment Haemorrhagic disease of newborn

A

IV Vit K
FFP

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46
Q

Blood groups for Rh haemolytic disease

A

Rh +ve foetus
Rh -ve mother

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47
Q

Presentation of Rh haemolytic disease

A

Foetal anaemia / hydrops
Early severe jaundice
Blueberry muffin rash
Hepatosplenomegaly
Coagulopathy/ thrombocytopenia
Leucopenia

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48
Q

ABO incompatibility presentation / Tx

A

Jaundice <24 hours
Usually less severe than Rh incompatibility
Tx: PTx, IVIg. Rarely needs exchange transfusion.

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49
Q

Features of Foetal Alcohol Syndrome

A
  • Microcephaly
  • Cognitive impairment / GDD
  • Abnormal corpus collosum
  • Dysmorphic - short palpebral fissure, smooth philtrum, cleft palate, micrognathia, thin lip
  • VSD
  • Joint abnormalities
50
Q

Which medications in pregnancy are teratogenic?

A
  • Valproate - NTD, cleft
  • Phenytoin/ carbamazepine - IUGR, GDD, limb and finger deformities
  • Nicotine- IUGR, LD
  • Alcohol
  • Warfarin - Nasal hypoplasia, chloanal atresia
  • Thalidomide
  • Isotretanoin - craniofacial, cardiac, CNS
  • Methotrexate - microcephaly, NTD, short limbs
51
Q

Time of onset for different substances for NAS

A
  • Short time after birth = Opiods, SSRIs
  • Long = BDZ
52
Q

Which maternal substance abuse requires avoiding breast feeding?

A

Methadone
Amphetamines
Cocaine

53
Q

Central causes for “floppy baby” (preserved strength)

A
  • Acute: HIE, infection, ICH, drugs
  • Chronic: Chromosomal eg Down’s, Prader-Willi, structural cerebral
  • Inborn errors of metabolism
  • Spinal cord birth trauma
54
Q

Peripheral causes for “floppy baby” (weak and floppy) by location

A
  • Ant. horn cell: SMA
  • NMJ: Transient / congenital myaesthenia, infantile botulism
  • Peripheral n: Guillain-Barre, demyelinating / hypomyelinating neuropathy
  • Muscle: Myopathies, muscular dystrophies, myotonic dystrophy, hypothyroidism, glycogen storage disorders
  • CT: Marfan, Ehler’s Danlos, Oestogenesis imperfecta
55
Q

What causes transient neonatal myasthenia gravis?

A

Transplacental acetylcholine receptor antibodies

56
Q

Genetics and presentation of myotonic dystrophy in neonate

A
  • Autosomal dominant, trinucleotide repeats DMPK gene Ch 19 –> anticipation
  • Hypotonia
  • Polyhydramnios / RDS
  • Parent - unable to loosen grip/ open eyes.
  • Myopathic face.
57
Q

Which condition is there a risk of malignant hyperthermia with analgesia?

A

Myotonic dystrophy

58
Q

Causes of Hydrops Foetalis

A
  • Haemolytic disease
  • Genetic - Trisomies, Noonan’s, Turner’s
  • Foetal anaemia - TTTS, alpha thalassaemia
  • Infection- Parvovirus B19, TORCH
  • Cardiac - Structural, arrhythmia, cardiomyopathy
  • Cystic hygroma
  • Malformation - CPAM, Bowel atresia
  • Idiopathic
59
Q

Hydrops treatment

A
  • Antenatally - Blood Tx, Tx SVT, laser ablation TTTS
  • Supportive
  • Chest / ascitic drain
  • Octreotide for chylothorax / ascites
60
Q

Pathogens that cause early-onset neonatal sepsis (<48 hours)

A
  • GBS
  • Gram negative organisms
  • Staph
  • Listeria monocyotogenes
  • Klebsiella
  • Pseudomonas
61
Q

Pathogens that cause late-onset neonatal sepsis (>48 hours)

