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3a Child Health > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What does extended hypoxia lead to?

A

hypoxic-ischaemic encephalopathy(HIE)

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2
Q

What is the APGAR score?

A

Scores heart rate, resp effort, muscle tone, response to stimulation and skin colour in a newborn

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3
Q

What can you do if there is still significant volume of blood in the placenta?

A

Delayed umbilical cord clamping to give more time for Hb, iron stores and blood pressure to increase

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4
Q

What is respiratory distress syndrome?

A

Inadequate surfactant commonly in babies under 32 weeks leads to lung collapse and inadequate gas exchange

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5
Q

What is the presentation of RDS?

A

Cyanosis, tachypnoea, chest in drawing, grunting

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6
Q

What is the main investigation for RDS?

A

CXR - bilateral, diffuse ground glass lungs

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7
Q

What is the management of RDS?

A

Antenatal dexamethasone to mothers of suspected preterm labour to increase surfactant
Intubation and ventilation
Endotracheal surfactant

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8
Q

What is bronchopulmonary dysplasia?

A

Impaired alveolar development in pre-term infants and require mechanical ventilation damaging their fragile lungs

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9
Q

What are the symptoms of bronchopulmonary dysplasia?

A

Breathing quickly
Nostril flaring
Grunting
Pulling at the chest

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10
Q

What is the treatment for bronchopulmonary dysplasia?

A

None specifically
Oxygen
Diuretics
Corticosteroids

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11
Q

What is meconium aspiration?

A

Meconium enters the respiratory tract and can cause mechanical obstruction and chemical pneumonitis

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12
Q

What is meconium composed of?

A

Skin, intestinal cells, hair, vernix and amniotic fluid

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13
Q

What are the features of meconium aspiration?

A

Respiratory distress, pneumonitis, pneumothorax, bacterial pneumonia

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14
Q

What are the investigations for meconium aspiration?

A

Pre and post ductal saturations to assess respiratory involvement and detect congenital cardiac lesions
Capillary gas
FBC
CRP
CXR

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15
Q

What is the management of meconium aspiration?

A

Endotracheal suction for prevention
Oxygen therapy
Antibiotics
Surfactant

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16
Q

What is HIE?

A

Hypoxia during birth

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17
Q

What can HIE lead to?

A

Permanent brain damage causing cerebral palsy

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18
Q

What are some causes of HIE?

A

Maternal shock
Asphyxia
Intrapartum haemorrhage
Prolapse cord
Nuchal cord

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19
Q

What is the staging for HIE?

A

Sarnat Staging (mild, moderate and severe)

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20
Q

What is the management of HIE?

A

Neonatal resuscitation
Circulatory support
Nutrition
Acid base balance treatment
Therapeutic hypothermia

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21
Q

What does TORCH stand for?

A

Toxoplasmosis
Rubella
CMV
HSV
HIV
Zika

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22
Q

What are TORCH infections?

A

An infection of the developing foetus or newborn that can occur in utero, delivery or after birth

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23
Q

How are TORCH infections transmitted?

A

Placenta, passing through the birth canal or through breastmilk

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24
Q

What are some shared symptoms of TORCH infections?

A

Fever, lethargy, cataracts, jaundice, hepatosplenomegaly, low birth weight, hearing loss

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25
Q

What rash is often seen in TORCH infections?

A

Blueberry muffin rash

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26
Q

What is toxoplasmosis?

A

Protozoan parasite transmitted via undercooked meats and cat faeces

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27
Q

How do you treat toxoplasmosis?

A

Pyrimethamine and sulfadiazine

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28
Q

What can Zika cause in pregnancy?

A

Microcephaly
Foetal growth restriction
Cerebellar atrophy

29
Q

What are some investigations for TORCH infections?

A

Prenatal USS
PCR
Viral culture
CT scans

30
Q

What are some causes of increased bilirubin production?

A

Haemorrhage
ABO incompatibility
Haemolytic disease of the newborn
Polycythaemia
Sepsis and DIC

31
Q

What are some causes of decreased bilirubin clearance?

A

Prematurity - immature liver
Breast milk jaundice
Neonatal cholestasis
Gilbert syndrome

32
Q

What are some investigations for neonatal jaundice?

A

FBC and blood film
Conjugated bilirubin
Blood type testing
Thyroid function

33
Q

What is a treatment for neonatal jaundice?

A

Phototherapy - blue light breaks down bilirubin
Exchange transfusions

34
Q

What is kernicterus?

A

Bilirubin crossing the blood-brain barrier causing CNS damage

35
Q

What is necrotising entercolitis?

A

Part of the bowel becomes necrotic and can lead to perforation, peritonitis and shock

36
Q

What are some risk factors for necrotising enterocolitis?

