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child and family > neonatology > Flashcards

neonatology Flashcards

1
Q

what is an inguinal hernia

A

weakness in the muscle around the groin, resulting in a loop of bowel bulging through

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2
Q

in babies, is an inguinal hernia congenital or acquired

A

congenital

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3
Q

how does an inguinal hernia present in babies

A

bulging of the testes

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4
Q

complications of inguinal hernias

A

bowel obstruction and perforation

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5
Q

what is a meconium ileus

A

neonatal bowel obstruction of the distal ileum due to abnormally thick and impacted meconium

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6
Q

what does meconium ileus usually indicate

A

cystic fibrosis

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7
Q

investigation of a meconium ileus

A

x-ray with contrast

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8
Q

what must be ruled out in a baby with bilious (green) vomiting

A

malrotation

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9
Q

investigation for malrotation

A

upper GI contrast and follow through

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10
Q

what is jejunal atresia

A

congenital abnormality characterised by obliteration of the lumen of the jejunum

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11
Q

what is associated with duodenal atresia

A

down syndrome

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12
Q

clinical presentation of jejunal atresia

A

abdominal distension and bilious vomiting within the first 24 hrs after birth

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13
Q

investigation of jejunal atresia

A

x-ray

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14
Q

what is intraventricular haemorrhage

A

bleeding into the ventricles inside the brain

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15
Q

who is at most risk of intraventricular haemorrhage in neonates

A

premature infants

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16
Q

what is the most common type of intraventricular haemorrhage in neonates

A

germinal matrix

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17
Q

at what point in gestation does the risk of interventricular haemorrhage significantly decrease

A

35-36 weeks as the germinal matrix baso disappears at this point

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18
Q

what is necrotising enterocolitis

A

where part of the bowel becomes necrotic

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19
Q

who is at risk of necrotising enterocolitis

A

premature neonates

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20
Q

what can cause necrotising enterocolitis

A

premature baby being fed too early

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21
Q

pathophysiology of necrotising enterocolitis

A

serious intestinal injury to a relatively immature gut resulting in perforation

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22
Q

clinical presentation of necrotising enterocolitis

A

intolerance to feeds
vomiting
distended, tender abdo
absent bowel sounds, blood in stools

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23
Q

what is used to investigate suspected necrotising enterocolitis

A

abdo x-ray

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24
Q

clinical signs of necrotising enterocolitis

A

(on abdo x-ray)
dilated loops of bowel
bowel wall oedema, gas

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25
Q

what can gas in the peritoneal cavity indicate

A

bowel perforation

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26
Q

management of necrotising enterocolitis

A

nil by mouth, clindamycin, cefotaxime
IMMEDIATE referral to surgical team

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27
Q

what is hydrocephalus

A

CSF buildup within the brain and spinal chord

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28
Q

what causes hydrocephalus

A

over production of CSF or problem with drainage

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29
Q

clinical presentation of hydrocephalus

A

enlarged or rapidly increasing head circumference
bulging anterior fontanelle
poor feeding and vomiting

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30
Q

management of hydrocephalus

A

ventriculoperitoneal shunt

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31
Q

what is neonatal hypoglycaemia

A

BGL < 2.6

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32
Q

name some factors that may contribute to neonatal hypoglycaemia

A

preterm, small for gestational age, low birth weight
infant of diabetic mother
hypothermia
infection/sepsis
neonatal abstinence syndrome

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33
Q

clinical presentation of neonatal hypoglycaemia

A

lethargy
jitteriness
seizure activity

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34
Q

management of neonatal hypoglycaemia

A

early feed and keeping baby warm to prevent
feeding: enterally if safe, IV glucose if not

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35
Q

who does neonatal respiratory distress affect

A

75% of infants born before 29 weeks

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36
Q

pathophysiology of respiratory distress of the newborn

A

not enough surfactant so high surface tension in the alveoli
lung collapse -> inadequate gas exchange

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37
Q

clinical presentation of respiratory distress of the newborn

A

tachypnoea, grunting, intercostal recession, nasal flaring, cyanosis

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38
Q

investigation for respiratory distress of the newborn

A

CXR

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39
Q

clinical finding of investigation of respiratory distress of the newborn

A

ground glass appearance and air bronchograms

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40
Q

how to prevent respiratory distress in potentially preterm babies

A

steroids

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41
Q

management of neonatal respiratory distress

A

surfactant replacement, ventilation

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42
Q

name 2 metabolic causes of neonatal respiratory distress

A

acidosis
hypoglycaemia

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43
Q

name 2 haematological causes of neonatal respiratory distress

A

polycythaemia, blood loss/anaemia

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44
Q

name 3 neurological causes of neonatal respiratory distress

A

seizures
intracranial bleed
withdrawal

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45
Q

name a congenital cause of neonatal respiratory distress

A

congenital lung malformations

46
Q

define preterm

A

a birth that occurs before 37 weeks of gestation

47
Q

define a term birth

A

between 37-42 weeks of gestation

48
Q

define post-term birth

A

occurs after 42 weeks of gestation

49
Q

what is defined as a normal birth weight

A

2.5kg - 4kg

50
Q

when, during gestation, does most weight gain occur

A

3rd trimester

51
Q

at what part during labour is the baby in a hypoxic environment

A

during contractions

52
Q

what is used to measure perinatal adaptation

A

APGAR score

53
Q

why is vitamin K offered in the newborn period

A

prevents haemorrhagic disease of the newborn

54
Q

what is haemorrhagic disease of the newborn

A

vitamin K dependent clotting disorder

55
Q

what is the preferred route of administration of vitamin K during the new born period

A

IM

56
Q

name some risk factors for having a preterm birth

A

past history of preterm births
abnormally shaped uterus
multiple pregnancy
IVF
smoking, alcohol, drugs
interval <6 months between pregnancies