A
  • GBS
  • Coagulase negative staphylococcus eg preterms with lines
    ABx - Fluclox and Gent
62
Q

Presentation of Congenital HSV infection

A
  • Vesicular rash
  • Conjunctivitis
  • Encephalitis
  • Systemic: Shock, respiratory failure, deranged clotting
63
Q

Presentation of congenital syphyillis

A
  • Fever
  • Irritability
  • Saddle nose
  • Rashes / ulceration
64
Q

Presentation congenital listeria

A
  • Preterm
  • Delayed meconium
    Risk = soft cheese and unpasturised milk
65
Q

Maternal Hep B: Indications for treatment at birth

A
  • HBsAg positive –> Hep B vaccine
  • e-antigen +ve or e-antibody negative –> Hep B Ig
66
Q

Indications for and treatment in maternal VZV

A
  • Varicella zoster immunoglobulin if maternal infection <7 days before or <4 days after delivery
67
Q

Presentation of infant of mother with VZV in pregnancy

A
  • If in first half of pregnancy –> affect dev of that dermatome. Aysmmetrical.
  • Skin / digital dysplasia
  • Ocular
  • Neuro damage / GDD
  • Bladder/ bowel dysfunction
68
Q

Presentation of congenital toxoplasmosis

A

Protozoal infection
- Cerebral calcification
- Hydrocephalus
- Chorioretinitis
(Risk = raw meat, cat faeces)

69
Q

Presentation of congenital CMV

A
  • Microcephaly
  • Hepatosplenomegaly
  • IUGR - symmetrical
  • Cardiac defects
  • Jaundice
  • Petechiae
  • CrUSS - periventricular calcification
  • Seizures
  • Childhood SN hearing loss
70
Q

Presentation of congenital rubella infection

A

If in 1st trimester –> 80% congenital anomalies
- Cataracts
- SN Deafness
- CHD - PDA, pulm. stenosis
- Rash
- Microcephaly
- GDD

71
Q

Hearing screening tests in newborns

A
  1. Automated otoacoustic emission test (vibrations of basilar membrane)
  2. Repeat 1
  3. Automated auditory brainstem response - records neuro activity in response to noise. More accurate.
72
Q

What conditions are screened for on D5 blood spot test?

A
  • Sickle cell disease
  • CF
  • Congenital hypothyroid
  • 6 metabolic diseases - PKU, MCADD, maple syrup urine disease, isovolaemic acidaemia, glutaric aciduria type 1, homocystinuria
  • +/- SCID
73
Q

What conditions are associated with duodenal atresia?

A

Down’s
Prader Willi

74
Q

Presentation of duoedenal atresia

A

Polyhydramnios
Early bilious vomiting
USS - ‘double bubble’

75
Q

Presentation of Exomphalos

A

Herniation of abdominal organs outside body, covered in sac
Associated with trisomies

76
Q

RF for gastroschisis

A

Young Mum
Smoking
Drugs
Low SES.

77
Q

Most common type of TOF?

A

Type C - Oesophageal atresia with TOF to distal oesophageal segment

78
Q

Presentation TOF

A
  • Polyhydramnios
  • Choking / coughing/ cyanosis during feeding
  • Oral secretions ++
79
Q

Complications of TOF-OA repair

A

Anastamotic leak
Strictures
GOR
Recurrent cough
Bronchitis
LRTI

80
Q

Presentation of CDH

A
  • Polyhydramnios
  • Cardio-mediastinal shift
  • Inability to demonstrate stomach bubble
  • Scaphoid anterior wall.
  • Bochdalek hernia (most common) = left posterolateral defect in diaphragm wall
  • Significant resp. distress.
81
Q

Management CDH

A

NO BVM VENTILATION
Intubation
Gastric decompression
Support - correct acidosis, Tx PPHN
+/- surfactant
Surgery

82
Q

What is Kernicterus?