A

Very low birth weight or premature
Formula feeds
Respiratory distress
Assisted ventilation
Sepsis
PDA

37
Q

What is the presentation of necrotising entercolitis?

A

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

38
Q

What are some investigations for necrotising entercolitis and what is the gold standard?

A

Gold - X-ray showing dilated loops of bowel
CRP
DBC
U&E

39
Q

What is the management of necrotising entercolitis?

A

NBM with IV fluids
NG tube to drain fluid and gas
Surgical emergency - remove dead bowel tissue

40
Q

What is gastroschisis?

A

Foetal abdominal organs protrude outside the abdomen with no protective membrane coating

41
Q

What are some risk factors for gastroschisis?

A

Maternal smoking
Maternal age under 20
Environmental exposures
Aspirin and ibuprofen

42
Q

What is the presentation of gastroschisis?

A

Visible at birth or on USS at 20 weeks
Omphalocele

43
Q

What is the management of gastroschisis?

A

Sterile clear covering over the herniated contents such as cling film
Surgery to reduce organs and close abdominal wall defect
NG tube to decompress bowel

44
Q

What is oesophageal atresia?

A

Congenital birth defect with incomplete formation of the oesophagus
Upper and lower oesophagus and stomach do not connect

45
Q

What does oesophageal atresia cause?

A

A pouch so food doesn’t reach the stomach

46
Q

What does oesophageal atresia occur alongside?

A

Tracheo-oesophageal fistula - connection between lower oesophagus and trachea

47
Q

What are the causes of oesophageal atresia?

A

Polyhydraminos
VACTERL conditions

48
Q

What are the symptoms of oesophageal atresia?

A

Aspiration pneumonia at any feeding attempt
Excessive secretions
Coughing
Cyanosis
Failure to thrive
White frothy bubbles in the mouth

49
Q

What are the investigations for oesophageal atresia?

A

USS
Feeding tube to see if it reaches the stomach
X-ray

50
Q

What is the treatment for oesophageal atresia?

A

Surgical repair
IV nutrition and suction tube
Antibiotics

51
Q

When are most cases of gestational diabetes diagnosed?

A

Routine testing at 24-28 weeks

52
Q

What are some complications of gestational diabetes?

A

Marcosomia (large baby)
Increased risk of shoulder dystocia
Neonatal hypoglycaemia
Hyperbilirubininaemia

53
Q

What is shoulder dystocia?

A

Shoulder stuck at pubic bone during delivery

54
Q

What are some risk factors for gestational diabetes?

A

Previous GDM
Over 35 years
Obesity
PCOS
Smoking
Family history of T2DM

55
Q

What are the investigations for gestational diabetes?

A

Oral glucose tolerance test at 24-28 weeks
HbA1c
Foetal USS every 4 weeks from 36-38 weeks

56
Q

What is the management of gestational diabetes?

A

Glucose monitoring
Diet
Exercise
Metformin and insulin if exercise and diet cannot control

57
Q

What is hypoglycaemia?

A

A blood glucose of less than 2.6 mmol/L

58
Q

What are the risk factors for hypoglycaemia?

A

Gestation/ prematurity under 37 weeks
Maternal beta blocker use
Infant of a diabetic mother
Hypothermia
Cord pH of less than 7.1
Inborn errors of metabolism

59
Q

What is the presentation of hypoglycaemia?

A

Hypotonia
Lethargy
Poor feeding
Hypothermia
Apnoea
Irritability
Pallor

60
Q

What is the treatment for hypoglycaemia?

A

IV dextrose infusion as a bolus then continuous infusion
IM glucagon
Keep them ‘warm, pink, sweet and calm’

61
Q

What is group B strep?

A

Lives in rectum or vagina and normally harmless but it can cause meningitis and sepsis

62
Q

What are some risk factors for group B strep infection?

A

Premature baby, previous GBS infection, fever during labour, waters broken more than 24 hours before birth

63
Q

What is cleft lip/ palate?

A

Congenital condition with split or open section of the upper lip
Palate - defect in the hard or soft palate at the roof of the mouth

64
Q

What are some complications of cleft lip/ palate?

A

Feeding, swallowing and speech problems
Psycho-social implications
Hearing problems
Ear infections
Glue ear

65
Q

What is the management of cleft lip and palate?

A

plastic, maxillofacial and ENT surgeons
Dentists
SLT
Surgery - lip at 3 months and palate at 6-12 months

66
Q

When are the effects of alcohol in pregnancy the greatest?

A

First 3 months - can lead to miscarriage, small for dates and premature delivery

67
Q

What are some features of foetal alcohol syndrome?

A

Microcephaly
Thin upper lib
Small flat philtrum
Short palpebral fissure
Learning disability
Cerebral palsy

68
Q

What is pathognomic of NEC?

A

Pneumatosis intestinalis/ gas in the gut wall

3a Child Health (14 decks)

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