57
Q

name some ways we can manage neonatal hypothermia

A

wraps/bags
skin-skin care
transwarmer mattress
incubators

58
Q

why are neonates at an increased risk of nutritional compromise (4)

A

limited reserves
gut immaturity
immature metabolic pathways
increased demands

59
Q

when does retinopathy of prematurity usually occur

A

6-8 weeks after delivery

60
Q

define the neonatal period

A

the first 28 days of life

61
Q

scoring system of APGAR

A

total score of 1-10

62
Q

what does APGAR stand for

A

appearance
pulse
grimace
activity (muscle tone)
respiration

63
Q

name 3 respiratory problems of a term infant

A

transient tachypnoea of the newborn
pneumothorax
congenital respiratory disease

64
Q

give 2 examples of congenital respiratory diseases

A

tracheo-oesophageal fistula
diaphragmatic hernia

65
Q

who is TTN most common in

A

term infants delivered by caesarean

66
Q

what is TTN

A

transient tachypnoea of the newborn

67
Q

management of TTN

A

nothing - resolves over the first 24 hours of life

68
Q

what causes TTN

A

fluid in the lungs doesnt clear away after birth

69
Q

CXR of TTN

A

shows fluid in the horizontal fissure

70
Q

what causes early onset neonatal sepsis

A

bacteria acquired before and during delivery

71
Q

organisms associated with early onset neonatal sepsis

A

group B strep
gram negatives

72
Q

what causes late onset neonatal sepsis

A

bacteria acquired after delivery

73
Q

organisms associated with late onset neonatal sepsis

A

coagulase negative staph
gram negatives
staph aureus

74
Q

name 3 risk factors of neonatal sepsis associated with premature infants

A

immature immune enviro
intensive care enviro
indwelling tubes and lines

75
Q

name some symptoms of neonatal sepsis

A

temperature instability
reduced tone and activity
poor feeding
vomiting

76
Q

what is the most common cause of jaundice within the first 24 hours of life

A

neonatal sepsis

77
Q

management of neonatal sepsis

A

benzylpenicillin and gentamicin

78
Q

what causes neonatal jaundice

A

hyperbilirubinemia

79
Q

name some risk factors for developing significant hyperbilirubinaemia

A

lower gestational age, jaundice within first 24 hrs, haemolysis, G6PD deficiency, diabetic mothers

80
Q

pathophysiology of neonatal jaundice

A

reticuloendothelial cells maintain normal RBCs by destroying old and abnormal cells

81
Q

name 5 causes of unconjugated neonatal jaundice

A

physiological
breast milk jaundice
haemolysis
hypothyroidism
infection/sepsis

82
Q

what may be the earliest sign of hypothyroidism in neonates

A

persistent jaundice

83
Q

clinical presentation of breast milk jaundice

A

persistent jaundice in an otherwise healthy, breast-fed baby

84
Q

management of breast milk jaundice

A

reassurance

85
Q

what causes physiological jaundice to be exaggerated in preterm babies

A

immature liver

86
Q

how long does physiological jaundice usually lasy

A

around 2 weeks

87
Q

name 4 causes of conjugated neonatal jaundice

A

biliary atresia
hepatitis
TPN
genetic conditions

88
Q

name 2 genetic conditions that may cause neonatal jaundice

A

CF, down syndrome

89
Q

define prolonged jaundice in a term baby

A

lasting longer than 14 days

90
Q

define prolonged jaundice in a preterm baby

A

lasting longer than 21 days

91
Q

what neonatal jaundice is always pathological

A

jaundice in the first 24 hours

92
Q

investigations for early neonatal jaundice (3)

A

FBC, SBR, DCT

93
Q

investigations of prolonged neonatal jaundice (4)

A

FBC, LFTs, SBR, TFTs

94
Q

management of early neonatal jaundice

A

phototherapy
adequate hydration

95
Q

how does phototherapy help treat neonatal jaundice

A

lowers serum bilirubin level by transforming it into water soluble without conjugation in the liver

96
Q

name 2 rare complications of prolonged neonatal jaundice

A

encephalopathy
hearing impairment

97
Q

name 3 possible complications of using phototherapy to treat neonatal jaundice

A

increased water loss
circadian rhythm disorder
bronze baby syndrome

98
Q

clinical presentation of biliary atresia

A

pale, clay-coloured stools and dark urine

99
Q

management of biliary atresia

A

portoenterostomy before 3 months of age

100
Q

what is neonatal abstinence syndrome

A

withdrawal symptoms that happens in neonates of mothers that used substances in pregnancy

101
Q

name some substances that can cause neonatal abstinence syndrome

A

opiates
methadone
benzos
alcohol
SSRIs

102
Q

clinical presentation of neonatal abstinence syndrome

A

irritability, tremors, seizures
sweating, unstable temp, tachypnoea
poor feeding, hypoglycaemia

103
Q

how is neonatal abstinence syndrome measured

A

modified finnegan score

104
Q

management of neonatal abstinence syndrome

A

mums breastmilk for weaning
oral morphine

105
Q

what is birth asphyxia

A

when a baby doesn’t receive enough oxygen before, during or just after birth

106
Q

name some causes of birth asphyxia

A

maternal shock
intrapartum haemorrhage
prolapsed chord
nuchal chord

107
Q

what is a nuchal chord

A

where the chord is wrapped around the neck of the baby

108
Q

name a complication of birth asphyxia

A

hypoxic ischaemic encephalopathy

109
Q

what is another name for neonatal hypotonia

A

floppy baby

110
Q

what is neonatal hypotonia

A

baby with low muscle tone

child and family (11 decks)

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