A

Bilirubin induced encephalopathy. Caused by bilirubin not bound to albumin –> staining and necrosis

83
Q

Factors that increased risk for bilirubin neurotoxicity

A
  • High bilirubin
  • Low albumin
  • Drugs which displace bili: ceftriaxone, ibuprofen
  • Disruption of BBB eg HIE, seizures, meningitis
  • Acidosis
  • Hyperosmolality –> increased BF to brain
84
Q

Long term effects of Kernicterus

A

Choreoathetoid CP
SN hearing loss
Upward gaze abnormality
Dental enamel dysplasia

85
Q

Breakdown of Hb by the reticuloendothelial system can be determined by measurement of which exhaled gas?

A

Carbon Monoxide

86
Q

What substances are created for excretion when conjugated bilirubin is hydrolysed in the gut?

A

Sercobilinogen –> Faeces
Urobilinogen –> urine

87
Q

What are the 3 mechanisms for jaundice in neonates?

A
  1. Increased RBC turnover eg polycythaemia, haemolysis, G6PD def
  2. Delayed bilirubin clearance eg delayed meconium
  3. Conjugated hyperbilirubinaemia eg obstruction due to biliary atresia
88
Q

Differentials for Jaundice <24 hours of age

A
  • Haemolysis - Rhesus / ABO incompatibility
  • Sepsis
89
Q

Presentation Crigler-Najjar syndrome

A

AR
Congenital unconjugated jaundice

90
Q

Define polycythaemia and what is the threshold to treat?

A

Haematocrit >65%
Treated if >70% - liberal fluids +/- exchange transfusion

91
Q

Jaundice investigations in neonate

A
  • TCB / SBR
  • FBC/ Film/ Haematocrit
  • ?Septic screen
  • Blood group and DAT
    -?G6PD levels
92
Q

Differentials for neonatal conjugated hyperbilirubinaemia

A

CAMOF(L)AGED
Congenital infection
Acquired infection
Metabolic
Obstructive - BA, choledochal cyst
Flow - CF, Alagille syndrome
Alpha-1-antitrypsin
General - Unwell, Prem
Endocrine - Hypothyroid, hypopituitary
Drugs - TPN

93
Q

Oxygenation is dependent on MAP. How is MAP calculated?

A

MAP = PEEP + [(PIP-PEEP) x(Ti/Total respiratory cycle)]

94
Q

Ventilation adjustments to improve CO2 clearance

A
  • Suctioning / reducing dead space
  • Increase Rate
  • Increase PIP, reduce PEEP
  • Increase VG
95
Q

Ventilation adjustments to increase oxygenation

A
  • Increase FiO2
  • Increase PEEP / PIP
  • Increase Ti
  • Consider muscle relaxant
  • Consider Surfactant
  • Patient triggered ventilation
96
Q

Minute volume calculation

A

MV = Tidal volume x Respiratory Rate

97
Q

Causes of physiological jaundice

A

Multifactorial.
Immature liver with low levels of UDGT
Unconjugated hyperbilirubinaemia.
Low concentrations of ligandin
High red cell mass with shortened life span.
Increased enterohepatic circulation

98
Q

Risk to newborn in mother with SLE

A

Heart block
Anti-Ro/ La Abs can damage conduction system of foetal heart.
NB ECG
Also thrombocytopenia, cutaneous malformation

99
Q

What is Potter Sequence?

A
  • Sequence of congenital anomalies. NOT genetic. Secondary to oligohydramnios of other cause
  • Oligohydramnios
  • Severe pulm. hypoplasia –> resp distress
  • PUV, small kidneys/ renal agenesis
  • Clubbed feet
  • Cardiac anomalies
  • Facial anomalies: Low-set ears, beaked nose, micrognathia
100
Q

Presentation of Posterior-urethral valves

A
  • BOYS
  • Oligohydramnios, hyronephrosis AN
  • Depending on severity, pulmonary hypoplasia
  • Oligouria
101
Q

Complications of Posterior urethral valves

A

VUR
Hydronephrosis
Renal failure
Renal dysplasia
UTIs
Bladder dysfunction

102
Q

Maternal Cocaine - presentation of baby

A
  • IUGR
  • Microcephaly
  • CrUSS - subependymal haemorrhage and cysts.
  • Behavioural probs later
103
Q

Maternal gonorrhoea, presentation in baby and treatment

A
  • Bilateral conjunctivitis, profuse purulent discharge
  • MC&S: Gram negative diplococci
  • Tx: IV BenPen
104
Q

Presentation congenital Chlamydia and Tx

A
  • Neonatal pneumonitis
  • Bilateral purulent conjunctivitis (D5-14)
  • +/- Middle ear infection.
  • Ix: Raised IgG, IgA and IgM, high eosinophils
  • Tx conjunctivitis: Oral erythromycin. 12.5mg/kg every 6 hours for 2 weeks.
105
Q

Insulinoma biochemistry

A
  • Hypoglycaemia
  • High insulin
  • High c-peptide (endogenous)
106
Q

Hypercarbic stimulus used to establish brain stem death in testing in neonates

A

PaCo2 >8.0kPa

107
Q

Criteria to confirm brainstem death

A
  • Absent brainstem reflexes – pupillary, corneal, vetibulo-ocular reflex, gag and cough reflexes
  • Absent motor response to pain (supraorbital pressure)
  • Absent respiratory response to rise in arterial blood pressure of CO2.
108
Q

Genetic defect retinoblastoma?

A

RB1 tumour-suppressor gene

109
Q

What is SIPPV? (PCAC)

A

Synchronised intermittent positive pressure ventilation
Every breath is assisted and additional breaths given if breathing below back up rate.

110
Q

What is volume guarantee?

A

Ventilator will adjust the pressures delivered to provide desired vol air to lungs.
Auto-weaning, as lung compliance reduces, pressures will drop.

111
Q

What is SIMV?

A

= Synchronised intermittent mandatory ventilation
Ventilator will give a certain number of breaths synchronising with the patients breathing. Doesn’t support breaths above back up rate.

112
Q

Causes of oligohydramnios

A
  • Abnormal renal function eg PUV, hydronephrosis, Potter Sequence
  • ROM
  • Placental insufficiency
  • TTTS
113
Q

Causes of polyhydramnios

A
  • GDM
  • TOF-OA
  • Neuromuscular disorder affecting swallow
  • Bowel obstruction eg atresia, annular pancreas
  • Infection eg CMV
114
Q

Differentials for baby with protruding tongue

A
  • Down’s
  • Congenital hypothyroid
  • Beckwith-Wiedemann
  • Mucopolysaccharide syndrome
115
Q

Erb’s palsy - nerve roots and presentation

A

C5,6
“Tip waiter”
- Arm adduction, internal rotation, forarm pronation, wrist flexion.
- Able to grasp, other arm reflexes absent

116
Q

Klumpke’s palsy - Nerve roots and presentation

A

C8, T1
- “Claw hand”
- Weak intrinsic muscles of hand
- Grasp absent, all other arm reflexes present

117
Q

Total brachial plexus palsy nerve roots and presentation

A

C5 - T1
Limp arm, all reflexes absent

118
Q

Brachial plexus injury at birth - Ix and Mx

A

Ix: CXR ?fracture ?diaphragmatic palsy
Mx: Surgery –> Nerve conduction studies / MRI

119
Q

Causes of neonatal thrombocytopenia

A

IUGR / preterm
Sepsis / DIC
Asphyxia
Alloimmune thrombocytopenia
Viral infections - CMV, HSV
AI

120
Q

Most common causes of meconium ileus

A

CF (90%)
Hypothyroidism

121
Q

Symptoms of Gastro-oesophageal reflux

A

Regurgitation / vomiting
Feeding difficulty / irritability
Back arching
Cough / wheeze
Hoarse voice
ABCs
Chest pain

RCPCH TAS/ AKP (20 decks)

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